|
Vascular Acquisition
|
Facility
|
OP
|
$1,641.00
|
|
|
Service Code
|
CPT 93971 RT
|
| Hospital Charge Code |
5376677
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$477.86 |
| Max. Negotiated Rate |
$1,570.11 |
| Rate for Payer: Aetna Commercial |
$1,535.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,467.71
|
| Rate for Payer: Aetna Managed Medicare |
$477.86
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,109.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$853.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$819.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$904.52
|
| Rate for Payer: Cash Price |
$492.30
|
| Rate for Payer: Cigna Commercial |
$1,570.11
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$955.06
|
| Rate for Payer: Health EOS Commercial |
$1,518.91
|
| Rate for Payer: HFN Commercial |
$1,570.11
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,279.98
|
| Rate for Payer: Multiplan Commercial |
$1,365.31
|
| Rate for Payer: NAPHCARE Commercial |
$1,023.98
|
| Rate for Payer: Preferred Network Access Commercial |
$1,570.11
|
| Rate for Payer: Quartz Beloit One Network |
$836.25
|
| Rate for Payer: Quartz Commercial |
$1,109.32
|
| Rate for Payer: Quartz Medicare Advantage |
$1,023.98
|
| Rate for Payer: The Alliance Commercial |
$853.32
|
| Rate for Payer: United Healthcare PPO |
$1,279.98
|
| Rate for Payer: WEA Trust Commercial |
$938.65
|
| Rate for Payer: WPS Commercial |
$1,264.06
|
|
|
Vascular Acquisition
|
Facility
|
IP
|
$1,227.00
|
|
|
Service Code
|
CPT 93923
|
| Hospital Charge Code |
5376737
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$625.28 |
| Max. Negotiated Rate |
$1,173.99 |
| Rate for Payer: Aetna Commercial |
$1,148.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,097.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$676.32
|
| Rate for Payer: Cash Price |
$368.10
|
| Rate for Payer: Cigna Commercial |
$1,173.99
|
| Rate for Payer: Health EOS Commercial |
$1,135.71
|
| Rate for Payer: HFN Commercial |
$1,173.99
|
| Rate for Payer: Multiplan Commercial |
$1,020.86
|
| Rate for Payer: Preferred Network Access Commercial |
$1,173.99
|
| Rate for Payer: Quartz Beloit One Network |
$625.28
|
| Rate for Payer: Quartz Commercial |
$765.65
|
| Rate for Payer: WEA Trust Commercial |
$701.84
|
| Rate for Payer: WPS Commercial |
$945.16
|
|
|
Vascular Acquisition
|
Facility
|
IP
|
$1,274.00
|
|
|
Service Code
|
CPT 93926 RT
|
| Hospital Charge Code |
5376659
|
|
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
|
$1,274.00
|
|
|
Service Code
|
CPT 93926 RT
|
| Hospital Charge Code |
5376659
|
|
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
|
OP
|
$1,227.00
|
|
|
Service Code
|
CPT 93923
|
| Hospital Charge Code |
5376662
|
|
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
|
$1,641.00
|
|
|
Service Code
|
CPT 93971 LT
|
| Hospital Charge Code |
6195114
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$836.25 |
| Max. Negotiated Rate |
$1,570.11 |
| Rate for Payer: Aetna Commercial |
$1,535.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,467.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$904.52
|
| Rate for Payer: Cash Price |
$492.30
|
| Rate for Payer: Cigna Commercial |
$1,570.11
|
| Rate for Payer: Health EOS Commercial |
$1,518.91
|
| Rate for Payer: HFN Commercial |
$1,570.11
|
| Rate for Payer: Multiplan Commercial |
$1,365.31
|
| Rate for Payer: Preferred Network Access Commercial |
$1,570.11
|
| Rate for Payer: Quartz Beloit One Network |
$836.25
|
| Rate for Payer: Quartz Commercial |
$1,023.98
|
| Rate for Payer: WEA Trust Commercial |
$938.65
|
| Rate for Payer: WPS Commercial |
$1,264.06
|
|
|
VASCULAR EMBOLIZATION, TUMORS, ORGAN SCHEMIA/INFARCTION
|
Facility
|
OP
|
$19,949.00
|
|
|
Service Code
|
CPT 37243
|
| Hospital Charge Code |
5464766
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$9,979.84 |
| Max. Negotiated Rate |
$48,595.91 |
| Rate for Payer: Aetna Commercial |
$18,672.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$17,842.39
|
| Rate for Payer: Aetna Managed Medicare |
$12,148.98
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$19,394.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$19,394.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$17,919.20
|
| Rate for Payer: Anthem Medicare Advantage |
$12,148.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$10,995.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12,148.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12,148.98
|
| Rate for Payer: Cash Price |
$5,984.70
|
| Rate for Payer: Cash Price |
$5,984.70
|
| Rate for Payer: Cash Price |
$5,984.70
|
| Rate for Payer: Cigna Commercial |
$19,087.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12,148.98
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,349.86
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12,148.98
|
| Rate for Payer: Health EOS Commercial |
$18,464.79
|
| Rate for Payer: HFN Commercial |
$19,087.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$45,194.20
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12,148.98
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12,148.98
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12,148.98
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12,148.98
|
| Rate for Payer: Multiplan Commercial |
$16,597.57
|
| Rate for Payer: NAPHCARE Commercial |
$18,223.47
|
| Rate for Payer: Preferred Network Access Commercial |
$19,087.20
|
| Rate for Payer: Quartz Beloit One Network |
$10,166.01
|
| Rate for Payer: Quartz Commercial |
$13,485.52
|
| Rate for Payer: Quartz Medicare Advantage |
$12,148.98
|
| Rate for Payer: The Alliance Commercial |
$48,595.91
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12,148.98
|
| Rate for Payer: United Healthcare PPO |
$9,979.84
|
| Rate for Payer: WEA Trust Commercial |
$11,410.83
|
| Rate for Payer: Wellcare Medicare |
