|
VL UE Arterial Duplex Left
|
Facility
|
OP
|
$1,135.00
|
|
|
Service Code
|
CPT 93931 TC
|
| Hospital Charge Code |
1483375
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$330.51 |
| Max. Negotiated Rate |
$1,085.97 |
| Rate for Payer: Aetna Commercial |
$1,062.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,015.14
|
| Rate for Payer: Aetna Managed Medicare |
$330.51
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$767.26
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$590.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$566.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$625.61
|
| Rate for Payer: Cash Price |
$340.50
|
| Rate for Payer: Cash Price |
$340.50
|
| Rate for Payer: Cigna Commercial |
$1,085.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$660.57
|
| Rate for Payer: Health EOS Commercial |
$1,050.56
|
| Rate for Payer: HFN Commercial |
$1,085.97
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$885.30
|
| Rate for Payer: Multiplan Commercial |
$944.32
|
| Rate for Payer: NAPHCARE Commercial |
$708.24
|
| Rate for Payer: Preferred Network Access Commercial |
$1,085.97
|
| Rate for Payer: Quartz Beloit One Network |
$578.40
|
| Rate for Payer: Quartz Commercial |
$767.26
|
| Rate for Payer: Quartz Medicare Advantage |
$708.24
|
| Rate for Payer: The Alliance Commercial |
$389.54
|
| Rate for Payer: United Healthcare PPO |
$885.30
|
| Rate for Payer: WEA Trust Commercial |
$649.22
|
| Rate for Payer: WPS Commercial |
$874.29
|
|
|
VL UE Arterial Duplex Right
|
Facility
|
OP
|
$1,630.00
|
|
|
Service Code
|
CPT 93930 TC,RT
|
| Hospital Charge Code |
3115223
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$474.66 |
| Max. Negotiated Rate |
$1,559.58 |
| Rate for Payer: Aetna Commercial |
$1,525.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,457.87
|
| Rate for Payer: Aetna Managed Medicare |
$474.66
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,101.88
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$847.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$813.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$898.46
|
| Rate for Payer: Cash Price |
$489.00
|
| Rate for Payer: Cigna Commercial |
$1,559.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$948.66
|
| Rate for Payer: Health EOS Commercial |
$1,508.73
|
| Rate for Payer: HFN Commercial |
$1,559.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,271.40
|
| Rate for Payer: Multiplan Commercial |
$1,356.16
|
| Rate for Payer: NAPHCARE Commercial |
$1,017.12
|
| Rate for Payer: Preferred Network Access Commercial |
$1,559.58
|
| Rate for Payer: Quartz Beloit One Network |
$830.65
|
| Rate for Payer: Quartz Commercial |
$1,101.88
|
| Rate for Payer: Quartz Medicare Advantage |
$1,017.12
|
| Rate for Payer: The Alliance Commercial |
$847.60
|
| Rate for Payer: United Healthcare PPO |
$1,271.40
|
| Rate for Payer: WEA Trust Commercial |
$932.36
|
| Rate for Payer: WPS Commercial |
$1,255.59
|
|
|
VL UE Arterial Duplex Right
|
Facility
|
OP
|
$1,135.00
|
|
|
Service Code
|
CPT 93931 TC
|
| Hospital Charge Code |
1483378
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$330.51 |
| Max. Negotiated Rate |
$1,085.97 |
| Rate for Payer: Aetna Commercial |
$1,062.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,015.14
|
| Rate for Payer: Aetna Managed Medicare |
$330.51
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$767.26
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$590.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$566.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$625.61
|
| Rate for Payer: Cash Price |
$340.50
|
| Rate for Payer: Cash Price |
$340.50
|
| Rate for Payer: Cigna Commercial |
$1,085.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$660.57
|
| Rate for Payer: Health EOS Commercial |
$1,050.56
|
| Rate for Payer: HFN Commercial |
$1,085.97
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$885.30
|
| Rate for Payer: Multiplan Commercial |
$944.32
|
| Rate for Payer: NAPHCARE Commercial |
$708.24
|
| Rate for Payer: Preferred Network Access Commercial |
$1,085.97
|
| Rate for Payer: Quartz Beloit One Network |
$578.40
|
| Rate for Payer: Quartz Commercial |
