|
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
|
|
|
VL Duplex Hemodialysis Access Flow
|
Facility
|
OP
|
$1,207.00
|
|
|
Service Code
|
CPT 93990 TC
|
| Hospital Charge Code |
1482922
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$351.48 |
| Max. Negotiated Rate |
$1,154.86 |
| Rate for Payer: Aetna Commercial |
$1,129.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,079.54
|
| Rate for Payer: Aetna Managed Medicare |
$351.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$815.93
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$627.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$602.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$665.30
|
| Rate for Payer: Cash Price |
$362.10
|
| Rate for Payer: Cash Price |
$362.10
|
| Rate for Payer: Cigna Commercial |
$1,154.86
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$702.47
|
| Rate for Payer: Health EOS Commercial |
$1,117.20
|
| Rate for Payer: HFN Commercial |
$1,154.86
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$941.46
|
| Rate for Payer: Multiplan Commercial |
$1,004.22
|
| Rate for Payer: NAPHCARE Commercial |
$753.17
|
| Rate for Payer: Preferred Network Access Commercial |
$1,154.86
|
| Rate for Payer: Quartz Beloit One Network |
$615.09
|
| Rate for Payer: Quartz Commercial |
$815.93
|
| Rate for Payer: Quartz Medicare Advantage |
$753.17
|
| Rate for Payer: The Alliance Commercial |
$483.14
|
| Rate for Payer: United Healthcare PPO |
$941.46
|
| Rate for Payer: WEA Trust Commercial |
$690.40
|
| Rate for Payer: WPS Commercial |
$929.75
|
|
|
VL Duplex Hemodialysis Access Flow
|
Professional
|
Both
|
$1,207.00
|
|
|
Service Code
|
CPT 93990 TC
|
| Hospital Charge Code |
1482922
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$120.79 |
| Max. Negotiated Rate |
$1,192.52 |
| Rate for Payer: Aetna Commercial |
$1,192.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,079.54
|
| Rate for Payer: Aetna Managed Medicare |
$120.79
|
| Rate for Payer: Anthem Medicare Advantage |
$120.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$120.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$120.79
|
| Rate for Payer: Cash Price |
$362.10
|
| Rate for Payer: Cash Price |
$362.10
|
| Rate for Payer: Cash Price |
$362.10
|
| Rate for Payer: Cigna Commercial |
$1,192.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$129.13
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$120.79
|
| Rate for Payer: Health EOS Commercial |
$1,142.30
|
| Rate for Payer: HFN Commercial |
$1,192.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$458.09
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$458.09
|
| Rate for Payer: Independent Care Health Plan Medicare |
$120.79
|
| Rate for Payer: Multiplan Commercial |
$1,004.22
|
| Rate for Payer: NAPHCARE Commercial |
$181.18
|
| Rate for Payer: Preferred Network Access Commercial |
$1,192.52
|
| Rate for Payer: Quartz Beloit One Network |
$552.32
|
| Rate for Payer: Quartz Commercial |
$715.51
|
| Rate for Payer: Quartz Medicare Advantage |
$120.79
|
| Rate for Payer: The Alliance Commercial |
$301.96
|
| Rate for Payer: United Healthcare Medicaid |
$129.13
|
| Rate for Payer: United Healthcare Medicare Advantage |
$120.79
|
| Rate for Payer: WEA Trust Commercial |
$690.40
|
| Rate for Payer: WPS Commercial |
$483.14
|
|
|
VL Duplex Hemodialysis Access Flow
|
Facility
|
IP
|
$1,207.00
|
|
|
Service Code
|
CPT 93990 TC
|
| Hospital Charge Code |
1482922
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$615.09 |
| Max. Negotiated Rate |
$1,154.86 |
| Rate for Payer: Aetna Commercial |
$1,129.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,079.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$665.30
|
| Rate for Payer: Cash Price |
$362.10
|
| Rate for Payer: Cigna Commercial |
$1,154.86
|
| Rate for Payer: Health EOS Commercial |
$1,117.20
|
| Rate for Payer: HFN Commercial |
$1,154.86
|
| Rate for Payer: Multiplan Commercial |
$1,004.22
|
| Rate for Payer: Preferred Network Access Commercial |
$1,154.86
|
| Rate for Payer: Quartz Beloit One Network |
