|
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 |
$3.43 |
| Max. Negotiated Rate |
$6.44 |
| Rate for Payer: Aetna Commercial |
$6.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3.71
|
| Rate for Payer: Cash Price |
$2.10
|
| Rate for Payer: Cigna Commercial |
$6.44
|
| Rate for Payer: Health EOS Commercial |
$6.23
|
| Rate for Payer: HFN Commercial |
$6.44
|
| Rate for Payer: Multiplan Commercial |
$5.60
|
| Rate for Payer: NAPHCARE Commercial |
$4.20
|
| Rate for Payer: Preferred Network Access Commercial |
$6.44
|
| Rate for Payer: Quartz Beloit One Network |
$3.43
|
| Rate for Payer: Quartz Commercial |
$4.20
|
| Rate for Payer: WEA Trust Commercial |
$3.85
|
| Rate for Payer: WPS Commercial |
$5.18
|
|
|
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 |
$2.80 |
| Max. Negotiated Rate |
$7.01 |
| Rate for Payer: Aetna Commercial |
$6.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6.02
|
| Rate for Payer: Cash Price |
$2.10
|
| Rate for Payer: Cash Price |
$2.10
|
| Rate for Payer: Cigna Commercial |
$6.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2.80
|
| Rate for Payer: Health EOS Commercial |
$6.37
|
| Rate for Payer: HFN Commercial |
$6.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5.46
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5.46
|
| Rate for Payer: Multiplan Commercial |
$5.60
|
| Rate for Payer: Preferred Network Access Commercial |
$6.65
|
| Rate for Payer: Quartz Beloit One Network |
$3.08
|
| Rate for Payer: Quartz Commercial |
$3.99
|
| Rate for Payer: The Alliance Commercial |
$3.50
|
| Rate for Payer: United Healthcare Medicaid |
$2.80
|
| Rate for Payer: WEA Trust Commercial |
$3.85
|
| Rate for Payer: WPS Commercial |
$7.01
|
|
|
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 |
$1.96 |
| Max. Negotiated Rate |
$28.00 |
| Rate for Payer: Aetna Commercial |
$6.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6.02
|
| Rate for Payer: Aetna Managed Medicare |
$1.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3.71
|
| Rate for Payer: Cash Price |
$2.10
|
| Rate for Payer: Cash Price |
$2.10
|
| Rate for Payer: Cigna Commercial |
$6.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3.71
|
| Rate for Payer: Health EOS Commercial |
$6.23
|
| Rate for Payer: HFN Commercial |
$6.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5.25
|
| Rate for Payer: Multiplan Commercial |
$5.60
|
| Rate for Payer: NAPHCARE Commercial |
$4.20
|
| Rate for Payer: Preferred Network Access Commercial |
$6.44
|
| Rate for Payer: Quartz Beloit One Network |
$3.43
|
| Rate for Payer: Quartz Commercial |
$4.55
|
| Rate for Payer: Quartz Medicare Advantage |
$4.20
|
| Rate for Payer: The Alliance Commercial |
$28.00
|
| Rate for Payer: WEA Trust Commercial |
$3.85
|
| Rate for Payer: WPS Commercial |
$7.01
|
|
|
VITRECTOMY
|
Facility
|
IP
|
$5,660.00
|
|
| Hospital Charge Code |
2960505
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,773.40 |
| Max. Negotiated Rate |
$5,207.20 |
| Rate for Payer: Aetna Commercial |
$5,094.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,867.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,999.80
|
| Rate for Payer: Cash Price |
$1,698.00
|
| Rate for Payer: Cigna Commercial |
$5,207.20
|
| Rate for Payer: Health EOS Commercial |
$5,037.40
|
| Rate for Payer: HFN Commercial |
$5,207.20
|
| Rate for Payer: Multiplan Commercial |
$4,528.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,396.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,207.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,773.40
|
| Rate for Payer: Quartz Commercial |
$3,396.00
|
| Rate for Payer: WEA Trust Commercial |
$3,113.00
|
| Rate for Payer: WPS Commercial |
$4,192.36
|
|
|
VITRECTOMY
|
Facility
|
OP
|
$5,660.00
|
|
| Hospital Charge Code |
2960505
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,584.80 |
| Max. Negotiated Rate |
$22,640.00 |
| Rate for Payer: Aetna Commercial |
$5,094.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,867.60
|
| Rate for Payer: Aetna Managed Medicare |
$1,584.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,679.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,830.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,716.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,999.80
|
| Rate for Payer: Cash Price |
$1,698.00
|
| Rate for Payer: Cigna Commercial |
$5,207.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,167.34
