|
VL LE Arterial Duplex Right
|
Facility
|
IP
|
$1,227.00
|
|
|
Service Code
|
CPT 93926 TC
|
| Hospital Charge Code |
1483087
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$601.23 |
| Max. Negotiated Rate |
$1,128.84 |
| Rate for Payer: Aetna Commercial |
$1,104.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,055.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$650.31
|
| Rate for Payer: Cash Price |
$368.10
|
| Rate for Payer: Cigna Commercial |
$1,128.84
|
| Rate for Payer: Health EOS Commercial |
$1,092.03
|
| Rate for Payer: HFN Commercial |
$1,128.84
|
| Rate for Payer: Multiplan Commercial |
$981.60
|
| Rate for Payer: NAPHCARE Commercial |
$736.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,128.84
|
| Rate for Payer: Quartz Beloit One Network |
$601.23
|
| Rate for Payer: Quartz Commercial |
$736.20
|
| Rate for Payer: WEA Trust Commercial |
$674.85
|
| Rate for Payer: WPS Commercial |
$908.84
|
|
|
VL LE Arterial Duplex Right
|
Facility
|
OP
|
$1,227.00
|
|
|
Service Code
|
CPT 93926 TC
|
| Hospital Charge Code |
1483087
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$343.56 |
| Max. Negotiated Rate |
$4,908.00 |
| Rate for Payer: Aetna Commercial |
$1,104.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,055.22
|
| Rate for Payer: Aetna Managed Medicare |
$343.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$797.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$613.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$588.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$650.31
|
| Rate for Payer: Cash Price |
$368.10
|
| Rate for Payer: Cigna Commercial |
$1,128.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$686.63
|
| Rate for Payer: Health EOS Commercial |
$1,092.03
|
| Rate for Payer: HFN Commercial |
$1,128.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$920.25
|
| Rate for Payer: Multiplan Commercial |
$981.60
|
| Rate for Payer: NAPHCARE Commercial |
$736.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,128.84
|
| Rate for Payer: Quartz Beloit One Network |
$601.23
|
| Rate for Payer: Quartz Commercial |
$797.55
|
| Rate for Payer: Quartz Medicare Advantage |
$736.20
|
| Rate for Payer: The Alliance Commercial |
$4,908.00
|
| Rate for Payer: United Healthcare PPO |
$920.25
|
| Rate for Payer: WEA Trust Commercial |
$674.85
|
| Rate for Payer: WPS Commercial |
$908.84
|
|
|
VL LE Arterial Duplex Right
|
Professional
|
Both
|
$1,227.00
|
|
|
Service Code
|
CPT 93926 TC
|
| Hospital Charge Code |
1483087
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$428.86 |
| Max. Negotiated Rate |
$1,165.65 |
| Rate for Payer: Aetna Commercial |
$1,165.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,055.22
|
| Rate for Payer: Cash Price |
$368.10
|
| Rate for Payer: Cash Price |
$368.10
|
| Rate for Payer: Cigna Commercial |
$1,165.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$613.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$736.20
|
| Rate for Payer: Health EOS Commercial |
$1,116.57
|
| Rate for Payer: HFN Commercial |
$1,165.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$428.86
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$428.86
|
| Rate for Payer: Multiplan Commercial |
$981.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,165.65
|
| Rate for Payer: Quartz Beloit One Network |
$539.88
|
| Rate for Payer: Quartz Commercial |
$699.39
|
| Rate for Payer: The Alliance Commercial |
$613.50
|
| Rate for Payer: WEA Trust Commercial |
$674.85
|
| Rate for Payer: WPS Commercial |
$908.84
|
|
|
VL LE Arterial Graft Patency Bilateral
|
Facility
|
OP
|
$2,194.00
|
|
|
Service Code
|
CPT 93925 TC
|
| Hospital Charge Code |
5238990
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$614.32 |
| Max. Negotiated Rate |
$8,776.00 |
| Rate for Payer: Aetna Commercial |
$1,974.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,886.84
|
| Rate for Payer: Aetna Managed Medicare |
$614.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,426.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,097.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,053.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,162.82
|
| Rate for Payer: Cash Price |
$658.20
|
| Rate for Payer: Cigna Commercial |
$2,018.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,227.76
