|
BCE VL Echo Doppler
|
Facility
OP
|
$905.00
|
|
|
Service Code
|
CPT 93320 TC
|
| Hospital Charge Code |
3114955
|
|
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: 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: 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
|
|
|
BCE VL Echo During Therap/Diag Intervention
|
Professional
|
$1,753.00
|
|
|
Service Code
|
CPT 93662 TC
|
| Hospital Charge Code |
3114956
|
|
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: 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
|
|
|
BCE VL Echo During Therap/Diag Intervention
|
Facility
IP
|
$1,753.00
|
|
|
Service Code
|
CPT 93662 TC
|
| Hospital Charge Code |
3114956
|
|
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: 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
|
|
|
BCE VL Echo During Therap/Diag Intervention
|
Facility
OP
|
$1,753.00
|
|
|
Service Code
|
CPT 93662 TC
|
| Hospital Charge Code |
3114956
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$490.84 |
| Max. Negotiated Rate |
$7,012.00 |
| Rate for Payer: Health EOS Commercial |
$1,560.17
|
| 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: Cash Price |
$525.90
|
| Rate for Payer: Cigna Commercial |
$1,612.76
|
| 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
|
|
|
BCE VL Echo Limited
|
Facility
OP
|
$1,756.00
|
|
|
Service Code
|
CPT 93308 TC
|
| Hospital Charge Code |
3114957
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$491.68 |
| Max. Negotiated Rate |
$7,024.00 |
| Rate for Payer: Aetna Commercial |
$1,580.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,510.16
|
| Rate for Payer: Aetna Managed Medicare |
$491.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,141.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$878.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$842.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$930.68
|
| Rate for Payer: Cash Price |
$526.80
|
| Rate for Payer: Cash Price |
$526.80
|
| Rate for Payer: Cigna Commercial |
$1,615.52
|
| Rate for Payer: Health EOS Commercial |
$1,562.84
|
| Rate for Payer: HFN Commercial |
$1,615.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,317.00
|
| Rate for Payer: Multiplan Commercial |
$1,404.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,053.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,615.52
|
| Rate for Payer: Quartz Beloit One Network |
$860.44
|
| Rate for Payer: Quartz Commercial |
$1,141.40
|
| Rate for Payer: Quartz Medicare Advantage |
$1,053.60
|
| Rate for Payer: The Alliance Commercial |
$7,024.00
|
| Rate for Payer: United Healthcare PPO |
$1,317.00
|
| Rate for Payer: WEA Trust Commercial |
$965.80
|
| Rate for Payer: WPS Commercial |
$1,300.67
|
|
|
BCE VL Echo Limited
|
Facility
IP
|
$1,756.00
|
|
|
Service Code
|
CPT 93308 TC
|
| Hospital Charge Code |
3114957
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$860.44 |
| Max. Negotiated Rate |
$1,615.52 |
| Rate for Payer: Aetna Commercial |
$1,580.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$930.68
|
| Rate for Payer: Cash Price |
$526.80
|
| Rate for Payer: Cigna Commercial |
$1,615.52
|
| Rate for Payer: Health EOS Commercial |
$1,562.84
|
| Rate for Payer: HFN Commercial |
$1,615.52
|
| Rate for Payer: Multiplan Commercial |
$1,404.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,053.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,615.52
|
| Rate for Payer: Quartz Beloit One Network |
$860.44
|
| Rate for Payer: Quartz Commercial |
$1,053.60
|
| Rate for Payer: WEA Trust Commercial |
$965.80
|
| Rate for Payer: WPS Commercial |
$1,300.67
|
|
|
BCE VL Echo Limited
|
Professional
|
$1,756.00
|
|
|
Service Code
|
CPT 93308 TC
|
| Hospital Charge Code |
3114957
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$70.72 |
| Max. Negotiated Rate |
$1,668.20 |
| Rate for Payer: Aetna Commercial |
$1,668.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,510.16
|
| Rate for Payer: Aetna Managed Medicare |
$70.72
|
| Rate for Payer: Anthem Medicare Advantage |
$70.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$70.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$70.72
|
| Rate for Payer: Cash Price |
$526.80
|
| Rate for Payer: Cash Price |
$526.80
|
| Rate for Payer: Cigna Commercial |
$1,668.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$878.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$70.72
|
| Rate for Payer: Health EOS Commercial |
$1,597.96