|
| Rate for Payer: Health EOS Commercial |
$5,037.40
|
| Rate for Payer: HFN Commercial |
$5,207.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,245.00
|
| Rate for Payer: Multiplan Commercial |
$4,528.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,396.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,207.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,773.40
|
| Rate for Payer: Quartz Commercial |
$3,679.00
|
| Rate for Payer: Quartz Medicare Advantage |
$3,396.00
|
| Rate for Payer: The Alliance Commercial |
$22,640.00
|
| Rate for Payer: WEA Trust Commercial |
$3,113.00
|
| Rate for Payer: WPS Commercial |
$4,192.36
|
|
|
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 |
$229.24 |
| Max. Negotiated Rate |
$494.95 |
| Rate for Payer: Aetna Commercial |
$494.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$448.06
|
| Rate for Payer: Cash Price |
$156.30
|
| Rate for Payer: Cash Price |
$156.30
|
| Rate for Payer: Cigna Commercial |
$494.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$260.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$312.60
|
| Rate for Payer: Health EOS Commercial |
$474.11
|
| Rate for Payer: HFN Commercial |
$494.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$246.32
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$246.32
|
| Rate for Payer: Multiplan Commercial |
$416.80
|
| Rate for Payer: Preferred Network Access Commercial |
$494.95
|
| Rate for Payer: Quartz Beloit One Network |
$229.24
|
| Rate for Payer: Quartz Commercial |
$296.97
|
| Rate for Payer: The Alliance Commercial |
$260.50
|
| Rate for Payer: WEA Trust Commercial |
$286.55
|
| Rate for Payer: WPS Commercial |
$385.90
|
|
|
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 |
$255.29 |
| Max. Negotiated Rate |
$479.32 |
| Rate for Payer: Aetna Commercial |
$468.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$448.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$276.13
|
| Rate for Payer: Cash Price |
$156.30
|
| Rate for Payer: Cigna Commercial |
$479.32
|
| Rate for Payer: Health EOS Commercial |
$463.69
|
| Rate for Payer: HFN Commercial |
$479.32
|
| Rate for Payer: Multiplan Commercial |
$416.80
|
| Rate for Payer: NAPHCARE Commercial |
$312.60
|
| Rate for Payer: Preferred Network Access Commercial |
$479.32
|
| Rate for Payer: Quartz Beloit One Network |
$255.29
|
| Rate for Payer: Quartz Commercial |
$312.60
|
| Rate for Payer: WEA Trust Commercial |
$286.55
|
| Rate for Payer: WPS Commercial |
$385.90
|
|
|
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 |
$145.88 |
| Max. Negotiated Rate |
$2,084.00 |
| Rate for Payer: Aetna Commercial |
$468.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$448.06
|
| Rate for Payer: Aetna Managed Medicare |
$145.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$338.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$260.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$250.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$276.13
|
| Rate for Payer: Cash Price |
$156.30
|
| Rate for Payer: Cigna Commercial |
$479.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$291.55
|
| Rate for Payer: Health EOS Commercial |
$463.69
|
| Rate for Payer: HFN Commercial |
$479.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$390.75
|
| Rate for Payer: Multiplan Commercial |
$416.80
|
| Rate for Payer: NAPHCARE Commercial |
$312.60
|
| Rate for Payer: Preferred Network Access Commercial |
$479.32
|
| Rate for Payer: Quartz Beloit One Network |
$255.29
|
| Rate for Payer: Quartz Commercial |
$338.65
|
| Rate for Payer: Quartz Medicare Advantage |
$312.60
|
| Rate for Payer: The Alliance Commercial |
$2,084.00
|
| Rate for Payer: United Healthcare PPO |
$390.75
|
| Rate for Payer: WEA Trust Commercial |
$286.55
|
| Rate for Payer: WPS Commercial |
$385.90
|
|
|
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 |
$877.59 |
| Max. Negotiated Rate |
$1,647.72 |
| Rate for Payer: Aetna Commercial |
$1,611.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,540.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$949.23
|
| Rate for Payer: Cash Price |
$537.30
|
| Rate for Payer: Cigna Commercial |
$1,647.72
|
| Rate for Payer: Health EOS Commercial |
$1,593.99
|
| Rate for Payer: HFN Commercial |
$1,647.72
|
| Rate for Payer: Multiplan Commercial |