|
| Rate for Payer: Health EOS Commercial |
$1,952.66
|
| Rate for Payer: HFN Commercial |
$2,018.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,645.50
|
| Rate for Payer: Multiplan Commercial |
$1,755.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,316.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,018.48
|
| Rate for Payer: Quartz Beloit One Network |
$1,075.06
|
| Rate for Payer: Quartz Commercial |
$1,426.10
|
| Rate for Payer: Quartz Medicare Advantage |
$1,316.40
|
| Rate for Payer: The Alliance Commercial |
$8,776.00
|
| Rate for Payer: United Healthcare PPO |
$1,645.50
|
| Rate for Payer: WEA Trust Commercial |
$1,206.70
|
| Rate for Payer: WPS Commercial |
$1,625.10
|
|
|
VL LE Arterial Graft Patency Bilateral
|
Facility
|
IP
|
$2,194.00
|
|
|
Service Code
|
CPT 93925 TC
|
| Hospital Charge Code |
5238990
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$1,075.06 |
| Max. Negotiated Rate |
$2,018.48 |
| Rate for Payer: Aetna Commercial |
$1,974.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,886.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,162.82
|
| Rate for Payer: Cash Price |
$658.20
|
| Rate for Payer: Cigna Commercial |
$2,018.48
|
| Rate for Payer: Health EOS Commercial |
$1,952.66
|
| Rate for Payer: HFN Commercial |
$2,018.48
|
| Rate for Payer: Multiplan Commercial |
$1,755.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,316.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,018.48
|
| Rate for Payer: Quartz Beloit One Network |
$1,075.06
|
| Rate for Payer: Quartz Commercial |
$1,316.40
|
| Rate for Payer: WEA Trust Commercial |
$1,206.70
|
| Rate for Payer: WPS Commercial |
$1,625.10
|
|
|
VL LE Arterial Graft Patency Bilateral
|
Professional
|
Both
|
$2,194.00
|
|
|
Service Code
|
CPT 93925 TC
|
| Hospital Charge Code |
5238990
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$733.60 |
| Max. Negotiated Rate |
$2,084.30 |
| Rate for Payer: Aetna Commercial |
$2,084.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,886.84
|
| Rate for Payer: Cash Price |
$658.20
|
| Rate for Payer: Cash Price |
$658.20
|
| Rate for Payer: Cigna Commercial |
$2,084.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,097.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,316.40
|
| Rate for Payer: Health EOS Commercial |
$1,996.54
|
| Rate for Payer: HFN Commercial |
$2,084.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$733.60
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$733.60
|
| Rate for Payer: Multiplan Commercial |
$1,755.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,084.30
|
| Rate for Payer: Quartz Beloit One Network |
$965.36
|
| Rate for Payer: Quartz Commercial |
$1,250.58
|
| Rate for Payer: The Alliance Commercial |
$1,097.00
|
| Rate for Payer: WEA Trust Commercial |
$1,206.70
|
| Rate for Payer: WPS Commercial |
$1,625.10
|
|
|
VL LE Arterial Graft Patency Left
|
Professional
|
Both
|
$1,227.00
|
|
|
Service Code
|
CPT 93926 TC
|
| Hospital Charge Code |
5238992
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$428.86 |
| Max. Negotiated Rate |
$1,165.65 |
| Rate for Payer: Aetna Commercial |
$1,165.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,055.22
|
| Rate for Payer: Cash Price |
$368.10
|
| Rate for Payer: Cash Price |
$368.10
|
| Rate for Payer: Cigna Commercial |
$1,165.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$613.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$736.20
|
| Rate for Payer: Health EOS Commercial |
$1,116.57
|
| Rate for Payer: HFN Commercial |
$1,165.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$428.86
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$428.86
|
| Rate for Payer: Multiplan Commercial |
$981.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,165.65
|
| Rate for Payer: Quartz Beloit One Network |
$539.88
|
| Rate for Payer: Quartz Commercial |
$699.39
|
| Rate for Payer: The Alliance Commercial |
$613.50
|
| Rate for Payer: WEA Trust Commercial |
$674.85
|
| Rate for Payer: WPS Commercial |
$908.84
|
|
|
VL LE Arterial Graft Patency Left
|
Facility
|
IP
|
$1,227.00
|
|
|
Service Code
|
CPT 93926 TC
|
| Hospital Charge Code |
5238992
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$601.23 |
| Max. Negotiated Rate |
