|
BCE VL Carotid Duplex Right or Limited
|
Professional
|
$739.00
|
|
|
Service Code
|
CPT 93882 TC,RT
|
| Hospital Charge Code |
5266752
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$325.16 |
| Max. Negotiated Rate |
$702.05 |
| Rate for Payer: Aetna Commercial |
$702.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$635.54
|
| Rate for Payer: Cash Price |
$221.70
|
| Rate for Payer: Cash Price |
$221.70
|
| Rate for Payer: Cigna Commercial |
$702.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$369.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$443.40
|
| Rate for Payer: Health EOS Commercial |
$672.49
|
| Rate for Payer: Multiplan Commercial |
$591.20
|
| Rate for Payer: Preferred Network Access Commercial |
$702.05
|
| Rate for Payer: Quartz Beloit One Network |
$325.16
|
| Rate for Payer: Quartz Commercial |
$421.23
|
| Rate for Payer: The Alliance Commercial |
$369.50
|
| Rate for Payer: WEA Trust Commercial |
$406.45
|
| Rate for Payer: WPS Commercial |
$547.38
|
|
|
BCE VL Carotid Duplex Right or Limited
|
Facility
OP
|
$739.00
|
|
|
Service Code
|
CPT 93882 TC,RT
|
| Hospital Charge Code |
5266752
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$206.92 |
| Max. Negotiated Rate |
$2,956.00 |
| Rate for Payer: Aetna Commercial |
$665.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$635.54
|
| Rate for Payer: Aetna Managed Medicare |
$206.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$480.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$369.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$354.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$391.67
|
| Rate for Payer: Cash Price |
$221.70
|
| Rate for Payer: Cigna Commercial |
$679.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$413.54
|
| Rate for Payer: Health EOS Commercial |
$657.71
|
| Rate for Payer: HFN Commercial |
$679.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$554.25
|
| Rate for Payer: Multiplan Commercial |
$591.20
|
| Rate for Payer: NAPHCARE Commercial |
$443.40
|
| Rate for Payer: Preferred Network Access Commercial |
$679.88
|
| Rate for Payer: Quartz Beloit One Network |
$362.11
|
| Rate for Payer: Quartz Commercial |
$480.35
|
| Rate for Payer: Quartz Medicare Advantage |
$443.40
|
| Rate for Payer: The Alliance Commercial |
$2,956.00
|
| Rate for Payer: United Healthcare PPO |
$554.25
|
| Rate for Payer: WEA Trust Commercial |
$406.45
|
| Rate for Payer: WPS Commercial |
$547.38
|
|
|
BCE VL Duplex Arterial/Venous Visceral
|
Facility
IP
|
$1,539.00
|
|
|
Service Code
|
CPT 93975 TC
|
| Hospital Charge Code |
3114948
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$754.11 |
| Max. Negotiated Rate |
$1,415.88 |
| Rate for Payer: Aetna Commercial |
$1,385.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$815.67
|
| Rate for Payer: Cash Price |
$461.70
|
| Rate for Payer: Cigna Commercial |
$1,415.88
|
| Rate for Payer: Health EOS Commercial |
$1,369.71
|
| Rate for Payer: HFN Commercial |
$1,415.88
|
| Rate for Payer: Multiplan Commercial |
$1,231.20
|
| Rate for Payer: NAPHCARE Commercial |
$923.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,415.88
|
| Rate for Payer: Quartz Beloit One Network |
$754.11
|
| Rate for Payer: Quartz Commercial |
$923.40
|
| Rate for Payer: WEA Trust Commercial |
$846.45
|
| Rate for Payer: WPS Commercial |
$1,139.94
|
|
|
BCE VL Duplex Arterial/Venous Visceral
|
Professional
|
$1,539.00
|
|
|
Service Code
|
CPT 93975 TC
|
| Hospital Charge Code |
3114948
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$203.24 |
| Max. Negotiated Rate |
$1,462.05 |
| Rate for Payer: Aetna Commercial |
$1,462.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,323.54
|
| Rate for Payer: Aetna Managed Medicare |
$203.24
|
| Rate for Payer: Anthem Medicare Advantage |
$203.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$203.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$203.24
|
| Rate for Payer: Cash Price |
$461.70
|
| Rate for Payer: Cash Price |
$461.70
