|
Vitamin K 1 mg Charge
|
Professional
|
Both
|
$7.00
|
|
|
Service Code
|
HCPCS J3430
|
| Hospital Charge Code |
2958928
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.92 |
| Max. Negotiated Rate |
$8.04 |
| Rate for Payer: Aetna Commercial |
$6.92
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6.26
|
| Rate for Payer: Aetna Managed Medicare |
$2.92
|
| Rate for Payer: Anthem Medicare Advantage |
$2.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$2.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$2.92
|
| Rate for Payer: Cash Price |
$2.10
|
| Rate for Payer: Cash Price |
$2.10
|
| Rate for Payer: Cigna Commercial |
$6.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2.92
|
| Rate for Payer: Health EOS Commercial |
$6.62
|
| Rate for Payer: HFN Commercial |
$6.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5.68
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5.68
|
| Rate for Payer: Independent Care Health Plan Medicare |
$2.92
|
| Rate for Payer: Multiplan Commercial |
$5.82
|
| Rate for Payer: NAPHCARE Commercial |
$4.38
|
| Rate for Payer: Preferred Network Access Commercial |
$6.92
|
| Rate for Payer: Quartz Beloit One Network |
$3.20
|
| Rate for Payer: Quartz Commercial |
$4.15
|
| Rate for Payer: Quartz Medicare Advantage |
$2.92
|
| Rate for Payer: The Alliance Commercial |
$8.04
|
| Rate for Payer: United Healthcare Medicaid |
$2.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2.92
|
| Rate for Payer: WEA Trust Commercial |
$4.00
|
| Rate for Payer: WPS Commercial |
$7.29
|
|
|
Vitamin K 1 mg Charge
|
Facility
|
OP
|
$7.00
|
|
|
Service Code
|
HCPCS J3430
|
| Hospital Charge Code |
2958928
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.04 |
| Max. Negotiated Rate |
$11.69 |
| Rate for Payer: Aetna Commercial |
$6.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6.26
|
| Rate for Payer: Aetna Managed Medicare |
$2.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4.73
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3.86
|
| Rate for Payer: Cash Price |
$2.10
|
| Rate for Payer: Cash Price |
$2.10
|
| Rate for Payer: Cigna Commercial |
$6.70
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3.86
|
| Rate for Payer: Health EOS Commercial |
$6.48
|
| Rate for Payer: HFN Commercial |
$6.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5.46
|
| Rate for Payer: Multiplan Commercial |
$5.82
|
| Rate for Payer: NAPHCARE Commercial |
$4.37
|
| Rate for Payer: Preferred Network Access Commercial |
$6.70
|
| Rate for Payer: Quartz Beloit One Network |
$3.57
|
| Rate for Payer: Quartz Commercial |
$4.73
|
| Rate for Payer: Quartz Medicare Advantage |
$4.37
|
| Rate for Payer: The Alliance Commercial |
$11.69
|
| Rate for Payer: WEA Trust Commercial |
$4.00
|
| Rate for Payer: WPS Commercial |
$7.29
|
|
|
Vitamin K 1 mg Charge
|
Facility
|
IP
|
$7.00
|
|
|
Service Code
|
HCPCS J3430
|
| Hospital Charge Code |
2958928
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.57 |
| Max. Negotiated Rate |
$6.70 |
| Rate for Payer: Aetna Commercial |
$6.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3.86
|
| Rate for Payer: Cash Price |
$2.10
|
| Rate for Payer: Cigna Commercial |
$6.70
|
| Rate for Payer: Health EOS Commercial |
$6.48
|
| Rate for Payer: HFN Commercial |
$6.70
|
| Rate for Payer: Multiplan Commercial |
$5.82
|
| Rate for Payer: Preferred Network Access Commercial |
$6.70
|
| Rate for Payer: Quartz Beloit One Network |
$3.57
|
| Rate for Payer: Quartz Commercial |
$4.37
|
| Rate for Payer: WEA Trust Commercial |
$4.00
|
| Rate for Payer: WPS Commercial |
$5.39
|
|
|
Vit K phytonadione inj 1 mg J3430
|
Professional
|
Both
|
$7.00
|
|
|
Service Code
|
HCPCS J3430
|
| Hospital Charge Code |
3697521
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.92 |
| Max. Negotiated Rate |
$8.04 |
| Rate for Payer: Aetna Commercial |
$6.92
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6.26
|
| Rate for Payer: Aetna Managed Medicare |
$2.92
|
| Rate for Payer: Anthem Medicare Advantage |
