|
Varicella Zoster Virus Ab CSF
|
Facility
|
OP
|
$53.00
|
|
|
Service Code
|
CPT 86787
|
| Hospital Charge Code |
4378581
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.40 |
| Max. Negotiated Rate |
$53.58 |
| Rate for Payer: Aetna Commercial |
$49.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$47.40
|
| Rate for Payer: Aetna Managed Medicare |
$13.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$50.23
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$23.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$22.24
|
| Rate for Payer: Anthem Medicare Advantage |
$13.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$29.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.40
|
| Rate for Payer: Cash Price |
$15.90
|
| Rate for Payer: Cash Price |
$15.90
|
| Rate for Payer: Cigna Commercial |
$50.71
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$30.85
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13.40
|
| Rate for Payer: Health EOS Commercial |
$49.06
|
| Rate for Payer: HFN Commercial |
$50.71
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$49.83
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.40
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.40
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13.40
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13.40
|
| Rate for Payer: Multiplan Commercial |
$44.10
|
| Rate for Payer: NAPHCARE Commercial |
$20.09
|
| Rate for Payer: Preferred Network Access Commercial |
$50.71
|
| Rate for Payer: Quartz Beloit One Network |
$27.01
|
| Rate for Payer: Quartz Commercial |
$35.83
|
| Rate for Payer: Quartz Medicare Advantage |
$13.40
|
| Rate for Payer: The Alliance Commercial |
$53.58
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.40
|
| Rate for Payer: United Healthcare PPO |
$41.34
|
| Rate for Payer: WEA Trust Commercial |
$30.32
|
| Rate for Payer: Wellcare Medicare |
$13.40
|
| Rate for Payer: WPS Commercial |
$40.83
|
|
|
Varicella Zoster Virus Ab CSF
|
Professional
|
Both
|
$53.00
|
|
|
Service Code
|
CPT 86787
|
| Hospital Charge Code |
4378581
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.40 |
| Max. Negotiated Rate |
$58.94 |
| Rate for Payer: Aetna Commercial |
$52.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$47.40
|
| Rate for Payer: Aetna Managed Medicare |
$13.40
|
| Rate for Payer: Anthem Medicare Advantage |
$13.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.40
|
| Rate for Payer: Cash Price |
$15.90
|
| Rate for Payer: Cash Price |
$15.90
|
| Rate for Payer: Cigna Commercial |
$52.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$27.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13.40
|
| Rate for Payer: Health EOS Commercial |
$50.16
|
| Rate for Payer: HFN Commercial |
$52.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$47.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$47.29
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.40
|
| Rate for Payer: Multiplan Commercial |
$44.10
|
| Rate for Payer: NAPHCARE Commercial |
$20.09
|
| Rate for Payer: Preferred Network Access Commercial |
$52.36
|
| Rate for Payer: Quartz Beloit One Network |
$24.25
|
| Rate for Payer: Quartz Commercial |
$31.42
|
| Rate for Payer: Quartz Medicare Advantage |
$13.40
|
| Rate for Payer: The Alliance Commercial |
$52.91
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.40
|
| Rate for Payer: WEA Trust Commercial |
$30.32
|
| Rate for Payer: WPS Commercial |
$58.94
|
|
|
Varicella Zoster Virus Ab CSF
|
Facility
|
IP
|
$53.00
|
|
|
Service Code
|
CPT 86787
|
| Hospital Charge Code |
4378581
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$27.01 |
| Max. Negotiated Rate |
$50.71 |
| Rate for Payer: Aetna Commercial |
$49.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$47.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$29.21
|
| Rate for Payer: Cash Price |
$15.90
|
| Rate for Payer: Cigna Commercial |
$50.71
|
| Rate for Payer: Health EOS Commercial |
$49.06
|
| Rate for Payer: HFN Commercial |
$50.71
|
| Rate for Payer: Multiplan Commercial |
$44.10
|
| Rate for Payer: Preferred Network Access Commercial |