|
| Rate for Payer: Cigna Commercial |
$1,462.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$769.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$203.24
|
| Rate for Payer: Health EOS Commercial |
$1,400.49
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$752.14
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$752.14
|
| Rate for Payer: Independent Care Health Plan Medicare |
$203.24
|
| Rate for Payer: Multiplan Commercial |
$1,231.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,462.05
|
| Rate for Payer: Quartz Beloit One Network |
$677.16
|
| Rate for Payer: Quartz Commercial |
$877.23
|
| Rate for Payer: Quartz Medicare Advantage |
$203.24
|
| Rate for Payer: The Alliance Commercial |
$508.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$203.24
|
| Rate for Payer: WEA Trust Commercial |
$846.45
|
| Rate for Payer: WPS Commercial |
$812.96
|
|
|
BCE VL Duplex Arterial/Venous Visceral
|
Facility
OP
|
$1,539.00
|
|
|
Service Code
|
CPT 93975 TC
|
| Hospital Charge Code |
3114948
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$430.92 |
| Max. Negotiated Rate |
$6,156.00 |
| Rate for Payer: Aetna Commercial |
$1,385.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,323.54
|
| Rate for Payer: Aetna Managed Medicare |
$430.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,000.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$769.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$738.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$815.67
|
| Rate for Payer: Cash Price |
$461.70
|
| Rate for Payer: Cigna Commercial |
$1,415.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$861.22
|
| Rate for Payer: Health EOS Commercial |
$1,369.71
|
| Rate for Payer: HFN Commercial |
$1,415.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,154.25
|
| Rate for Payer: Multiplan Commercial |
$1,231.20
|
| Rate for Payer: NAPHCARE Commercial |
$923.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,415.88
|
| Rate for Payer: Quartz Beloit One Network |
$754.11
|
| Rate for Payer: Quartz Commercial |
$1,000.35
|
| Rate for Payer: Quartz Medicare Advantage |
$923.40
|
| Rate for Payer: The Alliance Commercial |
$6,156.00
|
| Rate for Payer: United Healthcare PPO |
$1,154.25
|
| Rate for Payer: WEA Trust Commercial |
$846.45
|
| Rate for Payer: WPS Commercial |
$1,139.94
|
|
|
BCE VL Duplex Arterial/Venous Visceral Limit
|
Facility
IP
|
$626.00
|
|
|
Service Code
|
CPT 93976 TC
|
| Hospital Charge Code |
3114949
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$306.74 |
| Max. Negotiated Rate |
$575.92 |
| Rate for Payer: Aetna Commercial |
$563.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$331.78
|
| Rate for Payer: Cash Price |
$187.80
|
| Rate for Payer: Cigna Commercial |
$575.92
|
| Rate for Payer: Health EOS Commercial |
$557.14
|
| Rate for Payer: HFN Commercial |
$575.92
|
| Rate for Payer: Multiplan Commercial |
$500.80
|
| Rate for Payer: NAPHCARE Commercial |
$375.60
|
| Rate for Payer: Preferred Network Access Commercial |
$575.92
|
| Rate for Payer: Quartz Beloit One Network |
$306.74
|
| Rate for Payer: Quartz Commercial |
$375.60
|
| Rate for Payer: WEA Trust Commercial |
$344.30
|
| Rate for Payer: WPS Commercial |
$463.68
|
|
|
BCE VL Duplex Arterial/Venous Visceral Limit
|
Facility
OP
|
$626.00
|
|
|
Service Code
|
CPT 93976 TC
|
| Hospital Charge Code |
3114949
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$175.28 |
| Max. Negotiated Rate |
$2,504.00 |
| Rate for Payer: Aetna Commercial |
$563.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$538.36
|
| Rate for Payer: Aetna Managed Medicare |
$175.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$406.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$313.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$300.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$331.78
|
| Rate for Payer: Cash Price |
$187.80
|
| Rate for Payer: Cigna Commercial |
$575.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$350.31
