|
Vascular Acquisition
|
Facility
|
OP
|
$1,641.00
|
|
|
Service Code
|
CPT 93971 LT
|
| Hospital Charge Code |
5376719
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$477.86 |
| Max. Negotiated Rate |
$1,570.11 |
| Rate for Payer: Aetna Commercial |
$1,535.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,467.71
|
| Rate for Payer: Aetna Managed Medicare |
$477.86
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,109.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$853.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$819.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$904.52
|
| Rate for Payer: Cash Price |
$492.30
|
| Rate for Payer: Cigna Commercial |
$1,570.11
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$955.06
|
| Rate for Payer: Health EOS Commercial |
$1,518.91
|
| Rate for Payer: HFN Commercial |
$1,570.11
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,279.98
|
| Rate for Payer: Multiplan Commercial |
$1,365.31
|
| Rate for Payer: NAPHCARE Commercial |
$1,023.98
|
| Rate for Payer: Preferred Network Access Commercial |
$1,570.11
|
| Rate for Payer: Quartz Beloit One Network |
$836.25
|
| Rate for Payer: Quartz Commercial |
$1,109.32
|
| Rate for Payer: Quartz Medicare Advantage |
$1,023.98
|
| Rate for Payer: The Alliance Commercial |
$853.32
|
| Rate for Payer: United Healthcare PPO |
$1,279.98
|
| Rate for Payer: WEA Trust Commercial |
$938.65
|
| Rate for Payer: WPS Commercial |
$1,264.06
|
|
|
Vascular Acquisition
|
Facility
|
OP
|
$1,234.00
|
|
|
Service Code
|
CPT 93979 RT
|
| Hospital Charge Code |
5376643
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$359.34 |
| Max. Negotiated Rate |
$1,180.69 |
| Rate for Payer: Aetna Commercial |
$1,155.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,103.69
|
| Rate for Payer: Aetna Managed Medicare |
$359.34
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$834.18
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$641.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$616.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$680.18
|
| Rate for Payer: Cash Price |
$370.20
|
| Rate for Payer: Cigna Commercial |
$1,180.69
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$718.19
|
| Rate for Payer: Health EOS Commercial |
$1,142.19
|
| Rate for Payer: HFN Commercial |
$1,180.69
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$962.52
|
| Rate for Payer: Multiplan Commercial |
$1,026.69
|
| Rate for Payer: NAPHCARE Commercial |
$770.02
|
| Rate for Payer: Preferred Network Access Commercial |
$1,180.69
|
| Rate for Payer: Quartz Beloit One Network |
$628.85
|
| Rate for Payer: Quartz Commercial |
$834.18
|
| Rate for Payer: Quartz Medicare Advantage |
$770.02
|
| Rate for Payer: The Alliance Commercial |
$641.68
|
| Rate for Payer: United Healthcare PPO |
$962.52
|
| Rate for Payer: WEA Trust Commercial |
$705.85
|
| Rate for Payer: WPS Commercial |
$950.55
|
|
|
Vascular Acquisition
|
Facility
|
IP
|
$1,641.00
|
|
|
Service Code
|
CPT 93971 RT
|
| Hospital Charge Code |
6195140
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$836.25 |
| Max. Negotiated Rate |
$1,570.11 |
| Rate for Payer: Aetna Commercial |
$1,535.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,467.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$904.52
|
| Rate for Payer: Cash Price |
$492.30
|
| Rate for Payer: Cigna Commercial |
$1,570.11
|
| Rate for Payer: Health EOS Commercial |
$1,518.91
|
| Rate for Payer: HFN Commercial |
$1,570.11
|
| Rate for Payer: Multiplan Commercial |
$1,365.31
|
| Rate for Payer: Preferred Network Access Commercial |
$1,570.11
|
| Rate for Payer: Quartz Beloit One Network |
$836.25
|
| Rate for Payer: Quartz Commercial |
$1,023.98
|
| Rate for Payer: WEA Trust Commercial |
$938.65
|
| Rate for Payer: WPS Commercial |
$1,264.06
|
|
|
Vascular Acquisition
|
Facility
|
OP
|
$1,274.00
|
|
|
Service Code
|
CPT 93926 RT
|
| Hospital Charge Code |
5375806
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$370.99 |
| Max. Negotiated Rate |
$1,218.96 |
| Rate for Payer: Aetna Commercial |
$1,192.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,139.47