$767.26
|
| Rate for Payer: Quartz Medicare Advantage |
$708.24
|
| Rate for Payer: The Alliance Commercial |
$389.54
|
| Rate for Payer: United Healthcare PPO |
$885.30
|
| Rate for Payer: WEA Trust Commercial |
$649.22
|
| Rate for Payer: WPS Commercial |
$874.29
|
|
|
VL UE Arterial Duplex Right
|
Professional
|
Both
|
$1,135.00
|
|
|
Service Code
|
CPT 93931 TC
|
| Hospital Charge Code |
1483378
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$97.39 |
| Max. Negotiated Rate |
$1,121.38 |
| Rate for Payer: Aetna Commercial |
$1,121.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,015.14
|
| Rate for Payer: Aetna Managed Medicare |
$97.39
|
| Rate for Payer: Anthem Medicare Advantage |
$97.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$97.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$97.39
|
| Rate for Payer: Cash Price |
$340.50
|
| Rate for Payer: Cash Price |
$340.50
|
| Rate for Payer: Cash Price |
$340.50
|
| Rate for Payer: Cigna Commercial |
$1,121.38
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$106.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$97.39
|
| Rate for Payer: Health EOS Commercial |
$1,074.16
|
| Rate for Payer: HFN Commercial |
$1,121.38
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$370.02
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$370.02
|
| Rate for Payer: Independent Care Health Plan Medicare |
$97.39
|
| Rate for Payer: Multiplan Commercial |
$944.32
|
| Rate for Payer: NAPHCARE Commercial |
$146.08
|
| Rate for Payer: Preferred Network Access Commercial |
$1,121.38
|
| Rate for Payer: Quartz Beloit One Network |
$519.38
|
| Rate for Payer: Quartz Commercial |
$672.83
|
| Rate for Payer: Quartz Medicare Advantage |
$97.39
|
| Rate for Payer: The Alliance Commercial |
$243.46
|
| Rate for Payer: United Healthcare Medicaid |
$106.88
|
| Rate for Payer: United Healthcare Medicare Advantage |
$97.39
|
| Rate for Payer: WEA Trust Commercial |
$649.22
|
| Rate for Payer: WPS Commercial |
$389.54
|
|
|
VL UE Arterial Duplex Right
|
Professional
|
Both
|
$1,630.00
|
|
|
Service Code
|
CPT 93930 TC,RT
|
| Hospital Charge Code |
3115223
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$172.22 |
| Max. Negotiated Rate |
$1,610.44 |
| Rate for Payer: Aetna Commercial |
$1,610.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,457.87
|
| Rate for Payer: Cash Price |
$489.00
|
| Rate for Payer: Cash Price |
$489.00
|
| Rate for Payer: Cash Price |
$489.00
|
| Rate for Payer: Cigna Commercial |
$1,610.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$172.22
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,017.12
|
| Rate for Payer: Health EOS Commercial |
$1,542.63
|
| Rate for Payer: HFN Commercial |
$1,610.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$725.24
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$725.24
|
| Rate for Payer: Multiplan Commercial |
$1,356.16
|
| Rate for Payer: Preferred Network Access Commercial |
$1,610.44
|
| Rate for Payer: Quartz Beloit One Network |
$745.89
|
| Rate for Payer: Quartz Commercial |
$966.26
|
| Rate for Payer: The Alliance Commercial |
$847.60
|
| Rate for Payer: United Healthcare Medicaid |
$172.22
|
| Rate for Payer: WEA Trust Commercial |
$932.36
|
| Rate for Payer: WPS Commercial |
$1,255.59
|
|
|
VL UE Arterial Duplex Right
|
Facility
|
IP
|
$1,135.00
|
|
|
Service Code
|
CPT 93931 TC
|
| Hospital Charge Code |
1483378
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$578.40 |
| Max. Negotiated Rate |
$1,085.97 |
| Rate for Payer: Aetna Commercial |
$1,062.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,015.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$625.61
|
| Rate for Payer: Cash Price |
$340.50
|
| Rate for Payer: Cigna Commercial |
$1,085.97
|
| Rate for Payer: Health EOS Commercial |
$1,050.56
|
| Rate for Payer: HFN Commercial |
$1,085.97
|
| Rate for Payer: Multiplan Commercial |
$944.32
|
| Rate for Payer: Preferred Network Access Commercial |
$1,085.97
|
| Rate for Payer: Quartz Beloit One Network |
$578.40
|
| Rate for Payer: Quartz Commercial |
$708.24
|
| Rate for Payer: WEA Trust Commercial |
$649.22
|
| Rate for Payer: WPS Commercial |
$874.29
|
|
|