|
| Rate for Payer: Health EOS Commercial |
$557.14
|
| Rate for Payer: HFN Commercial |
$575.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$469.50
|
| Rate for Payer: Multiplan Commercial |
$500.80
|
| Rate for Payer: NAPHCARE Commercial |
$375.60
|
| Rate for Payer: Preferred Network Access Commercial |
$575.92
|
| Rate for Payer: Quartz Beloit One Network |
$306.74
|
| Rate for Payer: Quartz Commercial |
$406.90
|
| Rate for Payer: Quartz Medicare Advantage |
$375.60
|
| Rate for Payer: The Alliance Commercial |
$2,504.00
|
| Rate for Payer: United Healthcare PPO |
$469.50
|
| Rate for Payer: WEA Trust Commercial |
$344.30
|
| Rate for Payer: WPS Commercial |
$463.68
|
|
|
BCE VL Duplex Arterial/Venous Visceral Limit
|
Professional
|
$626.00
|
|
|
Service Code
|
CPT 93976 TC
|
| Hospital Charge Code |
3114949
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$116.43 |
| Max. Negotiated Rate |
$594.70 |
| Rate for Payer: Aetna Commercial |
$594.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$538.36
|
| Rate for Payer: Aetna Managed Medicare |
$116.43
|
| Rate for Payer: Anthem Medicare Advantage |
$116.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$116.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$116.43
|
| Rate for Payer: Cash Price |
$187.80
|
| Rate for Payer: Cash Price |
$187.80
|
| Rate for Payer: Cigna Commercial |
$594.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$313.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$116.43
|
| Rate for Payer: Health EOS Commercial |
$569.66
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$426.57
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$426.57
|
| Rate for Payer: Independent Care Health Plan Medicare |
$116.43
|
| Rate for Payer: Multiplan Commercial |
$500.80
|
| Rate for Payer: Preferred Network Access Commercial |
$594.70
|
| Rate for Payer: Quartz Beloit One Network |
$275.44
|
| Rate for Payer: Quartz Commercial |
$356.82
|
| Rate for Payer: Quartz Medicare Advantage |
$116.43
|
| Rate for Payer: The Alliance Commercial |
$291.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$116.43
|
| Rate for Payer: WEA Trust Commercial |
$344.30
|
| Rate for Payer: WPS Commercial |
$465.72
|
|
|
BCE VL Duplex Hemodialysis Access Flow
|
Facility
IP
|
$1,207.00
|
|
|
Service Code
|
CPT 93990 TC
|
| Hospital Charge Code |
3114950
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$591.43 |
| Max. Negotiated Rate |
$1,110.44 |
| Rate for Payer: Aetna Commercial |
$1,086.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$639.71
|
| Rate for Payer: Cash Price |
$362.10
|
| Rate for Payer: Cigna Commercial |
$1,110.44
|
| Rate for Payer: Health EOS Commercial |
$1,074.23
|
| Rate for Payer: HFN Commercial |
$1,110.44
|
| Rate for Payer: Multiplan Commercial |
$965.60
|
| Rate for Payer: NAPHCARE Commercial |
$724.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,110.44
|
| Rate for Payer: Quartz Beloit One Network |
$591.43
|
| Rate for Payer: Quartz Commercial |
$724.20
|
| Rate for Payer: WEA Trust Commercial |
$663.85
|
| Rate for Payer: WPS Commercial |
$894.02
|
|
|
BCE VL Duplex Hemodialysis Access Flow
|
Professional
|
$1,207.00
|
|
|
Service Code
|
CPT 93990 TC
|
| Hospital Charge Code |
3114950
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$118.68 |
| Max. Negotiated Rate |
$1,146.65 |
| Rate for Payer: Aetna Commercial |
$1,146.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,038.02
|
| Rate for Payer: Aetna Managed Medicare |
$118.68
|
| Rate for Payer: Anthem Medicare Advantage |
$118.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$118.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$118.68
|
| Rate for Payer: Cash Price |
$362.10
|
| Rate for Payer: Cash Price |
$362.10
|
| Rate for Payer: Cigna Commercial |
$1,146.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$603.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$118.68
|
| Rate for Payer: Health EOS Commercial |