$2.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$2.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$2.92
|
| Rate for Payer: Cash Price |
$2.10
|
| Rate for Payer: Cash Price |
$2.10
|
| Rate for Payer: Cigna Commercial |
$6.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2.92
|
| Rate for Payer: Health EOS Commercial |
$6.62
|
| Rate for Payer: HFN Commercial |
$6.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5.68
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5.68
|
| Rate for Payer: Independent Care Health Plan Medicare |
$2.92
|
| Rate for Payer: Multiplan Commercial |
$5.82
|
| Rate for Payer: NAPHCARE Commercial |
$4.38
|
| Rate for Payer: Preferred Network Access Commercial |
$6.92
|
| Rate for Payer: Quartz Beloit One Network |
$3.20
|
| Rate for Payer: Quartz Commercial |
$4.15
|
| Rate for Payer: Quartz Medicare Advantage |
$2.92
|
| Rate for Payer: The Alliance Commercial |
$8.04
|
| Rate for Payer: United Healthcare Medicaid |
$2.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2.92
|
| Rate for Payer: WEA Trust Commercial |
$4.00
|
| Rate for Payer: WPS Commercial |
$7.29
|
|
|
Vit K phytonadione inj 1 mg J3430
|
Facility
|
IP
|
$7.00
|
|
|
Service Code
|
HCPCS J3430
|
| Hospital Charge Code |
3697521
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.57 |
| Max. Negotiated Rate |
$6.70 |
| Rate for Payer: Aetna Commercial |
$6.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3.86
|
| Rate for Payer: Cash Price |
$2.10
|
| Rate for Payer: Cigna Commercial |
$6.70
|
| Rate for Payer: Health EOS Commercial |
$6.48
|
| Rate for Payer: HFN Commercial |
$6.70
|
| Rate for Payer: Multiplan Commercial |
$5.82
|
| Rate for Payer: Preferred Network Access Commercial |
$6.70
|
| Rate for Payer: Quartz Beloit One Network |
$3.57
|
| Rate for Payer: Quartz Commercial |
$4.37
|
| Rate for Payer: WEA Trust Commercial |
$4.00
|
| Rate for Payer: WPS Commercial |
$5.39
|
|
|
Vit K phytonadione inj 1 mg J3430
|
Facility
|
OP
|
$7.00
|
|
|
Service Code
|
HCPCS J3430
|
| Hospital Charge Code |
3697521
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.04 |
| Max. Negotiated Rate |
$11.69 |
| Rate for Payer: Aetna Commercial |
$6.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6.26
|
| Rate for Payer: Aetna Managed Medicare |
$2.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4.73
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3.86
|
| Rate for Payer: Cash Price |
$2.10
|
| Rate for Payer: Cash Price |
$2.10
|
| Rate for Payer: Cigna Commercial |
$6.70
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3.86
|
| Rate for Payer: Health EOS Commercial |
$6.48
|
| Rate for Payer: HFN Commercial |
$6.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5.46
|
| Rate for Payer: Multiplan Commercial |
$5.82
|
| Rate for Payer: NAPHCARE Commercial |
$4.37
|
| Rate for Payer: Preferred Network Access Commercial |
$6.70
|
| Rate for Payer: Quartz Beloit One Network |
$3.57
|
| Rate for Payer: Quartz Commercial |
$4.73
|
| Rate for Payer: Quartz Medicare Advantage |
$4.37
|
| Rate for Payer: The Alliance Commercial |
$11.69
|
| Rate for Payer: WEA Trust Commercial |
$4.00
|
| Rate for Payer: WPS Commercial |
$7.29
|
|
|
VITRECTOMY
|
Facility
|
OP
|
$5,660.00
|
|
| Hospital Charge Code |
2960505
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,648.19 |
| Max. Negotiated Rate |
$5,415.49 |
| Rate for Payer: Aetna Commercial |
$5,297.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,062.30
|
| Rate for Payer: Aetna Managed Medicare |
$1,648.19
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,826.16
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,943.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,825.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,119.79
|
| Rate for Payer: Cash Price |
$1,698.00
|
| Rate for Payer: Cigna Commercial |
$5,415.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,294.12
|
| Rate for Payer: Health EOS Commercial |
$5,238.90
|
| Rate for Payer: HFN Commercial |
$5,415.49
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,414.80
