|
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
|
$1,641.00
|
|
|
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
|
$1,376.00
|
|
| Hospital Charge Code |
5375875
|
| Min. Negotiated Rate |
$701.21 |
| 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: 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: Health EOS Commercial |
$1,273.63
|
| Rate for Payer: HFN Commercial |
$1,316.56
|
| Rate for Payer: Multiplan Commercial |
$1,144.83
|
| Rate for Payer: Preferred Network Access Commercial |
$1,316.56
|
| Rate for Payer: Quartz Beloit One Network |
$701.21
|
| Rate for Payer: Quartz Commercial |
$858.62
|
| Rate for Payer: WEA Trust Commercial |
$787.07
|
| Rate for Payer: WPS Commercial |
$1,059.93
|
|
|
Vascular Acquisition
|
Facility
|
OP
|
$1,234.00
|
|
|
Service Code
|
CPT 93979 LT
|
| Hospital Charge Code |
5376640
|
|
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 |
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
|
$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
|
IP
|
$626.00
|
|
|
Service Code
|
CPT 93976
|
| Hospital Charge Code |
5375863
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$319.01 |
| Max. Negotiated Rate |
$598.96 |
| Rate for Payer: Aetna Commercial |
$585.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$559.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$345.05
|
| Rate for Payer: Cash Price |
$187.80
|
| Rate for Payer: Cigna Commercial |
$598.96
|
| Rate for Payer: Health EOS Commercial |
$579.43
|
| Rate for Payer: HFN Commercial |
$598.96
|
| Rate for Payer: Multiplan Commercial |
$520.83
|
| Rate for Payer: Preferred Network Access Commercial |
$598.96
|
| Rate for Payer: Quartz Beloit One Network |
$319.01
|
| Rate for Payer: Quartz Commercial |
$390.62
|
| Rate for Payer: WEA Trust Commercial |
$358.07
|
| Rate for Payer: WPS Commercial |
$482.21
|
|
|
Vascular Acquisition
|
Facility
|
OP
|
$1,104.00
|
|
|
Service Code
|
CPT 93922
|
| Hospital Charge Code |
5376710
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$140.02 |
| 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: Aetna Managed Medicare |
$140.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$746.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$574.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$551.12
|
| Rate for Payer: Anthem Medicare Advantage |
$140.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$608.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$140.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$140.02
|
| Rate for Payer: Cash Price |
$331.20
|
| Rate for Payer: Cash Price |
$331.20
|
| Rate for Payer: Cigna Commercial |
$1,056.31
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$140.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$642.53
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$140.02
|
| Rate for Payer: Health EOS Commercial |
$1,021.86
|
| Rate for Payer: HFN Commercial |
$1,056.31
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$520.86
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$140.02
|
| Rate for Payer: Independent Care Health Plan Medicare |
$140.02
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$140.02
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$140.02
|
| Rate for Payer: Multiplan Commercial |
$918.53
|
| Rate for Payer: NAPHCARE Commercial |
$210.02
|
| Rate for Payer: Preferred Network Access Commercial |
$1,056.31
|
| Rate for Payer: Quartz Beloit One Network |
$562.60
|
| Rate for Payer: Quartz Commercial |
$746.30
|
| Rate for Payer: Quartz Medicare Advantage |
$140.02
|
| Rate for Payer: The Alliance Commercial |
$560.06
|
| Rate for Payer: United Healthcare Medicare Advantage |
$140.02
|
| Rate for Payer: United Healthcare PPO |
$861.12
|
| Rate for Payer: WEA Trust Commercial |
$631.49
|
| Rate for Payer: Wellcare Medicare |
$140.02
|
| 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
|
$1,641.00
|
|
|
Service Code
|
CPT 93971 RT
|
| Hospital Charge Code |
5376677
|
|
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
|
IP
|
$1,641.00
|
|
|
Service Code
|
CPT 93971
|
| Hospital Charge Code |
5376716
|
|