$1,098.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$440.47
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$440.47
|
| Rate for Payer: Independent Care Health Plan Medicare |
$118.68
|
| Rate for Payer: Multiplan Commercial |
$965.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,146.65
|
| Rate for Payer: Quartz Beloit One Network |
$531.08
|
| Rate for Payer: Quartz Commercial |
$687.99
|
| Rate for Payer: Quartz Medicare Advantage |
$118.68
|
| Rate for Payer: The Alliance Commercial |
$296.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$118.68
|
| Rate for Payer: WEA Trust Commercial |
$663.85
|
| Rate for Payer: WPS Commercial |
$474.72
|
|
|
BCE VL Duplex Hemodialysis Access Flow
|
Facility
OP
|
$1,207.00
|
|
|
Service Code
|
CPT 93990 TC
|
| Hospital Charge Code |
3114950
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$337.96 |
| Max. Negotiated Rate |
$4,828.00 |
| Rate for Payer: Aetna Commercial |
$1,086.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,038.02
|
| Rate for Payer: Aetna Managed Medicare |
$337.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$784.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$603.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$579.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$639.71
|
| Rate for Payer: Cash Price |
$362.10
|
| Rate for Payer: Cigna Commercial |
$1,110.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$675.44
|
| Rate for Payer: Health EOS Commercial |
$1,074.23
|
| Rate for Payer: HFN Commercial |
$1,110.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$905.25
|
| Rate for Payer: Multiplan Commercial |
$965.60
|
| Rate for Payer: NAPHCARE Commercial |
$724.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,110.44
|
| Rate for Payer: Quartz Beloit One Network |
$591.43
|
| Rate for Payer: Quartz Commercial |
$784.55
|
| Rate for Payer: Quartz Medicare Advantage |
$724.20
|
| Rate for Payer: The Alliance Commercial |
$4,828.00
|
| Rate for Payer: United Healthcare PPO |
$905.25
|
| Rate for Payer: WEA Trust Commercial |
$663.85
|
| Rate for Payer: WPS Commercial |
$894.02
|
|
|
BCE VL Echo 2D w M Mode w Doppler
|
Facility
OP
|
$3,701.00
|
|
|
Service Code
|
CPT 93306 TC
|
| Hospital Charge Code |
3114951
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$1,036.28 |
| Max. Negotiated Rate |
$14,804.00 |
| Rate for Payer: Aetna Commercial |
$3,330.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,182.86
|
| Rate for Payer: Aetna Managed Medicare |
$1,036.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,405.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,850.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,776.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,961.53
|
| Rate for Payer: Cash Price |
$1,110.30
|
| Rate for Payer: Cash Price |
$1,110.30
|
| Rate for Payer: Cigna Commercial |
$3,404.92
|
| Rate for Payer: Health EOS Commercial |
$3,293.89
|
| Rate for Payer: HFN Commercial |
$3,404.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,775.75
|
| Rate for Payer: Multiplan Commercial |
$2,960.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,220.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,404.92
|
| Rate for Payer: Quartz Beloit One Network |
$1,813.49
|
| Rate for Payer: Quartz Commercial |
$2,405.65
|
| Rate for Payer: Quartz Medicare Advantage |
$2,220.60
|
| Rate for Payer: The Alliance Commercial |
$14,804.00
|
| Rate for Payer: United Healthcare PPO |
$2,775.75
|
| Rate for Payer: WEA Trust Commercial |
$2,035.55
|
| Rate for Payer: WPS Commercial |
$2,741.33
|
|
|
BCE VL Echo 2D w M Mode w Doppler
|
Professional
|
$3,701.00
|
|
|
Service Code
|
CPT 93306 TC
|
| Hospital Charge Code |
3114951
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$123.08 |
| Max. Negotiated Rate |
$3,515.95 |
| Rate for Payer: Aetna Commercial |
$3,515.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,182.86
|
| Rate for Payer: Aetna Managed Medicare |
$123.08
|
| Rate for Payer: Anthem Medicare Advantage |
