|
Vascular Interpretation
|
Facility
|
IP
|
$104.00
|
|
|
Service Code
|
CPT 93926 26
|
| Hospital Charge Code |
5376658
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$53.00 |
| Max. Negotiated Rate |
$99.51 |
| Rate for Payer: Aetna Commercial |
$97.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$93.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$57.32
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cigna Commercial |
$99.51
|
| Rate for Payer: Health EOS Commercial |
$96.26
|
| Rate for Payer: HFN Commercial |
$99.51
|
| Rate for Payer: Multiplan Commercial |
$86.53
|
| Rate for Payer: Preferred Network Access Commercial |
$99.51
|
| Rate for Payer: Quartz Beloit One Network |
$53.00
|
| Rate for Payer: Quartz Commercial |
$64.90
|
| Rate for Payer: WEA Trust Commercial |
$59.49
|
| Rate for Payer: WPS Commercial |
$80.11
|
|
|
Vascular Interpretation
|
Facility
|
IP
|
$104.00
|
|
|
Service Code
|
CPT 93926 26
|
| Hospital Charge Code |
5376651
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$53.00 |
| Max. Negotiated Rate |
$99.51 |
| Rate for Payer: Aetna Commercial |
$97.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$93.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$57.32
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cigna Commercial |
$99.51
|
| Rate for Payer: Health EOS Commercial |
$96.26
|
| Rate for Payer: HFN Commercial |
$99.51
|
| Rate for Payer: Multiplan Commercial |
$86.53
|
| Rate for Payer: Preferred Network Access Commercial |
$99.51
|
| Rate for Payer: Quartz Beloit One Network |
$53.00
|
| Rate for Payer: Quartz Commercial |
$64.90
|
| Rate for Payer: WEA Trust Commercial |
$59.49
|
| Rate for Payer: WPS Commercial |
$80.11
|
|
|
Vascular Interpretation
|
Facility
|
OP
|
$104.00
|
|
|
Service Code
|
CPT 93926 26
|
| Hospital Charge Code |
5376658
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$30.28 |
| Max. Negotiated Rate |
$99.51 |
| Rate for Payer: Aetna Commercial |
$97.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$93.02
|
| Rate for Payer: Aetna Managed Medicare |
$30.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$70.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$54.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$51.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$57.32
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cigna Commercial |
$99.51
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$60.53
|
| Rate for Payer: Health EOS Commercial |
$96.26
|
| Rate for Payer: HFN Commercial |
$99.51
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$81.12
|
| Rate for Payer: Multiplan Commercial |
$86.53
|
| Rate for Payer: NAPHCARE Commercial |
$64.90
|
| Rate for Payer: Preferred Network Access Commercial |
$99.51
|
| Rate for Payer: Quartz Beloit One Network |
$53.00
|
| Rate for Payer: Quartz Commercial |
$70.30
|
| Rate for Payer: Quartz Medicare Advantage |
$64.90
|
| Rate for Payer: The Alliance Commercial |
$87.53
|
| Rate for Payer: WEA Trust Commercial |
$59.49
|
| Rate for Payer: WPS Commercial |
$80.11
|
|
|
Vascular Interpretation
|
Facility
|
IP
|
$272.00
|
|
|
Service Code
|
CPT 93978 26
|
| Hospital Charge Code |
5376639
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$138.61 |
| Max. Negotiated Rate |
$260.25 |
| Rate for Payer: Aetna Commercial |
$254.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$243.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$149.93
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cigna Commercial |
$260.25
|
| Rate for Payer: Health EOS Commercial |
$251.76
|
| Rate for Payer: HFN Commercial |
$260.25
|
| Rate for Payer: Multiplan Commercial |
$226.30
|
| Rate for Payer: Preferred Network Access Commercial |
$260.25
|
| Rate for Payer: Quartz Beloit One Network |
$138.61
|
| Rate for Payer: Quartz Commercial |
$169.73
|
| Rate for Payer: WEA Trust Commercial |
$155.58
|
| Rate for Payer: WPS Commercial |
