|
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
|
|
|
VASCULAR GRAFT 30MM X 15CM GELWEAVE VALSALVA 730030ADP
|
Facility
|
IP
|
$13,590.00
|
|
| Hospital Charge Code |
5286886
|
|
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
|
|
|
VASCULAR GRAFT 30MM X 15CM GELWEAVE VALSALVA 730030ADP
|
Facility
|
OP
|
$13,590.00
|
|
| Hospital Charge Code |
5286886
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,957.41 |
| 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: Aetna Managed Medicare |
$3,957.41
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,186.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7,066.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,784.13
|
| 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: Dean Health DHI/DHP/ASO |
$7,909.38
|
| Rate for Payer: Health EOS Commercial |
$12,578.90
|
| Rate for Payer: HFN Commercial |
$13,002.91
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$10,600.20
|
| Rate for Payer: Multiplan Commercial |
$11,306.88
|
| Rate for Payer: NAPHCARE Commercial |
$8,480.16
|
| 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 |
$9,186.84
|
| Rate for Payer: Quartz Medicare Advantage |
$8,480.16
|
| Rate for Payer: The Alliance Commercial |
$7,066.80
|
| Rate for Payer: WEA Trust Commercial |
$7,773.48
|
| Rate for Payer: WPS Commercial |
$10,468.38
|
|
|
VASCULAR GRAFT 32MM X 15CM GELWEAVE VALSALVA 730032ADP
|
Facility
|
IP
|
$14,112.00
|
|
| Hospital Charge Code |
5286741
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,191.48 |
| Max. Negotiated Rate |
$13,502.36 |
| Rate for Payer: Aetna Commercial |
$13,208.83
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$12,621.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,778.53
|
| Rate for Payer: Cash Price |
$4,233.60
|
| Rate for Payer: Cigna Commercial |
$13,502.36
|
| Rate for Payer: Health EOS Commercial |
$13,062.07
|
| Rate for Payer: HFN Commercial |
$13,502.36
|
| Rate for Payer: Multiplan Commercial |
$11,741.18
|
| Rate for Payer: Preferred Network Access Commercial |
$13,502.36
|
| Rate for Payer: Quartz Beloit One Network |
$7,191.48
|
| Rate for Payer: Quartz Commercial |
$8,805.89
|
| Rate for Payer: WEA Trust Commercial |
$8,072.06
|
| Rate for Payer: WPS Commercial |
$10,870.47
|
|
|
VASCULAR GRAFT 32MM X 15CM GELWEAVE VALSALVA 730032ADP
|
Facility
|
OP
|
$14,112.00
|
|
| Hospital Charge Code |
5286741
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,109.41 |
| Max. Negotiated Rate |
$13,502.36 |
| Rate for Payer: Aetna Commercial |
$13,208.83
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$12,621.77
|
| Rate for Payer: Aetna Managed Medicare |
$4,109.41
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,539.71
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7,338.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,044.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,778.53
|
| Rate for Payer: Cash Price |
$4,233.60
|
| Rate for Payer: Cigna Commercial |
$13,502.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,213.18
|
| Rate for Payer: Health EOS Commercial |
$13,062.07
|
| Rate for Payer: HFN Commercial |
$13,502.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,007.36
|
| Rate for Payer: Multiplan Commercial |
$11,741.18
|
| Rate for Payer: NAPHCARE Commercial |
$8,805.89
|
| Rate for Payer: Preferred Network Access Commercial |
$13,502.36
|
| Rate for Payer: Quartz Beloit One Network |
$7,191.48
|
| Rate for Payer: Quartz Commercial |
$9,539.71
|
| Rate for Payer: Quartz Medicare Advantage |
$8,805.89
|
| Rate for Payer: The Alliance Commercial |
$7,338.24
|
| Rate for Payer: WEA Trust Commercial |
$8,072.06
|
| Rate for Payer: WPS Commercial |
$10,870.47
|
|
|
VASCULAR GRAFT 34MM X 15CM GELWEAVE VALSALVA 730034ADP
|
Facility
|
IP
|