VL UE Arterial Duplex Right
|
Facility
|
IP
|
$1,630.00
|
|
|
Service Code
|
CPT 93930 TC,RT
|
| Hospital Charge Code |
3115223
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$830.65 |
| Max. Negotiated Rate |
$1,559.58 |
| Rate for Payer: Aetna Commercial |
$1,525.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,457.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$898.46
|
| Rate for Payer: Cash Price |
$489.00
|
| Rate for Payer: Cigna Commercial |
$1,559.58
|
| Rate for Payer: Health EOS Commercial |
$1,508.73
|
| Rate for Payer: HFN Commercial |
$1,559.58
|
| Rate for Payer: Multiplan Commercial |
$1,356.16
|
| Rate for Payer: Preferred Network Access Commercial |
$1,559.58
|
| Rate for Payer: Quartz Beloit One Network |
$830.65
|
| Rate for Payer: Quartz Commercial |
$1,017.12
|
| Rate for Payer: WEA Trust Commercial |
$932.36
|
| Rate for Payer: WPS Commercial |
$1,255.59
|
|
|
VL UE/LE Physiological Study
|
Facility
|
IP
|
$1,571.00
|
|
|
Service Code
|
CPT 93923 TC
|
| Hospital Charge Code |
1483390
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$800.58 |
| Max. Negotiated Rate |
$1,503.13 |
| Rate for Payer: Aetna Commercial |
$1,470.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,405.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$865.94
|
| Rate for Payer: Cash Price |
$471.30
|
| Rate for Payer: Cigna Commercial |
$1,503.13
|
| Rate for Payer: Health EOS Commercial |
$1,454.12
|
| Rate for Payer: HFN Commercial |
$1,503.13
|
| Rate for Payer: Multiplan Commercial |
$1,307.07
|
| Rate for Payer: Preferred Network Access Commercial |
$1,503.13
|
| Rate for Payer: Quartz Beloit One Network |
$800.58
|
| Rate for Payer: Quartz Commercial |
$980.30
|
| Rate for Payer: WEA Trust Commercial |
$898.61
|
| Rate for Payer: WPS Commercial |
$1,210.14
|
|
|
VL UE/LE Physiological Study
|
Professional
|
Both
|
$1,571.00
|
|
|
Service Code
|
CPT 93923 TC
|
| Hospital Charge Code |
1483390
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$111.13 |
| Max. Negotiated Rate |
$1,552.15 |
| Rate for Payer: Aetna Commercial |
$1,552.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,405.10
|
| Rate for Payer: Aetna Managed Medicare |
$111.13
|
| Rate for Payer: Anthem Medicare Advantage |
$111.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$111.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$111.13
|
| Rate for Payer: Cash Price |
$471.30
|
| Rate for Payer: Cash Price |
$471.30
|
| Rate for Payer: Cash Price |
$471.30
|
| Rate for Payer: Cigna Commercial |
$1,552.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$111.30
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$111.13
|
| Rate for Payer: Health EOS Commercial |
$1,486.79
|
| Rate for Payer: HFN Commercial |
$1,552.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$389.33
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$389.33
|
| Rate for Payer: Independent Care Health Plan Medicare |
$111.13
|
| Rate for Payer: Multiplan Commercial |
$1,307.07
|
| Rate for Payer: NAPHCARE Commercial |
$166.70
|
| Rate for Payer: Preferred Network Access Commercial |
$1,552.15
|
| Rate for Payer: Quartz Beloit One Network |
$718.89
|
| Rate for Payer: Quartz Commercial |
$931.29
|
| Rate for Payer: Quartz Medicare Advantage |
$111.13
|
| Rate for Payer: The Alliance Commercial |
$277.84
|
| Rate for Payer: United Healthcare Medicaid |
$111.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$111.13
|
| Rate for Payer: WEA Trust Commercial |
$898.61
|
| Rate for Payer: WPS Commercial |
$444.54
|
|
|
VL UE/LE Physiological Study
|
Facility
|
OP
|
$1,571.00
|
|
|
Service Code
|
CPT 93923 TC
|
| Hospital Charge Code |
1483390
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$444.54 |
| Max. Negotiated Rate |
$1,503.13 |
| Rate for Payer: Aetna Commercial |
$1,470.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,405.10
|
| Rate for Payer: Aetna Managed Medicare |
$457.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,062.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$816.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$784.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$865.94
|
| Rate for Payer: Cash Price |
$471.30
|