$1,128.84 |
| Rate for Payer: Aetna Commercial |
$1,104.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,055.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$650.31
|
| Rate for Payer: Cash Price |
$368.10
|
| Rate for Payer: Cigna Commercial |
$1,128.84
|
| Rate for Payer: Health EOS Commercial |
$1,092.03
|
| Rate for Payer: HFN Commercial |
$1,128.84
|
| Rate for Payer: Multiplan Commercial |
$981.60
|
| Rate for Payer: NAPHCARE Commercial |
$736.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,128.84
|
| Rate for Payer: Quartz Beloit One Network |
$601.23
|
| Rate for Payer: Quartz Commercial |
$736.20
|
| Rate for Payer: WEA Trust Commercial |
$674.85
|
| Rate for Payer: WPS Commercial |
$908.84
|
|
|
VL LE Arterial Graft Patency Left
|
Facility
|
OP
|
$1,227.00
|
|
|
Service Code
|
CPT 93926 TC
|
| Hospital Charge Code |
5238992
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$343.56 |
| Max. Negotiated Rate |
$4,908.00 |
| Rate for Payer: Aetna Commercial |
$1,104.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,055.22
|
| Rate for Payer: Aetna Managed Medicare |
$343.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$797.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$613.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$588.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$650.31
|
| Rate for Payer: Cash Price |
$368.10
|
| Rate for Payer: Cigna Commercial |
$1,128.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$686.63
|
| Rate for Payer: Health EOS Commercial |
$1,092.03
|
| Rate for Payer: HFN Commercial |
$1,128.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$920.25
|
| Rate for Payer: Multiplan Commercial |
$981.60
|
| Rate for Payer: NAPHCARE Commercial |
$736.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,128.84
|
| Rate for Payer: Quartz Beloit One Network |
$601.23
|
| Rate for Payer: Quartz Commercial |
$797.55
|
| Rate for Payer: Quartz Medicare Advantage |
$736.20
|
| Rate for Payer: The Alliance Commercial |
$4,908.00
|
| Rate for Payer: United Healthcare PPO |
$920.25
|
| Rate for Payer: WEA Trust Commercial |
$674.85
|
| Rate for Payer: WPS Commercial |
$908.84
|
|
|
VL LE Arterial Graft Patency Right
|
Professional
|
Both
|
$1,227.00
|
|
|
Service Code
|
CPT 93926 TC
|
| Hospital Charge Code |
5238994
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$428.86 |
| Max. Negotiated Rate |
$1,165.65 |
| Rate for Payer: Aetna Commercial |
$1,165.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,055.22
|
| Rate for Payer: Cash Price |
$368.10
|
| Rate for Payer: Cash Price |
$368.10
|
| Rate for Payer: Cigna Commercial |
$1,165.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$613.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$736.20
|
| Rate for Payer: Health EOS Commercial |
$1,116.57
|
| Rate for Payer: HFN Commercial |
$1,165.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$428.86
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$428.86
|
| Rate for Payer: Multiplan Commercial |
$981.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,165.65
|
| Rate for Payer: Quartz Beloit One Network |
$539.88
|
| Rate for Payer: Quartz Commercial |
$699.39
|
| Rate for Payer: The Alliance Commercial |
$613.50
|
| Rate for Payer: WEA Trust Commercial |
$674.85
|
| Rate for Payer: WPS Commercial |
$908.84
|
|
|
VL LE Arterial Graft Patency Right
|
Facility
|
IP
|
$1,227.00
|
|
|
Service Code
|
CPT 93926 TC
|
| Hospital Charge Code |
5238994
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$601.23 |
| Max. Negotiated Rate |
$1,128.84 |
| Rate for Payer: Aetna Commercial |
$1,104.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,055.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$650.31
|
| Rate for Payer: Cash Price |
$368.10
|
| Rate for Payer: Cigna Commercial |
$1,128.84
|
| Rate for Payer: Health EOS Commercial |
$1,092.03
|
| Rate for Payer: HFN Commercial |
$1,128.84
|
| Rate for Payer: Multiplan Commercial |
$981.60
|
| Rate for Payer: NAPHCARE Commercial |
$736.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,128.84
|
| Rate for Payer: Quartz Beloit One Network |
$601.23
|
| Rate for Payer: Quartz Commercial |
$736.20
|
| Rate for Payer: WEA Trust Commercial |
$674.85
|
| Rate for Payer: WPS Commercial |
$908.84