|
| Rate for Payer: Multiplan Commercial |
$4,709.12
|
| Rate for Payer: NAPHCARE Commercial |
$3,531.84
|
| Rate for Payer: Preferred Network Access Commercial |
$5,415.49
|
| Rate for Payer: Quartz Beloit One Network |
$2,884.34
|
| Rate for Payer: Quartz Commercial |
$3,826.16
|
| Rate for Payer: Quartz Medicare Advantage |
$3,531.84
|
| Rate for Payer: The Alliance Commercial |
$2,943.20
|
| Rate for Payer: WEA Trust Commercial |
$3,237.52
|
| Rate for Payer: WPS Commercial |
$4,359.90
|
|
|
VITRECTOMY
|
Facility
|
IP
|
$5,660.00
|
|
| Hospital Charge Code |
2960505
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,884.34 |
| Max. Negotiated Rate |
$5,415.49 |
| Rate for Payer: Aetna Commercial |
$5,297.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,062.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,119.79
|
| Rate for Payer: Cash Price |
$1,698.00
|
| Rate for Payer: Cigna Commercial |
$5,415.49
|
| Rate for Payer: Health EOS Commercial |
$5,238.90
|
| Rate for Payer: HFN Commercial |
$5,415.49
|
| Rate for Payer: Multiplan Commercial |
$4,709.12
|
| Rate for Payer: Preferred Network Access Commercial |
$5,415.49
|
| Rate for Payer: Quartz Beloit One Network |
$2,884.34
|
| Rate for Payer: Quartz Commercial |
$3,531.84
|
| Rate for Payer: WEA Trust Commercial |
$3,237.52
|
| Rate for Payer: WPS Commercial |
$4,359.90
|
|
|
VL ANkle Pressure Single Level
|
Facility
|
IP
|
$521.00
|
|
|
Service Code
|
CPT 93922 TC
|
| Hospital Charge Code |
3077325
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$265.50 |
| Max. Negotiated Rate |
$498.49 |
| Rate for Payer: Aetna Commercial |
$487.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$465.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$287.18
|
| Rate for Payer: Cash Price |
$156.30
|
| Rate for Payer: Cigna Commercial |
$498.49
|
| Rate for Payer: Health EOS Commercial |
$482.24
|
| Rate for Payer: HFN Commercial |
$498.49
|
| Rate for Payer: Multiplan Commercial |
$433.47
|
| Rate for Payer: Preferred Network Access Commercial |
$498.49
|
| Rate for Payer: Quartz Beloit One Network |
$265.50
|
| Rate for Payer: Quartz Commercial |
$325.10
|
| Rate for Payer: WEA Trust Commercial |
$298.01
|
| Rate for Payer: WPS Commercial |
$401.33
|
|
|
VL ANkle Pressure Single Level
|
Facility
|
OP
|
$521.00
|
|
|
Service Code
|
CPT 93922 TC
|
| Hospital Charge Code |
3077325
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$151.72 |
| Max. Negotiated Rate |
$498.49 |
| Rate for Payer: Aetna Commercial |
$487.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$465.98
|
| Rate for Payer: Aetna Managed Medicare |
$151.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$352.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$270.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$260.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$287.18
|
| Rate for Payer: Cash Price |
$156.30
|
| Rate for Payer: Cash Price |
$156.30
|
| Rate for Payer: Cigna Commercial |
$498.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$303.22
|
| Rate for Payer: Health EOS Commercial |
$482.24
|
| Rate for Payer: HFN Commercial |
$498.49
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$406.38
|
| Rate for Payer: Multiplan Commercial |
$433.47
|
| Rate for Payer: NAPHCARE Commercial |
$325.10
|
| Rate for Payer: Preferred Network Access Commercial |
$498.49
|
| Rate for Payer: Quartz Beloit One Network |
$265.50
|
| Rate for Payer: Quartz Commercial |
$352.20
|
| Rate for Payer: Quartz Medicare Advantage |
$325.10
|
| Rate for Payer: The Alliance Commercial |
$283.05
|
| Rate for Payer: United Healthcare PPO |
$406.38
|
| Rate for Payer: WEA Trust Commercial |
$298.01
|
| Rate for Payer: WPS Commercial |
$401.33
|
|
|
VL ANkle Pressure Single Level
|
Professional
|
Both
|
$521.00
|
|
|
Service Code
|
CPT 93922 TC
|
| Hospital Charge Code |
3077325
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$70.76 |
| Max. Negotiated Rate |
$514.75 |
| Rate for Payer: Aetna Commercial |
$514.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$465.98