|
| 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: Independent Care Health Plan Medicare |
$70.72
|
| Rate for Payer: Multiplan Commercial |
$1,404.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,668.20
|
| Rate for Payer: Quartz Beloit One Network |
$772.64
|
| Rate for Payer: Quartz Commercial |
$1,000.92
|
| Rate for Payer: Quartz Medicare Advantage |
$70.72
|
| Rate for Payer: The Alliance Commercial |
$268.74
|
| Rate for Payer: United Healthcare Medicare Advantage |
$70.72
|
| Rate for Payer: WEA Trust Commercial |
$965.80
|
| Rate for Payer: WPS Commercial |
$282.88
|
|
|
BCE VL Echo Stress Contrast +
|
Facility
OP
|
$425.00
|
|
|
Service Code
|
CPT 93352 TC
|
| Hospital Charge Code |
4592618
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$119.00 |
| Max. Negotiated Rate |
$1,700.00 |
| Rate for Payer: Aetna Commercial |
$382.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$365.50
|
| Rate for Payer: Aetna Managed Medicare |
$119.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$276.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$212.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$204.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$225.25
|
| Rate for Payer: Cash Price |
$127.50
|
| Rate for Payer: Cash Price |
$127.50
|
| Rate for Payer: Cigna Commercial |
$391.00
|
| Rate for Payer: Health EOS Commercial |
$378.25
|
| Rate for Payer: HFN Commercial |
$391.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$318.75
|
| Rate for Payer: Multiplan Commercial |
$340.00
|
| Rate for Payer: NAPHCARE Commercial |
$255.00
|
| Rate for Payer: Preferred Network Access Commercial |
$391.00
|
| Rate for Payer: Quartz Beloit One Network |
$208.25
|
| Rate for Payer: Quartz Commercial |
$276.25
|
| Rate for Payer: Quartz Medicare Advantage |
$255.00
|
| Rate for Payer: The Alliance Commercial |
$1,700.00
|
| Rate for Payer: United Healthcare PPO |
$318.75
|
| Rate for Payer: WEA Trust Commercial |
$233.75
|
| Rate for Payer: WPS Commercial |
$314.80
|
|
|
BCE VL Echo Stress Contrast +
|
Facility
IP
|
$425.00
|
|
|
Service Code
|
CPT 93352 TC
|
| Hospital Charge Code |
4592618
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$208.25 |
| Max. Negotiated Rate |
$391.00 |
| Rate for Payer: Aetna Commercial |
$382.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$225.25
|
| Rate for Payer: Cash Price |
$127.50
|
| Rate for Payer: Cigna Commercial |
$391.00
|
| Rate for Payer: Health EOS Commercial |
$378.25
|
| Rate for Payer: HFN Commercial |
$391.00
|
| Rate for Payer: Multiplan Commercial |
$340.00
|
| Rate for Payer: NAPHCARE Commercial |
$255.00
|
| Rate for Payer: Preferred Network Access Commercial |
$391.00
|
| Rate for Payer: Quartz Beloit One Network |
$208.25
|
| Rate for Payer: Quartz Commercial |
$255.00
|
| Rate for Payer: WEA Trust Commercial |
$233.75
|
| Rate for Payer: WPS Commercial |
$314.80
|
|
|
BCE VL Echo Stress Contrast +
|
Professional
|
$425.00
|
|
|
Service Code
|
CPT 93352 TC
|
| Hospital Charge Code |
4592618
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$187.00 |
| Max. Negotiated Rate |
$403.75 |
| Rate for Payer: Aetna Commercial |
$403.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$365.50
|
| Rate for Payer: Cash Price |
$127.50
|
| Rate for Payer: Cash Price |
$127.50
|
| Rate for Payer: Cigna Commercial |
$403.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$212.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$255.00
|
| Rate for Payer: Health EOS Commercial |
$386.75
|
| Rate for Payer: Multiplan Commercial |
$340.00
|
| Rate for Payer: Preferred Network Access Commercial |
$403.75
|
| Rate for Payer: Quartz Beloit One Network |
$187.00
|
| Rate for Payer: Quartz Commercial |
$242.25
|
| Rate for Payer: The Alliance Commercial |
$212.50
|
| Rate for Payer: WEA Trust Commercial |
$233.75
|
| Rate for Payer: WPS Commercial |
$314.80
|
|
|
BCE VL Echo Stress Test
|
Professional
|
$4,308.00
|
|
|
Service Code
|
CPT 93350 TC
|
| Hospital Charge Code |
3114958
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$113.21 |
| Max. Negotiated Rate |
$4,092.60 |
| Rate for Payer: Aetna Commercial |
$4,092.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,704.88
|
| Rate for Payer: Aetna Managed Medicare |
$113.21
|
| Rate for Payer: Anthem Medicare Advantage |
$113.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$113.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$113.21