$615.09
|
| Rate for Payer: Quartz Commercial |
$753.17
|
| Rate for Payer: WEA Trust Commercial |
$690.40
|
| Rate for Payer: WPS Commercial |
$929.75
|
|
|
VL Echo 2D w M Mode w Doppler w/ Con
|
Facility
|
IP
|
$3,456.00
|
|
|
Service Code
|
CPT 93306 TC
|
| Hospital Charge Code |
4628608
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$1,761.18 |
| Max. Negotiated Rate |
$3,306.70 |
| Rate for Payer: Aetna Commercial |
$3,234.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,091.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,904.95
|
| Rate for Payer: Cash Price |
$1,036.80
|
| Rate for Payer: Cigna Commercial |
$3,306.70
|
| Rate for Payer: Health EOS Commercial |
$3,198.87
|
| Rate for Payer: HFN Commercial |
$3,306.70
|
| Rate for Payer: Multiplan Commercial |
$2,875.39
|
| Rate for Payer: Preferred Network Access Commercial |
$3,306.70
|
| Rate for Payer: Quartz Beloit One Network |
$1,761.18
|
| Rate for Payer: Quartz Commercial |
$2,156.54
|
| Rate for Payer: WEA Trust Commercial |
$1,976.83
|
| Rate for Payer: WPS Commercial |
$2,662.16
|
|
|
VL Echo 2D w M Mode w Doppler w/ Con
|
Professional
|
Both
|
$3,456.00
|
|
|
Service Code
|
CPT 93306 TC
|
| Hospital Charge Code |
4628608
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$128.11 |
| Max. Negotiated Rate |
$3,414.53 |
| Rate for Payer: Aetna Commercial |
$3,414.53
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,091.05
|
| Rate for Payer: Aetna Managed Medicare |
$128.11
|
| Rate for Payer: Anthem Medicare Advantage |
$128.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$128.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$128.11
|
| Rate for Payer: Cash Price |
$1,036.80
|
| Rate for Payer: Cash Price |
$1,036.80
|
| Rate for Payer: Cash Price |
$1,036.80
|
| Rate for Payer: Cigna Commercial |
$3,414.53
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$163.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$128.11
|
| Rate for Payer: Health EOS Commercial |
$3,270.76
|
| Rate for Payer: HFN Commercial |
$3,414.53
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$472.60
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$472.60
|
| Rate for Payer: Independent Care Health Plan Medicare |
$128.11
|
| Rate for Payer: Multiplan Commercial |
$2,875.39
|
| Rate for Payer: NAPHCARE Commercial |
$192.16
|
| Rate for Payer: Preferred Network Access Commercial |
$3,414.53
|
| Rate for Payer: Quartz Beloit One Network |
$1,581.47
|
| Rate for Payer: Quartz Commercial |
$2,048.72
|
| Rate for Payer: Quartz Medicare Advantage |
$128.11
|
| Rate for Payer: The Alliance Commercial |
$486.81
|
| Rate for Payer: United Healthcare Medicaid |
$163.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$128.11
|
| Rate for Payer: WEA Trust Commercial |
$1,976.83
|
| Rate for Payer: WPS Commercial |
$512.43
|
|
|
VL Echo 2D w M Mode w Doppler w/ Con
|
Facility
|
OP
|
$3,456.00
|
|
|
Service Code
|
CPT 93306 TC
|
| Hospital Charge Code |
4628608
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$512.43 |
| Max. Negotiated Rate |
$3,306.70 |
| Rate for Payer: Aetna Commercial |
$3,234.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,091.05
|
| Rate for Payer: Aetna Managed Medicare |
$1,006.39
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,336.26
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,797.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,725.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,904.95
|
| Rate for Payer: Cash Price |
$1,036.80
|
| Rate for Payer: Cash Price |
$1,036.80
|
| Rate for Payer: Cigna Commercial |
$3,306.70
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,011.39
|
| Rate for Payer: Health EOS Commercial |
$3,198.87
|
| Rate for Payer: HFN Commercial |
$3,306.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,695.68
|
| Rate for Payer: Multiplan Commercial |
$2,875.39
|
| Rate for Payer: NAPHCARE Commercial |
$2,156.54
|
| Rate for Payer: Preferred Network Access Commercial |
$3,306.70
|
| Rate for Payer: Quartz Beloit One Network |
