|
Vascular Acquisition
|
Facility
|
IP
|
$1,274.00
|
|
|
Service Code
|
CPT 93926 LT
|
| Hospital Charge Code |
5376656
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$649.23 |
| 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: 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: Health EOS Commercial |
$1,179.21
|
| Rate for Payer: HFN Commercial |
$1,218.96
|
| Rate for Payer: Multiplan Commercial |
$1,059.97
|
| Rate for Payer: Preferred Network Access Commercial |
$1,218.96
|
| Rate for Payer: Quartz Beloit One Network |
$649.23
|
| Rate for Payer: Quartz Commercial |
$794.98
|
| 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 LT
|
| Hospital Charge Code |
5376674
|
|
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
|
$1,644.00
|
|
|
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
|
$792.00
|
|
|
Service Code
|
CPT 93922
|
| Hospital Charge Code |
5375850
|
|
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
|
|
|
Vascular Acquisition
|
Facility
|
IP
|
$1,342.00
|
|
|
Service Code
|
CPT 93931 LT
|
| Hospital Charge Code |
5376701
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$683.88 |
| 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: 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: Health EOS Commercial |
$1,242.16
|
| Rate for Payer: HFN Commercial |
$1,284.03
|
| Rate for Payer: Multiplan Commercial |
$1,116.54
|
| Rate for Payer: Preferred Network Access Commercial |
$1,284.03
|
| Rate for Payer: Quartz Beloit One Network |
$683.88
|
| Rate for Payer: Quartz Commercial |
$837.41
|
| Rate for Payer: WEA Trust Commercial |
$767.62
|
| Rate for Payer: WPS Commercial |
$1,033.74
|
|
|
Vascular Acquisition
|
Facility
|
IP
|
$1,227.00
|
|
|
Service Code
|
CPT 93923
|
| Hospital Charge Code |
5376737
|
|
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
|
$812.00
|
|
|
Service Code
|
CPT 93990
|
| Hospital Charge Code |
5375869
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$413.80 |
| Max. Negotiated Rate |
$776.92 |
| Rate for Payer: Aetna Commercial |
$760.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$726.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$447.57
|
| Rate for Payer: Cash Price |
$243.60
|
| Rate for Payer: Cigna Commercial |
$776.92
|
| Rate for Payer: Health EOS Commercial |
$751.59
|
| Rate for Payer: HFN Commercial |
$776.92
|
| Rate for Payer: Multiplan Commercial |
$675.58
|
| Rate for Payer: Preferred Network Access Commercial |
$776.92
|
| Rate for Payer: Quartz Beloit One Network |
$413.80
|
| Rate for Payer: Quartz Commercial |
$506.69
|
| Rate for Payer: WEA Trust Commercial |
$464.46
|
| Rate for Payer: WPS Commercial |
$625.48
|
|
|
Vascular Acquisition
|
Facility
|
IP
|
$1,227.00
|
|
|
Service Code
|
CPT 93923
|
| Hospital Charge Code |
5376665
|
|
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
|
$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
|
$1,826.00
|
|
|
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
|
$1,274.00
|
|
|
Service Code
|
CPT 93926 LT
|
| Hospital Charge Code |
5376649
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$649.23 |
| 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: 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: Health EOS Commercial |
$1,179.21
|
| Rate for Payer: HFN Commercial |
$1,218.96
|
| Rate for Payer: Multiplan Commercial |
$1,059.97
|
| Rate for Payer: Preferred Network Access Commercial |
$1,218.96
|
| Rate for Payer: Quartz Beloit One Network |
$649.23
|
| Rate for Payer: Quartz Commercial |
$794.98
|
| Rate for Payer: WEA Trust Commercial |
$728.73
|
| Rate for Payer: WPS Commercial |
$981.36
|
|
|
Vascular Acquisition
|
Facility
|
IP
|
$1,342.00
|
|
|
Service Code
|
CPT 93931 RT
|
| Hospital Charge Code |
5376704
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$683.88 |
| 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: 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: Health EOS Commercial |
$1,242.16
|
| Rate for Payer: HFN Commercial |
$1,284.03
|
| Rate for Payer: Multiplan Commercial |
$1,116.54
|
| Rate for Payer: Preferred Network Access Commercial |
$1,284.03
|
| Rate for Payer: Quartz Beloit One Network |
$683.88
|
| Rate for Payer: Quartz Commercial |
$837.41
|
| Rate for Payer: WEA Trust Commercial |
$767.62
|
| Rate for Payer: WPS Commercial |