$209.52
|
|
|
Vascular Interpretation
|
Facility
|
IP
|
$138.00
|
|
|
Service Code
|
CPT 93930 26
|
| Hospital Charge Code |
5376700
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$70.32 |
| Max. Negotiated Rate |
$132.04 |
| Rate for Payer: Aetna Commercial |
$129.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$123.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$76.07
|
| Rate for Payer: Cash Price |
$41.40
|
| Rate for Payer: Cigna Commercial |
$132.04
|
| Rate for Payer: Health EOS Commercial |
$127.73
|
| Rate for Payer: HFN Commercial |
$132.04
|
| Rate for Payer: Multiplan Commercial |
$114.82
|
| Rate for Payer: Preferred Network Access Commercial |
$132.04
|
| Rate for Payer: Quartz Beloit One Network |
$70.32
|
| Rate for Payer: Quartz Commercial |
$86.11
|
| Rate for Payer: WEA Trust Commercial |
$78.94
|
| Rate for Payer: WPS Commercial |
$106.30
|
|
|
Vascular Interpretation
|
Facility
|
OP
|
$136.00
|
|
|
Service Code
|
CPT 93931 26
|
| Hospital Charge Code |
5376703
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$39.60 |
| Max. Negotiated Rate |
$130.12 |
| Rate for Payer: Aetna Commercial |
$127.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$121.64
|
| Rate for Payer: Aetna Managed Medicare |
$39.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$91.94
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$70.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$67.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$74.96
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cigna Commercial |
$130.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$79.15
|
| Rate for Payer: Health EOS Commercial |
$125.88
|
| Rate for Payer: HFN Commercial |
$130.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$106.08
|
| Rate for Payer: Multiplan Commercial |
$113.15
|
| Rate for Payer: NAPHCARE Commercial |
$84.86
|
| Rate for Payer: Preferred Network Access Commercial |
$130.12
|
| Rate for Payer: Quartz Beloit One Network |
$69.31
|
| Rate for Payer: Quartz Commercial |
$91.94
|
| Rate for Payer: Quartz Medicare Advantage |
$84.86
|
| Rate for Payer: The Alliance Commercial |
$88.86
|
| Rate for Payer: WEA Trust Commercial |
$77.79
|
| Rate for Payer: WPS Commercial |
$104.76
|
|
|
Vascular Interpretation
|
Facility
|
OP
|
$138.00
|
|
|
Service Code
|
CPT 93930 26
|
| Hospital Charge Code |
5376700
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$40.19 |
| Max. Negotiated Rate |
$145.97 |
| Rate for Payer: Aetna Commercial |
$129.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$123.43
|
| Rate for Payer: Aetna Managed Medicare |
$40.19
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$93.29
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$71.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$68.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$76.07
|
| Rate for Payer: Cash Price |
$41.40
|
| Rate for Payer: Cash Price |
$41.40
|
| Rate for Payer: Cigna Commercial |
$132.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$80.32
|
| Rate for Payer: Health EOS Commercial |
$127.73
|
| Rate for Payer: HFN Commercial |
$132.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$107.64
|
| Rate for Payer: Multiplan Commercial |
$114.82
|
| Rate for Payer: NAPHCARE Commercial |
$86.11
|
| Rate for Payer: Preferred Network Access Commercial |
$132.04
|
| Rate for Payer: Quartz Beloit One Network |
$70.32
|
| Rate for Payer: Quartz Commercial |
$93.29
|
| Rate for Payer: Quartz Medicare Advantage |
$86.11
|
| Rate for Payer: The Alliance Commercial |
$145.97
|
| Rate for Payer: WEA Trust Commercial |
$78.94
|
| Rate for Payer: WPS Commercial |
$106.30
|
|
|
Vascular Interpretation
|
Facility
|
IP
|
$136.00
|
|
|
Service Code
|
CPT 93931 26
|
| Hospital Charge Code |
5376703
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$69.31 |
| Max. Negotiated Rate |
$130.12 |
| Rate for Payer: Aetna Commercial |