| Rate for Payer: Cash Price |
$471.30
|
| Rate for Payer: Cigna Commercial |
$1,503.13
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$914.32
|
| Rate for Payer: Health EOS Commercial |
$1,454.12
|
| Rate for Payer: HFN Commercial |
$1,503.13
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,225.38
|
| Rate for Payer: Multiplan Commercial |
$1,307.07
|
| Rate for Payer: NAPHCARE Commercial |
$980.30
|
| Rate for Payer: Preferred Network Access Commercial |
$1,503.13
|
| Rate for Payer: Quartz Beloit One Network |
$800.58
|
| Rate for Payer: Quartz Commercial |
$1,062.00
|
| Rate for Payer: Quartz Medicare Advantage |
$980.30
|
| Rate for Payer: The Alliance Commercial |
$444.54
|
| Rate for Payer: United Healthcare PPO |
$1,225.38
|
| Rate for Payer: WEA Trust Commercial |
$898.61
|
| Rate for Payer: WPS Commercial |
$1,210.14
|
|
|
VL UE Venous Duplex Bilateral
|
Facility
|
IP
|
$1,975.00
|
|
|
Service Code
|
CPT 93970 TC
|
| Hospital Charge Code |
1483381
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$1,006.46 |
| Max. Negotiated Rate |
$1,889.68 |
| Rate for Payer: Aetna Commercial |
$1,848.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,766.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,088.62
|
| Rate for Payer: Cash Price |
$592.50
|
| Rate for Payer: Cigna Commercial |
$1,889.68
|
| Rate for Payer: Health EOS Commercial |
$1,828.06
|
| Rate for Payer: HFN Commercial |
$1,889.68
|
| Rate for Payer: Multiplan Commercial |
$1,643.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,889.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,006.46
|
| Rate for Payer: Quartz Commercial |
$1,232.40
|
| Rate for Payer: WEA Trust Commercial |
$1,129.70
|
| Rate for Payer: WPS Commercial |
$1,521.34
|
|
|
VL UE Venous Duplex Bilateral
|
Facility
|
OP
|
$1,975.00
|
|
|
Service Code
|
CPT 93970 TC
|
| Hospital Charge Code |
1483381
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$575.12 |
| Max. Negotiated Rate |
$1,889.68 |
| Rate for Payer: Aetna Commercial |
$1,848.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,766.44
|
| Rate for Payer: Aetna Managed Medicare |
$575.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,335.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,027.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$985.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,088.62
|
| Rate for Payer: Cash Price |
$592.50
|
| Rate for Payer: Cash Price |
$592.50
|
| Rate for Payer: Cigna Commercial |
$1,889.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,149.45
|
| Rate for Payer: Health EOS Commercial |
$1,828.06
|
| Rate for Payer: HFN Commercial |
$1,889.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,540.50
|
| Rate for Payer: Multiplan Commercial |
$1,643.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,232.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,889.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,006.46
|
| Rate for Payer: Quartz Commercial |
$1,335.10
|
| Rate for Payer: Quartz Medicare Advantage |
$1,232.40
|
| Rate for Payer: The Alliance Commercial |
$602.95
|
| Rate for Payer: United Healthcare PPO |
$1,540.50
|
| Rate for Payer: WEA Trust Commercial |
$1,129.70
|
| Rate for Payer: WPS Commercial |
$1,521.34
|
|
|
VL UE Venous Duplex Bilateral
|
Professional
|
Both
|
$1,975.00
|
|
|
Service Code
|
CPT 93970 TC
|
| Hospital Charge Code |
1483381
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$141.44 |
| Max. Negotiated Rate |
$1,951.30 |
| Rate for Payer: Aetna Commercial |
$1,951.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,766.44
|
| Rate for Payer: Aetna Managed Medicare |
$150.74
|
| Rate for Payer: Anthem Medicare Advantage |
$150.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$150.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$150.74
|
| Rate for Payer: Cash Price |
$592.50
|
| Rate for Payer: Cash Price |
$592.50
|
| Rate for Payer: Cash Price |
$592.50
|
| Rate for Payer: Cigna Commercial |
$1,951.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$141.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$150.74
|
| Rate for Payer: Health EOS Commercial |
$1,869.14
|
| Rate for Payer: HFN Commercial |