$1,432.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,074.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,647.72
|
| Rate for Payer: Quartz Beloit One Network |
$877.59
|
| Rate for Payer: Quartz Commercial |
$1,074.60
|
| Rate for Payer: WEA Trust Commercial |
$985.05
|
| Rate for Payer: WPS Commercial |
$1,326.59
|
|
|
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 |
$547.22 |
| Max. Negotiated Rate |
$1,701.45 |
| Rate for Payer: Aetna Commercial |
$1,701.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,540.26
|
| Rate for Payer: Cash Price |
$537.30
|
| Rate for Payer: Cash Price |
$537.30
|
| Rate for Payer: Cigna Commercial |
$1,701.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$895.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,074.60
|
| Rate for Payer: Health EOS Commercial |
$1,629.81
|
| Rate for Payer: HFN Commercial |
$1,701.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$547.22
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$547.22
|
| Rate for Payer: Multiplan Commercial |
$1,432.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,701.45
|
| Rate for Payer: Quartz Beloit One Network |
$788.04
|
| Rate for Payer: Quartz Commercial |
$1,020.87
|
| Rate for Payer: The Alliance Commercial |
$895.50
|
| Rate for Payer: WEA Trust Commercial |
$985.05
|
| Rate for Payer: WPS Commercial |
$1,326.59
|
|
|
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 |
$501.48 |
| Max. Negotiated Rate |
$7,164.00 |
| Rate for Payer: Aetna Commercial |
$1,611.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,540.26
|
| Rate for Payer: Aetna Managed Medicare |
$501.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,164.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$895.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$859.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$949.23
|
| Rate for Payer: Cash Price |
$537.30
|
| Rate for Payer: Cigna Commercial |
$1,647.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,002.24
|
| Rate for Payer: Health EOS Commercial |
$1,593.99
|
| Rate for Payer: HFN Commercial |
$1,647.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,343.25
|
| Rate for Payer: Multiplan Commercial |
$1,432.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,074.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,647.72
|
| Rate for Payer: Quartz Beloit One Network |
$877.59
|
| Rate for Payer: Quartz Commercial |
$1,164.15
|
| Rate for Payer: Quartz Medicare Advantage |
$1,074.60
|
| Rate for Payer: The Alliance Commercial |
$7,164.00
|
| Rate for Payer: United Healthcare PPO |
$1,343.25
|
| Rate for Payer: WEA Trust Commercial |
$985.05
|
| Rate for Payer: WPS Commercial |
$1,326.59
|
|
|
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 |
$325.16 |
| Max. Negotiated Rate |
$702.05 |
| Rate for Payer: Aetna Commercial |
$702.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$635.54
|
| Rate for Payer: Cash Price |
$221.70
|
| Rate for Payer: Cash Price |
$221.70
|
| Rate for Payer: Cigna Commercial |
$702.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$369.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$443.40
|
| Rate for Payer: Health EOS Commercial |
$672.49
|
| Rate for Payer: HFN Commercial |
$702.05
|
| Rate for Payer: Multiplan Commercial |
$591.20
|
| Rate for Payer: Preferred Network Access Commercial |
$702.05
|
| Rate for Payer: Quartz Beloit One Network |
$325.16
|
| Rate for Payer: Quartz Commercial |
$421.23
|
| Rate for Payer: The Alliance Commercial |
$369.50
|
| Rate for Payer: WEA Trust Commercial |
$406.45
|
| Rate for Payer: WPS Commercial |
$547.38
|
|
|
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 |
$362.11 |
| Max. Negotiated Rate |
$679.88 |
| Rate for Payer: Aetna Commercial |
$665.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$635.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$391.67
|
| Rate for Payer: Cash Price |
$221.70
|
| Rate for Payer: Cigna Commercial |
$679.88
|
| Rate for Payer: Health EOS Commercial |
$657.71
|
| Rate for Payer: HFN Commercial |
$679.88
|
| Rate for Payer: Multiplan Commercial |
$591.20
|
| Rate for Payer: NAPHCARE Commercial |
$443.40
|
| Rate for Payer: Preferred Network Access Commercial |
$679.88
|
| Rate for Payer: Quartz Beloit One Network |
$362.11
|
| Rate for Payer: Quartz Commercial |
$443.40
|
| Rate for Payer: WEA Trust Commercial |
$406.45
|
| Rate for Payer: WPS Commercial |
$547.38
|
|
|