$23,619.00
|
|
| Hospital Charge Code |
6234137
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,036.24 |
| Max. Negotiated Rate |
$22,598.66 |
| Rate for Payer: Aetna Commercial |
$22,107.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$21,124.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$13,018.79
|
| Rate for Payer: Cash Price |
$7,085.70
|
| Rate for Payer: Cigna Commercial |
$22,598.66
|
| Rate for Payer: Health EOS Commercial |
$21,861.75
|
| Rate for Payer: HFN Commercial |
$22,598.66
|
| Rate for Payer: Multiplan Commercial |
$19,651.01
|
| Rate for Payer: Preferred Network Access Commercial |
$22,598.66
|
| Rate for Payer: Quartz Beloit One Network |
$12,036.24
|
| Rate for Payer: Quartz Commercial |
$14,738.26
|
| Rate for Payer: WEA Trust Commercial |
$13,510.07
|
| Rate for Payer: WPS Commercial |
$18,193.72
|
|
|
VASCULAR GRAFT 34MM X 15CM GELWEAVE VALSALVA 730034ADP
|
Facility
|
OP
|
$23,619.00
|
|
| Hospital Charge Code |
6234137
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,877.85 |
| Max. Negotiated Rate |
$22,598.66 |
| Rate for Payer: Aetna Commercial |
$22,107.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$21,124.83
|
| Rate for Payer: Aetna Managed Medicare |
$6,877.85
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$15,966.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$12,281.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$11,790.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$13,018.79
|
| Rate for Payer: Cash Price |
$7,085.70
|
| Rate for Payer: Cigna Commercial |
$22,598.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13,746.26
|
| Rate for Payer: Health EOS Commercial |
$21,861.75
|
| Rate for Payer: HFN Commercial |
$22,598.66
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$18,422.82
|
| Rate for Payer: Multiplan Commercial |
$19,651.01
|
| Rate for Payer: NAPHCARE Commercial |
$14,738.26
|
| Rate for Payer: Preferred Network Access Commercial |
$22,598.66
|
| Rate for Payer: Quartz Beloit One Network |
$12,036.24
|
| Rate for Payer: Quartz Commercial |
$15,966.44
|
| Rate for Payer: Quartz Medicare Advantage |
$14,738.26
|
| Rate for Payer: The Alliance Commercial |
$12,281.88
|
| Rate for Payer: WEA Trust Commercial |
$13,510.07
|
| Rate for Payer: WPS Commercial |
$18,193.72
|
|
|
VASCULAR GRAFT HYBRID 6-7MM X 50CM 0650HYB0705A
|
Facility
|
IP
|
$15,313.00
|
|
| Hospital Charge Code |
3525502
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,803.50 |
| Max. Negotiated Rate |
$14,651.48 |
| Rate for Payer: Aetna Commercial |
$14,332.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$13,695.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,440.53
|
| Rate for Payer: Cash Price |
$4,593.90
|
| Rate for Payer: Cigna Commercial |
$14,651.48
|
| Rate for Payer: Health EOS Commercial |
$14,173.71
|
| Rate for Payer: HFN Commercial |
$14,651.48
|
| Rate for Payer: Multiplan Commercial |
$12,740.42
|
| Rate for Payer: Preferred Network Access Commercial |
$14,651.48
|
| Rate for Payer: Quartz Beloit One Network |
$7,803.50
|
| Rate for Payer: Quartz Commercial |
$9,555.31
|
| Rate for Payer: WEA Trust Commercial |
$8,759.04
|
| Rate for Payer: WPS Commercial |
$11,795.60
|
|
|
VASCULAR GRAFT HYBRID 6-7MM X 50CM 0650HYB0705A
|
Facility
|
OP
|
$15,313.00
|
|
| Hospital Charge Code |
3525502
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,459.15 |
| Max. Negotiated Rate |
$14,651.48 |
| Rate for Payer: Aetna Commercial |
$14,332.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$13,695.95
|
| Rate for Payer: Aetna Managed Medicare |
$4,459.15
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$10,351.59
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7,962.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,644.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,440.53