|
| Rate for Payer: Cash Price |
$1,292.40
|
| Rate for Payer: Cash Price |
$1,292.40
|
| Rate for Payer: Cigna Commercial |
$4,092.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,154.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$113.21
|
| Rate for Payer: Health EOS Commercial |
$3,920.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$417.28
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$417.28
|
| Rate for Payer: Independent Care Health Plan Medicare |
$113.21
|
| Rate for Payer: Multiplan Commercial |
$3,446.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,092.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,895.52
|
| Rate for Payer: Quartz Commercial |
$2,455.56
|
| Rate for Payer: Quartz Medicare Advantage |
$113.21
|
| Rate for Payer: The Alliance Commercial |
$430.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$113.21
|
| Rate for Payer: WEA Trust Commercial |
$2,369.40
|
| Rate for Payer: WPS Commercial |
$452.84
|
|
|
BCE VL Echo Stress Test
|
Facility
IP
|
$4,308.00
|
|
|
Service Code
|
CPT 93350 TC
|
| Hospital Charge Code |
3114958
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$2,110.92 |
| Max. Negotiated Rate |
$3,963.36 |
| Rate for Payer: Aetna Commercial |
$3,877.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,283.24
|
| Rate for Payer: Cash Price |
$1,292.40
|
| Rate for Payer: Cigna Commercial |
$3,963.36
|
| Rate for Payer: Health EOS Commercial |
$3,834.12
|
| Rate for Payer: HFN Commercial |
$3,963.36
|
| Rate for Payer: Multiplan Commercial |
$3,446.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,584.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,963.36
|
| Rate for Payer: Quartz Beloit One Network |
$2,110.92
|
| Rate for Payer: Quartz Commercial |
$2,584.80
|
| Rate for Payer: WEA Trust Commercial |
$2,369.40
|
| Rate for Payer: WPS Commercial |
$3,190.94
|
|
|
BCE VL Echo Stress Test
|
Facility
OP
|
$4,308.00
|
|
|
Service Code
|
CPT 93350 TC
|
| Hospital Charge Code |
3114958
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$1,206.24 |
| Max. Negotiated Rate |
$17,232.00 |
| Rate for Payer: Aetna Commercial |
$3,877.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,704.88
|
| Rate for Payer: Aetna Managed Medicare |
$1,206.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,800.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,154.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,067.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,283.24
|
| Rate for Payer: Cash Price |
$1,292.40
|
| Rate for Payer: Cash Price |
$1,292.40
|
| Rate for Payer: Cigna Commercial |
$3,963.36
|
| Rate for Payer: Health EOS Commercial |
$3,834.12
|
| Rate for Payer: HFN Commercial |
$3,963.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,231.00
|
| Rate for Payer: Multiplan Commercial |
$3,446.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,584.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,963.36
|
| Rate for Payer: Quartz Beloit One Network |
$2,110.92
|
| Rate for Payer: Quartz Commercial |
$2,800.20
|
| Rate for Payer: Quartz Medicare Advantage |
$2,584.80
|
| Rate for Payer: The Alliance Commercial |
$17,232.00
|
| Rate for Payer: United Healthcare PPO |
$3,231.00
|
| Rate for Payer: WEA Trust Commercial |
$2,369.40
|
| Rate for Payer: WPS Commercial |
$3,190.94
|
|
|
BCE VL Echo Stress Test Chemical
|
Facility
IP
|
$4,308.00
|
|
|
Service Code
|
CPT 93350 TC
|
| Hospital Charge Code |
3114959
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$2,110.92 |
| Max. Negotiated Rate |
$3,963.36 |
| Rate for Payer: Aetna Commercial |
$3,877.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,283.24
|
| Rate for Payer: Cash Price |
$1,292.40
|
| Rate for Payer: Cigna Commercial |
$3,963.36
|
| Rate for Payer: Health EOS Commercial |
$3,834.12
|
| Rate for Payer: HFN Commercial |
$3,963.36
|
| Rate for Payer: Multiplan Commercial |
$3,446.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,584.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,963.36
|
| Rate for Payer: Quartz Beloit One Network |
$2,110.92
|
| Rate for Payer: Quartz Commercial |
$2,584.80
|
| Rate for Payer: WEA Trust Commercial |
$2,369.40
|
| Rate for Payer: WPS Commercial |
$3,190.94
|
|
|
BCE VL Echo Stress Test Chemical
|
Facility
OP
|
$4,308.00
|
|
|
Service Code
|
CPT 93350 TC
|
| Hospital Charge Code |
3114959
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$1,206.24 |
| Max. Negotiated Rate |