|
| Rate for Payer: Aetna Managed Medicare |
$70.76
|
| Rate for Payer: Anthem Medicare Advantage |
$70.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$70.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$70.76
|
| Rate for Payer: Cash Price |
$156.30
|
| Rate for Payer: Cash Price |
$156.30
|
| Rate for Payer: Cash Price |
$156.30
|
| Rate for Payer: Cigna Commercial |
$514.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$71.45
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$70.76
|
| Rate for Payer: Health EOS Commercial |
$493.07
|
| Rate for Payer: HFN Commercial |
$514.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$256.17
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$256.17
|
| Rate for Payer: Independent Care Health Plan Medicare |
$70.76
|
| Rate for Payer: Multiplan Commercial |
$433.47
|
| Rate for Payer: NAPHCARE Commercial |
$106.14
|
| Rate for Payer: Preferred Network Access Commercial |
$514.75
|
| Rate for Payer: Quartz Beloit One Network |
$238.41
|
| Rate for Payer: Quartz Commercial |
$308.85
|
| Rate for Payer: Quartz Medicare Advantage |
$70.76
|
| Rate for Payer: The Alliance Commercial |
$176.90
|
| Rate for Payer: United Healthcare Medicaid |
$71.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$70.76
|
| Rate for Payer: WEA Trust Commercial |
$298.01
|
| Rate for Payer: WPS Commercial |
$283.05
|
|
|
VL Carotid Duplex Bilateral
|
Professional
|
Both
|
$1,791.00
|
|
|
Service Code
|
CPT 93880 TC
|
| Hospital Charge Code |
1482841
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$142.02 |
| Max. Negotiated Rate |
$1,769.51 |
| Rate for Payer: Aetna Commercial |
$1,769.51
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,601.87
|
| Rate for Payer: Aetna Managed Medicare |
$150.40
|
| Rate for Payer: Anthem Medicare Advantage |
$150.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$150.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$150.40
|
| Rate for Payer: Cash Price |
$537.30
|
| Rate for Payer: Cash Price |
$537.30
|
| Rate for Payer: Cash Price |
$537.30
|
| Rate for Payer: Cigna Commercial |
$1,769.51
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$142.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$150.40
|
| Rate for Payer: Health EOS Commercial |
$1,695.00
|
| Rate for Payer: HFN Commercial |
$1,769.51
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$569.11
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$569.11
|
| Rate for Payer: Independent Care Health Plan Medicare |
$150.40
|
| Rate for Payer: Multiplan Commercial |
$1,490.11
|
| Rate for Payer: NAPHCARE Commercial |
$225.61
|
| Rate for Payer: Preferred Network Access Commercial |
$1,769.51
|
| Rate for Payer: Quartz Beloit One Network |
$819.56
|
| Rate for Payer: Quartz Commercial |
$1,061.70
|
| Rate for Payer: Quartz Medicare Advantage |
$150.40
|
| Rate for Payer: The Alliance Commercial |
$376.01
|
| Rate for Payer: United Healthcare Medicaid |
$142.02
|
| Rate for Payer: United Healthcare Medicare Advantage |
$150.40
|
| Rate for Payer: WEA Trust Commercial |
$1,024.45
|
| Rate for Payer: WPS Commercial |
$601.62
|
|
|
VL Carotid Duplex Bilateral
|
Facility
|
IP
|
$1,791.00
|
|
|
Service Code
|
CPT 93880 TC
|
| Hospital Charge Code |
1482841
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$912.69 |
| Max. Negotiated Rate |
$1,713.63 |
| Rate for Payer: Aetna Commercial |
$1,676.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,601.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$987.20
|
| Rate for Payer: Cash Price |
$537.30
|
| Rate for Payer: Cigna Commercial |
$1,713.63
|
| Rate for Payer: Health EOS Commercial |
$1,657.75
|
| Rate for Payer: HFN Commercial |
$1,713.63
|
| Rate for Payer: Multiplan Commercial |
$1,490.11
|
| Rate for Payer: Preferred Network Access Commercial |
$1,713.63
|
| Rate for Payer: Quartz Beloit One Network |
$912.69
|
| Rate for Payer: Quartz Commercial |
$1,117.58
|
| Rate for Payer: WEA Trust Commercial |
$1,024.45
|
| Rate for Payer: WPS Commercial |