$1,033.74
|
|
|
Vascular Acquisition
|
Facility
|
OP
|
$792.00
|
|
|
Service Code
|
CPT 93922
|
| Hospital Charge Code |
5376713
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$140.02 |
| Max. Negotiated Rate |
$757.79 |
| Rate for Payer: Aetna Commercial |
$741.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$708.36
|
| Rate for Payer: Aetna Managed Medicare |
$140.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$535.39
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$411.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$395.37
|
| Rate for Payer: Anthem Medicare Advantage |
$140.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$436.55
|
| 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 |
$237.60
|
| Rate for Payer: Cash Price |
$237.60
|
| Rate for Payer: Cigna Commercial |
$757.79
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$140.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$460.94
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$140.02
|
| Rate for Payer: Health EOS Commercial |
$733.08
|
| Rate for Payer: HFN Commercial |
$757.79
|
| 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 |
$658.94
|
| Rate for Payer: NAPHCARE Commercial |
$210.02
|
| Rate for Payer: Preferred Network Access Commercial |
$757.79
|
| Rate for Payer: Quartz Beloit One Network |
$403.60
|
| Rate for Payer: Quartz Commercial |
$535.39
|
| 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 |
$617.76
|
| Rate for Payer: WEA Trust Commercial |
$453.02
|
| Rate for Payer: Wellcare Medicare |
$140.02
|
| Rate for Payer: WPS Commercial |
$610.08
|
|
|
Vascular Acquisition
|
Facility
|
OP
|
$1,692.00
|
|
|
Service Code
|
CPT 93930
|
| Hospital Charge Code |
5376698
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$251.10 |
| Max. Negotiated Rate |
$1,618.91 |
| Rate for Payer: Aetna Commercial |
$1,583.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,513.32
|
| Rate for Payer: Aetna Managed Medicare |
$251.10
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,143.79
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$879.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$844.65
|
| Rate for Payer: Anthem Medicare Advantage |
$251.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$932.63
|
| 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 |
$507.60
|
| Rate for Payer: Cash Price |
$507.60
|
| Rate for Payer: Cigna Commercial |
$1,618.91
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$251.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$984.74
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$251.10
|
| Rate for Payer: Health EOS Commercial |
$1,566.12
|
| Rate for Payer: HFN Commercial |
$1,618.91
|
| 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 |
$1,407.74
|
| Rate for Payer: NAPHCARE Commercial |
$376.65
|
| Rate for Payer: Preferred Network Access Commercial |
$1,618.91
|
| Rate for Payer: Quartz Beloit One Network |
$862.24
|
| Rate for Payer: Quartz Commercial |
$1,143.79
|
| 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 |
$1,319.76
|
| Rate for Payer: WEA Trust Commercial |
$967.82
|
| Rate for Payer: Wellcare Medicare |
$251.10
|
| Rate for Payer: WPS Commercial |
$1,303.35
|
|
|
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
|
|
|
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
|
$2,194.00
|
|
|
Service Code
|
CPT 93925
|
| Hospital Charge Code |
5376653
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$1,118.06 |
| Max. Negotiated Rate |
$2,099.22 |
| Rate for Payer: Aetna Commercial |
$2,053.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,962.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,209.33
|
| Rate for Payer: Cash Price |
$658.20
|
| Rate for Payer: Cigna Commercial |
$2,099.22
|
| Rate for Payer: Health EOS Commercial |
$2,030.77
|
| Rate for Payer: HFN Commercial |
$2,099.22
|
| Rate for Payer: Multiplan Commercial |
$1,825.41
|
| Rate for Payer: Preferred Network Access Commercial |
$2,099.22
|
| Rate for Payer: Quartz Beloit One Network |
$1,118.06
|
| Rate for Payer: Quartz Commercial |
$1,369.06
|
| Rate for Payer: WEA Trust Commercial |
$1,254.97
|
| Rate for Payer: WPS Commercial |
$1,690.04
|
|
|
Vascular Acquisition
|
Facility
|
OP
|
$1,826.00
|
|
|
Service Code
|
CPT 93975
|
| Hospital Charge Code |
5376689
|
|