$127.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$121.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$74.96
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cigna Commercial |
$130.12
|
| Rate for Payer: Health EOS Commercial |
$125.88
|
| Rate for Payer: HFN Commercial |
$130.12
|
| Rate for Payer: Multiplan Commercial |
$113.15
|
| Rate for Payer: Preferred Network Access Commercial |
$130.12
|
| Rate for Payer: Quartz Beloit One Network |
$69.31
|
| Rate for Payer: Quartz Commercial |
$84.86
|
| Rate for Payer: WEA Trust Commercial |
$77.79
|
| Rate for Payer: WPS Commercial |
$104.76
|
|
|
Vascular Interpretation
|
Facility
|
OP
|
$160.00
|
|
|
Service Code
|
CPT 93923 26
|
| Hospital Charge Code |
5376739
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$46.59 |
| Max. Negotiated Rate |
$153.09 |
| Rate for Payer: Aetna Commercial |
$149.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$143.10
|
| Rate for Payer: Aetna Managed Medicare |
$46.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$108.16
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$83.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$79.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$88.19
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cigna Commercial |
$153.09
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$93.12
|
| Rate for Payer: Health EOS Commercial |
$148.10
|
| Rate for Payer: HFN Commercial |
$153.09
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$124.80
|
| Rate for Payer: Multiplan Commercial |
$133.12
|
| Rate for Payer: NAPHCARE Commercial |
$99.84
|
| Rate for Payer: Preferred Network Access Commercial |
$153.09
|
| Rate for Payer: Quartz Beloit One Network |
$81.54
|
| Rate for Payer: Quartz Commercial |
$108.16
|
| Rate for Payer: Quartz Medicare Advantage |
$99.84
|
| Rate for Payer: The Alliance Commercial |
$82.33
|
| Rate for Payer: WEA Trust Commercial |
$91.52
|
| Rate for Payer: WPS Commercial |
$123.25
|
|
|
Vascular Interpretation
|
Facility
|
OP
|
$104.00
|
|
|
Service Code
|
CPT 93926 26
|
| Hospital Charge Code |
5376651
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$30.28 |
| Max. Negotiated Rate |
$99.51 |
| Rate for Payer: Aetna Commercial |
$97.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$93.02
|
| Rate for Payer: Aetna Managed Medicare |
$30.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$70.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$54.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$51.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$57.32
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cigna Commercial |
$99.51
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$60.53
|
| Rate for Payer: Health EOS Commercial |
$96.26
|
| Rate for Payer: HFN Commercial |
$99.51
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$81.12
|
| Rate for Payer: Multiplan Commercial |
$86.53
|
| Rate for Payer: NAPHCARE Commercial |
$64.90
|
| Rate for Payer: Preferred Network Access Commercial |
$99.51
|
| Rate for Payer: Quartz Beloit One Network |
$53.00
|
| Rate for Payer: Quartz Commercial |
$70.30
|
| Rate for Payer: Quartz Medicare Advantage |
$64.90
|
| Rate for Payer: The Alliance Commercial |
$87.53
|
| Rate for Payer: WEA Trust Commercial |
$59.49
|
| Rate for Payer: WPS Commercial |
$80.11
|
|
|
VASCULAR RETRIEVAL (G07187)
|
Facility
|
OP
|
$4,658.00
|
|
| Hospital Charge Code |
2973633
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,356.41 |
| Max. Negotiated Rate |
$4,456.77 |
| Rate for Payer: Aetna Commercial |
$4,359.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,166.12
|
| Rate for Payer: Aetna Managed Medicare |
$1,356.41
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,148.81
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,422.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,325.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,567.49
