|
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 |
$355.79 |
| Max. Negotiated Rate |
$1,078.25 |
| Rate for Payer: Aetna Commercial |
$1,078.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$976.10
|
| Rate for Payer: Cash Price |
$340.50
|
| Rate for Payer: Cash Price |
$340.50
|
| Rate for Payer: Cigna Commercial |
$1,078.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$567.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$681.00
|
| Rate for Payer: Health EOS Commercial |
$1,032.85
|
| Rate for Payer: HFN Commercial |
$1,078.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$355.79
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$355.79
|
| Rate for Payer: Multiplan Commercial |
$908.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,078.25
|
| Rate for Payer: Quartz Beloit One Network |
$499.40
|
| Rate for Payer: Quartz Commercial |
$646.95
|
| Rate for Payer: The Alliance Commercial |
$567.50
|
| Rate for Payer: WEA Trust Commercial |
$624.25
|
| Rate for Payer: WPS Commercial |
$840.69
|
|
|
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 |
$798.70 |
| Max. Negotiated Rate |
$1,499.60 |
| Rate for Payer: Aetna Commercial |
$1,467.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,401.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$863.90
|
| Rate for Payer: Cash Price |
$489.00
|
| Rate for Payer: Cigna Commercial |
$1,499.60
|
| Rate for Payer: Health EOS Commercial |
$1,450.70
|
| Rate for Payer: HFN Commercial |
$1,499.60
|
| Rate for Payer: Multiplan Commercial |
$1,304.00
|
| Rate for Payer: NAPHCARE Commercial |
$978.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,499.60
|
| Rate for Payer: Quartz Beloit One Network |
$798.70
|
| Rate for Payer: Quartz Commercial |
$978.00
|
| Rate for Payer: WEA Trust Commercial |
$896.50
|
| Rate for Payer: WPS Commercial |
$1,207.34
|
|
|
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 |
$556.15 |
| Max. Negotiated Rate |
$1,044.20 |
| Rate for Payer: Aetna Commercial |
$1,021.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$976.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$601.55
|
| Rate for Payer: Cash Price |
$340.50
|
| Rate for Payer: Cigna Commercial |
$1,044.20
|
| Rate for Payer: Health EOS Commercial |
$1,010.15
|
| Rate for Payer: HFN Commercial |
$1,044.20
|
| Rate for Payer: Multiplan Commercial |
$908.00
|
| Rate for Payer: NAPHCARE Commercial |
$681.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,044.20
|
| Rate for Payer: Quartz Beloit One Network |
$556.15
|
| Rate for Payer: Quartz Commercial |
$681.00
|
| Rate for Payer: WEA Trust Commercial |
$624.25
|
| Rate for Payer: WPS Commercial |
$840.69
|
|
|
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 |
$717.20 |
| Max. Negotiated Rate |
$1,548.50 |
| Rate for Payer: Aetna Commercial |
$1,548.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,401.80
|
| Rate for Payer: Cash Price |
$489.00
|
| Rate for Payer: Cash Price |
$489.00
|
| Rate for Payer: Cigna Commercial |
$1,548.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$815.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$978.00
|
| Rate for Payer: Health EOS Commercial |
$1,483.30
|
| Rate for Payer: HFN Commercial |
$1,548.50
|
| Rate for Payer: Multiplan Commercial |
$1,304.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,548.50
|
| Rate for Payer: Quartz Beloit One Network |
$717.20
|
| Rate for Payer: Quartz Commercial |
$929.10
|
| Rate for Payer: The Alliance Commercial |
$815.00
|
| Rate for Payer: WEA Trust Commercial |
$896.50
|
| Rate for Payer: WPS Commercial |
$1,207.34
|
|
|
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 |
$374.36 |
| Max. Negotiated Rate |
$1,492.45 |
| Rate for Payer: Aetna Commercial |
$1,492.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,351.06
|
| Rate for Payer: Cash Price |
$471.30
|
| Rate for Payer: Cash Price |
$471.30
|
| Rate for Payer: Cigna Commercial |
$1,492.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$785.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$942.60
|
| Rate for Payer: Health EOS Commercial |
$1,429.61
|
| Rate for Payer: HFN Commercial |
$1,492.45
|
| 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 |
$1,256.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,492.45
|
| Rate for Payer: Quartz Beloit One Network |
$691.24
|
| Rate for Payer: Quartz Commercial |
$895.47
|
| Rate for Payer: The Alliance Commercial |
$785.50
|
| Rate for Payer: WEA Trust Commercial |
$864.05
|
| Rate for Payer: WPS Commercial |
$1,163.64
|
|
|
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 |
$439.88 |
| Max. Negotiated Rate |
$6,284.00 |
| Rate for Payer: Aetna Commercial |
$1,413.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,351.06
|
| Rate for Payer: Aetna Managed Medicare |
$439.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,021.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$785.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$754.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$832.63