|
| Rate for Payer: Aetna Managed Medicare |
$370.99
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$861.22
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$662.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$635.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$702.23
|
| Rate for Payer: Cash Price |
$382.20
|
| Rate for Payer: Cigna Commercial |
$1,218.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$741.47
|
| Rate for Payer: Health EOS Commercial |
$1,179.21
|
| Rate for Payer: HFN Commercial |
$1,218.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$993.72
|
| Rate for Payer: Multiplan Commercial |
$1,059.97
|
| Rate for Payer: NAPHCARE Commercial |
$794.98
|
| Rate for Payer: Preferred Network Access Commercial |
$1,218.96
|
| Rate for Payer: Quartz Beloit One Network |
$649.23
|
| Rate for Payer: Quartz Commercial |
$861.22
|
| Rate for Payer: Quartz Medicare Advantage |
$794.98
|
| Rate for Payer: The Alliance Commercial |
$662.48
|
| Rate for Payer: United Healthcare PPO |
$993.72
|
| Rate for Payer: WEA Trust Commercial |
$728.73
|
| Rate for Payer: WPS Commercial |
$981.36
|
|
|
Vascular Acquisition
|
Facility
|
OP
|
$1,641.00
|
|
|
Service Code
|
CPT 93971
|
| Hospital Charge Code |
5376716
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$110.02 |
| Max. Negotiated Rate |
$1,570.11 |
| Rate for Payer: Aetna Commercial |
$1,535.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,467.71
|
| Rate for Payer: Aetna Managed Medicare |
$110.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,109.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$853.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$819.19
|
| Rate for Payer: Anthem Medicare Advantage |
$110.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$904.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$110.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$110.02
|
| Rate for Payer: Cash Price |
$492.30
|
| Rate for Payer: Cash Price |
$492.30
|
| Rate for Payer: Cigna Commercial |
$1,570.11
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$110.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$955.06
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$110.02
|
| Rate for Payer: Health EOS Commercial |
$1,518.91
|
| Rate for Payer: HFN Commercial |
$1,570.11
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$409.28
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$110.02
|
| Rate for Payer: Independent Care Health Plan Medicare |
$110.02
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$110.02
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$110.02
|
| Rate for Payer: Multiplan Commercial |
$1,365.31
|
| Rate for Payer: NAPHCARE Commercial |
$165.03
|
| Rate for Payer: Preferred Network Access Commercial |
$1,570.11
|
| Rate for Payer: Quartz Beloit One Network |
$836.25
|
| Rate for Payer: Quartz Commercial |
$1,109.32
|
| Rate for Payer: Quartz Medicare Advantage |
$110.02
|
| Rate for Payer: The Alliance Commercial |
$440.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$110.02
|
| Rate for Payer: United Healthcare PPO |
$1,279.98
|
| Rate for Payer: WEA Trust Commercial |
$938.65
|
| Rate for Payer: Wellcare Medicare |
$110.02
|
| Rate for Payer: WPS Commercial |
$1,264.06
|
|
|
Vascular Acquisition
|
Facility
|
OP
|
$1,493.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
5375872
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$255.76 |
| Max. Negotiated Rate |
$1,428.50 |
| Rate for Payer: Aetna Commercial |
$1,397.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,335.34
|
| Rate for Payer: Aetna Managed Medicare |
$434.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,009.27
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$776.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$745.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$822.94
|
| Rate for Payer: Cash Price |
$447.90
|
| Rate for Payer: Cash Price |
$447.90
|
| Rate for Payer: Cigna Commercial |
$1,428.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$868.93
|
| Rate for Payer: Health EOS Commercial |
$1,381.92
|