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 |
$206.92 |
| Max. Negotiated Rate |
$2,956.00 |
| Rate for Payer: Aetna Commercial |
$665.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$635.54
|
| Rate for Payer: Aetna Managed Medicare |
$206.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$480.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$369.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$354.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$391.67
|
| Rate for Payer: Cash Price |
$221.70
|
| Rate for Payer: Cigna Commercial |
$679.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$413.54
|
| Rate for Payer: Health EOS Commercial |
$657.71
|
| Rate for Payer: HFN Commercial |
$679.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$554.25
|
| Rate for Payer: Multiplan Commercial |
$591.20
|
| Rate for Payer: NAPHCARE Commercial |
$443.40
|
| Rate for Payer: Preferred Network Access Commercial |
$679.88
|
| Rate for Payer: Quartz Beloit One Network |
$362.11
|
| Rate for Payer: Quartz Commercial |
$480.35
|
| Rate for Payer: Quartz Medicare Advantage |
$443.40
|
| Rate for Payer: The Alliance Commercial |
$2,956.00
|
| Rate for Payer: United Healthcare PPO |
$554.25
|
| Rate for Payer: WEA Trust Commercial |
$406.45
|
| Rate for Payer: WPS Commercial |
$547.38
|
|
|
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 |
$206.92 |
| Max. Negotiated Rate |
$2,956.00 |
| Rate for Payer: Aetna Commercial |
$665.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$635.54
|
| Rate for Payer: Aetna Managed Medicare |
$206.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$480.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$369.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$354.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$391.67
|
| Rate for Payer: Cash Price |
$221.70
|
| Rate for Payer: Cigna Commercial |
$679.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$413.54
|
| Rate for Payer: Health EOS Commercial |
$657.71
|
| Rate for Payer: HFN Commercial |
$679.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$554.25
|
| Rate for Payer: Multiplan Commercial |
$591.20
|
| Rate for Payer: NAPHCARE Commercial |
$443.40
|
| Rate for Payer: Preferred Network Access Commercial |
$679.88
|
| Rate for Payer: Quartz Beloit One Network |
$362.11
|
| Rate for Payer: Quartz Commercial |
$480.35
|
| Rate for Payer: Quartz Medicare Advantage |
$443.40
|
| Rate for Payer: The Alliance Commercial |
$2,956.00
|
| Rate for Payer: United Healthcare PPO |
$554.25
|
| Rate for Payer: WEA Trust Commercial |
$406.45
|
| Rate for Payer: WPS Commercial |
$547.38
|
|
|
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 |
$325.16 |
| Max. Negotiated Rate |
$702.05 |
| Rate for Payer: Aetna Commercial |
$702.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$635.54
|
| Rate for Payer: Cash Price |
$221.70
|
| Rate for Payer: Cash Price |
$221.70
|
| Rate for Payer: Cigna Commercial |
$702.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$369.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$443.40
|
| Rate for Payer: Health EOS Commercial |
$672.49
|
| Rate for Payer: HFN Commercial |
$702.05
|
| Rate for Payer: Multiplan Commercial |
$591.20
|
| Rate for Payer: Preferred Network Access Commercial |
$702.05
|
| Rate for Payer: Quartz Beloit One Network |
$325.16
|
| Rate for Payer: Quartz Commercial |
$421.23
|
| Rate for Payer: The Alliance Commercial |
$369.50
|
| Rate for Payer: WEA Trust Commercial |
$406.45
|
| Rate for Payer: WPS Commercial |
$547.38
|
|
|
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 |
$362.11 |
| Max. Negotiated Rate |
$679.88 |
| Rate for Payer: Aetna Commercial |
$665.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$635.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$391.67
|
| Rate for Payer: Cash Price |
$221.70
|
| Rate for Payer: Cigna Commercial |
$679.88
|
| Rate for Payer: Health EOS Commercial |
$657.71
|
| Rate for Payer: HFN Commercial |
$679.88
|
| Rate for Payer: Multiplan Commercial |
$591.20
|
| Rate for Payer: NAPHCARE Commercial |
$443.40
|
| Rate for Payer: Preferred Network Access Commercial |
$679.88
|
| Rate for Payer: Quartz Beloit One Network |
$362.11
|
| Rate for Payer: Quartz Commercial |
$443.40
|
| Rate for Payer: WEA Trust Commercial |
$406.45
|
| Rate for Payer: WPS Commercial |
$547.38
|
|
|
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 |