|
| Rate for Payer: Cash Price |
$1,397.40
|
| Rate for Payer: Cigna Commercial |
$4,456.77
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,710.96
|
| Rate for Payer: Health EOS Commercial |
$4,311.44
|
| Rate for Payer: HFN Commercial |
$4,456.77
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,633.24
|
| Rate for Payer: Multiplan Commercial |
$3,875.46
|
| Rate for Payer: NAPHCARE Commercial |
$2,906.59
|
| Rate for Payer: Preferred Network Access Commercial |
$4,456.77
|
| Rate for Payer: Quartz Beloit One Network |
$2,373.72
|
| Rate for Payer: Quartz Commercial |
$3,148.81
|
| Rate for Payer: Quartz Medicare Advantage |
$2,906.59
|
| Rate for Payer: The Alliance Commercial |
$2,422.16
|
| Rate for Payer: WEA Trust Commercial |
$2,664.38
|
| Rate for Payer: WPS Commercial |
$3,588.06
|
|
|
VASCULAR RETRIEVAL (G07187)
|
Facility
|
IP
|
$4,658.00
|
|
| Hospital Charge Code |
2973633
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,373.72 |
| Max. Negotiated Rate |
$4,456.77 |
| Rate for Payer: Aetna Commercial |
$4,359.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,166.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,567.49
|
| Rate for Payer: Cash Price |
$1,397.40
|
| Rate for Payer: Cigna Commercial |
$4,456.77
|
| Rate for Payer: Health EOS Commercial |
$4,311.44
|
| Rate for Payer: HFN Commercial |
$4,456.77
|
| Rate for Payer: Multiplan Commercial |
$3,875.46
|
| Rate for Payer: Preferred Network Access Commercial |
$4,456.77
|
| Rate for Payer: Quartz Beloit One Network |
$2,373.72
|
| Rate for Payer: Quartz Commercial |
$2,906.59
|
| Rate for Payer: WEA Trust Commercial |
$2,664.38
|
| Rate for Payer: WPS Commercial |
$3,588.06
|
|
|
VASCULAR STUDY 9397926
|
Professional
|
Both
|
$254.00
|
|
|
Service Code
|
CPT 93979 26
|
| Hospital Charge Code |
3015444
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$22.32 |
| Max. Negotiated Rate |
$250.95 |
| Rate for Payer: Aetna Commercial |
$250.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$227.18
|
| Rate for Payer: Aetna Managed Medicare |
$22.32
|
| Rate for Payer: Anthem Medicare Advantage |
$22.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$22.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$22.32
|
| Rate for Payer: Cash Price |
$76.20
|
| Rate for Payer: Cash Price |
$76.20
|
| Rate for Payer: Cash Price |
$76.20
|
| Rate for Payer: Cigna Commercial |
$250.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$24.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$22.32
|
| Rate for Payer: Health EOS Commercial |
$240.39
|
| Rate for Payer: HFN Commercial |
$250.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$82.83
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$82.83
|
| Rate for Payer: Independent Care Health Plan Medicare |
$22.32
|
| Rate for Payer: Multiplan Commercial |
$211.33
|
| Rate for Payer: NAPHCARE Commercial |
$33.48
|
| Rate for Payer: Preferred Network Access Commercial |
$250.95
|
| Rate for Payer: Quartz Beloit One Network |
$116.23
|
| Rate for Payer: Quartz Commercial |
$150.57
|
| Rate for Payer: Quartz Medicare Advantage |
$22.32
|
| Rate for Payer: The Alliance Commercial |
$55.80
|
| Rate for Payer: United Healthcare Medicaid |
$24.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$22.32
|
| Rate for Payer: WEA Trust Commercial |
$145.29
|
| Rate for Payer: WPS Commercial |
$89.27
|
|
|
VASCULAR STUDY RENAL ARTERIES 9397526
|
Professional
|
Both
|
$760.00
|
|
|
Service Code
|
CPT 93975 26
|
| Hospital Charge Code |
3015448
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$52.53 |
| Max. Negotiated Rate |
$750.88 |
| Rate for Payer: Aetna Commercial |
$750.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$679.74
|
| Rate for Payer: Aetna Managed Medicare |
$52.53
|
| Rate for Payer: Anthem Medicare Advantage |
$52.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$52.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$52.53