|
| Rate for Payer: Cash Price |
$4,593.90
|
| Rate for Payer: Cigna Commercial |
$14,651.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,912.17
|
| Rate for Payer: Health EOS Commercial |
$14,173.71
|
| Rate for Payer: HFN Commercial |
$14,651.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,944.14
|
| Rate for Payer: Multiplan Commercial |
$12,740.42
|
| Rate for Payer: NAPHCARE Commercial |
$9,555.31
|
| Rate for Payer: Preferred Network Access Commercial |
$14,651.48
|
| Rate for Payer: Quartz Beloit One Network |
$7,803.50
|
| Rate for Payer: Quartz Commercial |
$10,351.59
|
| Rate for Payer: Quartz Medicare Advantage |
$9,555.31
|
| Rate for Payer: The Alliance Commercial |
$7,962.76
|
| Rate for Payer: WEA Trust Commercial |
$8,759.04
|
| Rate for Payer: WPS Commercial |
$11,795.60
|
|
|
VASCULAR GRAFT HYBRID 6-8MM X 50CM 0650HYB0805A
|
Facility
|
IP
|
$15,313.00
|
|
| Hospital Charge Code |
3525503
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,803.50 |
| Max. Negotiated Rate |
$14,651.48 |
| Rate for Payer: Aetna Commercial |
$14,332.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$13,695.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,440.53
|
| Rate for Payer: Cash Price |
$4,593.90
|
| Rate for Payer: Cigna Commercial |
$14,651.48
|
| Rate for Payer: Health EOS Commercial |
$14,173.71
|
| Rate for Payer: HFN Commercial |
$14,651.48
|
| Rate for Payer: Multiplan Commercial |
$12,740.42
|
| Rate for Payer: Preferred Network Access Commercial |
$14,651.48
|
| Rate for Payer: Quartz Beloit One Network |
$7,803.50
|
| Rate for Payer: Quartz Commercial |
$9,555.31
|
| Rate for Payer: WEA Trust Commercial |
$8,759.04
|
| Rate for Payer: WPS Commercial |
$11,795.60
|
|
|
VASCULAR GRAFT HYBRID 6-8MM X 50CM 0650HYB0805A
|
Facility
|
OP
|
$15,313.00
|
|
| Hospital Charge Code |
3525503
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,459.15 |
| Max. Negotiated Rate |
$14,651.48 |
| Rate for Payer: Aetna Commercial |
$14,332.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$13,695.95
|
| Rate for Payer: Aetna Managed Medicare |
$4,459.15
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$10,351.59
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7,962.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,644.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,440.53
|
| Rate for Payer: Cash Price |
$4,593.90
|
| Rate for Payer: Cigna Commercial |
$14,651.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,912.17
|
| Rate for Payer: Health EOS Commercial |
$14,173.71
|
| Rate for Payer: HFN Commercial |
$14,651.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,944.14
|
| Rate for Payer: Multiplan Commercial |
$12,740.42
|
| Rate for Payer: NAPHCARE Commercial |
$9,555.31
|
| Rate for Payer: Preferred Network Access Commercial |
$14,651.48
|
| Rate for Payer: Quartz Beloit One Network |
$7,803.50
|
| Rate for Payer: Quartz Commercial |
$10,351.59
|
| Rate for Payer: Quartz Medicare Advantage |
$9,555.31
|
| Rate for Payer: The Alliance Commercial |
$7,962.76
|
| Rate for Payer: WEA Trust Commercial |
$8,759.04
|
| Rate for Payer: WPS Commercial |
$11,795.60
|
|
|
Vascular Interpretation
|
Facility
|
IP
|
$272.00
|
|
|
Service Code
|
CPT 93978 26
|
| Hospital Charge Code |
5376639
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$138.61 |
| Max. Negotiated Rate |
$260.25 |
| Rate for Payer: Aetna Commercial |
$254.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$243.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$149.93
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cigna Commercial |
$260.25
|
| Rate for Payer: Health EOS Commercial |
$251.76
|
| Rate for Payer: HFN Commercial |
$260.25
|
| Rate for Payer: Multiplan Commercial |
