|
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 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 |
$1,693.44 |
| Max. Negotiated Rate |
$3,179.52 |
| Rate for Payer: Aetna Commercial |
$3,110.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,972.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,831.68
|
| Rate for Payer: Cash Price |
$1,036.80
|
| Rate for Payer: Cigna Commercial |
$3,179.52
|
| Rate for Payer: Health EOS Commercial |
$3,075.84
|
| Rate for Payer: HFN Commercial |
$3,179.52
|
| Rate for Payer: Multiplan Commercial |
$2,764.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,073.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,179.52
|
| Rate for Payer: Quartz Beloit One Network |
$1,693.44
|
| Rate for Payer: Quartz Commercial |
$2,073.60
|
| Rate for Payer: WEA Trust Commercial |
$1,900.80
|
| Rate for Payer: WPS Commercial |
$2,559.86
|
|
|
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 |
$454.42 |
| Max. Negotiated Rate |
$3,283.20 |
| Rate for Payer: Aetna Commercial |
$3,283.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,972.16
|
| Rate for Payer: Cash Price |
$1,036.80
|
| Rate for Payer: Cash Price |
$1,036.80
|
| Rate for Payer: Cigna Commercial |
$3,283.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,728.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,073.60
|
| Rate for Payer: Health EOS Commercial |
$3,144.96
|
| Rate for Payer: HFN Commercial |
$3,283.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$454.42
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$454.42
|
| Rate for Payer: Multiplan Commercial |
$2,764.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,283.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,520.64
|
| Rate for Payer: Quartz Commercial |
$1,969.92
|
| Rate for Payer: The Alliance Commercial |
$1,728.00
|
| Rate for Payer: WEA Trust Commercial |
$1,900.80
|
| Rate for Payer: WPS Commercial |
$2,559.86
|
|
|
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 |
$967.68 |
| Max. Negotiated Rate |
$13,824.00 |
| Rate for Payer: Aetna Commercial |
$3,110.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,972.16
|
| Rate for Payer: Aetna Managed Medicare |
$967.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,246.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,728.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,658.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,831.68
|
| Rate for Payer: Cash Price |
$1,036.80
|
| Rate for Payer: Cigna Commercial |
$3,179.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,933.98
|
| Rate for Payer: Health EOS Commercial |
$3,075.84
|
| Rate for Payer: HFN Commercial |
$3,179.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,592.00
|
| Rate for Payer: Multiplan Commercial |
$2,764.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,073.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,179.52
|
| Rate for Payer: Quartz Beloit One Network |
$1,693.44
|
| Rate for Payer: Quartz Commercial |
$2,246.40
|
| Rate for Payer: Quartz Medicare Advantage |
$2,073.60
|
| Rate for Payer: The Alliance Commercial |
$13,824.00
|
| Rate for Payer: United Healthcare PPO |
$2,592.00
|
| Rate for Payer: WEA Trust Commercial |
$1,900.80
|
| Rate for Payer: WPS Commercial |
$2,559.86
|
|
|
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 |
$235.76 |
| Max. Negotiated Rate |
$3,368.00 |
| Rate for Payer: Aetna Commercial |
$757.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$724.12
|
| Rate for Payer: Aetna Managed Medicare |
$235.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$547.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$421.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$404.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$446.26
|
| Rate for Payer: Cash Price |
$252.60
|
| Rate for Payer: Cigna Commercial |
$774.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$471.18
|
| Rate for Payer: Health EOS Commercial |
$749.38
|
| Rate for Payer: HFN Commercial |
$774.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$631.50
|
| Rate for Payer: Multiplan Commercial |
$673.60
|
| Rate for Payer: NAPHCARE Commercial |
$505.20
|
| Rate for Payer: Preferred Network Access Commercial |
$774.64
|
| Rate for Payer: Quartz Beloit One Network |
$412.58
|
| Rate for Payer: Quartz Commercial |
$547.30
|
| Rate for Payer: Quartz Medicare Advantage |
$505.20
|
| Rate for Payer: The Alliance Commercial |