|
| Rate for Payer: Cash Price |
$228.00
|
| Rate for Payer: Cash Price |
$228.00
|
| Rate for Payer: Cash Price |
$228.00
|
| Rate for Payer: Cigna Commercial |
$750.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$91.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$52.53
|
| Rate for Payer: Health EOS Commercial |
$719.26
|
| Rate for Payer: HFN Commercial |
$750.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$197.88
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$197.88
|
| Rate for Payer: Independent Care Health Plan Medicare |
$52.53
|
| Rate for Payer: Multiplan Commercial |
$632.32
|
| Rate for Payer: NAPHCARE Commercial |
$78.80
|
| Rate for Payer: Preferred Network Access Commercial |
$750.88
|
| Rate for Payer: Quartz Beloit One Network |
$347.78
|
| Rate for Payer: Quartz Commercial |
$450.53
|
| Rate for Payer: Quartz Medicare Advantage |
$52.53
|
| Rate for Payer: The Alliance Commercial |
$131.33
|
| Rate for Payer: United Healthcare Medicaid |
$91.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$52.53
|
| Rate for Payer: WEA Trust Commercial |
$434.72
|
| Rate for Payer: WPS Commercial |
$210.12
|
|
|
VASECTOMY
|
Facility
|
OP
|
$1,084.00
|
|
| Hospital Charge Code |
2960496
|
|
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
|
|
|
VASECTOMY
|
Facility
|
IP
|
$1,084.00
|
|
| Hospital Charge Code |
2960496
|
|
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
|
|
|
Vasectomy, Unilateral or Bilateral 55250
|
Professional
|
Both
|
$1,546.00
|
|
|
Service Code
|
CPT 55250
|
| Hospital Charge Code |
1188973
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$212.62 |
| Max. Negotiated Rate |
$1,527.45 |
| Rate for Payer: Aetna Commercial |
$1,527.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,382.74
|
| Rate for Payer: Aetna Managed Medicare |
$212.62
|
| Rate for Payer: Anthem Medicare Advantage |
$212.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$212.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$212.62
|
| Rate for Payer: Cash Price |
$463.80
|
| Rate for Payer: Cash Price |
$463.80
|
| Rate for Payer: Cash Price |
$463.80
|
| Rate for Payer: Cigna Commercial |
$1,527.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$308.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$212.62
|
| Rate for Payer: Health EOS Commercial |
$1,463.13
|
| Rate for Payer: HFN Commercial |
$1,527.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$796.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$796.43
|
| Rate for Payer: Independent Care Health Plan Medicare |
$212.62
|
| Rate for Payer: Multiplan Commercial |
$1,286.27
|
| Rate for Payer: NAPHCARE Commercial |
$318.93
|
| Rate for Payer: Preferred Network Access Commercial |
$1,527.45
|
| Rate for Payer: Quartz Beloit One Network |
$707.45
|
| Rate for Payer: Quartz Commercial |
$916.47
|
| Rate for Payer: Quartz Medicare Advantage |
$212.62
|
| Rate for Payer: The Alliance Commercial |
$903.62
|
| Rate for Payer: United Healthcare Medicaid |
$308.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$212.62
|
| Rate for Payer: WEA Trust Commercial |
$884.31
|
| Rate for Payer: WPS Commercial |
$956.78
|
|
|
Vasectomy, unilateral or bilateral (separate procedure), including postoperative semen examination(s)
|
Facility
|
OP
|
$8,799.61
|
|
|
Service Code
|
CPT 55250
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,199.90 |
| Max. Negotiated Rate |
$8,799.61 |
| Rate for Payer: Aetna Managed Medicare |
$2,199.90
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,635.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,985.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,835.04
|
| Rate for Payer: Anthem Medicare Advantage |
$2,199.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$2,199.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$2,199.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$2,199.90