|
|
|
VL LE Arterial Graft Patency Right
|
Facility
|
OP
|
$1,227.00
|
|
|
Service Code
|
CPT 93926 TC
|
| Hospital Charge Code |
5238994
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$343.56 |
| Max. Negotiated Rate |
$4,908.00 |
| Rate for Payer: Aetna Commercial |
$1,104.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,055.22
|
| Rate for Payer: Aetna Managed Medicare |
$343.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$797.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$613.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$588.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$650.31
|
| Rate for Payer: Cash Price |
$368.10
|
| Rate for Payer: Cigna Commercial |
$1,128.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$686.63
|
| Rate for Payer: Health EOS Commercial |
$1,092.03
|
| Rate for Payer: HFN Commercial |
$1,128.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$920.25
|
| Rate for Payer: Multiplan Commercial |
$981.60
|
| Rate for Payer: NAPHCARE Commercial |
$736.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,128.84
|
| Rate for Payer: Quartz Beloit One Network |
$601.23
|
| Rate for Payer: Quartz Commercial |
$797.55
|
| Rate for Payer: Quartz Medicare Advantage |
$736.20
|
| Rate for Payer: The Alliance Commercial |
$4,908.00
|
| Rate for Payer: United Healthcare PPO |
$920.25
|
| Rate for Payer: WEA Trust Commercial |
$674.85
|
| Rate for Payer: WPS Commercial |
$908.84
|
|
|
VL LE Venous Duplex Bilateral
|
Facility
|
OP
|
$1,975.00
|
|
|
Service Code
|
CPT 93970 TC
|
| Hospital Charge Code |
1483096
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$553.00 |
| Max. Negotiated Rate |
$7,900.00 |
| Rate for Payer: Aetna Commercial |
$1,777.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,698.50
|
| Rate for Payer: Aetna Managed Medicare |
$553.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,283.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$987.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$948.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,046.75
|
| Rate for Payer: Cash Price |
$592.50
|
| Rate for Payer: Cigna Commercial |
$1,817.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,105.21
|
| Rate for Payer: Health EOS Commercial |
$1,757.75
|
| Rate for Payer: HFN Commercial |
$1,817.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,481.25
|
| Rate for Payer: Multiplan Commercial |
$1,580.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,185.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,817.00
|
| Rate for Payer: Quartz Beloit One Network |
$967.75
|
| Rate for Payer: Quartz Commercial |
$1,283.75
|
| Rate for Payer: Quartz Medicare Advantage |
$1,185.00
|
| Rate for Payer: The Alliance Commercial |
$7,900.00
|
| Rate for Payer: United Healthcare PPO |
$1,481.25
|
| Rate for Payer: WEA Trust Commercial |
$1,086.25
|
| Rate for Payer: WPS Commercial |
$1,462.88
|
|
|
VL LE Venous Duplex Bilateral
|
Facility
|
IP
|
$1,975.00
|
|
|
Service Code
|
CPT 93970 TC
|
| Hospital Charge Code |
1483096
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$967.75 |
| Max. Negotiated Rate |
$1,817.00 |
| Rate for Payer: Aetna Commercial |
$1,777.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,698.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,046.75
|
| Rate for Payer: Cash Price |
$592.50
|
| Rate for Payer: Cigna Commercial |
$1,817.00
|
| Rate for Payer: Health EOS Commercial |
$1,757.75
|
| Rate for Payer: HFN Commercial |
$1,817.00
|
| Rate for Payer: Multiplan Commercial |
$1,580.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,185.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,817.00
|
| Rate for Payer: Quartz Beloit One Network |
$967.75
|
| Rate for Payer: Quartz Commercial |
$1,185.00
|
| Rate for Payer: WEA Trust Commercial |
$1,086.25
|
| Rate for Payer: WPS Commercial |
$1,462.88
|
|
|
VL LE Venous Duplex Bilateral
|
Professional
|
Both
|
$1,975.00
|
|
|
Service Code
|
CPT 93970 TC
|
| Hospital Charge Code |
1483096
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$551.88 |
| Max. Negotiated Rate |
$1,876.25 |
| Rate for Payer: Aetna Commercial |
$1,876.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,698.50
|
| Rate for Payer: Cash Price |
$592.50
|
| Rate for Payer: Cash Price |