$3,368.00
|
| Rate for Payer: United Healthcare PPO |
$631.50
|
| Rate for Payer: WEA Trust Commercial |
$463.10
|
| Rate for Payer: WPS Commercial |
$623.67
|
|
|
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 |
$412.58 |
| Max. Negotiated Rate |
$774.64 |
| Rate for Payer: Aetna Commercial |
$757.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$724.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$446.26
|
| Rate for Payer: Cash Price |
$252.60
|
| Rate for Payer: Cigna Commercial |
$774.64
|
| Rate for Payer: Health EOS Commercial |
$749.38
|
| Rate for Payer: HFN Commercial |
$774.64
|
| Rate for Payer: Multiplan Commercial |
$673.60
|
| Rate for Payer: NAPHCARE Commercial |
$505.20
|
| Rate for Payer: Preferred Network Access Commercial |
$774.64
|
| Rate for Payer: Quartz Beloit One Network |
$412.58
|
| Rate for Payer: Quartz Commercial |
$505.20
|
| Rate for Payer: WEA Trust Commercial |
$463.10
|
| Rate for Payer: WPS Commercial |
$623.67
|
|
|
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 |
$74.27 |
| Max. Negotiated Rate |
$799.90 |
| Rate for Payer: Aetna Commercial |
$799.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$724.12
|
| Rate for Payer: Cash Price |
$252.60
|
| Rate for Payer: Cash Price |
$252.60
|
| Rate for Payer: Cigna Commercial |
$799.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$421.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$505.20
|
| Rate for Payer: Health EOS Commercial |
$766.22
|
| Rate for Payer: HFN Commercial |
$799.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$74.27
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$74.27
|
| Rate for Payer: Multiplan Commercial |
$673.60
|
| Rate for Payer: Preferred Network Access Commercial |
$799.90
|
| Rate for Payer: Quartz Beloit One Network |
$370.48
|
| Rate for Payer: Quartz Commercial |
$479.94
|
| Rate for Payer: The Alliance Commercial |
$421.00
|
| Rate for Payer: WEA Trust Commercial |
$463.10
|
| Rate for Payer: WPS Commercial |
$623.67
|
|
|
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 |
$1,365.14 |
| Max. Negotiated Rate |
$2,563.12 |
| Rate for Payer: Aetna Commercial |
$2,507.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,395.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,476.58
|
| Rate for Payer: Cash Price |
$835.80
|
| Rate for Payer: Cigna Commercial |
$2,563.12
|
| Rate for Payer: Health EOS Commercial |
$2,479.54
|
| Rate for Payer: HFN Commercial |
$2,563.12
|
| Rate for Payer: Multiplan Commercial |
$2,228.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,671.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,563.12
|
| Rate for Payer: Quartz Beloit One Network |
$1,365.14
|
| Rate for Payer: Quartz Commercial |
$1,671.60
|
| Rate for Payer: WEA Trust Commercial |
$1,532.30
|
| Rate for Payer: WPS Commercial |
$2,063.59
|
|
|
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 |
$580.90 |
| Max. Negotiated Rate |
$2,646.70 |
| Rate for Payer: Aetna Commercial |
$2,646.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,395.96
|
| Rate for Payer: Cash Price |
$835.80
|
| Rate for Payer: Cash Price |
$835.80
|
| Rate for Payer: Cigna Commercial |
$2,646.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,393.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,671.60
|
| Rate for Payer: Health EOS Commercial |
$2,535.26
|
| Rate for Payer: HFN Commercial |
$2,646.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$580.90
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$580.90
|
| Rate for Payer: Multiplan Commercial |
$2,228.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,646.70
|
| Rate for Payer: Quartz Beloit One Network |
$1,225.84
|
| Rate for Payer: Quartz Commercial |
$1,588.02
|
| Rate for Payer: The Alliance Commercial |
$1,393.00
|
| Rate for Payer: WEA Trust Commercial |
$1,532.30
|
| Rate for Payer: WPS Commercial |
$2,063.59
|
|
|
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 |
$780.08 |
| Max. Negotiated Rate |
$11,144.00 |
| Rate for Payer: Aetna Commercial |
$2,507.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,395.96
|
| Rate for Payer: Aetna Managed Medicare |
$780.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,810.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,393.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,337.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,476.58
|
| Rate for Payer: Cash Price |
$835.80
|