$50.71
|
| Rate for Payer: Quartz Beloit One Network |
$27.01
|
| Rate for Payer: Quartz Commercial |
$33.07
|
| Rate for Payer: WEA Trust Commercial |
$30.32
|
| Rate for Payer: WPS Commercial |
$40.83
|
|
|
Varicella Zoster Virus Antibody CSF
|
Professional
|
Both
|
$78.00
|
|
|
Service Code
|
CPT 86787
|
| Hospital Charge Code |
4374623
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$13.40 |
| Max. Negotiated Rate |
$77.06 |
| Rate for Payer: Aetna Commercial |
$77.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$69.76
|
| Rate for Payer: Aetna Managed Medicare |
$13.40
|
| Rate for Payer: Anthem Medicare Advantage |
$13.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.40
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cigna Commercial |
$77.06
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$40.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13.40
|
| Rate for Payer: Health EOS Commercial |
$73.82
|
| Rate for Payer: HFN Commercial |
$77.06
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$47.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$47.29
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.40
|
| Rate for Payer: Multiplan Commercial |
$64.90
|
| Rate for Payer: NAPHCARE Commercial |
$20.09
|
| Rate for Payer: Preferred Network Access Commercial |
$77.06
|
| Rate for Payer: Quartz Beloit One Network |
$35.69
|
| Rate for Payer: Quartz Commercial |
$46.24
|
| Rate for Payer: Quartz Medicare Advantage |
$13.40
|
| Rate for Payer: The Alliance Commercial |
$52.91
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.40
|
| Rate for Payer: WEA Trust Commercial |
$44.62
|
| Rate for Payer: WPS Commercial |
$58.94
|
|
|
Varicella Zoster Virus Antibody CSF
|
Facility
|
IP
|
$78.00
|
|
|
Service Code
|
CPT 86787
|
| Hospital Charge Code |
4374623
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$39.75 |
| Max. Negotiated Rate |
$74.63 |
| Rate for Payer: Aetna Commercial |
$73.01
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$69.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$42.99
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cigna Commercial |
$74.63
|
| Rate for Payer: Health EOS Commercial |
$72.20
|
| Rate for Payer: HFN Commercial |
$74.63
|
| Rate for Payer: Multiplan Commercial |
$64.90
|
| Rate for Payer: Preferred Network Access Commercial |
$74.63
|
| Rate for Payer: Quartz Beloit One Network |
$39.75
|
| Rate for Payer: Quartz Commercial |
$48.67
|
| Rate for Payer: WEA Trust Commercial |
$44.62
|
| Rate for Payer: WPS Commercial |
$60.08
|
|
|
Varicella Zoster Virus Antibody CSF
|
Facility
|
OP
|
$78.00
|
|
|
Service Code
|
CPT 86787
|
| Hospital Charge Code |
4374623
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$13.40 |
| Max. Negotiated Rate |
$74.63 |
| Rate for Payer: Aetna Commercial |
$73.01
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$69.76
|
| Rate for Payer: Aetna Managed Medicare |
$13.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$50.23
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$23.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$22.24
|
| Rate for Payer: Anthem Medicare Advantage |
$13.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$42.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.40
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cigna Commercial |
$74.63
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$45.40
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13.40
|
| Rate for Payer: Health EOS Commercial |
$72.20
|
| Rate for Payer: HFN Commercial |
$74.63
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$49.83
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.40
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.40
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13.40
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13.40
|
| Rate for Payer: Multiplan Commercial |
$64.90
|
| Rate for Payer: NAPHCARE Commercial |
$20.09
|
| Rate for Payer: Preferred Network Access Commercial |
$74.63
|
| Rate for Payer: Quartz Beloit One Network |
$39.75
|
| Rate for Payer: Quartz Commercial |
$52.73
|