$1,379.61
|
|
|
VL Carotid Duplex Bilateral
|
Facility
|
OP
|
$1,791.00
|
|
|
Service Code
|
CPT 93880 TC
|
| Hospital Charge Code |
1482841
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$521.54 |
| Max. Negotiated Rate |
$1,713.63 |
| Rate for Payer: Aetna Commercial |
$1,676.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,601.87
|
| Rate for Payer: Aetna Managed Medicare |
$521.54
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,210.72
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$931.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$894.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$987.20
|
| Rate for Payer: Cash Price |
$537.30
|
| Rate for Payer: Cash Price |
$537.30
|
| Rate for Payer: Cigna Commercial |
$1,713.63
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,042.36
|
| Rate for Payer: Health EOS Commercial |
$1,657.75
|
| Rate for Payer: HFN Commercial |
$1,713.63
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,396.98
|
| Rate for Payer: Multiplan Commercial |
$1,490.11
|
| Rate for Payer: NAPHCARE Commercial |
$1,117.58
|
| Rate for Payer: Preferred Network Access Commercial |
$1,713.63
|
| Rate for Payer: Quartz Beloit One Network |
$912.69
|
| Rate for Payer: Quartz Commercial |
$1,210.72
|
| Rate for Payer: Quartz Medicare Advantage |
$1,117.58
|
| Rate for Payer: The Alliance Commercial |
$601.62
|
| Rate for Payer: United Healthcare PPO |
$1,396.98
|
| Rate for Payer: WEA Trust Commercial |
$1,024.45
|
| Rate for Payer: WPS Commercial |
$1,379.61
|
|
|
VL Carotid Duplex Left or Limited
|
Professional
|
Both
|
$739.00
|
|
|
Service Code
|
CPT 93882 TC,LT
|
| Hospital Charge Code |
5288657
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$134.51 |
| Max. Negotiated Rate |
$730.13 |
| Rate for Payer: Aetna Commercial |
$730.13
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$660.96
|
| Rate for Payer: Cash Price |
$221.70
|
| Rate for Payer: Cash Price |
$221.70
|
| Rate for Payer: Cash Price |
$221.70
|
| Rate for Payer: Cigna Commercial |
$730.13
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$134.51
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$461.14
|
| Rate for Payer: Health EOS Commercial |
$699.39
|
| Rate for Payer: HFN Commercial |
$730.13
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$456.84
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$456.84
|
| Rate for Payer: Multiplan Commercial |
$614.85
|
| Rate for Payer: Preferred Network Access Commercial |
$730.13
|
| Rate for Payer: Quartz Beloit One Network |
$338.17
|
| Rate for Payer: Quartz Commercial |
$438.08
|
| Rate for Payer: The Alliance Commercial |
$384.28
|
| Rate for Payer: United Healthcare Medicaid |
$134.51
|
| Rate for Payer: WEA Trust Commercial |
$422.71
|
| Rate for Payer: WPS Commercial |
$569.25
|
|
|
VL Carotid Duplex Left or Limited
|
Facility
|
IP
|
$739.00
|
|
|
Service Code
|
CPT 93882 TC,LT
|
| Hospital Charge Code |
5288657
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$376.59 |
| Max. Negotiated Rate |
$707.08 |
| Rate for Payer: Aetna Commercial |
$691.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$660.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$407.34
|
| Rate for Payer: Cash Price |
$221.70
|
| Rate for Payer: Cigna Commercial |
$707.08
|
| Rate for Payer: Health EOS Commercial |
$684.02
|
| Rate for Payer: HFN Commercial |
$707.08
|
| Rate for Payer: Multiplan Commercial |
$614.85
|
| Rate for Payer: Preferred Network Access Commercial |
$707.08
|
| Rate for Payer: Quartz Beloit One Network |
$376.59
|
| Rate for Payer: Quartz Commercial |
$461.14
|
| Rate for Payer: WEA Trust Commercial |
$422.71
|
| Rate for Payer: WPS Commercial |
$569.25
|
|
|
VL Carotid Duplex Left or Limited
|
Facility
|
OP
|
$739.00
|
|
|
Service Code
|
CPT 93882 TC,LT
|
| Hospital Charge Code |
5288657
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$215.20 |
| Max. Negotiated Rate |
$707.08 |
| Rate for Payer: Aetna Commercial |
$691.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$660.96
|