$1,761.18
|
| Rate for Payer: Quartz Commercial |
$2,336.26
|
| Rate for Payer: Quartz Medicare Advantage |
$2,156.54
|
| Rate for Payer: The Alliance Commercial |
$512.43
|
| Rate for Payer: United Healthcare PPO |
$2,695.68
|
| Rate for Payer: WEA Trust Commercial |
$1,976.83
|
| Rate for Payer: WPS Commercial |
$2,662.16
|
|
|
VL Echo Color Flow Velocity Mapping
|
Facility
|
OP
|
$842.00
|
|
|
Service Code
|
CPT 93325 TC
|
| Hospital Charge Code |
1482976
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$81.20 |
| Max. Negotiated Rate |
$805.63 |
| Rate for Payer: Aetna Commercial |
$788.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$753.08
|
| Rate for Payer: Aetna Managed Medicare |
$245.19
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$569.19
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$437.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$420.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$464.11
|
| Rate for Payer: Cash Price |
$252.60
|
| Rate for Payer: Cash Price |
$252.60
|
| Rate for Payer: Cigna Commercial |
$805.63
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$490.04
|
| Rate for Payer: Health EOS Commercial |
$779.36
|
| Rate for Payer: HFN Commercial |
$805.63
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$656.76
|
| Rate for Payer: Multiplan Commercial |
$700.54
|
| Rate for Payer: NAPHCARE Commercial |
$525.41
|
| Rate for Payer: Preferred Network Access Commercial |
$805.63
|
| Rate for Payer: Quartz Beloit One Network |
$429.08
|
| Rate for Payer: Quartz Commercial |
$569.19
|
| Rate for Payer: Quartz Medicare Advantage |
$525.41
|
| Rate for Payer: The Alliance Commercial |
$81.20
|
| Rate for Payer: United Healthcare PPO |
$656.76
|
| Rate for Payer: WEA Trust Commercial |
$481.62
|
| Rate for Payer: WPS Commercial |
$648.59
|
|
|
VL Echo Color Flow Velocity Mapping
|
Facility
|
IP
|
$842.00
|
|
|
Service Code
|
CPT 93325 TC
|
| Hospital Charge Code |
1482976
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$429.08 |
| Max. Negotiated Rate |
$805.63 |
| Rate for Payer: Aetna Commercial |
$788.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$753.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$464.11
|
| Rate for Payer: Cash Price |
$252.60
|
| Rate for Payer: Cigna Commercial |
$805.63
|
| Rate for Payer: Health EOS Commercial |
$779.36
|
| Rate for Payer: HFN Commercial |
$805.63
|
| Rate for Payer: Multiplan Commercial |
$700.54
|
| Rate for Payer: Preferred Network Access Commercial |
$805.63
|
| Rate for Payer: Quartz Beloit One Network |
$429.08
|
| Rate for Payer: Quartz Commercial |
$525.41
|
| Rate for Payer: WEA Trust Commercial |
$481.62
|
| Rate for Payer: WPS Commercial |
$648.59
|
|
|
VL Echo Color Flow Velocity Mapping
|
Professional
|
Both
|
$842.00
|
|
|
Service Code
|
CPT 93325 TC
|
| Hospital Charge Code |
1482976
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$20.30 |
| Max. Negotiated Rate |
$831.90 |
| Rate for Payer: Aetna Commercial |
$831.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$753.08
|
| Rate for Payer: Aetna Managed Medicare |
$20.30
|
| Rate for Payer: Anthem Medicare Advantage |
$20.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$20.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$20.30
|
| Rate for Payer: Cash Price |
$252.60
|
| Rate for Payer: Cash Price |
$252.60
|
| Rate for Payer: Cash Price |
$252.60
|
| Rate for Payer: Cigna Commercial |
$831.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$43.98
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$20.30
|
| Rate for Payer: Health EOS Commercial |
$796.87
|
| Rate for Payer: HFN Commercial |
$831.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$77.24
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$77.24
|
| Rate for Payer: Independent Care Health Plan Medicare |
$20.30
|
| Rate for Payer: Multiplan Commercial |
$700.54
|
| Rate for Payer: NAPHCARE Commercial |
$30.45
|
| Rate for Payer: Preferred Network Access Commercial |
$831.90
|
| Rate for Payer: Quartz Beloit One Network |
$385.30
|