| Rate for Payer: Cigna Commercial |
$2,563.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,559.05
|
| Rate for Payer: Health EOS Commercial |
$2,479.54
|
| Rate for Payer: HFN Commercial |
$2,563.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,089.50
|
| Rate for Payer: Multiplan Commercial |
$2,228.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,671.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,563.12
|
| Rate for Payer: Quartz Beloit One Network |
$1,365.14
|
| Rate for Payer: Quartz Commercial |
$1,810.90
|
| Rate for Payer: Quartz Medicare Advantage |
$1,671.60
|
| Rate for Payer: The Alliance Commercial |
$11,144.00
|
| Rate for Payer: United Healthcare PPO |
$2,089.50
|
| Rate for Payer: WEA Trust Commercial |
$1,532.30
|
| Rate for Payer: WPS Commercial |
$2,063.59
|
|
|
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 |
$430.02 |
| Max. Negotiated Rate |
$1,728.05 |
| Rate for Payer: Aetna Commercial |
$1,728.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,564.34
|
| Rate for Payer: Cash Price |
$545.70
|
| Rate for Payer: Cash Price |
$545.70
|
| Rate for Payer: Cigna Commercial |
$1,728.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$909.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,091.40
|
| Rate for Payer: Health EOS Commercial |
$1,655.29
|
| Rate for Payer: HFN Commercial |
$1,728.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$430.02
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$430.02
|
| Rate for Payer: Multiplan Commercial |
$1,455.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,728.05
|
| Rate for Payer: Quartz Beloit One Network |
$800.36
|
| Rate for Payer: Quartz Commercial |
$1,036.83
|
| Rate for Payer: The Alliance Commercial |
$909.50
|
| Rate for Payer: WEA Trust Commercial |
$1,000.45
|
| Rate for Payer: WPS Commercial |
$1,347.33
|
|
|
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 |
$509.32 |
| Max. Negotiated Rate |
$7,276.00 |
| Rate for Payer: Aetna Commercial |
$1,637.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,564.34
|
| Rate for Payer: Aetna Managed Medicare |
$509.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,182.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$909.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$873.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$964.07
|
| Rate for Payer: Cash Price |
$545.70
|
| Rate for Payer: Cigna Commercial |
$1,673.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,017.91
|
| Rate for Payer: Health EOS Commercial |
$1,618.91
|
| Rate for Payer: HFN Commercial |
$1,673.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,364.25
|
| Rate for Payer: Multiplan Commercial |
$1,455.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,091.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,673.48
|
| Rate for Payer: Quartz Beloit One Network |
$891.31
|
| Rate for Payer: Quartz Commercial |
$1,182.35
|
| Rate for Payer: Quartz Medicare Advantage |
$1,091.40
|
| Rate for Payer: The Alliance Commercial |
$7,276.00
|
| Rate for Payer: United Healthcare PPO |
$1,364.25
|
| Rate for Payer: WEA Trust Commercial |
$1,000.45
|
| Rate for Payer: WPS Commercial |
$1,347.33
|
|
|
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 |
$891.31 |
| Max. Negotiated Rate |
$1,673.48 |
| Rate for Payer: Aetna Commercial |
$1,637.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,564.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$964.07
|
| Rate for Payer: Cash Price |
$545.70
|
| Rate for Payer: Cigna Commercial |
$1,673.48
|
| Rate for Payer: Health EOS Commercial |
$1,618.91
|
| Rate for Payer: HFN Commercial |
$1,673.48
|
| Rate for Payer: Multiplan Commercial |
$1,455.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,091.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,673.48
|
| Rate for Payer: Quartz Beloit One Network |
$891.31
|
| Rate for Payer: Quartz Commercial |
$1,091.40
|
| Rate for Payer: WEA Trust Commercial |
$1,000.45
|
| Rate for Payer: WPS Commercial |
$1,347.33
|
|
|
VL Echo Doppler
|
Professional
|
Both
|
$905.00
|
|
|
Service Code
|
CPT 93320 TC
|
| Hospital Charge Code |
1482982
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$119.84 |
| Max. Negotiated Rate |
$859.75 |
| Rate for Payer: Aetna Commercial |
$859.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$778.30
|
| Rate for Payer: Cash Price |
$271.50
|
| Rate for Payer: Cash Price |
$271.50
|
| Rate for Payer: Cigna Commercial |