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,947.89
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$2,199.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,183.63
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2,199.90
|
| Rate for Payer: Independent Care Health Plan Medicare |
$2,199.90
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$2,199.90
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$2,199.90
|
| Rate for Payer: NAPHCARE Commercial |
$3,299.85
|
| Rate for Payer: Quartz Medicare Advantage |
$2,199.90
|
| Rate for Payer: The Alliance Commercial |
$8,799.61
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,199.90
|
| Rate for Payer: United Healthcare PPO |
$3,726.32
|
| Rate for Payer: Wellcare Medicare |
$2,199.90
|
|
|
Vasoactive Intestinal Polypeptide
|
Professional
|
Both
|
$817.00
|
|
|
Service Code
|
CPT 84586
|
| Hospital Charge Code |
980577
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$36.74 |
| Max. Negotiated Rate |
$807.20 |
| Rate for Payer: Aetna Commercial |
$807.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$730.72
|
| Rate for Payer: Aetna Managed Medicare |
$36.74
|
| Rate for Payer: Anthem Medicare Advantage |
$36.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$36.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$36.74
|
| Rate for Payer: Cash Price |
$245.10
|
| Rate for Payer: Cash Price |
$245.10
|
| Rate for Payer: Cigna Commercial |
$807.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$424.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$36.74
|
| Rate for Payer: Health EOS Commercial |
$773.21
|
| Rate for Payer: HFN Commercial |
$807.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$129.70
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$129.70
|
| Rate for Payer: Independent Care Health Plan Medicare |
$36.74
|
| Rate for Payer: Multiplan Commercial |
$679.74
|
| Rate for Payer: NAPHCARE Commercial |
$55.11
|
| Rate for Payer: Preferred Network Access Commercial |
$807.20
|
| Rate for Payer: Quartz Beloit One Network |
$373.86
|
| Rate for Payer: Quartz Commercial |
$484.32
|
| Rate for Payer: Quartz Medicare Advantage |
$36.74
|
| Rate for Payer: The Alliance Commercial |
$145.14
|
| Rate for Payer: United Healthcare Medicare Advantage |
$36.74
|
| Rate for Payer: WEA Trust Commercial |
$467.32
|
| Rate for Payer: WPS Commercial |
$161.67
|
|
|
Vasoactive Intestinal Polypeptide
|
Facility
|
OP
|
$817.00
|
|
|
Service Code
|
CPT 84586
|
| Hospital Charge Code |
980577
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$36.74 |
| Max. Negotiated Rate |
$781.71 |
| Rate for Payer: Aetna Commercial |
$764.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$730.72
|
| Rate for Payer: Aetna Managed Medicare |
$36.74
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$137.79
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$64.30
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$60.99
|
| Rate for Payer: Anthem Medicare Advantage |
$36.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$450.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$36.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$36.74
|
| Rate for Payer: Cash Price |
$245.10
|
| Rate for Payer: Cash Price |
$245.10
|
| Rate for Payer: Cigna Commercial |
$781.71
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$36.74
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$475.49
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$36.74
|
| Rate for Payer: Health EOS Commercial |
$756.22
|
| Rate for Payer: HFN Commercial |
$781.71
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$136.68
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$36.74
|
| Rate for Payer: Independent Care Health Plan Medicare |
$36.74
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$36.74
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$36.74
|
| Rate for Payer: Multiplan Commercial |
$679.74
|