$123.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$123.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$123.08
|
| Rate for Payer: Cash Price |
$1,110.30
|
| Rate for Payer: Cash Price |
$1,110.30
|
| Rate for Payer: Cigna Commercial |
$3,515.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,850.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$123.08
|
| Rate for Payer: Health EOS Commercial |
$3,367.91
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$454.42
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$454.42
|
| Rate for Payer: Independent Care Health Plan Medicare |
$123.08
|
| Rate for Payer: Multiplan Commercial |
$2,960.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,515.95
|
| Rate for Payer: Quartz Beloit One Network |
$1,628.44
|
| Rate for Payer: Quartz Commercial |
$2,109.57
|
| Rate for Payer: Quartz Medicare Advantage |
$123.08
|
| Rate for Payer: The Alliance Commercial |
$467.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$123.08
|
| Rate for Payer: WEA Trust Commercial |
$2,035.55
|
| Rate for Payer: WPS Commercial |
$492.32
|
|
|
BCE VL Echo 2D w M Mode w Doppler
|
Facility
IP
|
$3,701.00
|
|
|
Service Code
|
CPT 93306 TC
|
| Hospital Charge Code |
3114951
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$1,813.49 |
| Max. Negotiated Rate |
$3,404.92 |
| Rate for Payer: Aetna Commercial |
$3,330.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,961.53
|
| Rate for Payer: Cash Price |
$1,110.30
|
| Rate for Payer: Cigna Commercial |
$3,404.92
|
| Rate for Payer: Health EOS Commercial |
$3,293.89
|
| Rate for Payer: HFN Commercial |
$3,404.92
|
| Rate for Payer: Multiplan Commercial |
$2,960.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,220.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,404.92
|
| Rate for Payer: Quartz Beloit One Network |
$1,813.49
|
| Rate for Payer: Quartz Commercial |
$2,220.60
|
| Rate for Payer: WEA Trust Commercial |
$2,035.55
|
| Rate for Payer: WPS Commercial |
$2,741.33
|
|
|
BCE VL Echo Color Flow Velocity Mapping
|
Facility
IP
|
$917.00
|
|
|
Service Code
|
CPT 93325 TC
|
| Hospital Charge Code |
3114952
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$449.33 |
| Max. Negotiated Rate |
$843.64 |
| Rate for Payer: Aetna Commercial |
$825.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$486.01
|
| Rate for Payer: Cash Price |
$275.10
|
| Rate for Payer: Cigna Commercial |
$843.64
|
| Rate for Payer: Health EOS Commercial |
$816.13
|
| Rate for Payer: HFN Commercial |
$843.64
|
| Rate for Payer: Multiplan Commercial |
$733.60
|
| Rate for Payer: NAPHCARE Commercial |
$550.20
|
| Rate for Payer: Preferred Network Access Commercial |
$843.64
|
| Rate for Payer: Quartz Beloit One Network |
$449.33
|
| Rate for Payer: Quartz Commercial |
$550.20
|
| Rate for Payer: WEA Trust Commercial |
$504.35
|
| Rate for Payer: WPS Commercial |
$679.22
|
|
|
BCE VL Echo Color Flow Velocity Mapping
|
Facility
OP
|
$917.00
|
|
|
Service Code
|
CPT 93325 TC
|
| Hospital Charge Code |
3114952
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$256.76 |
| Max. Negotiated Rate |
$3,668.00 |
| Rate for Payer: Aetna Commercial |
$825.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$788.62
|
| Rate for Payer: Aetna Managed Medicare |
$256.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$596.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$458.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$440.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$486.01
|
| Rate for Payer: Cash Price |
$275.10
|
| Rate for Payer: Cash Price |
$275.10
|
| Rate for Payer: Cigna Commercial |
$843.64
|
| Rate for Payer: Health EOS Commercial |
$816.13
|
| Rate for Payer: HFN Commercial |
$843.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$687.75
|
| Rate for Payer: Multiplan Commercial |
$733.60
|
| Rate for Payer: NAPHCARE Commercial |
$550.20
|
| Rate for Payer: Preferred Network Access Commercial |
$843.64
|