$226.30
|
| Rate for Payer: Preferred Network Access Commercial |
$260.25
|
| Rate for Payer: Quartz Beloit One Network |
$138.61
|
| Rate for Payer: Quartz Commercial |
$169.73
|
| Rate for Payer: WEA Trust Commercial |
$155.58
|
| Rate for Payer: WPS Commercial |
$209.52
|
|
|
Vascular Interpretation
|
Facility
|
OP
|
$272.00
|
|
|
Service Code
|
CPT 93978 26
|
| Hospital Charge Code |
5376639
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$79.21 |
| Max. Negotiated Rate |
$260.25 |
| Rate for Payer: Aetna Commercial |
$254.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$243.28
|
| Rate for Payer: Aetna Managed Medicare |
$79.21
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$183.87
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$141.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$135.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$149.93
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cigna Commercial |
$260.25
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$158.30
|
| Rate for Payer: Health EOS Commercial |
$251.76
|
| Rate for Payer: HFN Commercial |
$260.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$212.16
|
| Rate for Payer: Multiplan Commercial |
$226.30
|
| Rate for Payer: NAPHCARE Commercial |
$169.73
|
| Rate for Payer: Preferred Network Access Commercial |
$260.25
|
| Rate for Payer: Quartz Beloit One Network |
$138.61
|
| Rate for Payer: Quartz Commercial |
$183.87
|
| Rate for Payer: Quartz Medicare Advantage |
$169.73
|
| Rate for Payer: The Alliance Commercial |
$143.69
|
| Rate for Payer: WEA Trust Commercial |
$155.58
|
| Rate for Payer: WPS Commercial |
$209.52
|
|
|
Vascular Interpretation
|
Facility
|
IP
|
$104.00
|
|
|
Service Code
|
CPT 93926 26
|
| Hospital Charge Code |
5376651
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$53.00 |
| Max. Negotiated Rate |
$99.51 |
| Rate for Payer: Aetna Commercial |
$97.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$93.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$57.32
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cigna Commercial |
$99.51
|
| Rate for Payer: Health EOS Commercial |
$96.26
|
| Rate for Payer: HFN Commercial |
$99.51
|
| Rate for Payer: Multiplan Commercial |
$86.53
|
| Rate for Payer: Preferred Network Access Commercial |
$99.51
|
| Rate for Payer: Quartz Beloit One Network |
$53.00
|
| Rate for Payer: Quartz Commercial |
$64.90
|
| Rate for Payer: WEA Trust Commercial |
$59.49
|
| Rate for Payer: WPS Commercial |
$80.11
|
|
|
Vascular Interpretation
|
Facility
|
OP
|
$160.00
|
|
|
Service Code
|
CPT 93923 26
|
| Hospital Charge Code |
5376739
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$46.59 |
| Max. Negotiated Rate |
$153.09 |
| Rate for Payer: Aetna Commercial |
$149.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$143.10
|
| Rate for Payer: Aetna Managed Medicare |
$46.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$108.16
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$83.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$79.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$88.19
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cigna Commercial |
$153.09
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$93.12
|
| Rate for Payer: Health EOS Commercial |
$148.10
|
| Rate for Payer: HFN Commercial |
$153.09
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$124.80
|
| Rate for Payer: Multiplan Commercial |
$133.12
|
| Rate for Payer: NAPHCARE Commercial |
$99.84
|
| Rate for Payer: Preferred Network Access Commercial |
$153.09
|
| Rate for Payer: Quartz Beloit One Network |
$81.54
|
| Rate for Payer: Quartz Commercial |
$108.16
|
| Rate for Payer: Quartz Medicare Advantage |
$99.84
|
| Rate for Payer: The Alliance Commercial |