$859.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$452.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$543.00
|
| Rate for Payer: Health EOS Commercial |
$823.55
|
| Rate for Payer: HFN Commercial |
$859.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$119.84
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$119.84
|
| Rate for Payer: Multiplan Commercial |
$724.00
|
| Rate for Payer: Preferred Network Access Commercial |
$859.75
|
| Rate for Payer: Quartz Beloit One Network |
$398.20
|
| Rate for Payer: Quartz Commercial |
$515.85
|
| Rate for Payer: The Alliance Commercial |
$452.50
|
| Rate for Payer: WEA Trust Commercial |
$497.75
|
| Rate for Payer: WPS Commercial |
$670.33
|
|
|
VL Echo Doppler
|
Facility
|
IP
|
$905.00
|
|
|
Service Code
|
CPT 93320 TC
|
| Hospital Charge Code |
1482982
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$443.45 |
| Max. Negotiated Rate |
$832.60 |
| Rate for Payer: Aetna Commercial |
$814.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$778.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$479.65
|
| Rate for Payer: Cash Price |
$271.50
|
| Rate for Payer: Cigna Commercial |
$832.60
|
| Rate for Payer: Health EOS Commercial |
$805.45
|
| Rate for Payer: HFN Commercial |
$832.60
|
| Rate for Payer: Multiplan Commercial |
$724.00
|
| Rate for Payer: NAPHCARE Commercial |
$543.00
|
| Rate for Payer: Preferred Network Access Commercial |
$832.60
|
| Rate for Payer: Quartz Beloit One Network |
$443.45
|
| Rate for Payer: Quartz Commercial |
$543.00
|
| Rate for Payer: WEA Trust Commercial |
$497.75
|
| Rate for Payer: WPS Commercial |
$670.33
|
|
|
VL Echo Doppler
|
Facility
|
OP
|
$905.00
|
|
|
Service Code
|
CPT 93320 TC
|
| Hospital Charge Code |
1482982
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$253.40 |
| Max. Negotiated Rate |
$3,620.00 |
| Rate for Payer: Aetna Commercial |
$814.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$778.30
|
| Rate for Payer: Aetna Managed Medicare |
$253.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$588.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$452.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$434.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$479.65
|
| Rate for Payer: Cash Price |
$271.50
|
| Rate for Payer: Cigna Commercial |
$832.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$506.44
|
| Rate for Payer: Health EOS Commercial |
$805.45
|
| Rate for Payer: HFN Commercial |
$832.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$678.75
|
| Rate for Payer: Multiplan Commercial |
$724.00
|
| Rate for Payer: NAPHCARE Commercial |
$543.00
|
| Rate for Payer: Preferred Network Access Commercial |
$832.60
|
| Rate for Payer: Quartz Beloit One Network |
$443.45
|
| Rate for Payer: Quartz Commercial |
$588.25
|
| Rate for Payer: Quartz Medicare Advantage |
$543.00
|
| Rate for Payer: The Alliance Commercial |
$3,620.00
|
| Rate for Payer: United Healthcare PPO |
$678.75
|
| Rate for Payer: WEA Trust Commercial |
$497.75
|
| Rate for Payer: WPS Commercial |
$670.33
|
|
|
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 |
$490.84 |
| Max. Negotiated Rate |
$7,012.00 |
| Rate for Payer: Aetna Commercial |
$1,577.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,507.58
|
| Rate for Payer: Aetna Managed Medicare |
$490.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,139.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$876.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$841.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$929.09
|
| Rate for Payer: Cash Price |
$525.90
|
| Rate for Payer: Cigna Commercial |
$1,612.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$980.98
|
| Rate for Payer: Health EOS Commercial |
$1,560.17
|
| Rate for Payer: HFN Commercial |
$1,612.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,314.75
|
| Rate for Payer: Multiplan Commercial |
$1,402.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,051.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,612.76
|
| Rate for Payer: Quartz Beloit One Network |
$858.97
|
| Rate for Payer: Quartz Commercial |
$1,139.45
|
| Rate for Payer: Quartz Medicare Advantage |
$1,051.80
|
| Rate for Payer: The Alliance Commercial |
$7,012.00
|
| Rate for Payer: United Healthcare PPO |
$1,314.75
|
| Rate for Payer: WEA Trust Commercial |
$964.15
|
| Rate for Payer: WPS Commercial |
$1,298.45
|
|
|
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 |