| Rate for Payer: Aetna Managed Medicare |
$215.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$499.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$384.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$368.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$407.34
|
| Rate for Payer: Cash Price |
$221.70
|
| Rate for Payer: Cigna Commercial |
$707.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$430.10
|
| Rate for Payer: Health EOS Commercial |
$684.02
|
| Rate for Payer: HFN Commercial |
$707.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$576.42
|
| Rate for Payer: Multiplan Commercial |
$614.85
|
| Rate for Payer: NAPHCARE Commercial |
$461.14
|
| Rate for Payer: Preferred Network Access Commercial |
$707.08
|
| Rate for Payer: Quartz Beloit One Network |
$376.59
|
| Rate for Payer: Quartz Commercial |
$499.56
|
| Rate for Payer: Quartz Medicare Advantage |
$461.14
|
| Rate for Payer: The Alliance Commercial |
$384.28
|
| Rate for Payer: United Healthcare PPO |
$576.42
|
| Rate for Payer: WEA Trust Commercial |
$422.71
|
| Rate for Payer: WPS Commercial |
$569.25
|
|
|
VL Carotid Duplex Right or Limited
|
Professional
|
Both
|
$739.00
|
|
|
Service Code
|
CPT 93882 TC,RT
|
| Hospital Charge Code |
5288655
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$134.51 |
| Max. Negotiated Rate |
$730.13 |
| Rate for Payer: Aetna Commercial |
$730.13
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$660.96
|
| Rate for Payer: Cash Price |
$221.70
|
| Rate for Payer: Cash Price |
$221.70
|
| Rate for Payer: Cash Price |
$221.70
|
| Rate for Payer: Cigna Commercial |
$730.13
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$134.51
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$461.14
|
| Rate for Payer: Health EOS Commercial |
$699.39
|
| Rate for Payer: HFN Commercial |
$730.13
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$456.84
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$456.84
|
| Rate for Payer: Multiplan Commercial |
$614.85
|
| Rate for Payer: Preferred Network Access Commercial |
$730.13
|
| Rate for Payer: Quartz Beloit One Network |
$338.17
|
| Rate for Payer: Quartz Commercial |
$438.08
|
| Rate for Payer: The Alliance Commercial |
$384.28
|
| Rate for Payer: United Healthcare Medicaid |
$134.51
|
| Rate for Payer: WEA Trust Commercial |
$422.71
|
| Rate for Payer: WPS Commercial |
$569.25
|
|
|
VL Carotid Duplex Right or Limited
|
Facility
|
IP
|
$739.00
|
|
|
Service Code
|
CPT 93882 TC,RT
|
| Hospital Charge Code |
5288655
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$376.59 |
| Max. Negotiated Rate |
$707.08 |
| Rate for Payer: Aetna Commercial |
$691.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$660.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$407.34
|
| Rate for Payer: Cash Price |
$221.70
|
| Rate for Payer: Cigna Commercial |
$707.08
|
| Rate for Payer: Health EOS Commercial |
$684.02
|
| Rate for Payer: HFN Commercial |
$707.08
|
| Rate for Payer: Multiplan Commercial |
$614.85
|
| Rate for Payer: Preferred Network Access Commercial |
$707.08
|
| Rate for Payer: Quartz Beloit One Network |
$376.59
|
| Rate for Payer: Quartz Commercial |
$461.14
|
| Rate for Payer: WEA Trust Commercial |
$422.71
|
| Rate for Payer: WPS Commercial |
$569.25
|
|
|
VL Carotid Duplex Right or Limited
|
Facility
|
OP
|
$739.00
|
|
|
Service Code
|
CPT 93882 TC,RT
|
| Hospital Charge Code |
5288655
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$215.20 |
| Max. Negotiated Rate |
$707.08 |
| Rate for Payer: Aetna Commercial |
$691.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$660.96
|
| Rate for Payer: Aetna Managed Medicare |
$215.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$499.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$384.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$368.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$407.34
|
| Rate for Payer: Cash Price |
$221.70
|
| Rate for Payer: Cigna Commercial |
$707.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$430.10