| Rate for Payer: HFN Commercial |
$1,428.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,164.54
|
| Rate for Payer: Multiplan Commercial |
$1,242.18
|
| Rate for Payer: NAPHCARE Commercial |
$931.63
|
| Rate for Payer: Preferred Network Access Commercial |
$1,428.50
|
| Rate for Payer: Quartz Beloit One Network |
$760.83
|
| Rate for Payer: Quartz Commercial |
$1,009.27
|
| Rate for Payer: Quartz Medicare Advantage |
$931.63
|
| Rate for Payer: The Alliance Commercial |
$255.76
|
| Rate for Payer: United Healthcare PPO |
$1,164.54
|
| Rate for Payer: WEA Trust Commercial |
$854.00
|
| Rate for Payer: WPS Commercial |
$1,150.06
|
|
|
Vascular Acquisition
|
Facility
|
IP
|
$1,493.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
5375872
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$760.83 |
| Max. Negotiated Rate |
$1,428.50 |
| Rate for Payer: Aetna Commercial |
$1,397.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,335.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$822.94
|
| Rate for Payer: Cash Price |
$447.90
|
| Rate for Payer: Cigna Commercial |
$1,428.50
|
| Rate for Payer: Health EOS Commercial |
$1,381.92
|
| Rate for Payer: HFN Commercial |
$1,428.50
|
| Rate for Payer: Multiplan Commercial |
$1,242.18
|
| Rate for Payer: Preferred Network Access Commercial |
$1,428.50
|
| Rate for Payer: Quartz Beloit One Network |
$760.83
|
| Rate for Payer: Quartz Commercial |
$931.63
|
| Rate for Payer: WEA Trust Commercial |
$854.00
|
| Rate for Payer: WPS Commercial |
$1,150.06
|
|
|
Vascular Acquisition
|
Facility
|
OP
|
$812.00
|
|
|
Service Code
|
CPT 93990
|
| Hospital Charge Code |
5375869
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$110.02 |
| Max. Negotiated Rate |
$776.92 |
| Rate for Payer: Aetna Commercial |
$760.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$726.25
|
| Rate for Payer: Aetna Managed Medicare |
$110.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$548.91
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$422.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$405.35
|
| Rate for Payer: Anthem Medicare Advantage |
$110.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$447.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$110.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$110.02
|
| Rate for Payer: Cash Price |
$243.60
|
| Rate for Payer: Cash Price |
$243.60
|
| Rate for Payer: Cigna Commercial |
$776.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$110.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$472.58
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$110.02
|
| Rate for Payer: Health EOS Commercial |
$751.59
|
| Rate for Payer: HFN Commercial |
$776.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$409.28
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$110.02
|
| Rate for Payer: Independent Care Health Plan Medicare |
$110.02
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$110.02
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$110.02
|
| Rate for Payer: Multiplan Commercial |
$675.58
|
| Rate for Payer: NAPHCARE Commercial |
$165.03
|
| Rate for Payer: Preferred Network Access Commercial |
$776.92
|
| Rate for Payer: Quartz Beloit One Network |
$413.80
|
| Rate for Payer: Quartz Commercial |
$548.91
|
| Rate for Payer: Quartz Medicare Advantage |
$110.02
|
| Rate for Payer: The Alliance Commercial |
$440.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$110.02
|
| Rate for Payer: United Healthcare PPO |
$633.36
|
| Rate for Payer: WEA Trust Commercial |
$464.46
|
| Rate for Payer: Wellcare Medicare |
$110.02
|
| Rate for Payer: WPS Commercial |
$625.48
|
|
|
Vascular Acquisition
|
Facility
|
IP
|
$2,085.00
|
|
|
Service Code
|
CPT 93970
|
| Hospital Charge Code |
5376725
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$1,062.52 |
| Max. Negotiated Rate |
$1,994.93 |
| Rate for Payer: Aetna Commercial |
$1,951.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,864.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,149.25
|
| Rate for Payer: Cash Price |
$625.50
|
| Rate for Payer: Cigna Commercial |
$1,994.93
|
| Rate for Payer: Health EOS Commercial |