| Rate for Payer: Quartz Medicare Advantage |
$13.40
|
| Rate for Payer: The Alliance Commercial |
$53.58
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.40
|
| Rate for Payer: United Healthcare PPO |
$60.84
|
| Rate for Payer: WEA Trust Commercial |
$44.62
|
| Rate for Payer: Wellcare Medicare |
$13.40
|
| Rate for Payer: WPS Commercial |
$60.08
|
|
|
Varicella Zoster Virus DNA, Quant Real Time PCR
|
Facility
|
IP
|
$552.00
|
|
|
Service Code
|
CPT 87799
|
| Hospital Charge Code |
3961341
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$281.30 |
| Max. Negotiated Rate |
$528.15 |
| Rate for Payer: Aetna Commercial |
$516.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$493.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$304.26
|
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Cigna Commercial |
$528.15
|
| Rate for Payer: Health EOS Commercial |
$510.93
|
| Rate for Payer: HFN Commercial |
$528.15
|
| Rate for Payer: Multiplan Commercial |
$459.26
|
| Rate for Payer: Preferred Network Access Commercial |
$528.15
|
| Rate for Payer: Quartz Beloit One Network |
$281.30
|
| Rate for Payer: Quartz Commercial |
$344.45
|
| Rate for Payer: WEA Trust Commercial |
$315.74
|
| Rate for Payer: WPS Commercial |
$425.21
|
|
|
Varicella Zoster Virus DNA, Quant Real Time PCR
|
Professional
|
Both
|
$552.00
|
|
|
Service Code
|
CPT 87799
|
| Hospital Charge Code |
3961341
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$44.55 |
| Max. Negotiated Rate |
$545.38 |
| Rate for Payer: Aetna Commercial |
$545.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$493.71
|
| Rate for Payer: Aetna Managed Medicare |
$44.55
|
| Rate for Payer: Anthem Medicare Advantage |
$44.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$44.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$44.55
|
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Cigna Commercial |
$545.38
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$287.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$44.55
|
| Rate for Payer: Health EOS Commercial |
$522.41
|
| Rate for Payer: HFN Commercial |
$545.38
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$157.28
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$157.28
|
| Rate for Payer: Independent Care Health Plan Medicare |
$44.55
|
| Rate for Payer: Multiplan Commercial |
$459.26
|
| Rate for Payer: NAPHCARE Commercial |
$66.83
|
| Rate for Payer: Preferred Network Access Commercial |
$545.38
|
| Rate for Payer: Quartz Beloit One Network |
$252.60
|
| Rate for Payer: Quartz Commercial |
$327.23
|
| Rate for Payer: Quartz Medicare Advantage |
$44.55
|
| Rate for Payer: The Alliance Commercial |
$175.99
|
| Rate for Payer: United Healthcare Medicare Advantage |
$44.55
|
| Rate for Payer: WEA Trust Commercial |
$315.74
|
| Rate for Payer: WPS Commercial |
$196.04
|
|
|
Varicella Zoster Virus DNA, Quant Real Time PCR
|
Facility
|
OP
|
$552.00
|
|
|
Service Code
|
CPT 87799
|
| Hospital Charge Code |
3961341
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$44.55 |
| Max. Negotiated Rate |
$528.15 |
| Rate for Payer: Aetna Commercial |
$516.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$493.71
|
| Rate for Payer: Aetna Managed Medicare |
$44.55
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$167.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$77.97
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$73.96
|
| Rate for Payer: Anthem Medicare Advantage |
$44.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$304.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$44.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$44.55
|
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Cigna Commercial |
$528.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$44.55
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$321.26
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$44.55
|
| Rate for Payer: Health EOS Commercial |
$510.93
|
| Rate for Payer: HFN Commercial |
$528.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$165.74
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$44.55
|