| Rate for Payer: Quartz Commercial |
$499.14
|
| Rate for Payer: Quartz Medicare Advantage |
$20.30
|
| Rate for Payer: The Alliance Commercial |
$77.14
|
| Rate for Payer: United Healthcare Medicaid |
$43.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20.30
|
| Rate for Payer: WEA Trust Commercial |
$481.62
|
| Rate for Payer: WPS Commercial |
$81.20
|
|
|
VL Echo Congenital Complete
|
Facility
|
OP
|
$2,786.00
|
|
|
Service Code
|
CPT 93303 TC
|
| Hospital Charge Code |
1482802
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$636.23 |
| Max. Negotiated Rate |
$2,665.64 |
| Rate for Payer: Aetna Commercial |
$2,607.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,491.80
|
| Rate for Payer: Aetna Managed Medicare |
$811.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,883.34
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,448.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,390.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,535.64
|
| Rate for Payer: Cash Price |
$835.80
|
| Rate for Payer: Cash Price |
$835.80
|
| Rate for Payer: Cigna Commercial |
$2,665.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,621.45
|
| Rate for Payer: Health EOS Commercial |
$2,578.72
|
| Rate for Payer: HFN Commercial |
$2,665.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,173.08
|
| Rate for Payer: Multiplan Commercial |
$2,317.95
|
| Rate for Payer: NAPHCARE Commercial |
$1,738.46
|
| Rate for Payer: Preferred Network Access Commercial |
$2,665.64
|
| Rate for Payer: Quartz Beloit One Network |
$1,419.75
|
| Rate for Payer: Quartz Commercial |
$1,883.34
|
| Rate for Payer: Quartz Medicare Advantage |
$1,738.46
|
| Rate for Payer: The Alliance Commercial |
$636.23
|
| Rate for Payer: United Healthcare PPO |
$2,173.08
|
| Rate for Payer: WEA Trust Commercial |
$1,593.59
|
| Rate for Payer: WPS Commercial |
$2,146.06
|
|
|
VL Echo Congenital Complete
|
Professional
|
Both
|
$2,786.00
|
|
|
Service Code
|
CPT 93303 TC
|
| Hospital Charge Code |
1482802
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$138.60 |
| Max. Negotiated Rate |
$2,752.57 |
| Rate for Payer: Aetna Commercial |
$2,752.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,491.80
|
| Rate for Payer: Aetna Managed Medicare |
$159.06
|
| Rate for Payer: Anthem Medicare Advantage |
$159.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$159.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$159.06
|
| Rate for Payer: Cash Price |
$835.80
|
| Rate for Payer: Cash Price |
$835.80
|
| Rate for Payer: Cash Price |
$835.80
|
| Rate for Payer: Cigna Commercial |
$2,752.57
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$138.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$159.06
|
| Rate for Payer: Health EOS Commercial |
$2,636.67
|
| Rate for Payer: HFN Commercial |
$2,752.57
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$604.14
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$604.14
|
| Rate for Payer: Independent Care Health Plan Medicare |
$159.06
|
| Rate for Payer: Multiplan Commercial |
$2,317.95
|
| Rate for Payer: NAPHCARE Commercial |
$238.59
|
| Rate for Payer: Preferred Network Access Commercial |
$2,752.57
|
| Rate for Payer: Quartz Beloit One Network |
$1,274.87
|
| Rate for Payer: Quartz Commercial |
$1,651.54
|
| Rate for Payer: Quartz Medicare Advantage |
$159.06
|
| Rate for Payer: The Alliance Commercial |
$604.42
|
| Rate for Payer: United Healthcare Medicaid |
$138.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$159.06
|
| Rate for Payer: WEA Trust Commercial |
$1,593.59
|
| Rate for Payer: WPS Commercial |
$636.23
|
|
|
VL Echo Congenital Complete
|
Facility
|
IP
|
$2,786.00
|
|
|
Service Code
|
CPT 93303 TC
|
| Hospital Charge Code |
1482802
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$1,419.75 |
| Max. Negotiated Rate |
$2,665.64 |
| Rate for Payer: Aetna Commercial |
$2,607.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,491.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,535.64
|
| Rate for Payer: Cash Price |
$835.80
|