$1,929.88
|
| Rate for Payer: HFN Commercial |
$1,994.93
|
| Rate for Payer: Multiplan Commercial |
$1,734.72
|
| Rate for Payer: Preferred Network Access Commercial |
$1,994.93
|
| Rate for Payer: Quartz Beloit One Network |
$1,062.52
|
| Rate for Payer: Quartz Commercial |
$1,301.04
|
| Rate for Payer: WEA Trust Commercial |
$1,192.62
|
| Rate for Payer: WPS Commercial |
$1,606.08
|
|
|
Vascular Acquisition
|
Facility
|
OP
|
$1,644.00
|
|
|
Service Code
|
CPT 93971 RT
|
| Hospital Charge Code |
5376722
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$478.73 |
| Max. Negotiated Rate |
$1,572.98 |
| Rate for Payer: Aetna Commercial |
$1,538.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,470.39
|
| Rate for Payer: Aetna Managed Medicare |
$478.73
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,111.34
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$854.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$820.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$906.17
|
| Rate for Payer: Cash Price |
$493.20
|
| Rate for Payer: Cigna Commercial |
$1,572.98
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$956.81
|
| Rate for Payer: Health EOS Commercial |
$1,521.69
|
| Rate for Payer: HFN Commercial |
$1,572.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,282.32
|
| Rate for Payer: Multiplan Commercial |
$1,367.81
|
| Rate for Payer: NAPHCARE Commercial |
$1,025.86
|
| Rate for Payer: Preferred Network Access Commercial |
$1,572.98
|
| Rate for Payer: Quartz Beloit One Network |
$837.78
|
| Rate for Payer: Quartz Commercial |
$1,111.34
|
| Rate for Payer: Quartz Medicare Advantage |
$1,025.86
|
| Rate for Payer: The Alliance Commercial |
$854.88
|
| Rate for Payer: United Healthcare PPO |
$1,282.32
|
| Rate for Payer: WEA Trust Commercial |
$940.37
|
| Rate for Payer: WPS Commercial |
$1,266.37
|
|
|
Vascular Acquisition
|
Facility
|
IP
|
$1,104.00
|
|
|
Service Code
|
CPT 93922
|
| Hospital Charge Code |
5376710
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$562.60 |
| Max. Negotiated Rate |
$1,056.31 |
| Rate for Payer: Aetna Commercial |
$1,033.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$987.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$608.52
|
| Rate for Payer: Cash Price |
$331.20
|
| Rate for Payer: Cigna Commercial |
$1,056.31
|
| Rate for Payer: Health EOS Commercial |
$1,021.86
|
| Rate for Payer: HFN Commercial |
$1,056.31
|
| Rate for Payer: Multiplan Commercial |
$918.53
|
| Rate for Payer: Preferred Network Access Commercial |
$1,056.31
|
| Rate for Payer: Quartz Beloit One Network |
$562.60
|
| Rate for Payer: Quartz Commercial |
$688.90
|
| Rate for Payer: WEA Trust Commercial |
$631.49
|
| Rate for Payer: WPS Commercial |
$850.41
|
|
|
Vascular Acquisition
|
Facility
|
OP
|
$2,085.00
|
|
|
Service Code
|
CPT 93970
|
| Hospital Charge Code |
5376725
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$251.10 |
| Max. Negotiated Rate |
$1,994.93 |
| Rate for Payer: Aetna Commercial |
$1,951.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,864.82
|
| Rate for Payer: Aetna Managed Medicare |
$251.10
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,409.46
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,084.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,040.83
|
| Rate for Payer: Anthem Medicare Advantage |
$251.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,149.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$251.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$251.10
|
| Rate for Payer: Cash Price |
$625.50
|
| Rate for Payer: Cash Price |
$625.50
|
| Rate for Payer: Cigna Commercial |
$1,994.93
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$251.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,213.47
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$251.10
|
| Rate for Payer: Health EOS Commercial |
$1,929.88
|
| Rate for Payer: HFN Commercial |
$1,994.93
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$934.08
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$251.10
|
| Rate for Payer: Independent Care Health Plan Medicare |
$251.10