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 RT
|
| Hospital Charge Code |
5376731
|
|
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
|
IP
|
$1,641.00
|
|
|
Service Code
|
CPT 93971 LT
|
| Hospital Charge Code |
5376728
|
|
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
|
$1,329.00
|
|
|
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
|
$1,296.00
|
|
|
Service Code
|
CPT 93924
|
| Hospital Charge Code |
5376668
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$660.44 |
| Max. Negotiated Rate |
$1,240.01 |
| Rate for Payer: Aetna Commercial |
$1,213.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,159.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$714.36
|
| Rate for Payer: Cash Price |
$388.80
|
| Rate for Payer: Cigna Commercial |
$1,240.01
|
| Rate for Payer: Health EOS Commercial |
$1,199.58
|
| Rate for Payer: HFN Commercial |
$1,240.01
|
| Rate for Payer: Multiplan Commercial |
$1,078.27
|
| Rate for Payer: Preferred Network Access Commercial |
$1,240.01
|
| Rate for Payer: Quartz Beloit One Network |
$660.44
|
| Rate for Payer: Quartz Commercial |
$808.70
|
| Rate for Payer: WEA Trust Commercial |
$741.31
|
| Rate for Payer: WPS Commercial |
$998.31
|
|
|
Vascular Acquisition
|
Facility
|
OP
|
$1,641.00
|
|
|
Service Code
|
CPT 93971 RT
|
| Hospital Charge Code |
5376686
|
|
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
|
$3,327.00
|
|
|
Service Code
|
CPT 93312
|
| Hospital Charge Code |
5376692
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$575.04 |
| Max. Negotiated Rate |
$3,183.27 |
| Rate for Payer: Aetna Commercial |
$3,114.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,975.67
|
| Rate for Payer: Aetna Managed Medicare |
$575.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,249.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,730.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,660.84
|
| Rate for Payer: Anthem Medicare Advantage |
$575.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,833.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$575.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$575.04
|
| Rate for Payer: Cash Price |
$998.10
|
| Rate for Payer: Cash Price |
$998.10
|
| Rate for Payer: Cigna Commercial |
$3,183.27
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$575.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,936.31
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$575.04
|
| Rate for Payer: Health EOS Commercial |
$3,079.47
|
| Rate for Payer: HFN Commercial |
$3,183.27
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,139.14
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$575.04
|
| Rate for Payer: Independent Care Health Plan Medicare |
$575.04
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$575.04
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$575.04
|
| Rate for Payer: Multiplan Commercial |
$2,768.06
|
| Rate for Payer: NAPHCARE Commercial |
$862.56
|
| Rate for Payer: Preferred Network Access Commercial |
$3,183.27
|
| Rate for Payer: Quartz Beloit One Network |
$1,695.44
|
| Rate for Payer: Quartz Commercial |
$2,249.05
|
| Rate for Payer: Quartz Medicare Advantage |
$575.04
|
| Rate for Payer: The Alliance Commercial |
$2,300.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$575.04
|
| Rate for Payer: United Healthcare PPO |
$2,595.06
|
| Rate for Payer: WEA Trust Commercial |
$1,903.04
|
| Rate for Payer: Wellcare Medicare |
$575.04
|
| Rate for Payer: WPS Commercial |
$2,562.79
|
|
|
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
|
$1,644.00
|
|
|
Service Code
|
CPT 93971 RT
|
| Hospital Charge Code |
5376722
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$837.78 |
| 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: 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: Health EOS Commercial |
$1,521.69
|
| Rate for Payer: HFN Commercial |
$1,572.98
|
| Rate for Payer: Multiplan Commercial |
$1,367.81
|
| Rate for Payer: Preferred Network Access Commercial |
$1,572.98
|
| Rate for Payer: Quartz Beloit One Network |
$837.78
|
| Rate for Payer: Quartz Commercial |
$1,025.86
|
| Rate for Payer: WEA Trust Commercial |