| Rate for Payer: Cigna Commercial |
$2,665.64
|
| Rate for Payer: Health EOS Commercial |
$2,578.72
|
| Rate for Payer: HFN Commercial |
$2,665.64
|
| Rate for Payer: Multiplan Commercial |
$2,317.95
|
| Rate for Payer: Preferred Network Access Commercial |
$2,665.64
|
| Rate for Payer: Quartz Beloit One Network |
$1,419.75
|
| Rate for Payer: Quartz Commercial |
$1,738.46
|
| Rate for Payer: WEA Trust Commercial |
$1,593.59
|
| Rate for Payer: WPS Commercial |
$2,146.06
|
|
|
VL Echo Congenital Limited
|
Facility
|
OP
|
$1,819.00
|
|
|
Service Code
|
CPT 93304 TC
|
| Hospital Charge Code |
1482979
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$472.08 |
| Max. Negotiated Rate |
$1,740.42 |
| Rate for Payer: Aetna Commercial |
$1,702.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,626.91
|
| Rate for Payer: Aetna Managed Medicare |
$529.69
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,229.64
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$945.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$908.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,002.63
|
| Rate for Payer: Cash Price |
$545.70
|
| Rate for Payer: Cash Price |
$545.70
|
| Rate for Payer: Cigna Commercial |
$1,740.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,058.66
|
| Rate for Payer: Health EOS Commercial |
$1,683.67
|
| Rate for Payer: HFN Commercial |
$1,740.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,418.82
|
| Rate for Payer: Multiplan Commercial |
$1,513.41
|
| Rate for Payer: NAPHCARE Commercial |
$1,135.06
|
| Rate for Payer: Preferred Network Access Commercial |
$1,740.42
|
| Rate for Payer: Quartz Beloit One Network |
$926.96
|
| Rate for Payer: Quartz Commercial |
$1,229.64
|
| Rate for Payer: Quartz Medicare Advantage |
$1,135.06
|
| Rate for Payer: The Alliance Commercial |
$472.08
|
| Rate for Payer: United Healthcare PPO |
$1,418.82
|
| Rate for Payer: WEA Trust Commercial |
$1,040.47
|
| Rate for Payer: WPS Commercial |
$1,401.18
|
|
|
VL Echo Congenital Limited
|
Facility
|
IP
|
$1,819.00
|
|
|
Service Code
|
CPT 93304 TC
|
| Hospital Charge Code |
1482979
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$926.96 |
| Max. Negotiated Rate |
$1,740.42 |
| Rate for Payer: Aetna Commercial |
$1,702.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,626.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,002.63
|
| Rate for Payer: Cash Price |
$545.70
|
| Rate for Payer: Cigna Commercial |
$1,740.42
|
| Rate for Payer: Health EOS Commercial |
$1,683.67
|
| Rate for Payer: HFN Commercial |
$1,740.42
|
| Rate for Payer: Multiplan Commercial |
$1,513.41
|
| Rate for Payer: Preferred Network Access Commercial |
$1,740.42
|
| Rate for Payer: Quartz Beloit One Network |
$926.96
|
| Rate for Payer: Quartz Commercial |
$1,135.06
|
| Rate for Payer: WEA Trust Commercial |
$1,040.47
|
| Rate for Payer: WPS Commercial |
$1,401.18
|
|
|
VL Echo Congenital Limited
|
Professional
|
Both
|
$1,819.00
|
|
|
Service Code
|
CPT 93304 TC
|
| Hospital Charge Code |
1482979
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$75.46 |
| Max. Negotiated Rate |
$1,797.17 |
| Rate for Payer: Aetna Commercial |
$1,797.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,626.91
|
| 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 |
$545.70
|
| Rate for Payer: Cash Price |
$545.70
|
| Rate for Payer: Cash Price |
$545.70
|
| Rate for Payer: Cigna Commercial |
$1,797.17
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$75.46
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$118.02
|
| Rate for Payer: Health EOS Commercial |
$1,721.50
|
| Rate for Payer: HFN Commercial |
$1,797.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$447.22
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$447.22
|
| Rate for Payer: Independent Care Health Plan Medicare |
$118.02
|
| Rate for Payer: Multiplan Commercial |
$1,513.41
|
| Rate for Payer: NAPHCARE Commercial |
$177.03
|
| Rate for Payer: Preferred Network Access Commercial |
$1,797.17
|
| Rate for Payer: Quartz Beloit One Network |
$832.37
|