$592.50
|
| Rate for Payer: Cigna Commercial |
$1,876.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$987.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,185.00
|
| Rate for Payer: Health EOS Commercial |
$1,797.25
|
| Rate for Payer: HFN Commercial |
$1,876.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$551.88
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$551.88
|
| Rate for Payer: Multiplan Commercial |
$1,580.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,876.25
|
| Rate for Payer: Quartz Beloit One Network |
$869.00
|
| Rate for Payer: Quartz Commercial |
$1,125.75
|
| Rate for Payer: The Alliance Commercial |
$987.50
|
| Rate for Payer: WEA Trust Commercial |
$1,086.25
|
| Rate for Payer: WPS Commercial |
$1,462.88
|
|
|
VL LE Venous Duplex Left
|
Facility
|
OP
|
$1,234.00
|
|
|
Service Code
|
CPT 93971 TC
|
| Hospital Charge Code |
1483099
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$345.52 |
| Max. Negotiated Rate |
$4,936.00 |
| Rate for Payer: Aetna Commercial |
$1,110.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,061.24
|
| Rate for Payer: Aetna Managed Medicare |
$345.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$802.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$617.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$592.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$654.02
|
| Rate for Payer: Cash Price |
$370.20
|
| Rate for Payer: Cigna Commercial |
$1,135.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$690.55
|
| Rate for Payer: Health EOS Commercial |
$1,098.26
|
| Rate for Payer: HFN Commercial |
$1,135.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$925.50
|
| Rate for Payer: Multiplan Commercial |
$987.20
|
| Rate for Payer: NAPHCARE Commercial |
$740.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,135.28
|
| Rate for Payer: Quartz Beloit One Network |
$604.66
|
| Rate for Payer: Quartz Commercial |
$802.10
|
| Rate for Payer: Quartz Medicare Advantage |
$740.40
|
| Rate for Payer: The Alliance Commercial |
$4,936.00
|
| Rate for Payer: United Healthcare PPO |
$925.50
|
| Rate for Payer: WEA Trust Commercial |
$678.70
|
| Rate for Payer: WPS Commercial |
$914.02
|
|
|
VL LE Venous Duplex Left
|
Facility
|
IP
|
$1,234.00
|
|
|
Service Code
|
CPT 93971 TC
|
| Hospital Charge Code |
1483099
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$604.66 |
| Max. Negotiated Rate |
$1,135.28 |
| Rate for Payer: Aetna Commercial |
$1,110.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,061.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$654.02
|
| Rate for Payer: Cash Price |
$370.20
|
| Rate for Payer: Cigna Commercial |
$1,135.28
|
| Rate for Payer: Health EOS Commercial |
$1,098.26
|
| Rate for Payer: HFN Commercial |
$1,135.28
|
| Rate for Payer: Multiplan Commercial |
$987.20
|
| Rate for Payer: NAPHCARE Commercial |
$740.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,135.28
|
| Rate for Payer: Quartz Beloit One Network |
$604.66
|
| Rate for Payer: Quartz Commercial |
$740.40
|
| Rate for Payer: WEA Trust Commercial |
$678.70
|
| Rate for Payer: WPS Commercial |
$914.02
|
|
|
VL LE Venous Duplex Left
|
Professional
|
Both
|
$1,234.00
|
|
|
Service Code
|
CPT 93971 TC
|
| Hospital Charge Code |
1483099
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$344.95 |
| Max. Negotiated Rate |
$1,172.30 |
| Rate for Payer: Aetna Commercial |
$1,172.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,061.24
|
| Rate for Payer: Cash Price |
$370.20
|
| Rate for Payer: Cash Price |
$370.20
|
| Rate for Payer: Cigna Commercial |
$1,172.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$617.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$740.40
|
| Rate for Payer: Health EOS Commercial |
$1,122.94
|
| Rate for Payer: HFN Commercial |
$1,172.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$344.95
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$344.95
|
| Rate for Payer: Multiplan Commercial |
$987.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,172.30
|
| Rate for Payer: Quartz Beloit One Network |
$542.96
|
| Rate for Payer: Quartz Commercial |
$703.38
|
| Rate for Payer: The Alliance Commercial |
$617.00
|
| Rate for Payer: WEA Trust Commercial |
$678.70
|
| Rate for Payer: WPS Commercial |