| Rate for Payer: NAPHCARE Commercial |
$55.11
|
| Rate for Payer: Preferred Network Access Commercial |
$781.71
|
| Rate for Payer: Quartz Beloit One Network |
$416.34
|
| Rate for Payer: Quartz Commercial |
$552.29
|
| Rate for Payer: Quartz Medicare Advantage |
$36.74
|
| Rate for Payer: The Alliance Commercial |
$146.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$36.74
|
| Rate for Payer: United Healthcare PPO |
$637.26
|
| Rate for Payer: WEA Trust Commercial |
$467.32
|
| Rate for Payer: Wellcare Medicare |
$36.74
|
| Rate for Payer: WPS Commercial |
$629.34
|
|
|
Vasoactive Intestinal Polypeptide
|
Facility
|
IP
|
$817.00
|
|
|
Service Code
|
CPT 84586
|
| Hospital Charge Code |
980577
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$416.34 |
| Max. Negotiated Rate |
$781.71 |
| Rate for Payer: Aetna Commercial |
$764.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$730.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$450.33
|
| Rate for Payer: Cash Price |
$245.10
|
| Rate for Payer: Cigna Commercial |
$781.71
|
| Rate for Payer: Health EOS Commercial |
$756.22
|
| Rate for Payer: HFN Commercial |
$781.71
|
| Rate for Payer: Multiplan Commercial |
$679.74
|
| Rate for Payer: Preferred Network Access Commercial |
$781.71
|
| Rate for Payer: Quartz Beloit One Network |
$416.34
|
| Rate for Payer: Quartz Commercial |
$509.81
|
| Rate for Payer: WEA Trust Commercial |
$467.32
|
| Rate for Payer: WPS Commercial |
$629.34
|
|
|
Vasopressin 20units/1ml vial [Med]
|
Facility
|
IP
|
$31.00
|
|
| Hospital Charge Code |
2974998
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.80 |
| Max. Negotiated Rate |
$29.66 |
| Rate for Payer: Aetna Commercial |
$29.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$27.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$17.09
|
| Rate for Payer: Cash Price |
$9.30
|
| Rate for Payer: Cigna Commercial |
$29.66
|
| Rate for Payer: Health EOS Commercial |
$28.69
|
| Rate for Payer: HFN Commercial |
$29.66
|
| Rate for Payer: Multiplan Commercial |
$25.79
|
| Rate for Payer: Preferred Network Access Commercial |
$29.66
|
| Rate for Payer: Quartz Beloit One Network |
$15.80
|
| Rate for Payer: Quartz Commercial |
$19.34
|
| Rate for Payer: WEA Trust Commercial |
$17.73
|
| Rate for Payer: WPS Commercial |
$23.88
|
|
|
Vasopressin 20units/1ml vial [Med]
|
Facility
|
OP
|
$31.00
|
|
| Hospital Charge Code |
2974998
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.03 |
| Max. Negotiated Rate |
$29.66 |
| Rate for Payer: Aetna Commercial |
$29.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$27.73
|
| Rate for Payer: Aetna Managed Medicare |
$9.03
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$20.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$16.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$15.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$17.09
|
| Rate for Payer: Cash Price |
$9.30
|
| Rate for Payer: Cigna Commercial |
$29.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$18.04
|
| Rate for Payer: Health EOS Commercial |
$28.69
|
| Rate for Payer: HFN Commercial |
$29.66
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$24.18
|
| Rate for Payer: Multiplan Commercial |
$25.79
|
| Rate for Payer: NAPHCARE Commercial |
$19.34
|
| Rate for Payer: Preferred Network Access Commercial |
$29.66
|
| Rate for Payer: Quartz Beloit One Network |
$15.80
|
| Rate for Payer: Quartz Commercial |
$20.96
|
| Rate for Payer: Quartz Medicare Advantage |
$19.34
|
| Rate for Payer: The Alliance Commercial |
$16.12
|
| Rate for Payer: WEA Trust Commercial |
$17.73
|
| Rate for Payer: WPS Commercial |
$23.88
|
|
|
VASOTOMY FOR VASOGRAM
|
Facility
|
IP
|
$1,084.00
|
|
| Hospital Charge Code |
2960497
|
|
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
|
|
|
VASOTOMY FOR VASOGRAM
|
Facility
|
OP
|
$1,084.00
|
|
| Hospital Charge Code |
2960497
|
|
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
|
|