$12,148.98
|
| Rate for Payer: WPS Commercial |
$15,366.71
|
|
|
VASCULAR EMBOLIZATION, TUMORS, ORGAN SCHEMIA/INFARCTION
|
Facility
|
IP
|
$19,949.00
|
|
|
Service Code
|
CPT 37243
|
| Hospital Charge Code |
5464766
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$10,166.01 |
| Max. Negotiated Rate |
$19,087.20 |
| Rate for Payer: Aetna Commercial |
$18,672.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$17,842.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$10,995.89
|
| Rate for Payer: Cash Price |
$5,984.70
|
| Rate for Payer: Cigna Commercial |
$19,087.20
|
| Rate for Payer: Health EOS Commercial |
$18,464.79
|
| Rate for Payer: HFN Commercial |
$19,087.20
|
| Rate for Payer: Multiplan Commercial |
$16,597.57
|
| Rate for Payer: Preferred Network Access Commercial |
$19,087.20
|
| Rate for Payer: Quartz Beloit One Network |
$10,166.01
|
| Rate for Payer: Quartz Commercial |
$12,448.18
|
| Rate for Payer: WEA Trust Commercial |
$11,410.83
|
| Rate for Payer: WPS Commercial |
$15,366.71
|
|
|
Vascular Endothelial Growth Factor (VEGF)
|
Facility
|
IP
|
$385.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
5242624
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$196.20 |
| Max. Negotiated Rate |
$368.37 |
| Rate for Payer: Aetna Commercial |
$360.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$344.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$212.21
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: Cigna Commercial |
$368.37
|
| Rate for Payer: Health EOS Commercial |
$356.36
|
| Rate for Payer: HFN Commercial |
$368.37
|
| Rate for Payer: Multiplan Commercial |
$320.32
|
| Rate for Payer: Preferred Network Access Commercial |
$368.37
|
| Rate for Payer: Quartz Beloit One Network |
$196.20
|
| Rate for Payer: Quartz Commercial |
$240.24
|
| Rate for Payer: WEA Trust Commercial |
$220.22
|
| Rate for Payer: WPS Commercial |
$296.57
|
|
|
Vascular Endothelial Growth Factor (VEGF)
|
Professional
|
Both
|
$385.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
5242624
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.96 |
| Max. Negotiated Rate |
$380.38 |
| Rate for Payer: Aetna Commercial |
$380.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$344.34
|
| Rate for Payer: Aetna Managed Medicare |
$17.96
|
| Rate for Payer: Anthem Medicare Advantage |
$17.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.96
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: Cigna Commercial |
$380.38
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$200.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$17.96
|
| Rate for Payer: Health EOS Commercial |
$364.36
|
| Rate for Payer: HFN Commercial |
$380.38
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$63.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$63.40
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.96
|
| Rate for Payer: Multiplan Commercial |
$320.32
|
| Rate for Payer: NAPHCARE Commercial |
$26.94
|
| Rate for Payer: Preferred Network Access Commercial |
$380.38
|
| Rate for Payer: Quartz Beloit One Network |
$176.18
|
| Rate for Payer: Quartz Commercial |
$228.23
|
| Rate for Payer: Quartz Medicare Advantage |
$17.96
|
| Rate for Payer: The Alliance Commercial |
$70.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.96
|
| Rate for Payer: WEA Trust Commercial |
$220.22
|
| Rate for Payer: WPS Commercial |
$79.03
|
|
|
Vascular Endothelial Growth Factor (VEGF)
|
Facility
|
OP
|
$385.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
5242624
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.96 |
| Max. Negotiated Rate |
$368.37 |
| Rate for Payer: Dean Health DHI/DHP/ASO |
$224.07
|
| Rate for Payer: Aetna Commercial |
$360.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$344.34
|
| Rate for Payer: Aetna Managed Medicare |
$17.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$67.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$31.43
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$29.81
|
| Rate for Payer: Anthem Medicare Advantage |
$17.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$212.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.96
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: Cigna Commercial |
$368.37
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17.96
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17.96
|
| Rate for Payer: Health EOS Commercial |
$356.36
|
| Rate for Payer: HFN Commercial |
$368.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$66.81
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17.96
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.96
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17.96
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17.96
|
| Rate for Payer: Multiplan Commercial |
$320.32
|
| Rate for Payer: NAPHCARE Commercial |
$26.94
|
| Rate for Payer: Preferred Network Access Commercial |
$368.37
|
| Rate for Payer: Quartz Beloit One Network |
$196.20
|
| Rate for Payer: Quartz Commercial |
$260.26
|
| Rate for Payer: Quartz Medicare Advantage |
$17.96
|
| Rate for Payer: The Alliance Commercial |
$71.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.96
|
| Rate for Payer: United Healthcare PPO |
$300.30
|
| Rate for Payer: WEA Trust Commercial |
$220.22
|
| Rate for Payer: Wellcare Medicare |
$17.96
|
| Rate for Payer: WPS Commercial |
$296.57
|
|
|
VASCULAR GRAFT 28MM X 15CM GELWEAVE VALSALVA 730028ADP
|
Facility
|
OP
|
$13,590.00
|
|
| Hospital Charge Code |
3595504
|
|
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 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
|
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 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 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
|
$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
|
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
|
|