$940.37
|
| Rate for Payer: WPS Commercial |
$1,266.37
|
|
|
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
|
$1,227.00
|
|
|
Service Code
|
CPT 93923
|
| Hospital Charge Code |
5376695
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$227.24 |
| 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: Aetna Managed Medicare |
$227.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$829.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$638.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$612.52
|
| Rate for Payer: Anthem Medicare Advantage |
$227.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$676.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$227.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$227.24
|
| Rate for Payer: Cash Price |
$368.10
|
| Rate for Payer: Cash Price |
$368.10
|
| Rate for Payer: Cigna Commercial |
$1,173.99
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$227.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$714.11
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$227.24
|
| Rate for Payer: Health EOS Commercial |
$1,135.71
|
| Rate for Payer: HFN Commercial |
$1,173.99
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$845.33
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$227.24
|
| Rate for Payer: Independent Care Health Plan Medicare |
$227.24
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$227.24
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$227.24
|
| Rate for Payer: Multiplan Commercial |
$1,020.86
|
| Rate for Payer: NAPHCARE Commercial |
$340.86
|
| Rate for Payer: Preferred Network Access Commercial |
$1,173.99
|
| Rate for Payer: Quartz Beloit One Network |
$625.28
|
| Rate for Payer: Quartz Commercial |
$829.45
|
| Rate for Payer: Quartz Medicare Advantage |
$227.24
|
| Rate for Payer: The Alliance Commercial |
$908.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$227.24
|
| Rate for Payer: United Healthcare PPO |
$957.06
|
| Rate for Payer: WEA Trust Commercial |
$701.84
|
| Rate for Payer: Wellcare Medicare |
$227.24
|
| Rate for Payer: WPS Commercial |
$945.16
|
|
|
Vascular Acquisition
|
Facility
|
OP
|
$2,085.00
|
|
|
Service Code
|
CPT 93970
|
| Hospital Charge Code |
5376680
|
|
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
|
IP
|
$926.00
|
|
|
Service Code
|
CPT 93882 RT
|
| Hospital Charge Code |
5375860
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$471.89 |
| Max. Negotiated Rate |
$886.00 |
| Rate for Payer: Aetna Commercial |
$866.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$828.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$510.41
|
| Rate for Payer: Cash Price |
$277.80
|
| Rate for Payer: Cigna Commercial |
$886.00
|
| Rate for Payer: Health EOS Commercial |
$857.11
|
| Rate for Payer: HFN Commercial |
$886.00
|
| Rate for Payer: Multiplan Commercial |
$770.43
|
| Rate for Payer: Preferred Network Access Commercial |
$886.00
|
| Rate for Payer: Quartz Beloit One Network |
$471.89
|
| Rate for Payer: Quartz Commercial |
$577.82
|
| Rate for Payer: WEA Trust Commercial |
$529.67
|
| Rate for Payer: WPS Commercial |
$713.30
|
|
|
Vascular Acquisition
|
Facility
|
IP
|
$1,641.00
|
|
|
Service Code
|
CPT 93971 LT
|
| Hospital Charge Code |
5376719
|
|
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
|
$792.00
|
|
|
Service Code
|
CPT 93922
|
| Hospital Charge Code |
5376713
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$403.60 |
| Max. Negotiated Rate |
$757.79 |
| Rate for Payer: Aetna Commercial |
$741.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$708.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$436.55
|
| Rate for Payer: Cash Price |
$237.60
|
| Rate for Payer: Cigna Commercial |
$757.79
|
| Rate for Payer: Health EOS Commercial |
$733.08
|
| Rate for Payer: HFN Commercial |
$757.79
|
| Rate for Payer: Multiplan Commercial |
$658.94
|
| Rate for Payer: Preferred Network Access Commercial |
$757.79
|
| Rate for Payer: Quartz Beloit One Network |
$403.60
|
| Rate for Payer: Quartz Commercial |
$494.21
|
| Rate for Payer: WEA Trust Commercial |
$453.02
|
| Rate for Payer: WPS Commercial |
$610.08
|
|