| Rate for Payer: Independent Care Health Plan Medicare |
$44.55
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$44.55
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$44.55
|
| Rate for Payer: Multiplan Commercial |
$459.26
|
| Rate for Payer: NAPHCARE Commercial |
$66.83
|
| Rate for Payer: Preferred Network Access Commercial |
$528.15
|
| Rate for Payer: Quartz Beloit One Network |
$281.30
|
| Rate for Payer: Quartz Commercial |
$373.15
|
| Rate for Payer: Quartz Medicare Advantage |
$44.55
|
| Rate for Payer: The Alliance Commercial |
$178.21
|
| Rate for Payer: United Healthcare Medicare Advantage |
$44.55
|
| Rate for Payer: United Healthcare PPO |
$430.56
|
| Rate for Payer: WEA Trust Commercial |
$315.74
|
| Rate for Payer: Wellcare Medicare |
$44.55
|
| Rate for Payer: WPS Commercial |
$425.21
|
|
|
VARICOCELECTOMY
|
Facility
|
OP
|
$1,084.00
|
|
| Hospital Charge Code |
2960494
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$315.66 |
| Max. Negotiated Rate |
$1,037.17 |
| Rate for Payer: Aetna Commercial |
$1,014.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$969.53
|
| Rate for Payer: Aetna Managed Medicare |
$315.66
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$732.78
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$563.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$541.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$597.50
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$1,037.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$630.89
|
| Rate for Payer: Health EOS Commercial |
$1,003.35
|
| Rate for Payer: HFN Commercial |
$1,037.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$845.52
|
| Rate for Payer: Multiplan Commercial |
$901.89
|
| Rate for Payer: NAPHCARE Commercial |
$676.42
|
| Rate for Payer: Preferred Network Access Commercial |
$1,037.17
|
| Rate for Payer: Quartz Beloit One Network |
$552.41
|
| Rate for Payer: Quartz Commercial |
$732.78
|
| Rate for Payer: Quartz Medicare Advantage |
$676.42
|
| Rate for Payer: The Alliance Commercial |
$563.68
|
| Rate for Payer: WEA Trust Commercial |
$620.05
|
| Rate for Payer: WPS Commercial |
$835.01
|
|
|
VARICOCELECTOMY
|
Facility
|
IP
|
$1,084.00
|
|
| Hospital Charge Code |
2960494
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$552.41 |
| Max. Negotiated Rate |
$1,037.17 |
| Rate for Payer: Aetna Commercial |
$1,014.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$969.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$597.50
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$1,037.17
|
| Rate for Payer: Health EOS Commercial |
$1,003.35
|
| Rate for Payer: HFN Commercial |
$1,037.17
|
| Rate for Payer: Multiplan Commercial |
$901.89
|
| Rate for Payer: Preferred Network Access Commercial |
$1,037.17
|
| Rate for Payer: Quartz Beloit One Network |
$552.41
|
| Rate for Payer: Quartz Commercial |
$676.42
|
| Rate for Payer: WEA Trust Commercial |
$620.05
|
| Rate for Payer: WPS Commercial |
$835.01
|
|
|
VASCULAR ACCESS BY NEEDLE OR CATHETER
|
Facility
|
OP
|
$144.92
|
|
|
Service Code
|
EAPG 00423
|
| Min. Negotiated Rate |
$139.34 |
| Max. Negotiated Rate |
$144.92 |
| Rate for Payer: Anthem Medicaid |
$139.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$139.34
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$139.34
|
| Rate for Payer: Dean Health Medicaid |
$139.34
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$139.34
|
| Rate for Payer: Managed Health Services Medicaid |
$144.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$139.34
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$139.34
|
| Rate for Payer: United Healthcare Medicaid |
$139.34
|
|
|
Vascular Acquisition
|
Facility
|
OP
|
$1,641.00
|
|
|
Service Code
|
CPT 93971 LT
|
| Hospital Charge Code |
5376683
|
|
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
|
$2,194.00
|
|
|
Service Code
|
CPT 93925
|
| Hospital Charge Code |
5376653
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$251.10 |
| 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: Aetna Managed Medicare |
$251.10
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,483.14