$82.33
|
| Rate for Payer: WEA Trust Commercial |
$91.52
|
| Rate for Payer: WPS Commercial |
$123.25
|
|
|
Vascular Interpretation
|
Facility
|
OP
|
$136.00
|
|
|
Service Code
|
CPT 93931 26
|
| Hospital Charge Code |
5376703
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$39.60 |
| Max. Negotiated Rate |
$130.12 |
| Rate for Payer: Aetna Commercial |
$127.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$121.64
|
| Rate for Payer: Aetna Managed Medicare |
$39.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$91.94
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$70.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$67.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$74.96
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cigna Commercial |
$130.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$79.15
|
| Rate for Payer: Health EOS Commercial |
$125.88
|
| Rate for Payer: HFN Commercial |
$130.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$106.08
|
| Rate for Payer: Multiplan Commercial |
$113.15
|
| Rate for Payer: NAPHCARE Commercial |
$84.86
|
| Rate for Payer: Preferred Network Access Commercial |
$130.12
|
| Rate for Payer: Quartz Beloit One Network |
$69.31
|
| Rate for Payer: Quartz Commercial |
$91.94
|
| Rate for Payer: Quartz Medicare Advantage |
$84.86
|
| Rate for Payer: The Alliance Commercial |
$88.86
|
| Rate for Payer: WEA Trust Commercial |
$77.79
|
| Rate for Payer: WPS Commercial |
$104.76
|
|
|
Vascular Interpretation
|
Facility
|
OP
|
$104.00
|
|
|
Service Code
|
CPT 93926 26
|
| Hospital Charge Code |
5376651
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$30.28 |
| Max. Negotiated Rate |
$99.51 |
| Rate for Payer: Aetna Commercial |
$97.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$93.02
|
| Rate for Payer: Aetna Managed Medicare |
$30.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$70.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$54.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$51.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$57.32
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cigna Commercial |
$99.51
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$60.53
|
| Rate for Payer: Health EOS Commercial |
$96.26
|
| Rate for Payer: HFN Commercial |
$99.51
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$81.12
|
| Rate for Payer: Multiplan Commercial |
$86.53
|
| Rate for Payer: NAPHCARE Commercial |
$64.90
|
| Rate for Payer: Preferred Network Access Commercial |
$99.51
|
| Rate for Payer: Quartz Beloit One Network |
$53.00
|
| Rate for Payer: Quartz Commercial |
$70.30
|
| Rate for Payer: Quartz Medicare Advantage |
$64.90
|
| Rate for Payer: The Alliance Commercial |
$87.53
|
| Rate for Payer: WEA Trust Commercial |
$59.49
|
| Rate for Payer: WPS Commercial |
$80.11
|
|
|
Vascular Interpretation
|
Facility
|
IP
|
$160.00
|
|
|
Service Code
|
CPT 93923 26
|
| Hospital Charge Code |
5376739
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$81.54 |
| Max. Negotiated Rate |
$153.09 |
| Rate for Payer: Aetna Commercial |
$149.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$143.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$88.19
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cigna Commercial |
$153.09
|
| Rate for Payer: Health EOS Commercial |
$148.10
|
| Rate for Payer: HFN Commercial |
$153.09
|
| Rate for Payer: Multiplan Commercial |
$133.12
|
| Rate for Payer: Preferred Network Access Commercial |
$153.09
|
| Rate for Payer: Quartz Beloit One Network |
$81.54
|
| Rate for Payer: Quartz Commercial |
$99.84
|
| Rate for Payer: WEA Trust Commercial |
$91.52
|
| Rate for Payer: WPS Commercial |
$123.25
|
|
|
Vascular Interpretation
|
Facility
|
OP
|
$138.00
|
|
|
Service Code
|
CPT 93930 26