|
| Rate for Payer: Cash Price |
$471.30
|
| Rate for Payer: Cigna Commercial |
$1,445.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$879.13
|
| Rate for Payer: Health EOS Commercial |
$1,398.19
|
| Rate for Payer: HFN Commercial |
$1,445.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,178.25
|
| Rate for Payer: Multiplan Commercial |
$1,256.80
|
| Rate for Payer: NAPHCARE Commercial |
$942.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,445.32
|
| Rate for Payer: Quartz Beloit One Network |
$769.79
|
| Rate for Payer: Quartz Commercial |
$1,021.15
|
| Rate for Payer: Quartz Medicare Advantage |
$942.60
|
| Rate for Payer: The Alliance Commercial |
$6,284.00
|
| Rate for Payer: United Healthcare PPO |
$1,178.25
|
| Rate for Payer: WEA Trust Commercial |
$864.05
|
| Rate for Payer: WPS Commercial |
$1,163.64
|
|
|
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 |
$769.79 |
| Max. Negotiated Rate |
$1,445.32 |
| Rate for Payer: Aetna Commercial |
$1,413.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,351.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$832.63
|
| Rate for Payer: Cash Price |
$471.30
|
| Rate for Payer: Cigna Commercial |
$1,445.32
|
| Rate for Payer: Health EOS Commercial |
$1,398.19
|
| Rate for Payer: HFN Commercial |
$1,445.32
|
| Rate for Payer: Multiplan Commercial |
$1,256.80
|
| Rate for Payer: NAPHCARE Commercial |
$942.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,445.32
|
| Rate for Payer: Quartz Beloit One Network |
$769.79
|
| Rate for Payer: Quartz Commercial |
$942.60
|
| Rate for Payer: WEA Trust Commercial |
$864.05
|
| Rate for Payer: WPS Commercial |
$1,163.64
|
|
|
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 |
$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 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 |
$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 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 |
$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 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 |
$869.00 |
| 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: 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 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 |
$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 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 |
$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 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 |
$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 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 |
$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 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 |
$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 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 |
$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 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 |
$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 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 |
$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 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 |
$486.08 |
| Max. Negotiated Rate |
$912.64 |
| Rate for Payer: Aetna Commercial |
$892.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$853.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$525.76
|
| Rate for Payer: Cash Price |
$297.60
|
| Rate for Payer: Cigna Commercial |
$912.64
|
| Rate for Payer: Health EOS Commercial |
$882.88
|
| Rate for Payer: HFN Commercial |
$912.64
|
| Rate for Payer: Multiplan Commercial |
$793.60
|
| Rate for Payer: NAPHCARE Commercial |
$595.20
|
| Rate for Payer: Preferred Network Access Commercial |
$912.64
|
| Rate for Payer: Quartz Beloit One Network |
$486.08
|
| Rate for Payer: Quartz Commercial |
$595.20
|
| Rate for Payer: WEA Trust Commercial |
$545.60
|
| Rate for Payer: WPS Commercial |
$734.77
|
|
|
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 |
$277.76 |
| Max. Negotiated Rate |
$3,968.00 |
| Rate for Payer: Aetna Commercial |
$892.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$853.12
|
| Rate for Payer: Aetna Managed Medicare |
$277.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$644.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$496.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$476.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$525.76
|
| Rate for Payer: Cash Price |
$297.60
|
| Rate for Payer: Cigna Commercial |
$912.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$555.12
|
| Rate for Payer: Health EOS Commercial |
$882.88
|
| Rate for Payer: HFN Commercial |
$912.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$744.00
|
| Rate for Payer: Multiplan Commercial |
$793.60
|
| Rate for Payer: NAPHCARE Commercial |
$595.20
|
| Rate for Payer: Preferred Network Access Commercial |
$912.64
|