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,140.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,095.24
|
| Rate for Payer: Anthem Medicare Advantage |
$251.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,209.33
|
| 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 |
$658.20
|
| Rate for Payer: Cash Price |
$658.20
|
| Rate for Payer: Cigna Commercial |
$2,099.22
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$251.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,276.91
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$251.10
|
| Rate for Payer: Health EOS Commercial |
$2,030.77
|
| Rate for Payer: HFN Commercial |
$2,099.22
|
| 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 |
$1,825.41
|
| Rate for Payer: NAPHCARE Commercial |
$376.65
|
| 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 |
$1,483.14
|
| 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 |
$1,711.32
|
| Rate for Payer: WEA Trust Commercial |
$1,254.97
|
| Rate for Payer: Wellcare Medicare |
$251.10
|
| Rate for Payer: WPS Commercial |
$1,690.04
|
|
|
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
|
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
|
$1,227.00
|
|
|
Service Code
|
CPT 93923
|
| Hospital Charge Code |
5376737
|
|
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
|
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
|
OP
|
$1,274.00
|
|
|
Service Code
|
CPT 93926 LT
|
| Hospital Charge Code |
5376656
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$370.99 |
| Max. Negotiated Rate |
$1,218.96 |
| Rate for Payer: Aetna Commercial |
$1,192.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,139.47
|
| Rate for Payer: Aetna Managed Medicare |
$370.99
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$861.22
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$662.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$635.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$702.23
|
| Rate for Payer: Cash Price |
$382.20
|
| Rate for Payer: Cigna Commercial |
$1,218.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$741.47
|
| Rate for Payer: Health EOS Commercial |
$1,179.21
|
| Rate for Payer: HFN Commercial |
$1,218.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$993.72
|
| Rate for Payer: Multiplan Commercial |
$1,059.97
|
| Rate for Payer: NAPHCARE Commercial |
$794.98
|
| Rate for Payer: Preferred Network Access Commercial |
$1,218.96
|
| Rate for Payer: Quartz Beloit One Network |
$649.23
|
| Rate for Payer: Quartz Commercial |
$861.22
|
| Rate for Payer: Quartz Medicare Advantage |
$794.98
|
| Rate for Payer: The Alliance Commercial |
$662.48
|
| Rate for Payer: United Healthcare PPO |
$993.72
|
| Rate for Payer: WEA Trust Commercial |
$728.73
|
| Rate for Payer: WPS Commercial |
$981.36
|
|
|
Vascular Acquisition
|
Facility
|
IP
|
$1,329.00
|
|
|
Service Code
|
CPT 93978
|
| Hospital Charge Code |
5376637
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$677.26 |
| Max. Negotiated Rate |
$1,271.59 |
| Rate for Payer: Aetna Commercial |
$1,243.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,188.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$732.54
|
| Rate for Payer: Cash Price |
$398.70
|
| Rate for Payer: Cigna Commercial |
$1,271.59
|
| Rate for Payer: Health EOS Commercial |
$1,230.12
|
| Rate for Payer: HFN Commercial |
$1,271.59
|
| Rate for Payer: Multiplan Commercial |
$1,105.73
|
| Rate for Payer: Preferred Network Access Commercial |
$1,271.59
|
| Rate for Payer: Quartz Beloit One Network |
$677.26
|
| Rate for Payer: Quartz Commercial |
$829.30
|
| Rate for Payer: WEA Trust Commercial |
$760.19
|
| Rate for Payer: WPS Commercial |
$1,023.73
|
|
|
Vascular Acquisition
|
Facility
|
OP
|
$1,342.00
|
|
|
Service Code
|
CPT 93931 LT
|
| Hospital Charge Code |
5376701
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$390.79 |
| Max. Negotiated Rate |
$1,284.03 |
| Rate for Payer: Aetna Commercial |
$1,256.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,200.28
|
| Rate for Payer: Aetna Managed Medicare |
$390.79
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$907.19