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$251.10
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$251.10
|
| Rate for Payer: Multiplan Commercial |
$1,734.72
|
| Rate for Payer: NAPHCARE Commercial |
$376.65
|
| Rate for Payer: Preferred Network Access Commercial |
$1,994.93
|
| Rate for Payer: Quartz Beloit One Network |
$1,062.52
|
| Rate for Payer: Quartz Commercial |
$1,409.46
|
| Rate for Payer: Quartz Medicare Advantage |
$251.10
|
| Rate for Payer: The Alliance Commercial |
$1,004.39
|
| Rate for Payer: United Healthcare Medicare Advantage |
$251.10
|
| Rate for Payer: United Healthcare PPO |
$1,626.30
|
| Rate for Payer: WEA Trust Commercial |
$1,192.62
|
| Rate for Payer: Wellcare Medicare |
$251.10
|
| Rate for Payer: WPS Commercial |
$1,606.08
|
|
|
Vascular Acquisition
|
Facility
|
OP
|
$1,342.00
|
|
|
Service Code
|
CPT 93931 RT
|
| Hospital Charge Code |
5376704
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$390.79 |
| Max. Negotiated Rate |
$1,284.03 |
| Rate for Payer: Aetna Commercial |
$1,256.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,200.28
|
| Rate for Payer: Aetna Managed Medicare |
$390.79
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$907.19
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$697.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$669.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$739.71
|
| Rate for Payer: Cash Price |
$402.60
|
| Rate for Payer: Cigna Commercial |
$1,284.03
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$781.04
|
| Rate for Payer: Health EOS Commercial |
$1,242.16
|
| Rate for Payer: HFN Commercial |
$1,284.03
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,046.76
|
| Rate for Payer: Multiplan Commercial |
$1,116.54
|
| Rate for Payer: NAPHCARE Commercial |
$837.41
|
| Rate for Payer: Preferred Network Access Commercial |
$1,284.03
|
| Rate for Payer: Quartz Beloit One Network |
$683.88
|
| Rate for Payer: Quartz Commercial |
$907.19
|
| Rate for Payer: Quartz Medicare Advantage |
$837.41
|
| Rate for Payer: The Alliance Commercial |
$697.84
|
| Rate for Payer: United Healthcare PPO |
$1,046.76
|
| Rate for Payer: WEA Trust Commercial |
$767.62
|
| Rate for Payer: WPS Commercial |
$1,033.74
|
|
|
Vascular Acquisition
|
Facility
|
IP
|
$1,826.00
|
|
|
Service Code
|
CPT 93975
|
| Hospital Charge Code |
5375866
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$930.53 |
| Max. Negotiated Rate |
$1,747.12 |
| Rate for Payer: Aetna Commercial |
$1,709.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,633.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,006.49
|
| Rate for Payer: Cash Price |
$547.80
|
| Rate for Payer: Cigna Commercial |
$1,747.12
|
| Rate for Payer: Health EOS Commercial |
$1,690.15
|
| Rate for Payer: HFN Commercial |
$1,747.12
|
| Rate for Payer: Multiplan Commercial |
$1,519.23
|
| Rate for Payer: Preferred Network Access Commercial |
$1,747.12
|
| Rate for Payer: Quartz Beloit One Network |
$930.53
|
| Rate for Payer: Quartz Commercial |
$1,139.42
|
| Rate for Payer: WEA Trust Commercial |
$1,044.47
|
| Rate for Payer: WPS Commercial |
$1,406.57
|
|
|
Vascular Acquisition
|
Facility
|
OP
|
$1,376.00
|
|
| Hospital Charge Code |
5375875
|
| Min. Negotiated Rate |
$400.69 |
| Max. Negotiated Rate |
$1,316.56 |
| Rate for Payer: Aetna Commercial |
$1,287.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,230.69
|
| Rate for Payer: Aetna Managed Medicare |
$400.69
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$930.18
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$715.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$686.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$758.45
|
| Rate for Payer: Cash Price |
$412.80
|
| Rate for Payer: Cigna Commercial |
$1,316.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$800.83
|
| Rate for Payer: Health EOS Commercial |
$1,273.63
|
| Rate for Payer: HFN Commercial |
$1,316.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,073.28
|
| Rate for Payer: Multiplan Commercial |
$1,144.83
|
| Rate for Payer: NAPHCARE Commercial |
$858.62
|
| Rate for Payer: Preferred Network Access Commercial |