|
| Hospital Charge Code |
5376700
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$40.19 |
| Max. Negotiated Rate |
$145.97 |
| Rate for Payer: Aetna Commercial |
$129.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$123.43
|
| Rate for Payer: Aetna Managed Medicare |
$40.19
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$93.29
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$71.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$68.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$76.07
|
| Rate for Payer: Cash Price |
$41.40
|
| Rate for Payer: Cash Price |
$41.40
|
| Rate for Payer: Cigna Commercial |
$132.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$80.32
|
| Rate for Payer: Health EOS Commercial |
$127.73
|
| Rate for Payer: HFN Commercial |
$132.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$107.64
|
| Rate for Payer: Multiplan Commercial |
$114.82
|
| Rate for Payer: NAPHCARE Commercial |
$86.11
|
| Rate for Payer: Preferred Network Access Commercial |
$132.04
|
| Rate for Payer: Quartz Beloit One Network |
$70.32
|
| Rate for Payer: Quartz Commercial |
$93.29
|
| Rate for Payer: Quartz Medicare Advantage |
$86.11
|
| Rate for Payer: The Alliance Commercial |
$145.97
|
| Rate for Payer: WEA Trust Commercial |
$78.94
|
| Rate for Payer: WPS Commercial |
$106.30
|
|
|
Vascular Interpretation
|
Facility
|
IP
|
$138.00
|
|
|
Service Code
|
CPT 93930 26
|
| Hospital Charge Code |
5376700
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$70.32 |
| Max. Negotiated Rate |
$132.04 |
| Rate for Payer: Aetna Commercial |
$129.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$123.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$76.07
|
| Rate for Payer: Cash Price |
$41.40
|
| Rate for Payer: Cigna Commercial |
$132.04
|
| Rate for Payer: Health EOS Commercial |
$127.73
|
| Rate for Payer: HFN Commercial |
$132.04
|
| Rate for Payer: Multiplan Commercial |
$114.82
|
| Rate for Payer: Preferred Network Access Commercial |
$132.04
|
| Rate for Payer: Quartz Beloit One Network |
$70.32
|
| Rate for Payer: Quartz Commercial |
$86.11
|
| Rate for Payer: WEA Trust Commercial |
$78.94
|
| Rate for Payer: WPS Commercial |
$106.30
|
|
|
Vascular Interpretation
|
Facility
|
OP
|
$104.00
|
|
|
Service Code
|
CPT 93926 26
|
| Hospital Charge Code |
5376658
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$30.28 |
| Max. Negotiated Rate |
$99.51 |
| Rate for Payer: Aetna Commercial |
$97.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$93.02
|
| Rate for Payer: Aetna Managed Medicare |
$30.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$70.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$54.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$51.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$57.32
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cigna Commercial |
$99.51
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$60.53
|
| Rate for Payer: Health EOS Commercial |
$96.26
|
| Rate for Payer: HFN Commercial |
$99.51
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$81.12
|
| Rate for Payer: Multiplan Commercial |
$86.53
|
| Rate for Payer: NAPHCARE Commercial |
$64.90
|
| Rate for Payer: Preferred Network Access Commercial |
$99.51
|
| Rate for Payer: Quartz Beloit One Network |
$53.00
|
| Rate for Payer: Quartz Commercial |
$70.30
|
| Rate for Payer: Quartz Medicare Advantage |
$64.90
|
| Rate for Payer: The Alliance Commercial |
$87.53
|
| Rate for Payer: WEA Trust Commercial |
$59.49
|
| Rate for Payer: WPS Commercial |
$80.11
|
|
|
Vascular Interpretation
|
Facility
|
IP
|
$136.00
|
|
|
Service Code
|
CPT 93931 26
|
| Hospital Charge Code |
5376703
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$69.31 |
| Max. Negotiated Rate |
$130.12 |