$1,951.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$573.96
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$573.96
|
| Rate for Payer: Independent Care Health Plan Medicare |
$150.74
|
| Rate for Payer: Multiplan Commercial |
$1,643.20
|
| Rate for Payer: NAPHCARE Commercial |
$226.11
|
| Rate for Payer: Preferred Network Access Commercial |
$1,951.30
|
| Rate for Payer: Quartz Beloit One Network |
$903.76
|
| Rate for Payer: Quartz Commercial |
$1,170.78
|
| Rate for Payer: Quartz Medicare Advantage |
$150.74
|
| Rate for Payer: The Alliance Commercial |
$376.84
|
| Rate for Payer: United Healthcare Medicaid |
$141.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$150.74
|
| Rate for Payer: WEA Trust Commercial |
$1,129.70
|
| Rate for Payer: WPS Commercial |
$602.95
|
|
|
VL UE Venous Duplex Bilat - Right
|
Facility
|
OP
|
$1,975.00
|
|
|
Service Code
|
CPT 93970 TC,RT
|
| Hospital Charge Code |
3100141
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$575.12 |
| Max. Negotiated Rate |
$1,889.68 |
| Rate for Payer: Aetna Commercial |
$1,848.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,766.44
|
| Rate for Payer: Aetna Managed Medicare |
$575.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,335.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,027.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$985.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,088.62
|
| Rate for Payer: Cash Price |
$592.50
|
| Rate for Payer: Cigna Commercial |
$1,889.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,149.45
|
| Rate for Payer: Health EOS Commercial |
$1,828.06
|
| Rate for Payer: HFN Commercial |
$1,889.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,540.50
|
| Rate for Payer: Multiplan Commercial |
$1,643.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,232.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,889.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,006.46
|
| Rate for Payer: Quartz Commercial |
$1,335.10
|
| Rate for Payer: Quartz Medicare Advantage |
$1,232.40
|
| Rate for Payer: The Alliance Commercial |
$1,027.00
|
| Rate for Payer: United Healthcare PPO |
$1,540.50
|
| Rate for Payer: WEA Trust Commercial |
$1,129.70
|
| Rate for Payer: WPS Commercial |
$1,521.34
|
|
|
VL UE Venous Duplex Bilat - Right
|
Professional
|
Both
|
$1,975.00
|
|
|
Service Code
|
CPT 93970 TC,RT
|
| Hospital Charge Code |
3100141
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$175.81 |
| Max. Negotiated Rate |
$1,951.30 |
| Rate for Payer: Aetna Commercial |
$1,951.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,766.44
|
| Rate for Payer: Cash Price |
$592.50
|
| Rate for Payer: Cash Price |
$592.50
|
| Rate for Payer: Cash Price |
$592.50
|
| Rate for Payer: Cigna Commercial |
$1,951.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$175.81
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,232.40
|
| Rate for Payer: Health EOS Commercial |
$1,869.14
|
| Rate for Payer: HFN Commercial |
$1,951.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$692.06
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$692.06
|
| Rate for Payer: Multiplan Commercial |
$1,643.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,951.30
|
| Rate for Payer: Quartz Beloit One Network |
$903.76
|
| Rate for Payer: Quartz Commercial |
$1,170.78
|
| Rate for Payer: The Alliance Commercial |
$1,027.00
|
| Rate for Payer: United Healthcare Medicaid |
$175.81
|
| Rate for Payer: WEA Trust Commercial |
$1,129.70
|
| Rate for Payer: WPS Commercial |
$1,521.34
|
|
|
VL UE Venous Duplex Bilat - Right
|
Facility
|
IP
|
$1,975.00
|
|
|
Service Code
|
CPT 93970 TC,RT
|
| Hospital Charge Code |
3100141
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$1,006.46 |
| Max. Negotiated Rate |
$1,889.68 |
| Rate for Payer: Aetna Commercial |
$1,848.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,766.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,088.62
|
| Rate for Payer: Cash Price |
$592.50
|
| Rate for Payer: Cigna Commercial |
$1,889.68
|
| Rate for Payer: Health EOS Commercial |
$1,828.06
|
| Rate for Payer: HFN Commercial |
$1,889.68
|
| Rate for Payer: Multiplan Commercial |