| Rate for Payer: Quartz Commercial |
$1,078.30
|
| Rate for Payer: Quartz Medicare Advantage |
$118.02
|
| Rate for Payer: The Alliance Commercial |
$448.47
|
| Rate for Payer: United Healthcare Medicaid |
$75.46
|
| Rate for Payer: United Healthcare Medicare Advantage |
$118.02
|
| Rate for Payer: WEA Trust Commercial |
$1,040.47
|
| Rate for Payer: WPS Commercial |
$472.08
|
|
|
VL Echo Doppler
|
Facility
|
OP
|
$905.00
|
|
|
Service Code
|
CPT 93320 TC
|
| Hospital Charge Code |
1482982
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$134.87 |
| Max. Negotiated Rate |
$865.90 |
| Rate for Payer: Aetna Commercial |
$847.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$809.43
|
| Rate for Payer: Aetna Managed Medicare |
$263.54
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$611.78
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$470.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$451.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$498.84
|
| Rate for Payer: Cash Price |
$271.50
|
| Rate for Payer: Cash Price |
$271.50
|
| Rate for Payer: Cigna Commercial |
$865.90
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$526.71
|
| Rate for Payer: Health EOS Commercial |
$837.67
|
| Rate for Payer: HFN Commercial |
$865.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$705.90
|
| Rate for Payer: Multiplan Commercial |
$752.96
|
| Rate for Payer: NAPHCARE Commercial |
$564.72
|
| Rate for Payer: Preferred Network Access Commercial |
$865.90
|
| Rate for Payer: Quartz Beloit One Network |
$461.19
|
| Rate for Payer: Quartz Commercial |
$611.78
|
| Rate for Payer: Quartz Medicare Advantage |
$564.72
|
| Rate for Payer: The Alliance Commercial |
$134.87
|
| Rate for Payer: United Healthcare PPO |
$705.90
|
| Rate for Payer: WEA Trust Commercial |
$517.66
|
| Rate for Payer: WPS Commercial |
$697.12
|
|
|
VL Echo Doppler
|
Facility
|
IP
|
$905.00
|
|
|
Service Code
|
CPT 93320 TC
|
| Hospital Charge Code |
1482982
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$461.19 |
| Max. Negotiated Rate |
$865.90 |
| Rate for Payer: Aetna Commercial |
$847.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$809.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$498.84
|
| Rate for Payer: Cash Price |
$271.50
|
| Rate for Payer: Cigna Commercial |
$865.90
|
| Rate for Payer: Health EOS Commercial |
$837.67
|
| Rate for Payer: HFN Commercial |
$865.90
|
| Rate for Payer: Multiplan Commercial |
$752.96
|
| Rate for Payer: Preferred Network Access Commercial |
$865.90
|
| Rate for Payer: Quartz Beloit One Network |
$461.19
|
| Rate for Payer: Quartz Commercial |
$564.72
|
| Rate for Payer: WEA Trust Commercial |
$517.66
|
| Rate for Payer: WPS Commercial |
$697.12
|
|
|
VL Echo Doppler
|
Professional
|
Both
|
$905.00
|
|
|
Service Code
|
CPT 93320 TC
|
| Hospital Charge Code |
1482982
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$33.72 |
| Max. Negotiated Rate |
$894.14 |
| Rate for Payer: Aetna Commercial |
$894.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$809.43
|
| Rate for Payer: Aetna Managed Medicare |
$33.72
|
| Rate for Payer: Anthem Medicare Advantage |
$33.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$33.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$33.72
|
| Rate for Payer: Cash Price |
$271.50
|
| Rate for Payer: Cash Price |
$271.50
|
| Rate for Payer: Cash Price |
$271.50
|
| Rate for Payer: Cigna Commercial |
$894.14
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$66.75
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$33.72
|
| Rate for Payer: Health EOS Commercial |
$856.49
|
| Rate for Payer: HFN Commercial |
$894.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$124.63
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$124.63
|
| Rate for Payer: Independent Care Health Plan Medicare |
$33.72
|
| Rate for Payer: Multiplan Commercial |
$752.96
|
| Rate for Payer: NAPHCARE Commercial |
$50.58
|
| Rate for Payer: Preferred Network Access Commercial |
$894.14
|
| Rate for Payer: Quartz Beloit One Network |
$414.13
|