| Rate for Payer: Quartz Beloit One Network |
$449.33
|
| Rate for Payer: Quartz Commercial |
$596.05
|
| Rate for Payer: Quartz Medicare Advantage |
$550.20
|
| Rate for Payer: The Alliance Commercial |
$3,668.00
|
| Rate for Payer: United Healthcare PPO |
$687.75
|
| Rate for Payer: WEA Trust Commercial |
$504.35
|
| Rate for Payer: WPS Commercial |
$679.22
|
|
|
BCE VL Echo Color Flow Velocity Mapping
|
Professional
|
$917.00
|
|
|
Service Code
|
CPT 93325 TC
|
| Hospital Charge Code |
3114952
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$19.64 |
| Max. Negotiated Rate |
$871.15 |
| Rate for Payer: Aetna Commercial |
$871.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$788.62
|
| Rate for Payer: Aetna Managed Medicare |
$19.64
|
| Rate for Payer: Anthem Medicare Advantage |
$19.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$19.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19.64
|
| Rate for Payer: Cash Price |
$275.10
|
| Rate for Payer: Cash Price |
$275.10
|
| Rate for Payer: Cigna Commercial |
$871.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$458.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$19.64
|
| Rate for Payer: Health EOS Commercial |
$834.47
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$74.27
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$74.27
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19.64
|
| Rate for Payer: Multiplan Commercial |
$733.60
|
| Rate for Payer: Preferred Network Access Commercial |
$871.15
|
| Rate for Payer: Quartz Beloit One Network |
$403.48
|
| Rate for Payer: Quartz Commercial |
$522.69
|
| Rate for Payer: Quartz Medicare Advantage |
$19.64
|
| Rate for Payer: The Alliance Commercial |
$74.63
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.64
|
| Rate for Payer: WEA Trust Commercial |
$504.35
|
| Rate for Payer: WPS Commercial |
$78.56
|
|
|
BCE VL Echo Congenital Complete
|
Facility
OP
|
$1,971.00
|
|
|
Service Code
|
CPT 93303 TC
|
| Hospital Charge Code |
3114953
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$551.88 |
| Max. Negotiated Rate |
$7,884.00 |
| Rate for Payer: Aetna Commercial |
$1,773.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,695.06
|
| Rate for Payer: Aetna Managed Medicare |
$551.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,281.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$985.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$946.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,044.63
|
| Rate for Payer: Cash Price |
$591.30
|
| Rate for Payer: Cash Price |
$591.30
|
| Rate for Payer: Cigna Commercial |
$1,813.32
|
| Rate for Payer: Health EOS Commercial |
$1,754.19
|
| Rate for Payer: HFN Commercial |
$1,813.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,478.25
|
| Rate for Payer: Multiplan Commercial |
$1,576.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,182.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,813.32
|
| Rate for Payer: Quartz Beloit One Network |
$965.79
|
| Rate for Payer: Quartz Commercial |
$1,281.15
|
| Rate for Payer: Quartz Medicare Advantage |
$1,182.60
|
| Rate for Payer: The Alliance Commercial |
$7,884.00
|
| Rate for Payer: United Healthcare PPO |
$1,478.25
|
| Rate for Payer: WEA Trust Commercial |
$1,084.05
|
| Rate for Payer: WPS Commercial |
$1,459.92
|
|
|
BCE VL Echo Congenital Complete
|
Facility
IP
|
$1,971.00
|
|
|
Service Code
|
CPT 93303 TC
|
| Hospital Charge Code |
3114953
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$965.79 |
| Max. Negotiated Rate |
$1,813.32 |
| Rate for Payer: Aetna Commercial |
$1,773.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,044.63
|
| Rate for Payer: Cash Price |
$591.30
|
| Rate for Payer: Cigna Commercial |
$1,813.32
|
| Rate for Payer: Health EOS Commercial |
$1,754.19
|
| Rate for Payer: HFN Commercial |
$1,813.32
|
| Rate for Payer: Multiplan Commercial |
$1,576.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,182.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,813.32
|