$1,643.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,889.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,006.46
|
| Rate for Payer: Quartz Commercial |
$1,232.40
|
| Rate for Payer: WEA Trust Commercial |
$1,129.70
|
| Rate for Payer: WPS Commercial |
$1,521.34
|
|
|
VL UE Venous Duplex Left
|
Facility
|
OP
|
$1,234.00
|
|
|
Service Code
|
CPT 93971 TC
|
| Hospital Charge Code |
1483384
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$359.34 |
| Max. Negotiated Rate |
$1,180.69 |
| Rate for Payer: Aetna Commercial |
$1,155.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,103.69
|
| Rate for Payer: Aetna Managed Medicare |
$359.34
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$834.18
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$641.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$616.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$680.18
|
| Rate for Payer: Cash Price |
$370.20
|
| Rate for Payer: Cash Price |
$370.20
|
| Rate for Payer: Cigna Commercial |
$1,180.69
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$718.19
|
| Rate for Payer: Health EOS Commercial |
$1,142.19
|
| Rate for Payer: HFN Commercial |
$1,180.69
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$962.52
|
| Rate for Payer: Multiplan Commercial |
$1,026.69
|
| Rate for Payer: NAPHCARE Commercial |
$770.02
|
| Rate for Payer: Preferred Network Access Commercial |
$1,180.69
|
| Rate for Payer: Quartz Beloit One Network |
$628.85
|
| Rate for Payer: Quartz Commercial |
$834.18
|
| Rate for Payer: Quartz Medicare Advantage |
$770.02
|
| Rate for Payer: The Alliance Commercial |
$380.22
|
| Rate for Payer: United Healthcare PPO |
$962.52
|
| Rate for Payer: WEA Trust Commercial |
$705.85
|
| Rate for Payer: WPS Commercial |
$950.55
|
|
|
VL UE Venous Duplex Left
|
Facility
|
IP
|
$1,234.00
|
|
|
Service Code
|
CPT 93971 TC
|
| Hospital Charge Code |
1483384
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$628.85 |
| Max. Negotiated Rate |
$1,180.69 |
| Rate for Payer: Aetna Commercial |
$1,155.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,103.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$680.18
|
| Rate for Payer: Cash Price |
$370.20
|
| Rate for Payer: Cigna Commercial |
$1,180.69
|
| Rate for Payer: Health EOS Commercial |
$1,142.19
|
| Rate for Payer: HFN Commercial |
$1,180.69
|
| Rate for Payer: Multiplan Commercial |
$1,026.69
|
| Rate for Payer: Preferred Network Access Commercial |
$1,180.69
|
| Rate for Payer: Quartz Beloit One Network |
$628.85
|
| Rate for Payer: Quartz Commercial |
$770.02
|
| Rate for Payer: WEA Trust Commercial |
$705.85
|
| Rate for Payer: WPS Commercial |
$950.55
|
|
|
VL UE Venous Duplex Left
|
Professional
|
Both
|
$1,234.00
|
|
|
Service Code
|
CPT 93971 TC
|
| Hospital Charge Code |
1483384
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$90.17 |
| Max. Negotiated Rate |
$1,219.19 |
| Rate for Payer: Aetna Commercial |
$1,219.19
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,103.69
|
| Rate for Payer: Aetna Managed Medicare |
$95.06
|
| Rate for Payer: Anthem Medicare Advantage |
$95.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$95.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$95.06
|
| Rate for Payer: Cash Price |
$370.20
|
| Rate for Payer: Cash Price |
$370.20
|
| Rate for Payer: Cash Price |
$370.20
|
| Rate for Payer: Cigna Commercial |
$1,219.19
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$90.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$95.06
|
| Rate for Payer: Health EOS Commercial |
$1,167.86
|
| Rate for Payer: HFN Commercial |
$1,219.19
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$358.75
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$358.75
|
| Rate for Payer: Independent Care Health Plan Medicare |
$95.06
|
| Rate for Payer: Multiplan Commercial |
$1,026.69
|
| Rate for Payer: NAPHCARE Commercial |
$142.58
|
| Rate for Payer: Preferred Network Access Commercial |
$1,219.19
|
| Rate for Payer: Quartz Beloit One Network |
$564.68
|
| Rate for Payer: Quartz Commercial |
$731.52
|
| Rate for Payer: Quartz Medicare Advantage |
$95.06
|
| Rate for Payer: The Alliance Commercial |
$237.64
|
| Rate for Payer: United Healthcare Medicaid |