| Rate for Payer: Quartz Commercial |
$536.48
|
| Rate for Payer: Quartz Medicare Advantage |
$33.72
|
| Rate for Payer: The Alliance Commercial |
$128.12
|
| Rate for Payer: United Healthcare Medicaid |
$66.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$33.72
|
| Rate for Payer: WEA Trust Commercial |
$517.66
|
| Rate for Payer: WPS Commercial |
$134.87
|
|
|
VL Echo During Therap/Diag Intervention
|
Professional
|
Both
|
$1,753.00
|
|
|
Service Code
|
CPT 93662 TC
|
| Hospital Charge Code |
2944148
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$802.17 |
| Max. Negotiated Rate |
$1,731.96 |
| Rate for Payer: Aetna Commercial |
$1,731.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,567.88
|
| Rate for Payer: Cash Price |
$525.90
|
| Rate for Payer: Cash Price |
$525.90
|
| Rate for Payer: Cash Price |
$525.90
|
| Rate for Payer: Cigna Commercial |
$1,731.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$911.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,093.87
|
| Rate for Payer: Health EOS Commercial |
$1,659.04
|
| Rate for Payer: HFN Commercial |
$1,731.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$843.39
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$843.39
|
| Rate for Payer: Multiplan Commercial |
$1,458.50
|
| Rate for Payer: Preferred Network Access Commercial |
$1,731.96
|
| Rate for Payer: Quartz Beloit One Network |
$802.17
|
| Rate for Payer: Quartz Commercial |
$1,039.18
|
| Rate for Payer: The Alliance Commercial |
$911.56
|
| Rate for Payer: WEA Trust Commercial |
$1,002.72
|
| Rate for Payer: WPS Commercial |
$1,350.34
|
|
|
VL Echo During Therap/Diag Intervention
|
Facility
|
IP
|
$1,753.00
|
|
|
Service Code
|
CPT 93662 TC
|
| Hospital Charge Code |
2944148
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$893.33 |
| Max. Negotiated Rate |
$1,677.27 |
| Rate for Payer: Aetna Commercial |
$1,640.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,567.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$966.25
|
| Rate for Payer: Cash Price |
$525.90
|
| Rate for Payer: Cigna Commercial |
$1,677.27
|
| Rate for Payer: Health EOS Commercial |
$1,622.58
|
| Rate for Payer: HFN Commercial |
$1,677.27
|
| Rate for Payer: Multiplan Commercial |
$1,458.50
|
| Rate for Payer: Preferred Network Access Commercial |
$1,677.27
|
| Rate for Payer: Quartz Beloit One Network |
$893.33
|
| Rate for Payer: Quartz Commercial |
$1,093.87
|
| Rate for Payer: WEA Trust Commercial |
$1,002.72
|
| Rate for Payer: WPS Commercial |
$1,350.34
|
|
|
VL Echo During Therap/Diag Intervention
|
Facility
|
OP
|
$1,753.00
|
|
|
Service Code
|
CPT 93662 TC
|
| Hospital Charge Code |
2944148
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$510.47 |
| Max. Negotiated Rate |
$1,677.27 |
| Rate for Payer: Aetna Commercial |
$1,640.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,567.88
|
| Rate for Payer: Aetna Managed Medicare |
$510.47
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,185.03
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$911.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$875.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$966.25
|
| Rate for Payer: Cash Price |
$525.90
|
| Rate for Payer: Cigna Commercial |
$1,677.27
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,020.25
|
| Rate for Payer: Health EOS Commercial |
$1,622.58
|
| Rate for Payer: HFN Commercial |
$1,677.27
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,367.34
|
| Rate for Payer: Multiplan Commercial |
$1,458.50
|
| Rate for Payer: NAPHCARE Commercial |
$1,093.87
|
| Rate for Payer: Preferred Network Access Commercial |
$1,677.27
|
| Rate for Payer: Quartz Beloit One Network |
$893.33
|
| Rate for Payer: Quartz Commercial |
$1,185.03
|
| Rate for Payer: Quartz Medicare Advantage |
$1,093.87
|
| Rate for Payer: The Alliance Commercial |
$911.56
|
| Rate for Payer: United Healthcare PPO |
$1,367.34
|
| Rate for Payer: WEA Trust Commercial |
$1,002.72
|
| Rate for Payer: WPS Commercial |
$1,350.34
|
|
|
VL Echo Limited
|
Professional
|
Both
|
$1,524.00