$914.02
|
|
|
VL LE Venous Duplex Right
|
Facility
|
IP
|
$1,234.00
|
|
|
Service Code
|
CPT 93971 TC
|
| Hospital Charge Code |
1483102
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$604.66 |
| Max. Negotiated Rate |
$1,135.28 |
| Rate for Payer: Aetna Commercial |
$1,110.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,061.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$654.02
|
| Rate for Payer: Cash Price |
$370.20
|
| Rate for Payer: Cigna Commercial |
$1,135.28
|
| Rate for Payer: Health EOS Commercial |
$1,098.26
|
| Rate for Payer: HFN Commercial |
$1,135.28
|
| Rate for Payer: Multiplan Commercial |
$987.20
|
| Rate for Payer: NAPHCARE Commercial |
$740.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,135.28
|
| Rate for Payer: Quartz Beloit One Network |
$604.66
|
| Rate for Payer: Quartz Commercial |
$740.40
|
| Rate for Payer: WEA Trust Commercial |
$678.70
|
| Rate for Payer: WPS Commercial |
$914.02
|
|
|
VL LE Venous Duplex Right
|
Facility
|
OP
|
$1,234.00
|
|
|
Service Code
|
CPT 93971 TC
|
| Hospital Charge Code |
1483102
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$345.52 |
| Max. Negotiated Rate |
$4,936.00 |
| Rate for Payer: Aetna Commercial |
$1,110.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,061.24
|
| Rate for Payer: Aetna Managed Medicare |
$345.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$802.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$617.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$592.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$654.02
|
| Rate for Payer: Cash Price |
$370.20
|
| Rate for Payer: Cigna Commercial |
$1,135.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$690.55
|
| Rate for Payer: Health EOS Commercial |
$1,098.26
|
| Rate for Payer: HFN Commercial |
$1,135.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$925.50
|
| Rate for Payer: Multiplan Commercial |
$987.20
|
| Rate for Payer: NAPHCARE Commercial |
$740.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,135.28
|
| Rate for Payer: Quartz Beloit One Network |
$604.66
|
| Rate for Payer: Quartz Commercial |
$802.10
|
| Rate for Payer: Quartz Medicare Advantage |
$740.40
|
| Rate for Payer: The Alliance Commercial |
$4,936.00
|
| Rate for Payer: United Healthcare PPO |
$925.50
|
| Rate for Payer: WEA Trust Commercial |
$678.70
|
| Rate for Payer: WPS Commercial |
$914.02
|
|
|
VL LE Venous Duplex Right
|
Professional
|
Both
|
$1,234.00
|
|
|
Service Code
|
CPT 93971 TC
|
| Hospital Charge Code |
1483102
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$344.95 |
| Max. Negotiated Rate |
$1,172.30 |
| Rate for Payer: Aetna Commercial |
$1,172.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,061.24
|
| Rate for Payer: Cash Price |
$370.20
|
| Rate for Payer: Cash Price |
$370.20
|
| Rate for Payer: Cigna Commercial |
$1,172.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$617.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$740.40
|
| Rate for Payer: Health EOS Commercial |
$1,122.94
|
| Rate for Payer: HFN Commercial |
$1,172.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$344.95
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$344.95
|
| Rate for Payer: Multiplan Commercial |
$987.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,172.30
|
| Rate for Payer: Quartz Beloit One Network |
$542.96
|
| Rate for Payer: Quartz Commercial |
$703.38
|
| Rate for Payer: The Alliance Commercial |
$617.00
|
| Rate for Payer: WEA Trust Commercial |
$678.70
|
| Rate for Payer: WPS Commercial |
$914.02
|
|
|
VL Lower Extremity PVR Resting
|
Facility
|
IP
|
$859.00
|
|
|
Service Code
|
CPT 93923 TC
|
| Hospital Charge Code |
2530803
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$420.91 |
| Max. Negotiated Rate |
$790.28 |
| Rate for Payer: Aetna Commercial |
$773.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$738.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$455.27
|
| Rate for Payer: Cash Price |
$257.70
|
| Rate for Payer: Cigna Commercial |
$790.28
|
| Rate for Payer: Health EOS Commercial |
$764.51
|
| Rate for Payer: HFN Commercial |
$790.28
|
| Rate for Payer: Multiplan Commercial |
$687.20
|
| Rate for Payer: NAPHCARE Commercial |
$515.40
|
| Rate for Payer: Preferred Network Access Commercial |