$90.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$95.06
|
| Rate for Payer: WEA Trust Commercial |
$705.85
|
| Rate for Payer: WPS Commercial |
$380.22
|
|
|
VL UE Venous Duplex Right
|
Professional
|
Both
|
$1,234.00
|
|
|
Service Code
|
CPT 93971 TC
|
| Hospital Charge Code |
1483387
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$90.17 |
| Max. Negotiated Rate |
$1,219.19 |
| Rate for Payer: Aetna Commercial |
$1,219.19
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,103.69
|
| Rate for Payer: Aetna Managed Medicare |
$95.06
|
| Rate for Payer: Anthem Medicare Advantage |
$95.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$95.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$95.06
|
| Rate for Payer: Cash Price |
$370.20
|
| Rate for Payer: Cash Price |
$370.20
|
| Rate for Payer: Cash Price |
$370.20
|
| Rate for Payer: Cigna Commercial |
$1,219.19
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$90.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$95.06
|
| Rate for Payer: Health EOS Commercial |
$1,167.86
|
| Rate for Payer: HFN Commercial |
$1,219.19
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$358.75
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$358.75
|
| Rate for Payer: Independent Care Health Plan Medicare |
$95.06
|
| Rate for Payer: Multiplan Commercial |
$1,026.69
|
| Rate for Payer: NAPHCARE Commercial |
$142.58
|
| Rate for Payer: Preferred Network Access Commercial |
$1,219.19
|
| Rate for Payer: Quartz Beloit One Network |
$564.68
|
| Rate for Payer: Quartz Commercial |
$731.52
|
| Rate for Payer: Quartz Medicare Advantage |
$95.06
|
| Rate for Payer: The Alliance Commercial |
$237.64
|
| Rate for Payer: United Healthcare Medicaid |
$90.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$95.06
|
| Rate for Payer: WEA Trust Commercial |
$705.85
|
| Rate for Payer: WPS Commercial |
$380.22
|
|
|
VL UE Venous Duplex Right
|
Facility
|
IP
|
$1,234.00
|
|
|
Service Code
|
CPT 93971 TC
|
| Hospital Charge Code |
1483387
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$628.85 |
| Max. Negotiated Rate |
$1,180.69 |
| Rate for Payer: Aetna Commercial |
$1,155.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,103.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$680.18
|
| Rate for Payer: Cash Price |
$370.20
|
| Rate for Payer: Cigna Commercial |
$1,180.69
|
| Rate for Payer: Health EOS Commercial |
$1,142.19
|
| Rate for Payer: HFN Commercial |
$1,180.69
|
| Rate for Payer: Multiplan Commercial |
$1,026.69
|
| Rate for Payer: Preferred Network Access Commercial |
$1,180.69
|
| Rate for Payer: Quartz Beloit One Network |
$628.85
|
| Rate for Payer: Quartz Commercial |
$770.02
|
| Rate for Payer: WEA Trust Commercial |
$705.85
|
| Rate for Payer: WPS Commercial |
$950.55
|
|
|
VL UE Venous Duplex Right
|
Facility
|
OP
|
$1,234.00
|
|
|
Service Code
|
CPT 93971 TC
|
| Hospital Charge Code |
1483387
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$359.34 |
| Max. Negotiated Rate |
$1,180.69 |
| Rate for Payer: Aetna Commercial |
$1,155.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,103.69
|
| Rate for Payer: Aetna Managed Medicare |
$359.34
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$834.18
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$641.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$616.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$680.18
|
| Rate for Payer: Cash Price |
$370.20
|
| Rate for Payer: Cash Price |
$370.20
|
| Rate for Payer: Cigna Commercial |
$1,180.69
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$718.19
|
| Rate for Payer: Health EOS Commercial |
$1,142.19
|
| Rate for Payer: HFN Commercial |
$1,180.69
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$962.52
|
| Rate for Payer: Multiplan Commercial |
$1,026.69
|
| Rate for Payer: NAPHCARE Commercial |
$770.02
|
| Rate for Payer: Preferred Network Access Commercial |
$1,180.69
|
| Rate for Payer: Quartz Beloit One Network |
$628.85
|
| Rate for Payer: Quartz Commercial |
$834.18
|
| Rate for Payer: Quartz Medicare Advantage |
$770.02
|
| Rate for Payer: The Alliance Commercial |
$380.22
|
| Rate for Payer: United Healthcare PPO |
$962.52
|