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$697.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$669.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$739.71
|
| Rate for Payer: Cash Price |
$402.60
|
| Rate for Payer: Cigna Commercial |
$1,284.03
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$781.04
|
| Rate for Payer: Health EOS Commercial |
$1,242.16
|
| Rate for Payer: HFN Commercial |
$1,284.03
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,046.76
|
| Rate for Payer: Multiplan Commercial |
$1,116.54
|
| Rate for Payer: NAPHCARE Commercial |
$837.41
|
| Rate for Payer: Preferred Network Access Commercial |
$1,284.03
|
| Rate for Payer: Quartz Beloit One Network |
$683.88
|
| Rate for Payer: Quartz Commercial |
$907.19
|
| Rate for Payer: Quartz Medicare Advantage |
$837.41
|
| Rate for Payer: The Alliance Commercial |
$697.84
|
| Rate for Payer: United Healthcare PPO |
$1,046.76
|
| Rate for Payer: WEA Trust Commercial |
$767.62
|
| Rate for Payer: WPS Commercial |
$1,033.74
|
|
|
Vascular Acquisition
|
Facility
|
IP
|
$1,644.00
|
|
|
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
|
$1,342.00
|
|
|
Service Code
|
CPT 93931 RT
|
| Hospital Charge Code |
5376704
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$390.79 |
| Max. Negotiated Rate |
$1,284.03 |
| Rate for Payer: Aetna Commercial |
$1,256.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,200.28
|
| Rate for Payer: Aetna Managed Medicare |
$390.79
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$907.19
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$697.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$669.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$739.71
|
| Rate for Payer: Cash Price |
$402.60
|
| Rate for Payer: Cigna Commercial |
$1,284.03
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$781.04
|
| Rate for Payer: Health EOS Commercial |
$1,242.16
|
| Rate for Payer: HFN Commercial |
$1,284.03
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,046.76
|
| Rate for Payer: Multiplan Commercial |
$1,116.54
|
| Rate for Payer: NAPHCARE Commercial |
$837.41
|
| Rate for Payer: Preferred Network Access Commercial |
$1,284.03
|
| Rate for Payer: Quartz Beloit One Network |
$683.88
|
| Rate for Payer: Quartz Commercial |
$907.19
|
| Rate for Payer: Quartz Medicare Advantage |
$837.41
|
| Rate for Payer: The Alliance Commercial |
$697.84
|
| Rate for Payer: United Healthcare PPO |
$1,046.76
|
| Rate for Payer: WEA Trust Commercial |
$767.62
|
| Rate for Payer: WPS Commercial |
$1,033.74
|
|
|
Vascular Acquisition
|
Facility
|
OP
|
$1,641.00
|
|
|
Service Code
|
CPT 93971 LT
|
| Hospital Charge Code |
5376719
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$477.86 |
| Max. Negotiated Rate |
$1,570.11 |
| Rate for Payer: Aetna Commercial |
$1,535.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,467.71
|
| Rate for Payer: Aetna Managed Medicare |
$477.86
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,109.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$853.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$819.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$904.52
|
| Rate for Payer: Cash Price |
$492.30
|
| Rate for Payer: Cigna Commercial |
$1,570.11
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$955.06
|
| Rate for Payer: Health EOS Commercial |
$1,518.91
|
| Rate for Payer: HFN Commercial |
$1,570.11
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,279.98
|
| Rate for Payer: Multiplan Commercial |
$1,365.31
|
| Rate for Payer: NAPHCARE Commercial |
$1,023.98
|
| Rate for Payer: Preferred Network Access Commercial |
$1,570.11
|
| Rate for Payer: Quartz Beloit One Network |
$836.25
|
| Rate for Payer: Quartz Commercial |
$1,109.32
|
| Rate for Payer: Quartz Medicare Advantage |
$1,023.98
|
| Rate for Payer: The Alliance Commercial |
$853.32
|
| Rate for Payer: United Healthcare PPO |
$1,279.98
|
| Rate for Payer: WEA Trust Commercial |
$938.65
|
| Rate for Payer: WPS Commercial |
$1,264.06
|
|
|
Vascular Acquisition
|
Facility
|
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
|
|