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
|
OP
|
$1,641.00
|
|
|
Service Code
|
CPT 93971
|
| Hospital Charge Code |
5376671
|
|
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 EMBOLIZATION, TUMORS, ORGAN SCHEMIA/INFARCTION
|
Facility
|
IP
|
$19,949.00
|
|
|
Service Code
|
CPT 37243
|
| Hospital Charge Code |
5464766
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$10,166.01 |
| Max. Negotiated Rate |
$19,087.20 |
| Rate for Payer: Aetna Commercial |
$18,672.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$17,842.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$10,995.89
|
| Rate for Payer: Cash Price |
$5,984.70
|
| Rate for Payer: Cigna Commercial |
$19,087.20
|
| Rate for Payer: Health EOS Commercial |
$18,464.79
|
| Rate for Payer: HFN Commercial |
$19,087.20
|
| Rate for Payer: Multiplan Commercial |
$16,597.57
|
| Rate for Payer: Preferred Network Access Commercial |
$19,087.20
|
| Rate for Payer: Quartz Beloit One Network |
$10,166.01
|
| Rate for Payer: Quartz Commercial |
$12,448.18
|
| Rate for Payer: WEA Trust Commercial |
$11,410.83
|
| Rate for Payer: WPS Commercial |
$15,366.71
|
|
|
VASCULAR EMBOLIZATION, TUMORS, ORGAN SCHEMIA/INFARCTION
|
Facility
|
OP
|
$19,949.00
|
|
|
Service Code
|
CPT 37243
|
| Hospital Charge Code |
5464766
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$9,979.84 |
| Max. Negotiated Rate |
$48,595.91 |
| Rate for Payer: Aetna Commercial |
$18,672.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$17,842.39
|
| Rate for Payer: Aetna Managed Medicare |
$12,148.98
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$19,394.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$19,394.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$17,919.20
|
| Rate for Payer: Anthem Medicare Advantage |
$12,148.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$10,995.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12,148.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12,148.98
|
| Rate for Payer: Cash Price |
$5,984.70
|
| Rate for Payer: Cash Price |
$5,984.70
|
| Rate for Payer: Cash Price |
$5,984.70
|
| Rate for Payer: Cigna Commercial |
$19,087.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12,148.98
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,349.86
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12,148.98
|
| Rate for Payer: Health EOS Commercial |
$18,464.79
|
| Rate for Payer: HFN Commercial |
$19,087.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$45,194.20
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12,148.98
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12,148.98
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12,148.98
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12,148.98
|
| Rate for Payer: Multiplan Commercial |
$16,597.57
|
| Rate for Payer: NAPHCARE Commercial |
$18,223.47
|
| Rate for Payer: Preferred Network Access Commercial |
$19,087.20
|
| Rate for Payer: Quartz Beloit One Network |
$10,166.01
|
| Rate for Payer: Quartz Commercial |
$13,485.52
|
| Rate for Payer: Quartz Medicare Advantage |
$12,148.98
|
| Rate for Payer: The Alliance Commercial |
$48,595.91
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12,148.98
|
| Rate for Payer: United Healthcare PPO |
$9,979.84
|
| Rate for Payer: WEA Trust Commercial |
$11,410.83
|
| Rate for Payer: Wellcare Medicare |
$12,148.98
|
| Rate for Payer: WPS Commercial |
$15,366.71
|
|
|
Vascular Endothelial Growth Factor (VEGF)
|
Facility
|
OP
|
$385.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
5242624
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.96 |
| Max. Negotiated Rate |
$368.37 |
| Rate for Payer: Aetna Commercial |
$360.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$344.34
|
| Rate for Payer: Aetna Managed Medicare |
$17.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$67.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$31.43
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$29.81
|
| Rate for Payer: Anthem Medicare Advantage |
$17.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$212.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.96
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: Cigna Commercial |
$368.37
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$224.07
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17.96