$771.32 |
| Max. Negotiated Rate |
$1,665.35 |
| Rate for Payer: Aetna Commercial |
$1,665.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,507.58
|
| Rate for Payer: Cash Price |
$525.90
|
| Rate for Payer: Cash Price |
$525.90
|
| Rate for Payer: Cigna Commercial |
$1,665.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$876.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,051.80
|
| Rate for Payer: Health EOS Commercial |
$1,595.23
|
| Rate for Payer: HFN Commercial |
$1,665.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$810.95
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$810.95
|
| Rate for Payer: Multiplan Commercial |
$1,402.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,665.35
|
| Rate for Payer: Quartz Beloit One Network |
$771.32
|
| Rate for Payer: Quartz Commercial |
$999.21
|
| Rate for Payer: The Alliance Commercial |
$876.50
|
| Rate for Payer: WEA Trust Commercial |
$964.15
|
| Rate for Payer: WPS Commercial |
$1,298.45
|
|
|
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 |
$858.97 |
| Max. Negotiated Rate |
$1,612.76 |
| Rate for Payer: Aetna Commercial |
$1,577.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,507.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$929.09
|
| Rate for Payer: Cash Price |
$525.90
|
| Rate for Payer: Cigna Commercial |
$1,612.76
|
| Rate for Payer: Health EOS Commercial |
$1,560.17
|
| Rate for Payer: HFN Commercial |
$1,612.76
|
| Rate for Payer: Multiplan Commercial |
$1,402.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,051.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,612.76
|
| Rate for Payer: Quartz Beloit One Network |
$858.97
|
| Rate for Payer: Quartz Commercial |
$1,051.80
|
| Rate for Payer: WEA Trust Commercial |
$964.15
|
| Rate for Payer: WPS Commercial |
$1,298.45
|
|
|
VL Echo Limited
|
Professional
|
Both
|
$1,524.00
|
|
|
Service Code
|
CPT 93308 TC
|
| Hospital Charge Code |
1482988
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$256.77 |
| Max. Negotiated Rate |
$1,447.80 |
| Rate for Payer: Aetna Commercial |
$1,447.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,310.64
|
| Rate for Payer: Cash Price |
$457.20
|
| Rate for Payer: Cash Price |
$457.20
|
| Rate for Payer: Cigna Commercial |
$1,447.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$762.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$914.40
|
| Rate for Payer: Health EOS Commercial |
$1,386.84
|
| Rate for Payer: HFN Commercial |
$1,447.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$256.77
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$256.77
|
| Rate for Payer: Multiplan Commercial |
$1,219.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,447.80
|
| Rate for Payer: Quartz Beloit One Network |
$670.56
|
| Rate for Payer: Quartz Commercial |
$868.68
|
| Rate for Payer: The Alliance Commercial |
$762.00
|
| Rate for Payer: WEA Trust Commercial |
$838.20
|
| Rate for Payer: WPS Commercial |
$1,128.83
|
|
|
VL Echo Limited
|
Facility
|
OP
|
$1,524.00
|
|
|
Service Code
|
CPT 93308 TC
|
| Hospital Charge Code |
1482988
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$426.72 |
| Max. Negotiated Rate |
$6,096.00 |
| Rate for Payer: Aetna Commercial |
$1,371.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,310.64
|
| Rate for Payer: Aetna Managed Medicare |
$426.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$990.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$762.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$731.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$807.72
|
| Rate for Payer: Cash Price |
$457.20
|
| Rate for Payer: Cigna Commercial |
$1,402.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$852.83
|
| Rate for Payer: Health EOS Commercial |
$1,356.36
|
| Rate for Payer: HFN Commercial |
$1,402.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,143.00
|
| Rate for Payer: Multiplan Commercial |
$1,219.20
|
| Rate for Payer: NAPHCARE Commercial |
$914.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,402.08
|
| Rate for Payer: Quartz Beloit One Network |
$746.76
|
| Rate for Payer: Quartz Commercial |
$990.60
|
| Rate for Payer: Quartz Medicare Advantage |
$914.40
|
| Rate for Payer: The Alliance Commercial |
$6,096.00
|
| Rate for Payer: United Healthcare PPO |
$1,143.00
|
| Rate for Payer: WEA Trust Commercial |
$838.20
|
| Rate for Payer: WPS Commercial |
$1,128.83
|
|
|
VL Echo Limited
|
Facility
|
IP
|