$754.11 |
| Max. Negotiated Rate |
$1,415.88 |
| Rate for Payer: Aetna Commercial |
$1,385.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,323.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$815.67
|
| Rate for Payer: Cash Price |
$461.70
|
| Rate for Payer: Cigna Commercial |
$1,415.88
|
| Rate for Payer: Health EOS Commercial |
$1,369.71
|
| Rate for Payer: HFN Commercial |
$1,415.88
|
| Rate for Payer: Multiplan Commercial |
$1,231.20
|
| Rate for Payer: NAPHCARE Commercial |
$923.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,415.88
|
| Rate for Payer: Quartz Beloit One Network |
$754.11
|
| Rate for Payer: Quartz Commercial |
$923.40
|
| Rate for Payer: WEA Trust Commercial |
$846.45
|
| Rate for Payer: WPS Commercial |
$1,139.94
|
|
|
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 |
$677.16 |
| Max. Negotiated Rate |
$1,462.05 |
| Rate for Payer: Aetna Commercial |
$1,462.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,323.54
|
| Rate for Payer: Cash Price |
$461.70
|
| Rate for Payer: Cash Price |
$461.70
|
| Rate for Payer: Cigna Commercial |
$1,462.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$769.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$923.40
|
| Rate for Payer: Health EOS Commercial |
$1,400.49
|
| Rate for Payer: HFN Commercial |
$1,462.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$752.14
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$752.14
|
| Rate for Payer: Multiplan Commercial |
$1,231.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,462.05
|
| Rate for Payer: Quartz Beloit One Network |
$677.16
|
| Rate for Payer: Quartz Commercial |
$877.23
|
| Rate for Payer: The Alliance Commercial |
$769.50
|
| Rate for Payer: WEA Trust Commercial |
$846.45
|
| Rate for Payer: WPS Commercial |
$1,139.94
|
|
|
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 |
$430.92 |
| Max. Negotiated Rate |
$6,156.00 |
| Rate for Payer: Aetna Commercial |
$1,385.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,323.54
|
| Rate for Payer: Aetna Managed Medicare |
$430.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,000.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$769.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$738.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$815.67
|
| Rate for Payer: Cash Price |
$461.70
|
| Rate for Payer: Cigna Commercial |
$1,415.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$861.22
|
| Rate for Payer: Health EOS Commercial |
$1,369.71
|
| Rate for Payer: HFN Commercial |
$1,415.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,154.25
|
| Rate for Payer: Multiplan Commercial |
$1,231.20
|
| Rate for Payer: NAPHCARE Commercial |
$923.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,415.88
|
| Rate for Payer: Quartz Beloit One Network |
$754.11
|
| Rate for Payer: Quartz Commercial |
$1,000.35
|
| Rate for Payer: Quartz Medicare Advantage |
$923.40
|
| Rate for Payer: The Alliance Commercial |
$6,156.00
|
| Rate for Payer: United Healthcare PPO |
$1,154.25
|
| Rate for Payer: WEA Trust Commercial |
$846.45
|
| Rate for Payer: WPS Commercial |
$1,139.94
|
|
|
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 |
$275.44 |
| Max. Negotiated Rate |
$594.70 |
| Rate for Payer: Aetna Commercial |
$594.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$538.36
|
| Rate for Payer: Cash Price |
$187.80
|
| Rate for Payer: Cash Price |
$187.80
|
| Rate for Payer: Cigna Commercial |
$594.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$313.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$375.60
|
| Rate for Payer: Health EOS Commercial |
$569.66
|
| Rate for Payer: HFN Commercial |
$594.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$426.57
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$426.57
|
| Rate for Payer: Multiplan Commercial |
$500.80
|
| Rate for Payer: Preferred Network Access Commercial |
$594.70
|
| Rate for Payer: Quartz Beloit One Network |
$275.44
|
| Rate for Payer: Quartz Commercial |
$356.82
|
| Rate for Payer: The Alliance Commercial |
$313.00
|
| Rate for Payer: WEA Trust Commercial |
$344.30
|
| Rate for Payer: WPS Commercial |
$463.68
|
|
|
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 |
$175.28 |
| Max. Negotiated Rate |
$2,504.00 |
| Rate for Payer: Aetna Commercial |
$563.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$538.36
|