$1,316.56
|
| Rate for Payer: Quartz Beloit One Network |
$701.21
|
| Rate for Payer: Quartz Commercial |
$930.18
|
| Rate for Payer: Quartz Medicare Advantage |
$858.62
|
| Rate for Payer: The Alliance Commercial |
$715.52
|
| Rate for Payer: WEA Trust Commercial |
$787.07
|
| Rate for Payer: WPS Commercial |
$1,059.93
|
|
|
Vascular Acquisition
|
Facility
|
OP
|
$1,826.00
|
|
|
Service Code
|
CPT 93975
|
| Hospital Charge Code |
5375866
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$251.10 |
| Max. Negotiated Rate |
$1,747.12 |
| Rate for Payer: Aetna Commercial |
$1,709.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,633.17
|
| Rate for Payer: Aetna Managed Medicare |
$251.10
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$848.64
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$716.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$681.20
|
| Rate for Payer: Anthem Medicare Advantage |
$251.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,006.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$251.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$251.10
|
| Rate for Payer: Cash Price |
$547.80
|
| Rate for Payer: Cash Price |
$547.80
|
| Rate for Payer: Cash Price |
$547.80
|
| Rate for Payer: Cigna Commercial |
$1,747.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$251.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,062.73
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$251.10
|
| Rate for Payer: Health EOS Commercial |
$1,690.15
|
| Rate for Payer: HFN Commercial |
$1,747.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$934.08
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$251.10
|
| Rate for Payer: Independent Care Health Plan Medicare |
$251.10
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$251.10
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$251.10
|
| Rate for Payer: Multiplan Commercial |
$1,519.23
|
| Rate for Payer: NAPHCARE Commercial |
$376.65
|
| Rate for Payer: Preferred Network Access Commercial |
$1,747.12
|
| Rate for Payer: Quartz Beloit One Network |
$930.53
|
| Rate for Payer: Quartz Commercial |
$1,234.38
|
| Rate for Payer: Quartz Medicare Advantage |
$251.10
|
| Rate for Payer: The Alliance Commercial |
$1,004.39
|
| Rate for Payer: United Healthcare Medicare Advantage |
$251.10
|
| Rate for Payer: United Healthcare PPO |
$596.96
|
| Rate for Payer: WEA Trust Commercial |
$1,044.47
|
| Rate for Payer: Wellcare Medicare |
$251.10
|
| Rate for Payer: WPS Commercial |
$1,406.57
|
|
|
Vascular Acquisition
|
Facility
|
IP
|
$1,641.00
|
|
|
Service Code
|
CPT 93971
|
| Hospital Charge Code |
6195111
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$836.25 |
| Max. Negotiated Rate |
$1,570.11 |
| Rate for Payer: Aetna Commercial |
$1,535.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,467.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$904.52
|
| Rate for Payer: Cash Price |
$492.30
|
| Rate for Payer: Cigna Commercial |
$1,570.11
|
| Rate for Payer: Health EOS Commercial |
$1,518.91
|
| Rate for Payer: HFN Commercial |
$1,570.11
|
| Rate for Payer: Multiplan Commercial |
$1,365.31
|
| Rate for Payer: Preferred Network Access Commercial |
$1,570.11
|
| Rate for Payer: Quartz Beloit One Network |
$836.25
|
| Rate for Payer: Quartz Commercial |
$1,023.98
|
| Rate for Payer: WEA Trust Commercial |
$938.65
|
| Rate for Payer: WPS Commercial |
$1,264.06
|
|
|
Vascular Acquisition
|
Facility
|
IP
|
$1,641.00
|
|
|
Service Code
|
CPT 93971 LT
|
| Hospital Charge Code |
6195114
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$836.25 |
| Max. Negotiated Rate |
$1,570.11 |
| Rate for Payer: Aetna Commercial |
$1,535.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,467.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$904.52
|
| Rate for Payer: Cash Price |
$492.30
|
| Rate for Payer: Cigna Commercial |
$1,570.11
|
| Rate for Payer: Health EOS Commercial |
$1,518.91
|
| Rate for Payer: HFN Commercial |
$1,570.11
|
| Rate for Payer: Multiplan Commercial |
$1,365.31
|
| Rate for Payer: Preferred Network Access Commercial |
$1,570.11
|