| Rate for Payer: Quartz Beloit One Network |
$965.79
|
| Rate for Payer: Quartz Commercial |
$1,182.60
|
| Rate for Payer: WEA Trust Commercial |
$1,084.05
|
| Rate for Payer: WPS Commercial |
$1,459.92
|
|
|
BCE VL Echo Congenital Complete
|
Professional
|
$1,971.00
|
|
|
Service Code
|
CPT 93303 TC
|
| Hospital Charge Code |
3114953
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$153.34 |
| Max. Negotiated Rate |
$1,872.45 |
| Rate for Payer: Aetna Commercial |
$1,872.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,695.06
|
| Rate for Payer: Aetna Managed Medicare |
$153.34
|
| Rate for Payer: Anthem Medicare Advantage |
$153.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$153.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$153.34
|
| Rate for Payer: Cash Price |
$591.30
|
| Rate for Payer: Cash Price |
$591.30
|
| Rate for Payer: Cigna Commercial |
$1,872.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$985.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$153.34
|
| Rate for Payer: Health EOS Commercial |
$1,793.61
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$580.90
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$580.90
|
| Rate for Payer: Independent Care Health Plan Medicare |
$153.34
|
| Rate for Payer: Multiplan Commercial |
$1,576.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,872.45
|
| Rate for Payer: Quartz Beloit One Network |
$867.24
|
| Rate for Payer: Quartz Commercial |
$1,123.47
|
| Rate for Payer: Quartz Medicare Advantage |
$153.34
|
| Rate for Payer: The Alliance Commercial |
$582.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$153.34
|
| Rate for Payer: WEA Trust Commercial |
$1,084.05
|
| Rate for Payer: WPS Commercial |
$613.36
|
|
|
BCE VL Echo Congenital Limited
|
Facility
OP
|
$1,819.00
|
|
|
Service Code
|
CPT 93304 TC
|
| Hospital Charge Code |
3114954
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$509.32 |
| Max. Negotiated Rate |
$7,276.00 |
| Rate for Payer: Aetna Commercial |
$1,637.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,564.34
|
| Rate for Payer: Aetna Managed Medicare |
$509.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,182.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$909.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$873.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$964.07
|
| Rate for Payer: Cash Price |
$545.70
|
| Rate for Payer: Cash Price |
$545.70
|
| Rate for Payer: Cigna Commercial |
$1,673.48
|
| Rate for Payer: Health EOS Commercial |
$1,618.91
|
| Rate for Payer: HFN Commercial |
$1,673.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,364.25
|
| Rate for Payer: Multiplan Commercial |
$1,455.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,091.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,673.48
|
| Rate for Payer: Quartz Beloit One Network |
$891.31
|
| Rate for Payer: Quartz Commercial |
$1,182.35
|
| Rate for Payer: Quartz Medicare Advantage |
$1,091.40
|
| Rate for Payer: The Alliance Commercial |
$7,276.00
|
| Rate for Payer: United Healthcare PPO |
$1,364.25
|
| Rate for Payer: WEA Trust Commercial |
$1,000.45
|
| Rate for Payer: WPS Commercial |
$1,347.33
|
|
|
BCE VL Echo Congenital Limited
|
Facility
IP
|
$1,819.00
|
|
|
Service Code
|
CPT 93304 TC
|
| Hospital Charge Code |
3114954
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$891.31 |
| Max. Negotiated Rate |
$1,673.48 |
| Rate for Payer: Aetna Commercial |
$1,637.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$964.07
|
| Rate for Payer: Cash Price |
$545.70
|
| Rate for Payer: Cigna Commercial |
$1,673.48
|
| Rate for Payer: Health EOS Commercial |
$1,618.91
|
| Rate for Payer: HFN Commercial |
$1,673.48
|
| Rate for Payer: Multiplan Commercial |
$1,455.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,091.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,673.48
|
| Rate for Payer: Quartz Beloit One Network |
$891.31
|
| Rate for Payer: Quartz Commercial |
$1,091.40
|