$17,232.00 |
| Rate for Payer: Aetna Commercial |
$3,877.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,704.88
|
| Rate for Payer: Aetna Managed Medicare |
$1,206.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,800.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,154.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,067.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,283.24
|
| Rate for Payer: Cash Price |
$1,292.40
|
| Rate for Payer: Cash Price |
$1,292.40
|
| Rate for Payer: Cigna Commercial |
$3,963.36
|
| Rate for Payer: Health EOS Commercial |
$3,834.12
|
| Rate for Payer: HFN Commercial |
$3,963.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,231.00
|
| Rate for Payer: Multiplan Commercial |
$3,446.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,584.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,963.36
|
| Rate for Payer: Quartz Beloit One Network |
$2,110.92
|
| Rate for Payer: Quartz Commercial |
$2,800.20
|
| Rate for Payer: Quartz Medicare Advantage |
$2,584.80
|
| Rate for Payer: The Alliance Commercial |
$17,232.00
|
| Rate for Payer: United Healthcare PPO |
$3,231.00
|
| Rate for Payer: WEA Trust Commercial |
$2,369.40
|
| Rate for Payer: WPS Commercial |
$3,190.94
|
|
|
BCE VL Echo Stress Test Chemical
|
Professional
|
$4,308.00
|
|
|
Service Code
|
CPT 93350 TC
|
| Hospital Charge Code |
3114959
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$113.21 |
| Max. Negotiated Rate |
$4,092.60 |
| Rate for Payer: Aetna Commercial |
$4,092.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,704.88
|
| Rate for Payer: Aetna Managed Medicare |
$113.21
|
| Rate for Payer: Anthem Medicare Advantage |
$113.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$113.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$113.21
|
| Rate for Payer: Cash Price |
$1,292.40
|
| Rate for Payer: Cash Price |
$1,292.40
|
| Rate for Payer: Cigna Commercial |
$4,092.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,154.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$113.21
|
| Rate for Payer: Health EOS Commercial |
$3,920.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$417.28
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$417.28
|
| Rate for Payer: Independent Care Health Plan Medicare |
$113.21
|
| Rate for Payer: Multiplan Commercial |
$3,446.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,092.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,895.52
|
| Rate for Payer: Quartz Commercial |
$2,455.56
|
| Rate for Payer: Quartz Medicare Advantage |
$113.21
|
| Rate for Payer: The Alliance Commercial |
$430.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$113.21
|
| Rate for Payer: WEA Trust Commercial |
$2,369.40
|
| Rate for Payer: WPS Commercial |
$452.84
|
|
|
BCE VL Guided Needle Placement
|
Facility
IP
|
$1,493.00
|
|
|
Service Code
|
CPT 76942 TC
|
| Hospital Charge Code |
5374692
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$731.57 |
| Max. Negotiated Rate |
$1,373.56 |
| Rate for Payer: Aetna Commercial |
$1,343.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$791.29
|
| Rate for Payer: Cash Price |
$447.90
|
| Rate for Payer: Cigna Commercial |
$1,373.56
|
| Rate for Payer: Health EOS Commercial |
$1,328.77
|
| Rate for Payer: HFN Commercial |
$1,373.56
|
| Rate for Payer: Multiplan Commercial |
$1,194.40
|
| Rate for Payer: NAPHCARE Commercial |
$895.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,373.56
|
| Rate for Payer: Quartz Beloit One Network |
$731.57
|
| Rate for Payer: Quartz Commercial |
$895.80
|
| Rate for Payer: WEA Trust Commercial |
$821.15
|
| Rate for Payer: WPS Commercial |
$1,105.87
|
|
|
BCE VL Guided Needle Placement
|
Professional
|
$1,493.00
|
|
|
Service Code
|
CPT 76942 TC
|
| Hospital Charge Code |
5374692
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$26.83 |
| Max. Negotiated Rate |
$1,418.35 |
| Rate for Payer: Aetna Commercial |
$1,418.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,283.98
|
| Rate for Payer: Aetna Managed Medicare |
$26.83
|
| Rate for Payer: Anthem Medicare Advantage |
$26.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$26.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$26.83
|
| Rate for Payer: Cash Price |
$447.90
|
| Rate for Payer: Cash Price |
$447.90
|
| Rate for Payer: Cigna Commercial |
$1,418.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$746.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$26.83