| Rate for Payer: Quartz Beloit One Network |
$836.25
|
| Rate for Payer: Quartz Commercial |
$1,023.98
|
| Rate for Payer: WEA Trust Commercial |
$938.65
|
| Rate for Payer: WPS Commercial |
$1,264.06
|
|
|
Vascular Acquisition
|
Facility
|
OP
|
$1,641.00
|
|
|
Service Code
|
CPT 93971
|
| Hospital Charge Code |
6195111
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$110.02 |
| Max. Negotiated Rate |
$1,570.11 |
| Rate for Payer: Aetna Commercial |
$1,535.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,467.71
|
| Rate for Payer: Aetna Managed Medicare |
$110.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,109.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$853.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$819.19
|
| Rate for Payer: Anthem Medicare Advantage |
$110.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$904.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$110.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$110.02
|
| Rate for Payer: Cash Price |
$492.30
|
| Rate for Payer: Cash Price |
$492.30
|
| Rate for Payer: Cigna Commercial |
$1,570.11
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$110.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$955.06
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$110.02
|
| Rate for Payer: Health EOS Commercial |
$1,518.91
|
| Rate for Payer: HFN Commercial |
$1,570.11
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$409.28
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$110.02
|
| Rate for Payer: Independent Care Health Plan Medicare |
$110.02
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$110.02
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$110.02
|
| Rate for Payer: Multiplan Commercial |
$1,365.31
|
| Rate for Payer: NAPHCARE Commercial |
$165.03
|
| Rate for Payer: Preferred Network Access Commercial |
$1,570.11
|
| Rate for Payer: Quartz Beloit One Network |
$836.25
|
| Rate for Payer: Quartz Commercial |
$1,109.32
|
| Rate for Payer: Quartz Medicare Advantage |
$110.02
|
| Rate for Payer: The Alliance Commercial |
$440.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$110.02
|
| Rate for Payer: United Healthcare PPO |
$1,279.98
|
| Rate for Payer: WEA Trust Commercial |
$938.65
|
| Rate for Payer: Wellcare Medicare |
$110.02
|
| Rate for Payer: WPS Commercial |
$1,264.06
|
|
|
Vascular Acquisition
|
Facility
|
IP
|
$1,227.00
|
|
|
Service Code
|
CPT 93923
|
| Hospital Charge Code |
5376662
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$625.28 |
| Max. Negotiated Rate |
$1,173.99 |
| Rate for Payer: Aetna Commercial |
$1,148.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,097.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$676.32
|
| Rate for Payer: Cash Price |
$368.10
|
| Rate for Payer: Cigna Commercial |
$1,173.99
|
| Rate for Payer: Health EOS Commercial |
$1,135.71
|
| Rate for Payer: HFN Commercial |
$1,173.99
|
| Rate for Payer: Multiplan Commercial |
$1,020.86
|
| Rate for Payer: Preferred Network Access Commercial |
$1,173.99
|
| Rate for Payer: Quartz Beloit One Network |
$625.28
|
| Rate for Payer: Quartz Commercial |
$765.65
|
| Rate for Payer: WEA Trust Commercial |
$701.84
|
| Rate for Payer: WPS Commercial |
$945.16
|
|
|
Vascular Acquisition
|
Facility
|
IP
|
$2,442.00
|
|
|
Service Code
|
CPT 93925
|
| Hospital Charge Code |
5376646
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$1,244.44 |
| Max. Negotiated Rate |
$2,336.51 |
| Rate for Payer: Aetna Commercial |
$2,285.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,184.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,346.03
|
| Rate for Payer: Cash Price |
$732.60
|
| Rate for Payer: Cigna Commercial |
$2,336.51
|
| Rate for Payer: Health EOS Commercial |
$2,260.32
|
| Rate for Payer: HFN Commercial |
$2,336.51
|
| Rate for Payer: Multiplan Commercial |
$2,031.74
|
| Rate for Payer: Preferred Network Access Commercial |
$2,336.51
|
| Rate for Payer: Quartz Beloit One Network |
$1,244.44
|
| Rate for Payer: Quartz Commercial |
$1,523.81
|
| Rate for Payer: WEA Trust Commercial |
$1,396.82
|
| Rate for Payer: WPS Commercial |
$1,881.07
|
|