| Rate for Payer: Aetna Managed Medicare |
$175.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$406.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$313.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$300.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$331.78
|
| Rate for Payer: Cash Price |
$187.80
|
| Rate for Payer: Cigna Commercial |
$575.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$350.31
|
| Rate for Payer: Health EOS Commercial |
$557.14
|
| Rate for Payer: HFN Commercial |
$575.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$469.50
|
| Rate for Payer: Multiplan Commercial |
$500.80
|
| Rate for Payer: NAPHCARE Commercial |
$375.60
|
| Rate for Payer: Preferred Network Access Commercial |
$575.92
|
| Rate for Payer: Quartz Beloit One Network |
$306.74
|
| Rate for Payer: Quartz Commercial |
$406.90
|
| Rate for Payer: Quartz Medicare Advantage |
$375.60
|
| Rate for Payer: The Alliance Commercial |
$2,504.00
|
| Rate for Payer: United Healthcare PPO |
$469.50
|
| Rate for Payer: WEA Trust Commercial |
$344.30
|
| Rate for Payer: WPS Commercial |
$463.68
|
|
|
VL Duplex Arterial/Venous Visceral Limit
|
Facility
|
IP
|
$626.00
|
|
|
Service Code
|
CPT 93976 TC
|
| Hospital Charge Code |
1482919
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$306.74 |
| Max. Negotiated Rate |
$575.92 |
| Rate for Payer: Aetna Commercial |
$563.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$538.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$331.78
|
| Rate for Payer: Cash Price |
$187.80
|
| Rate for Payer: Cigna Commercial |
$575.92
|
| Rate for Payer: Health EOS Commercial |
$557.14
|
| Rate for Payer: HFN Commercial |
$575.92
|
| Rate for Payer: Multiplan Commercial |
$500.80
|
| Rate for Payer: NAPHCARE Commercial |
$375.60
|
| Rate for Payer: Preferred Network Access Commercial |
$575.92
|
| Rate for Payer: Quartz Beloit One Network |
$306.74
|
| Rate for Payer: Quartz Commercial |
$375.60
|
| Rate for Payer: WEA Trust Commercial |
$344.30
|
| Rate for Payer: WPS Commercial |
$463.68
|
|
|
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 |
$337.96 |
| Max. Negotiated Rate |
$4,828.00 |
| Rate for Payer: Aetna Commercial |
$1,086.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,038.02
|
| Rate for Payer: Aetna Managed Medicare |
$337.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$784.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$603.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$579.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$639.71
|
| Rate for Payer: Cash Price |
$362.10
|
| Rate for Payer: Cigna Commercial |
$1,110.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$675.44
|
| Rate for Payer: Health EOS Commercial |
$1,074.23
|
| Rate for Payer: HFN Commercial |
$1,110.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$905.25
|
| Rate for Payer: Multiplan Commercial |
$965.60
|
| Rate for Payer: NAPHCARE Commercial |
$724.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,110.44
|
| Rate for Payer: Quartz Beloit One Network |
$591.43
|
| Rate for Payer: Quartz Commercial |
$784.55
|
| Rate for Payer: Quartz Medicare Advantage |
$724.20
|
| Rate for Payer: The Alliance Commercial |
$4,828.00
|
| Rate for Payer: United Healthcare PPO |
$905.25
|
| Rate for Payer: WEA Trust Commercial |
$663.85
|
| Rate for Payer: WPS Commercial |
$894.02
|
|
|
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 |
$440.47 |
| Max. Negotiated Rate |
$1,146.65 |
| Rate for Payer: Aetna Commercial |
$1,146.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,038.02
|
| Rate for Payer: Cash Price |
$362.10
|
| Rate for Payer: Cash Price |
$362.10
|
| Rate for Payer: Cigna Commercial |
$1,146.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$603.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$724.20
|
| Rate for Payer: Health EOS Commercial |
$1,098.37
|
| Rate for Payer: HFN Commercial |
$1,146.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$440.47
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$440.47
|
| Rate for Payer: Multiplan Commercial |
$965.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,146.65
|
| Rate for Payer: Quartz Beloit One Network |
$531.08
|
| Rate for Payer: Quartz Commercial |
$687.99
|
| Rate for Payer: The Alliance Commercial |
$603.50
|
| Rate for Payer: WEA Trust Commercial |
$663.85
|
| Rate for Payer: WPS Commercial |
$894.02
|
|