| Rate for Payer: Quartz Beloit One Network |
$486.08
|
| Rate for Payer: Quartz Commercial |
$644.80
|
| Rate for Payer: Quartz Medicare Advantage |
$595.20
|
| Rate for Payer: The Alliance Commercial |
$3,968.00
|
| Rate for Payer: United Healthcare PPO |
$744.00
|
| Rate for Payer: WEA Trust Commercial |
$545.60
|
| Rate for Payer: WPS Commercial |
$734.77
|
|
|
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 |
$246.32 |
| Max. Negotiated Rate |
$942.40 |
| Rate for Payer: Aetna Commercial |
$942.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$853.12
|
| Rate for Payer: Cash Price |
$297.60
|
| Rate for Payer: Cash Price |
$297.60
|
| Rate for Payer: Cigna Commercial |
$942.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$496.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$595.20
|
| Rate for Payer: Health EOS Commercial |
$902.72
|
| Rate for Payer: HFN Commercial |
$942.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$246.32
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$246.32
|
| Rate for Payer: Multiplan Commercial |
$793.60
|
| Rate for Payer: Preferred Network Access Commercial |
$942.40
|
| Rate for Payer: Quartz Beloit One Network |
$436.48
|
| Rate for Payer: Quartz Commercial |
$565.44
|
| Rate for Payer: The Alliance Commercial |
$496.00
|
| Rate for Payer: WEA Trust Commercial |
$545.60
|
| Rate for Payer: WPS Commercial |
$734.77
|
|
|
VL Upper Extremity PVR w Resting
|
Facility
|
OP
|
$836.00
|
|
|
Service Code
|
CPT 93922 TC
|
| Hospital Charge Code |
2530809
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$234.08 |
| Max. Negotiated Rate |
$3,344.00 |
| Rate for Payer: Aetna Commercial |
$752.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$718.96
|
| Rate for Payer: Aetna Managed Medicare |
$234.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$543.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$418.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$401.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$443.08
|
| Rate for Payer: Cash Price |
$250.80
|
| Rate for Payer: Cigna Commercial |
$769.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$467.83
|
| Rate for Payer: Health EOS Commercial |
$744.04
|
| Rate for Payer: HFN Commercial |
$769.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$627.00
|
| Rate for Payer: Multiplan Commercial |
$668.80
|
| Rate for Payer: NAPHCARE Commercial |
$501.60
|
| Rate for Payer: Preferred Network Access Commercial |
$769.12
|
| Rate for Payer: Quartz Beloit One Network |
$409.64
|
| Rate for Payer: Quartz Commercial |
$543.40
|
| Rate for Payer: Quartz Medicare Advantage |
$501.60
|
| Rate for Payer: The Alliance Commercial |
$3,344.00
|
| Rate for Payer: United Healthcare PPO |
$627.00
|
| Rate for Payer: WEA Trust Commercial |
$459.80
|
| Rate for Payer: WPS Commercial |
$619.23
|
|
|
VL Upper Extremity PVR w Resting
|
Facility
|
IP
|
$836.00
|
|
|
Service Code
|
CPT 93922 TC
|
| Hospital Charge Code |
2530809
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$409.64 |
| Max. Negotiated Rate |
$769.12 |
| Rate for Payer: Aetna Commercial |
$752.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$718.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$443.08
|
| Rate for Payer: Cash Price |
$250.80
|
| Rate for Payer: Cigna Commercial |
$769.12
|
| Rate for Payer: Health EOS Commercial |
$744.04
|
| Rate for Payer: HFN Commercial |
$769.12
|
| Rate for Payer: Multiplan Commercial |
$668.80
|
| Rate for Payer: NAPHCARE Commercial |
$501.60
|
| Rate for Payer: Preferred Network Access Commercial |
$769.12
|
| Rate for Payer: Quartz Beloit One Network |
$409.64
|
| Rate for Payer: Quartz Commercial |
$501.60
|
| Rate for Payer: WEA Trust Commercial |
$459.80
|
| Rate for Payer: WPS Commercial |
$619.23
|
|
|
VL Upper Extremity PVR w Resting
|
Professional
|
Both
|
$836.00
|
|
|
Service Code
|
CPT 93922 TC
|
| Hospital Charge Code |
2530809
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$246.32 |
| Max. Negotiated Rate |
$794.20 |
| Rate for Payer: Aetna Commercial |
$794.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$718.96
|
| Rate for Payer: Cash Price |
$250.80
|
| Rate for Payer: Cash Price |
$250.80
|
| Rate for Payer: Cigna Commercial |
$794.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$418.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$501.60
|
| Rate for Payer: Health EOS Commercial |
$760.76
|
| Rate for Payer: HFN Commercial |
$794.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$246.32
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$246.32
|
| Rate for Payer: Multiplan Commercial |
$668.80
|
| Rate for Payer: Preferred Network Access Commercial |
$794.20
|
| Rate for Payer: Quartz Beloit One Network |
$367.84
|
| Rate for Payer: Quartz Commercial |
$476.52
|
| Rate for Payer: The Alliance Commercial |
$418.00
|
| Rate for Payer: WEA Trust Commercial |
$459.80
|
| Rate for Payer: WPS Commercial |
$619.23
|
|