|
Vascular Acquisition
|
Facility
|
OP
|
$1,274.00
|
|
|
Service Code
|
CPT 93926 RT
|
| Hospital Charge Code |
5376659
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$370.99 |
| Max. Negotiated Rate |
$1,218.96 |
| Rate for Payer: Aetna Commercial |
$1,192.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,139.47
|
| Rate for Payer: Aetna Managed Medicare |
$370.99
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$861.22
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$662.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$635.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$702.23
|
| Rate for Payer: Cash Price |
$382.20
|
| Rate for Payer: Cigna Commercial |
$1,218.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$741.47
|
| Rate for Payer: Health EOS Commercial |
$1,179.21
|
| Rate for Payer: HFN Commercial |
$1,218.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$993.72
|
| Rate for Payer: Multiplan Commercial |
$1,059.97
|
| Rate for Payer: NAPHCARE Commercial |
$794.98
|
| Rate for Payer: Preferred Network Access Commercial |
$1,218.96
|
| Rate for Payer: Quartz Beloit One Network |
$649.23
|
| Rate for Payer: Quartz Commercial |
$861.22
|
| Rate for Payer: Quartz Medicare Advantage |
$794.98
|
| Rate for Payer: The Alliance Commercial |
$662.48
|
| Rate for Payer: United Healthcare PPO |
$993.72
|
| Rate for Payer: WEA Trust Commercial |
$728.73
|
| Rate for Payer: WPS Commercial |
$981.36
|
|
|
Vascular Acquisition
|
Facility
|
IP
|
$1,329.00
|
|
|
Service Code
|
CPT 93978
|
| Hospital Charge Code |
5376637
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$677.26 |
| Max. Negotiated Rate |
$1,271.59 |
| Rate for Payer: Aetna Commercial |
$1,243.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,188.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$732.54
|
| Rate for Payer: Cash Price |
$398.70
|
| Rate for Payer: Cigna Commercial |
$1,271.59
|
| Rate for Payer: Health EOS Commercial |
$1,230.12
|
| Rate for Payer: HFN Commercial |
$1,271.59
|
| Rate for Payer: Multiplan Commercial |
$1,105.73
|
| Rate for Payer: Preferred Network Access Commercial |
$1,271.59
|
| Rate for Payer: Quartz Beloit One Network |
$677.26
|
| Rate for Payer: Quartz Commercial |
$829.30
|
| Rate for Payer: WEA Trust Commercial |
$760.19
|
| Rate for Payer: WPS Commercial |
$1,023.73
|
|
|
Vascular Acquisition
|
Facility
|
IP
|
$1,641.00
|
|
|
Service Code
|
CPT 93971 RT
|
| Hospital Charge Code |
5376731
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$836.25 |
| Max. Negotiated Rate |
$1,570.11 |
| Rate for Payer: Aetna Commercial |
$1,535.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,467.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$904.52
|
| Rate for Payer: Cash Price |
$492.30
|
| Rate for Payer: Cigna Commercial |
$1,570.11
|
| Rate for Payer: Health EOS Commercial |
$1,518.91
|
| Rate for Payer: HFN Commercial |
$1,570.11
|
| Rate for Payer: Multiplan Commercial |
$1,365.31
|
| Rate for Payer: Preferred Network Access Commercial |
$1,570.11
|
| Rate for Payer: Quartz Beloit One Network |
$836.25
|
| Rate for Payer: Quartz Commercial |
$1,023.98
|
| Rate for Payer: WEA Trust Commercial |
$938.65
|
| Rate for Payer: WPS Commercial |
$1,264.06
|
|
|
Vascular Acquisition
|
Facility
|
IP
|
$1,227.00
|
|
|
Service Code
|
CPT 93923
|
| Hospital Charge Code |
5376695
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$625.28 |
| Max. Negotiated Rate |
$1,173.99 |
| Rate for Payer: Aetna Commercial |
$1,148.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,097.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$676.32
|
| Rate for Payer: Cash Price |
$368.10
|
| Rate for Payer: Cigna Commercial |
$1,173.99
|
| Rate for Payer: Health EOS Commercial |
$1,135.71
|
| Rate for Payer: HFN Commercial |
$1,173.99
|
| Rate for Payer: Multiplan Commercial |
$1,020.86
|
| Rate for Payer: Preferred Network Access Commercial |
$1,173.99
|
| Rate for Payer: Quartz Beloit One Network |
$625.28
|
| Rate for Payer: Quartz Commercial |
$765.65
|
| Rate for Payer: WEA Trust Commercial |
$701.84
|
| Rate for Payer: WPS Commercial |
$945.16
|
|