|
| Rate for Payer: Health EOS Commercial |
$356.36
|
| Rate for Payer: HFN Commercial |
$368.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$66.81
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17.96
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.96
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17.96
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17.96
|
| Rate for Payer: Multiplan Commercial |
$320.32
|
| Rate for Payer: NAPHCARE Commercial |
$26.94
|
| Rate for Payer: Preferred Network Access Commercial |
$368.37
|
| Rate for Payer: Quartz Beloit One Network |
$196.20
|
| Rate for Payer: Quartz Commercial |
$260.26
|
| Rate for Payer: Quartz Medicare Advantage |
$17.96
|
| Rate for Payer: The Alliance Commercial |
$71.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.96
|
| Rate for Payer: United Healthcare PPO |
$300.30
|
| Rate for Payer: WEA Trust Commercial |
$220.22
|
| Rate for Payer: Wellcare Medicare |
$17.96
|
| Rate for Payer: WPS Commercial |
$296.57
|
|
|
Vascular Endothelial Growth Factor (VEGF)
|
Professional
|
Both
|
$385.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
5242624
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.96 |
| Max. Negotiated Rate |
$380.38 |
| Rate for Payer: Aetna Commercial |
$380.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$344.34
|
| Rate for Payer: Aetna Managed Medicare |
$17.96
|
| Rate for Payer: Anthem Medicare Advantage |
$17.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.96
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: Cigna Commercial |
$380.38
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$200.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$17.96
|
| Rate for Payer: Health EOS Commercial |
$364.36
|
| Rate for Payer: HFN Commercial |
$380.38
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$63.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$63.40
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.96
|
| Rate for Payer: Multiplan Commercial |
$320.32
|
| Rate for Payer: NAPHCARE Commercial |
$26.94
|
| Rate for Payer: Preferred Network Access Commercial |
$380.38
|
| Rate for Payer: Quartz Beloit One Network |
$176.18
|
| Rate for Payer: Quartz Commercial |
$228.23
|
| Rate for Payer: Quartz Medicare Advantage |
$17.96
|
| Rate for Payer: The Alliance Commercial |
$70.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.96
|
| Rate for Payer: WEA Trust Commercial |
$220.22
|
| Rate for Payer: WPS Commercial |
$79.03
|
|
|
Vascular Endothelial Growth Factor (VEGF)
|
Facility
|
IP
|
$385.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
5242624
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$196.20 |
| Max. Negotiated Rate |
$368.37 |
| Rate for Payer: Aetna Commercial |
$360.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$344.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$212.21
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: Cigna Commercial |
$368.37
|
| Rate for Payer: Health EOS Commercial |
$356.36
|
| Rate for Payer: HFN Commercial |
$368.37
|
| Rate for Payer: Multiplan Commercial |
$320.32
|
| Rate for Payer: Preferred Network Access Commercial |
$368.37
|
| Rate for Payer: Quartz Beloit One Network |
$196.20
|
| Rate for Payer: Quartz Commercial |
$240.24
|
| Rate for Payer: WEA Trust Commercial |
$220.22
|
| Rate for Payer: WPS Commercial |
$296.57
|
|
|
VASCULAR GRAFT 28MM X 15CM GELWEAVE VALSALVA 730028ADP
|
Facility
|
IP
|
$13,590.00
|
|
| Hospital Charge Code |
3595504
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,925.46 |
| Max. Negotiated Rate |
$13,002.91 |
| Rate for Payer: Aetna Commercial |
$12,720.24
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$12,154.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,490.81
|
| Rate for Payer: Cash Price |
$4,077.00
|
| Rate for Payer: Cigna Commercial |
$13,002.91
|
| Rate for Payer: Health EOS Commercial |
$12,578.90
|
| Rate for Payer: HFN Commercial |
$13,002.91
|
| Rate for Payer: Multiplan Commercial |
$11,306.88
|
| Rate for Payer: Preferred Network Access Commercial |
$13,002.91
|
| Rate for Payer: Quartz Beloit One Network |
$6,925.46
|
| Rate for Payer: Quartz Commercial |
$8,480.16
|
| Rate for Payer: WEA Trust Commercial |
$7,773.48
|
| Rate for Payer: WPS Commercial |
$10,468.38
|
|