|
| Rate for Payer: Health EOS Commercial |
$1,358.63
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$90.86
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$90.86
|
| Rate for Payer: Independent Care Health Plan Medicare |
$26.83
|
| Rate for Payer: Multiplan Commercial |
$1,194.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,418.35
|
| Rate for Payer: Quartz Beloit One Network |
$656.92
|
| Rate for Payer: Quartz Commercial |
$851.01
|
| Rate for Payer: Quartz Medicare Advantage |
$26.83
|
| Rate for Payer: The Alliance Commercial |
$101.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$26.83
|
| Rate for Payer: WEA Trust Commercial |
$821.15
|
| Rate for Payer: WPS Commercial |
$134.15
|
|
|
BCE VL Guided Needle Placement
|
Facility
OP
|
$1,493.00
|
|
|
Service Code
|
CPT 76942 TC
|
| Hospital Charge Code |
5374692
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$5,972.00 |
| Rate for Payer: Aetna Commercial |
$1,343.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,283.98
|
| Rate for Payer: Aetna Managed Medicare |
$418.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$970.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$746.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$716.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$791.29
|
| Rate for Payer: Cash Price |
$447.90
|
| Rate for Payer: Cash Price |
$447.90
|
| Rate for Payer: Cash Price |
$447.90
|
| Rate for Payer: Cigna Commercial |
$1,373.56
|
| Rate for Payer: Health EOS Commercial |
$1,328.77
|
| Rate for Payer: HFN Commercial |
$1,373.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,119.75
|
| Rate for Payer: Multiplan Commercial |
$1,194.40
|
| Rate for Payer: NAPHCARE Commercial |
$895.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,373.56
|
| Rate for Payer: Quartz Beloit One Network |
$731.57
|
| Rate for Payer: Quartz Commercial |
$970.45
|
| Rate for Payer: Quartz Medicare Advantage |
$895.80
|
| Rate for Payer: The Alliance Commercial |
$5,972.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$821.15
|
| Rate for Payer: WPS Commercial |
$1,105.87
|
|
|
BCE VL Iliac Vasculature Duplex Comp Bilat
|
Professional
|
$1,975.00
|
|
|
Service Code
|
CPT 93978 TC
|
| Hospital Charge Code |
3114961
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$137.25 |
| 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: Aetna Managed Medicare |
$137.25
|
| Rate for Payer: Anthem Medicare Advantage |
$137.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$137.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$137.25
|
| 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 |
$137.25
|
| Rate for Payer: Health EOS Commercial |
$1,797.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$508.92
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$508.92
|
| Rate for Payer: Independent Care Health Plan Medicare |
$137.25
|
| 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: Quartz Medicare Advantage |
$137.25
|
| Rate for Payer: The Alliance Commercial |
$343.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$137.25
|
| Rate for Payer: WEA Trust Commercial |
$1,086.25
|
| Rate for Payer: WPS Commercial |
$549.00
|
|
|
BCE VL Iliac Vasculature Duplex Comp Bilat
|
Facility
IP
|
$1,975.00
|
|
|
Service Code
|
CPT 93978 TC
|
| Hospital Charge Code |
3114961
|
|
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: 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
|
|
|
BCE VL Iliac Vasculature Duplex Comp Bilat
|
Facility
OP
|
$1,975.00
|
|
|
Service Code
|
CPT 93978 TC
|
| Hospital Charge Code |
3114961
|
|
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
|
|
|
BCE VL Iliac Vasculature Duplex Left
|
Facility
OP
|
$1,234.00
|
|
|
Service Code
|
CPT 93979 TC,LT
|
| Hospital Charge Code |
3114962
|
|
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
|
|
|
BCE VL Iliac Vasculature Duplex Left
|
Professional
|
$1,234.00
|
|
|
Service Code
|
CPT 93979 TC,LT
|
| Hospital Charge Code |
3114962
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$542.96 |
| 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: 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
|
|
|
BCE VL Iliac Vasculature Duplex Left
|
Facility
IP
|
$1,234.00
|
|
|
Service Code
|
CPT 93979 TC,LT
|
| Hospital Charge Code |
3114962
|
|
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: 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
|
|