| Rate for Payer: WEA Trust Commercial |
$705.85
|
| Rate for Payer: WPS Commercial |
$950.55
|
|
|
VL Upper Extremity PVR w Excercise
|
Facility
|
IP
|
$992.00
|
|
|
Service Code
|
CPT 93922 TC
|
| Hospital Charge Code |
2530812
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$505.52 |
| Max. Negotiated Rate |
$949.15 |
| Rate for Payer: Aetna Commercial |
$928.51
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$887.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$546.79
|
| Rate for Payer: Cash Price |
$297.60
|
| Rate for Payer: Cigna Commercial |
$949.15
|
| Rate for Payer: Health EOS Commercial |
$918.20
|
| Rate for Payer: HFN Commercial |
$949.15
|
| Rate for Payer: Multiplan Commercial |
$825.34
|
| Rate for Payer: Preferred Network Access Commercial |
$949.15
|
| Rate for Payer: Quartz Beloit One Network |
$505.52
|
| Rate for Payer: Quartz Commercial |
$619.01
|
| Rate for Payer: WEA Trust Commercial |
$567.42
|
| Rate for Payer: WPS Commercial |
$764.14
|
|
|
VL Upper Extremity PVR w Excercise
|
Facility
|
OP
|
$992.00
|
|
|
Service Code
|
CPT 93922 TC
|
| Hospital Charge Code |
2530812
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$283.05 |
| Max. Negotiated Rate |
$949.15 |
| Rate for Payer: Aetna Commercial |
$928.51
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$887.24
|
| Rate for Payer: Aetna Managed Medicare |
$288.87
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$670.59
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$515.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$495.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$546.79
|
| Rate for Payer: Cash Price |
$297.60
|
| Rate for Payer: Cash Price |
$297.60
|
| Rate for Payer: Cigna Commercial |
$949.15
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$577.34
|
| Rate for Payer: Health EOS Commercial |
$918.20
|
| Rate for Payer: HFN Commercial |
$949.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$773.76
|
| Rate for Payer: Multiplan Commercial |
$825.34
|
| Rate for Payer: NAPHCARE Commercial |
$619.01
|
| Rate for Payer: Preferred Network Access Commercial |
$949.15
|
| Rate for Payer: Quartz Beloit One Network |
$505.52
|
| Rate for Payer: Quartz Commercial |
$670.59
|
| Rate for Payer: Quartz Medicare Advantage |
$619.01
|
| Rate for Payer: The Alliance Commercial |
$283.05
|
| Rate for Payer: United Healthcare PPO |
$773.76
|
| Rate for Payer: WEA Trust Commercial |
$567.42
|
| Rate for Payer: WPS Commercial |
$764.14
|
|
|
VL Upper Extremity PVR w Excercise
|
Professional
|
Both
|
$992.00
|
|
|
Service Code
|
CPT 93922 TC
|
| Hospital Charge Code |
2530812
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$70.76 |
| Max. Negotiated Rate |
$980.10 |
| Rate for Payer: Aetna Commercial |
$980.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$887.24
|
| Rate for Payer: Aetna Managed Medicare |
$70.76
|
| Rate for Payer: Anthem Medicare Advantage |
$70.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$70.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$70.76
|
| Rate for Payer: Cash Price |
$297.60
|
| Rate for Payer: Cash Price |
$297.60
|
| Rate for Payer: Cash Price |
$297.60
|
| Rate for Payer: Cigna Commercial |
$980.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$71.45
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$70.76
|
| Rate for Payer: Health EOS Commercial |
$938.83
|
| Rate for Payer: HFN Commercial |
$980.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$256.17
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$256.17
|
| Rate for Payer: Independent Care Health Plan Medicare |
$70.76
|
| Rate for Payer: Multiplan Commercial |
$825.34
|
| Rate for Payer: NAPHCARE Commercial |
$106.14
|
| Rate for Payer: Preferred Network Access Commercial |
$980.10
|
| Rate for Payer: Quartz Beloit One Network |
$453.94
|
| Rate for Payer: Quartz Commercial |
$588.06
|
| Rate for Payer: Quartz Medicare Advantage |
$70.76
|
| Rate for Payer: The Alliance Commercial |
$176.90
|
| Rate for Payer: United Healthcare Medicaid |
$71.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$70.76
|
| Rate for Payer: WEA Trust Commercial |
$567.42
|
| Rate for Payer: WPS Commercial |
$283.05
|
|