| Rate for Payer: WEA Trust Commercial |
$1,000.45
|
| Rate for Payer: WPS Commercial |
$1,347.33
|
|
|
BCE VL Echo Congenital Limited
|
Professional
|
$1,819.00
|
|
|
Service Code
|
CPT 93304 TC
|
| Hospital Charge Code |
3114954
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$115.14 |
| Max. Negotiated Rate |
$1,728.05 |
| Rate for Payer: Aetna Commercial |
$1,728.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,564.34
|
| Rate for Payer: Aetna Managed Medicare |
$115.14
|
| Rate for Payer: Anthem Medicare Advantage |
$115.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$115.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$115.14
|
| Rate for Payer: Cash Price |
$545.70
|
| Rate for Payer: Cash Price |
$545.70
|
| Rate for Payer: Cigna Commercial |
$1,728.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$909.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$115.14
|
| Rate for Payer: Health EOS Commercial |
$1,655.29
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$430.02
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$430.02
|
| Rate for Payer: Independent Care Health Plan Medicare |
$115.14
|
| Rate for Payer: Multiplan Commercial |
$1,455.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,728.05
|
| Rate for Payer: Quartz Beloit One Network |
$800.36
|
| Rate for Payer: Quartz Commercial |
$1,036.83
|
| Rate for Payer: Quartz Medicare Advantage |
$115.14
|
| Rate for Payer: The Alliance Commercial |
$437.53
|
| Rate for Payer: United Healthcare Medicare Advantage |
$115.14
|
| Rate for Payer: WEA Trust Commercial |
$1,000.45
|
| Rate for Payer: WPS Commercial |
$460.56
|
|
|
BCE VL Echo Doppler
|
Facility
IP
|
$905.00
|
|
|
Service Code
|
CPT 93320 TC
|
| Hospital Charge Code |
3114955
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$443.45 |
| Max. Negotiated Rate |
$832.60 |
| Rate for Payer: Aetna Commercial |
$814.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$479.65
|
| Rate for Payer: Cash Price |
$271.50
|
| Rate for Payer: Cigna Commercial |
$832.60
|
| Rate for Payer: Health EOS Commercial |
$805.45
|
| Rate for Payer: HFN Commercial |
$832.60
|
| Rate for Payer: Multiplan Commercial |
$724.00
|
| Rate for Payer: NAPHCARE Commercial |
$543.00
|
| Rate for Payer: Preferred Network Access Commercial |
$832.60
|
| Rate for Payer: Quartz Beloit One Network |
$443.45
|
| Rate for Payer: Quartz Commercial |
$543.00
|
| Rate for Payer: WEA Trust Commercial |
$497.75
|
| Rate for Payer: WPS Commercial |
$670.33
|
|
|
BCE VL Echo Doppler
|
Professional
|
$905.00
|
|
|
Service Code
|
CPT 93320 TC
|
| Hospital Charge Code |
3114955
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$31.66 |
| Max. Negotiated Rate |
$859.75 |
| Rate for Payer: Aetna Commercial |
$859.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$778.30
|
| Rate for Payer: Aetna Managed Medicare |
$31.66
|
| Rate for Payer: Anthem Medicare Advantage |
$31.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$31.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$31.66
|
| Rate for Payer: Cash Price |
$271.50
|
| Rate for Payer: Cash Price |
$271.50
|
| Rate for Payer: Cigna Commercial |
$859.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$452.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$31.66
|
| Rate for Payer: Health EOS Commercial |
$823.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$119.84
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$119.84
|
| Rate for Payer: Independent Care Health Plan Medicare |
$31.66
|
| Rate for Payer: Multiplan Commercial |
$724.00
|
| Rate for Payer: Preferred Network Access Commercial |
$859.75
|
| Rate for Payer: Quartz Beloit One Network |
$398.20
|
| Rate for Payer: Quartz Commercial |
$515.85
|
| Rate for Payer: Quartz Medicare Advantage |
$31.66
|
| Rate for Payer: The Alliance Commercial |
$120.31
|
| Rate for Payer: United Healthcare Medicare Advantage |
$31.66
|
| Rate for Payer: WEA Trust Commercial |
$497.75
|
| Rate for Payer: WPS Commercial |
$126.64
|
|