|
| Rate for Payer: Health EOS Commercial |
$684.02
|
| Rate for Payer: HFN Commercial |
$707.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$576.42
|
| Rate for Payer: Multiplan Commercial |
$614.85
|
| Rate for Payer: NAPHCARE Commercial |
$461.14
|
| Rate for Payer: Preferred Network Access Commercial |
$707.08
|
| Rate for Payer: Quartz Beloit One Network |
$376.59
|
| Rate for Payer: Quartz Commercial |
$499.56
|
| Rate for Payer: Quartz Medicare Advantage |
$461.14
|
| Rate for Payer: The Alliance Commercial |
$384.28
|
| Rate for Payer: United Healthcare PPO |
$576.42
|
| Rate for Payer: WEA Trust Commercial |
$422.71
|
| Rate for Payer: WPS Commercial |
$569.25
|
|
|
VL Duplex Arterial/Venous Visceral
|
Facility
|
IP
|
$1,539.00
|
|
|
Service Code
|
CPT 93975 TC
|
| Hospital Charge Code |
1482916
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$784.27 |
| Max. Negotiated Rate |
$1,472.52 |
| Rate for Payer: Aetna Commercial |
$1,440.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,376.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$848.30
|
| Rate for Payer: Cash Price |
$461.70
|
| Rate for Payer: Cigna Commercial |
$1,472.52
|
| Rate for Payer: Health EOS Commercial |
$1,424.50
|
| Rate for Payer: HFN Commercial |
$1,472.52
|
| Rate for Payer: Multiplan Commercial |
$1,280.45
|
| Rate for Payer: Preferred Network Access Commercial |
$1,472.52
|
| Rate for Payer: Quartz Beloit One Network |
$784.27
|
| Rate for Payer: Quartz Commercial |
$960.34
|
| Rate for Payer: WEA Trust Commercial |
$880.31
|
| Rate for Payer: WPS Commercial |
$1,185.49
|
|
|
VL Duplex Arterial/Venous Visceral
|
Professional
|
Both
|
$1,539.00
|
|
|
Service Code
|
CPT 93975 TC
|
| Hospital Charge Code |
1482916
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$142.41 |
| Max. Negotiated Rate |
$1,520.53 |
| Rate for Payer: Aetna Commercial |
$1,520.53
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,376.48
|
| Rate for Payer: Aetna Managed Medicare |
$204.42
|
| Rate for Payer: Anthem Medicare Advantage |
$204.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$204.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$204.42
|
| Rate for Payer: Cash Price |
$461.70
|
| Rate for Payer: Cash Price |
$461.70
|
| Rate for Payer: Cash Price |
$461.70
|
| Rate for Payer: Cigna Commercial |
$1,520.53
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$142.41
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$204.42
|
| Rate for Payer: Health EOS Commercial |
$1,456.51
|
| Rate for Payer: HFN Commercial |
$1,520.53
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$782.23
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$782.23
|
| Rate for Payer: Independent Care Health Plan Medicare |
$204.42
|
| Rate for Payer: Multiplan Commercial |
$1,280.45
|
| Rate for Payer: NAPHCARE Commercial |
$306.63
|
| Rate for Payer: Preferred Network Access Commercial |
$1,520.53
|
| Rate for Payer: Quartz Beloit One Network |
$704.25
|
| Rate for Payer: Quartz Commercial |
$912.32
|
| Rate for Payer: Quartz Medicare Advantage |
$204.42
|
| Rate for Payer: The Alliance Commercial |
$511.06
|
| Rate for Payer: United Healthcare Medicaid |
$142.41
|
| Rate for Payer: United Healthcare Medicare Advantage |
$204.42
|
| Rate for Payer: WEA Trust Commercial |
$880.31
|
| Rate for Payer: WPS Commercial |
$817.69
|
|
|
VL Duplex Arterial/Venous Visceral
|
Facility
|
OP
|
$1,539.00
|
|
|
Service Code
|
CPT 93975 TC
|
| Hospital Charge Code |
1482916
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$448.16 |
| Max. Negotiated Rate |
$1,472.52 |
| Rate for Payer: Aetna Commercial |
$1,440.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,376.48
|
| Rate for Payer: Aetna Managed Medicare |
$448.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,040.36
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$800.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$768.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$848.30
|
| Rate for Payer: Cash Price |
$461.70
|
| Rate for Payer: Cash Price |