$1,524.00
|
|
|
Service Code
|
CPT 93308 TC
|
| Hospital Charge Code |
1482988
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$746.76 |
| Max. Negotiated Rate |
$1,402.08 |
| Rate for Payer: Aetna Commercial |
$1,371.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,310.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$807.72
|
| Rate for Payer: Cash Price |
$457.20
|
| Rate for Payer: Cigna Commercial |
$1,402.08
|
| Rate for Payer: Health EOS Commercial |
$1,356.36
|
| Rate for Payer: HFN Commercial |
$1,402.08
|
| Rate for Payer: Multiplan Commercial |
$1,219.20
|
| Rate for Payer: NAPHCARE Commercial |
$914.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,402.08
|
| Rate for Payer: Quartz Beloit One Network |
$746.76
|
| Rate for Payer: Quartz Commercial |
$914.40
|
| Rate for Payer: WEA Trust Commercial |
$838.20
|
| Rate for Payer: WPS Commercial |
$1,128.83
|
|
|
VL Echo Limited w/ Contrast
|
Facility
|
IP
|
$1,524.00
|
|
|
Service Code
|
CPT 93308 TC
|
| Hospital Charge Code |
4628611
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$746.76 |
| Max. Negotiated Rate |
$1,402.08 |
| Rate for Payer: Aetna Commercial |
$1,371.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,310.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$807.72
|
| Rate for Payer: Cash Price |
$457.20
|
| Rate for Payer: Cigna Commercial |
$1,402.08
|
| Rate for Payer: Health EOS Commercial |
$1,356.36
|
| Rate for Payer: HFN Commercial |
$1,402.08
|
| Rate for Payer: Multiplan Commercial |
$1,219.20
|
| Rate for Payer: NAPHCARE Commercial |
$914.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,402.08
|
| Rate for Payer: Quartz Beloit One Network |
$746.76
|
| Rate for Payer: Quartz Commercial |
$914.40
|
| Rate for Payer: WEA Trust Commercial |
$838.20
|
| Rate for Payer: WPS Commercial |
$1,128.83
|
|
|
VL Echo Limited w/ Contrast
|
Facility
|
OP
|
$1,524.00
|
|
|
Service Code
|
CPT 93308 TC
|
| Hospital Charge Code |
4628611
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$426.72 |
| Max. Negotiated Rate |
$6,096.00 |
| Rate for Payer: Aetna Commercial |
$1,371.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,310.64
|
| Rate for Payer: Aetna Managed Medicare |
$426.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$990.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$762.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$731.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$807.72
|
| Rate for Payer: Cash Price |
$457.20
|
| Rate for Payer: Cigna Commercial |
$1,402.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$852.83
|
| Rate for Payer: Health EOS Commercial |
$1,356.36
|
| Rate for Payer: HFN Commercial |
$1,402.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,143.00
|
| Rate for Payer: Multiplan Commercial |
$1,219.20
|
| Rate for Payer: NAPHCARE Commercial |
$914.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,402.08
|
| Rate for Payer: Quartz Beloit One Network |
$746.76
|
| Rate for Payer: Quartz Commercial |
$990.60
|
| Rate for Payer: Quartz Medicare Advantage |
$914.40
|
| Rate for Payer: The Alliance Commercial |
$6,096.00
|
| Rate for Payer: United Healthcare PPO |
$1,143.00
|
| Rate for Payer: WEA Trust Commercial |
$838.20
|
| Rate for Payer: WPS Commercial |
$1,128.83
|
|
|
VL Echo Limited w/ Contrast
|
Professional
|
Both
|
$1,524.00
|
|
|
Service Code
|
CPT 93308 TC
|
| Hospital Charge Code |
4628611
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$256.77 |
| Max. Negotiated Rate |
$1,447.80 |
| Rate for Payer: Aetna Commercial |
$1,447.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,310.64
|
| Rate for Payer: Cash Price |
$457.20
|
| Rate for Payer: Cash Price |
$457.20
|
| Rate for Payer: Cigna Commercial |
$1,447.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$762.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$914.40
|
| Rate for Payer: Health EOS Commercial |
$1,386.84
|
| Rate for Payer: HFN Commercial |
$1,447.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$256.77
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$256.77
|
| Rate for Payer: Multiplan Commercial |
$1,219.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,447.80
|
| Rate for Payer: Quartz Beloit One Network |
$670.56
|
| Rate for Payer: Quartz Commercial |
$868.68
|
| Rate for Payer: The Alliance Commercial |
$762.00
|
| Rate for Payer: WEA Trust Commercial |
$838.20
|
| Rate for Payer: WPS Commercial |
$1,128.83
|
|