$790.28
|
| Rate for Payer: Quartz Beloit One Network |
$420.91
|
| Rate for Payer: Quartz Commercial |
$515.40
|
| Rate for Payer: WEA Trust Commercial |
$472.45
|
| Rate for Payer: WPS Commercial |
$636.26
|
|
|
VL Lower Extremity PVR Resting
|
Professional
|
Both
|
$859.00
|
|
|
Service Code
|
CPT 93923 TC
|
| Hospital Charge Code |
2530803
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$374.36 |
| Max. Negotiated Rate |
$816.05 |
| Rate for Payer: Aetna Commercial |
$816.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$738.74
|
| Rate for Payer: Cash Price |
$257.70
|
| Rate for Payer: Cash Price |
$257.70
|
| Rate for Payer: Cigna Commercial |
$816.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$429.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$515.40
|
| Rate for Payer: Health EOS Commercial |
$781.69
|
| Rate for Payer: HFN Commercial |
$816.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$374.36
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$374.36
|
| Rate for Payer: Multiplan Commercial |
$687.20
|
| Rate for Payer: Preferred Network Access Commercial |
$816.05
|
| Rate for Payer: Quartz Beloit One Network |
$377.96
|
| Rate for Payer: Quartz Commercial |
$489.63
|
| Rate for Payer: The Alliance Commercial |
$429.50
|
| Rate for Payer: WEA Trust Commercial |
$472.45
|
| Rate for Payer: WPS Commercial |
$636.26
|
|
|
VL Lower Extremity PVR Resting
|
Facility
|
OP
|
$859.00
|
|
|
Service Code
|
CPT 93923 TC
|
| Hospital Charge Code |
2530803
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$240.52 |
| Max. Negotiated Rate |
$3,436.00 |
| Rate for Payer: Aetna Commercial |
$773.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$738.74
|
| Rate for Payer: Aetna Managed Medicare |
$240.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$558.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$429.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$412.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$455.27
|
| Rate for Payer: Cash Price |
$257.70
|
| Rate for Payer: Cigna Commercial |
$790.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$480.70
|
| Rate for Payer: Health EOS Commercial |
$764.51
|
| Rate for Payer: HFN Commercial |
$790.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$644.25
|
| Rate for Payer: Multiplan Commercial |
$687.20
|
| Rate for Payer: NAPHCARE Commercial |
$515.40
|
| Rate for Payer: Preferred Network Access Commercial |
$790.28
|
| Rate for Payer: Quartz Beloit One Network |
$420.91
|
| Rate for Payer: Quartz Commercial |
$558.35
|
| Rate for Payer: Quartz Medicare Advantage |
$515.40
|
| Rate for Payer: The Alliance Commercial |
$3,436.00
|
| Rate for Payer: United Healthcare PPO |
$644.25
|
| Rate for Payer: WEA Trust Commercial |
$472.45
|
| Rate for Payer: WPS Commercial |
$636.26
|
|
|
VL Lower Extremity PVR w Excerise
|
Facility
|
OP
|
$1,924.00
|
|
|
Service Code
|
CPT 93924 TC
|
| Hospital Charge Code |
2530806
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$538.72 |
| Max. Negotiated Rate |
$7,696.00 |
| Rate for Payer: Aetna Commercial |
$1,731.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,654.64
|
| Rate for Payer: Aetna Managed Medicare |
$538.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,250.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$962.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$923.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,019.72
|
| Rate for Payer: Cash Price |
$577.20
|
| Rate for Payer: Cigna Commercial |
$1,770.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,076.67
|
| Rate for Payer: Health EOS Commercial |
$1,712.36
|
| Rate for Payer: HFN Commercial |
$1,770.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,443.00
|
| Rate for Payer: Multiplan Commercial |
$1,539.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,154.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,770.08
|
| Rate for Payer: Quartz Beloit One Network |
$942.76
|
| Rate for Payer: Quartz Commercial |
$1,250.60
|
| Rate for Payer: Quartz Medicare Advantage |
$1,154.40
|
| Rate for Payer: The Alliance Commercial |
$7,696.00
|
| Rate for Payer: United Healthcare PPO |
$1,443.00
|
| Rate for Payer: WEA Trust Commercial |
$1,058.20
|
| Rate for Payer: WPS Commercial |
$1,425.11
|
|