$461.70
|
| Rate for Payer: Cigna Commercial |
$1,472.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$895.70
|
| Rate for Payer: Health EOS Commercial |
$1,424.50
|
| Rate for Payer: HFN Commercial |
$1,472.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,200.42
|
| Rate for Payer: Multiplan Commercial |
$1,280.45
|
| Rate for Payer: NAPHCARE Commercial |
$960.34
|
| Rate for Payer: Preferred Network Access Commercial |
$1,472.52
|
| Rate for Payer: Quartz Beloit One Network |
$784.27
|
| Rate for Payer: Quartz Commercial |
$1,040.36
|
| Rate for Payer: Quartz Medicare Advantage |
$960.34
|
| Rate for Payer: The Alliance Commercial |
$817.69
|
| Rate for Payer: United Healthcare PPO |
$1,200.42
|
| Rate for Payer: WEA Trust Commercial |
$880.31
|
| Rate for Payer: WPS Commercial |
$1,185.49
|
|
|
VL Duplex Arterial/Venous Visceral Limit
|
Professional
|
Both
|
$626.00
|
|
|
Service Code
|
CPT 93976 TC
|
| Hospital Charge Code |
1482919
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$118.02 |
| Max. Negotiated Rate |
$618.49 |
| Rate for Payer: Aetna Commercial |
$618.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$559.89
|
| Rate for Payer: Aetna Managed Medicare |
$118.02
|
| Rate for Payer: Anthem Medicare Advantage |
$118.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$118.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$118.02
|
| Rate for Payer: Cash Price |
$187.80
|
| Rate for Payer: Cash Price |
$187.80
|
| Rate for Payer: Cash Price |
$187.80
|
| Rate for Payer: Cigna Commercial |
$618.49
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$121.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$118.02
|
| Rate for Payer: Health EOS Commercial |
$592.45
|
| Rate for Payer: HFN Commercial |
$618.49
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$443.63
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$443.63
|
| Rate for Payer: Independent Care Health Plan Medicare |
$118.02
|
| Rate for Payer: Multiplan Commercial |
$520.83
|
| Rate for Payer: NAPHCARE Commercial |
$177.03
|
| Rate for Payer: Preferred Network Access Commercial |
$618.49
|
| Rate for Payer: Quartz Beloit One Network |
$286.46
|
| Rate for Payer: Quartz Commercial |
$371.09
|
| Rate for Payer: Quartz Medicare Advantage |
$118.02
|
| Rate for Payer: The Alliance Commercial |
$295.05
|
| Rate for Payer: United Healthcare Medicaid |
$121.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$118.02
|
| Rate for Payer: WEA Trust Commercial |
$358.07
|
| Rate for Payer: WPS Commercial |
$472.08
|
|
|
VL Duplex Arterial/Venous Visceral Limit
|
Facility
|
OP
|
$626.00
|
|
|
Service Code
|
CPT 93976 TC
|
| Hospital Charge Code |
1482919
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$182.29 |
| Max. Negotiated Rate |
$598.96 |
| Rate for Payer: Aetna Commercial |
$585.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$559.89
|
| Rate for Payer: Aetna Managed Medicare |
$182.29
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$423.18
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$325.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$312.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$345.05
|
| Rate for Payer: Cash Price |
$187.80
|
| Rate for Payer: Cash Price |
$187.80
|
| Rate for Payer: Cigna Commercial |
$598.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$364.33
|
| Rate for Payer: Health EOS Commercial |
$579.43
|
| Rate for Payer: HFN Commercial |
$598.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$488.28
|
| Rate for Payer: Multiplan Commercial |
$520.83
|
| Rate for Payer: NAPHCARE Commercial |
$390.62
|
| Rate for Payer: Preferred Network Access Commercial |
$598.96
|
| Rate for Payer: Quartz Beloit One Network |
$319.01
|
| Rate for Payer: Quartz Commercial |
$423.18
|
| Rate for Payer: Quartz Medicare Advantage |
$390.62
|
| Rate for Payer: The Alliance Commercial |
$472.08
|
| Rate for Payer: United Healthcare PPO |
$488.28
|
| Rate for Payer: WEA Trust Commercial |
$358.07
|
| Rate for Payer: WPS Commercial |
$482.21
|
|