|
|
|
Service Code
|
CPT 93308 TC
|
| Hospital Charge Code |
1482988
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$75.46 |
| Max. Negotiated Rate |
$1,505.71 |
| Rate for Payer: Aetna Commercial |
$1,505.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,363.07
|
| Rate for Payer: Aetna Managed Medicare |
$75.75
|
| Rate for Payer: Anthem Medicare Advantage |
$75.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$75.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$75.75
|
| Rate for Payer: Cash Price |
$457.20
|
| Rate for Payer: Cash Price |
$457.20
|
| Rate for Payer: Cash Price |
$457.20
|
| Rate for Payer: Cigna Commercial |
$1,505.71
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$75.46
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$75.75
|
| Rate for Payer: Health EOS Commercial |
$1,442.31
|
| Rate for Payer: HFN Commercial |
$1,505.71
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$267.04
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$267.04
|
| Rate for Payer: Independent Care Health Plan Medicare |
$75.75
|
| Rate for Payer: Multiplan Commercial |
$1,267.97
|
| Rate for Payer: NAPHCARE Commercial |
$113.63
|
| Rate for Payer: Preferred Network Access Commercial |
$1,505.71
|
| Rate for Payer: Quartz Beloit One Network |
$697.38
|
| Rate for Payer: Quartz Commercial |
$903.43
|
| Rate for Payer: Quartz Medicare Advantage |
$75.75
|
| Rate for Payer: The Alliance Commercial |
$287.86
|
| Rate for Payer: United Healthcare Medicaid |
$75.46
|
| Rate for Payer: United Healthcare Medicare Advantage |
$75.75
|
| Rate for Payer: WEA Trust Commercial |
$871.73
|
| Rate for Payer: WPS Commercial |
$303.01
|
|
|
VL Echo Limited
|
Facility
|
OP
|
$1,524.00
|
|
|
Service Code
|
CPT 93308 TC
|
| Hospital Charge Code |
1482988
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$303.01 |
| Max. Negotiated Rate |
$1,458.16 |
| Rate for Payer: Aetna Commercial |
$1,426.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,363.07
|
| Rate for Payer: Aetna Managed Medicare |
$443.79
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,030.22
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$792.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$760.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$840.03
|
| Rate for Payer: Cash Price |
$457.20
|
| Rate for Payer: Cash Price |
$457.20
|
| Rate for Payer: Cigna Commercial |
$1,458.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$886.97
|
| Rate for Payer: Health EOS Commercial |
$1,410.61
|
| Rate for Payer: HFN Commercial |
$1,458.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,188.72
|
| Rate for Payer: Multiplan Commercial |
$1,267.97
|
| Rate for Payer: NAPHCARE Commercial |
$950.98
|
| Rate for Payer: Preferred Network Access Commercial |
$1,458.16
|
| Rate for Payer: Quartz Beloit One Network |
$776.63
|
| Rate for Payer: Quartz Commercial |
$1,030.22
|
| Rate for Payer: Quartz Medicare Advantage |
$950.98
|
| Rate for Payer: The Alliance Commercial |
$303.01
|
| Rate for Payer: United Healthcare PPO |
$1,188.72
|
| Rate for Payer: WEA Trust Commercial |
$871.73
|
| Rate for Payer: WPS Commercial |
$1,173.94
|
|
|
VL Echo Limited
|
Facility
|
IP
|
$1,524.00
|
|
|
Service Code
|
CPT 93308 TC
|
| Hospital Charge Code |
1482988
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$776.63 |
| Max. Negotiated Rate |
$1,458.16 |
| Rate for Payer: Aetna Commercial |
$1,426.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,363.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$840.03
|
| Rate for Payer: Cash Price |
$457.20
|
| Rate for Payer: Cigna Commercial |
$1,458.16
|
| Rate for Payer: Health EOS Commercial |
$1,410.61
|
| Rate for Payer: HFN Commercial |
$1,458.16
|
| Rate for Payer: Multiplan Commercial |
$1,267.97
|
| Rate for Payer: Preferred Network Access Commercial |
$1,458.16
|
| Rate for Payer: Quartz Beloit One Network |
$776.63
|
| Rate for Payer: Quartz Commercial |
$950.98
|
| Rate for Payer: WEA Trust Commercial |
$871.73
|
| Rate for Payer: WPS Commercial |
$1,173.94
|
|