| Rate for Payer: Aetna Commercial |
$127.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$121.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$74.96
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cigna Commercial |
$130.12
|
| Rate for Payer: Health EOS Commercial |
$125.88
|
| Rate for Payer: HFN Commercial |
$130.12
|
| Rate for Payer: Multiplan Commercial |
$113.15
|
| Rate for Payer: Preferred Network Access Commercial |
$130.12
|
| Rate for Payer: Quartz Beloit One Network |
$69.31
|
| Rate for Payer: Quartz Commercial |
$84.86
|
| Rate for Payer: WEA Trust Commercial |
$77.79
|
| Rate for Payer: WPS Commercial |
$104.76
|
|
|
Vascular Interpretation
|
Facility
|
IP
|
$104.00
|
|
|
Service Code
|
CPT 93926 26
|
| Hospital Charge Code |
5376658
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$53.00 |
| Max. Negotiated Rate |
$99.51 |
| Rate for Payer: Aetna Commercial |
$97.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$93.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$57.32
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cigna Commercial |
$99.51
|
| Rate for Payer: Health EOS Commercial |
$96.26
|
| Rate for Payer: HFN Commercial |
$99.51
|
| Rate for Payer: Multiplan Commercial |
$86.53
|
| Rate for Payer: Preferred Network Access Commercial |
$99.51
|
| Rate for Payer: Quartz Beloit One Network |
$53.00
|
| Rate for Payer: Quartz Commercial |
$64.90
|
| Rate for Payer: WEA Trust Commercial |
$59.49
|
| Rate for Payer: WPS Commercial |
$80.11
|
|
|
VASCULAR RETRIEVAL (G07187)
|
Facility
|
IP
|
$4,658.00
|
|
| Hospital Charge Code |
2973633
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,373.72 |
| Max. Negotiated Rate |
$4,456.77 |
| Rate for Payer: Aetna Commercial |
$4,359.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,166.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,567.49
|
| Rate for Payer: Cash Price |
$1,397.40
|
| Rate for Payer: Cigna Commercial |
$4,456.77
|
| Rate for Payer: Health EOS Commercial |
$4,311.44
|
| Rate for Payer: HFN Commercial |
$4,456.77
|
| Rate for Payer: Multiplan Commercial |
$3,875.46
|
| Rate for Payer: Preferred Network Access Commercial |
$4,456.77
|
| Rate for Payer: Quartz Beloit One Network |
$2,373.72
|
| Rate for Payer: Quartz Commercial |
$2,906.59
|
| Rate for Payer: WEA Trust Commercial |
$2,664.38
|
| Rate for Payer: WPS Commercial |
$3,588.06
|
|
|
VASCULAR RETRIEVAL (G07187)
|
Facility
|
OP
|
$4,658.00
|
|
| Hospital Charge Code |
2973633
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,356.41 |
| Max. Negotiated Rate |
$4,456.77 |
| Rate for Payer: Aetna Commercial |
$4,359.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,166.12
|
| Rate for Payer: Aetna Managed Medicare |
$1,356.41
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,148.81
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,422.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,325.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,567.49
|
| Rate for Payer: Cash Price |
$1,397.40
|
| Rate for Payer: Cigna Commercial |
$4,456.77
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,710.96
|
| Rate for Payer: Health EOS Commercial |
$4,311.44
|
| Rate for Payer: HFN Commercial |
$4,456.77
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,633.24
|
| Rate for Payer: Multiplan Commercial |
$3,875.46
|
| Rate for Payer: NAPHCARE Commercial |
$2,906.59
|
| Rate for Payer: Preferred Network Access Commercial |
$4,456.77
|
| Rate for Payer: Quartz Beloit One Network |
$2,373.72
|
| Rate for Payer: Quartz Commercial |
$3,148.81
|
| Rate for Payer: Quartz Medicare Advantage |
$2,906.59
|
| Rate for Payer: The Alliance Commercial |
$2,422.16
|
| Rate for Payer: WEA Trust Commercial |
$2,664.38
|
| Rate for Payer: WPS Commercial |
$3,588.06
|
|
