|
BCE VL Iliac Vasculature Duplex Right
|
Facility
OP
|
$1,234.00
|
|
|
Service Code
|
CPT 93979 TC,RT
|
| Hospital Charge Code |
3114963
|
|
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 Right
|
Professional
|
$1,234.00
|
|
|
Service Code
|
CPT 93979 TC,RT
|
| Hospital Charge Code |
3114963
|
|
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 Right
|
Facility
IP
|
$1,234.00
|
|
|
Service Code
|
CPT 93979 TC,RT
|
| Hospital Charge Code |
3114963
|
|
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
|
|
|
BCE VL LE Arterial Duplex Bilateral
|
Facility
IP
|
$2,194.00
|
|
|
Service Code
|
CPT 93925 TC
|
| Hospital Charge Code |
3114964
|
|
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: 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
|
|
|
BCE VL LE Arterial Duplex Bilateral
|
Facility
OP
|
$2,194.00
|
|
|
Service Code
|
CPT 93925 TC
|
| Hospital Charge Code |
3114964
|
|
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
|
|
|
BCE VL LE Arterial Duplex Bilateral
|
Professional
|
$2,194.00
|
|
|
Service Code
|
CPT 93925 TC
|
| Hospital Charge Code |
3114964
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$195.51 |
| 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: Aetna Managed Medicare |
$195.51
|
| Rate for Payer: Anthem Medicare Advantage |
$195.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$195.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$195.51
|
| 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 |
$195.51
|
| Rate for Payer: Health EOS Commercial |
$1,996.54
|
| 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: Independent Care Health Plan Medicare |
$195.51
|
| 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: Quartz Medicare Advantage |
$195.51
|
| Rate for Payer: The Alliance Commercial |
$488.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$195.51
|
| Rate for Payer: WEA Trust Commercial |
$1,206.70
|
| Rate for Payer: WPS Commercial |
$782.04
|
|
|
BCE VL LE Arterial Duplex Left
|
Facility
OP
|
$1,227.00
|
|
|
Service Code
|
CPT 93926 TC,LT
|
| Hospital Charge Code |
3114965
|
|
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
|
|
|
BCE VL LE Arterial Duplex Left
|
Facility
IP
|
$1,227.00
|
|
|
Service Code
|
CPT 93926 TC,LT
|
| Hospital Charge Code |
3114965
|
|
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: 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
|
|
|
BCE VL LE Arterial Duplex Left
|
Professional
|
$1,227.00
|
|
|
Service Code
|
CPT 93926 TC,LT
|
| Hospital Charge Code |
3114965
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$539.88 |
| 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: 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
|
|
|
BCE VL LE Arterial Duplex Right
|
Professional
|
$1,227.00
|
|
|
Service Code
|
CPT 93926 TC,RT
|
| Hospital Charge Code |
3114966
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$539.88 |
| 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: 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
|
|
|
BCE VL LE Arterial Duplex Right
|
Facility
IP
|
$1,227.00
|
|
|
Service Code
|
CPT 93926 TC,RT
|
| Hospital Charge Code |
3114966
|
|
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: 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
|
|
|
BCE VL LE Arterial Duplex Right
|
Facility
OP
|
$1,227.00
|
|
|
Service Code
|
CPT 93926 TC,RT
|
| Hospital Charge Code |
3114966
|
|
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
|
|
|
BCE VL LE Arterial Graft Patency Bilateral
|
Facility
OP
|
$2,194.00
|
|
|
Service Code
|
CPT 93925 TC
|
| Hospital Charge Code |
5238950
|
|
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
|
|
|
BCE VL LE Arterial Graft Patency Bilateral
|
Professional
|
$2,194.00
|
|
|
Service Code
|
CPT 93925 TC
|
| Hospital Charge Code |
5238950
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$195.51 |
| 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: Aetna Managed Medicare |
$195.51
|
| Rate for Payer: Anthem Medicare Advantage |
$195.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$195.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$195.51
|
| 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 |
$195.51
|
| Rate for Payer: Health EOS Commercial |
$1,996.54
|
| 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: Independent Care Health Plan Medicare |
$195.51
|
| 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: Quartz Medicare Advantage |
$195.51
|
| Rate for Payer: The Alliance Commercial |
$488.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$195.51
|
| Rate for Payer: WEA Trust Commercial |
$1,206.70
|
| Rate for Payer: WPS Commercial |
$782.04
|
|
|
BCE VL LE Arterial Graft Patency Bilateral
|
Facility
IP
|
$2,194.00
|
|
|
Service Code
|
CPT 93925 TC
|
| Hospital Charge Code |
5238950
|
|
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: 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
|
|
|
BCE VL LE Arterial Graft Patency Left
|
Facility
IP
|
$1,227.00
|
|
|
Service Code
|
CPT 93926 TC,LT
|
| Hospital Charge Code |
5238951
|
|
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: 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
|
|
|
BCE VL LE Arterial Graft Patency Left
|
Professional
|
$1,227.00
|
|
|
Service Code
|
CPT 93926 TC,LT
|
| Hospital Charge Code |
5238951
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$539.88 |
| 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: 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
|
|
|
BCE VL LE Arterial Graft Patency Left
|
Facility
OP
|
$1,227.00
|
|
|
Service Code
|
CPT 93926 TC,LT
|
| Hospital Charge Code |
5238951
|
|
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
|
|
|
BCE VL LE Arterial Graft Patency Right
|
Facility
OP
|
$1,227.00
|
|
|
Service Code
|
CPT 93926 TC,RT
|
| Hospital Charge Code |
5238952
|
|
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
|
|
|
BCE VL LE Arterial Graft Patency Right
|
Facility
IP
|
$1,227.00
|
|
|
Service Code
|
CPT 93926 TC,RT
|
| Hospital Charge Code |
5238952
|
|
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: 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
|
|
|
BCE VL LE Arterial Graft Patency Right
|
Professional
|
$1,227.00
|
|
|
Service Code
|
CPT 93926 TC,RT
|
| Hospital Charge Code |
5238952
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$539.88 |
| 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: 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
|
|
|
BCE VL LE Venous Duplex Bilateral
|
Facility
OP
|
$2,085.00
|
|
|
Service Code
|
CPT 93970 TC
|
| Hospital Charge Code |
3114967
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$583.80 |
| Max. Negotiated Rate |
$8,340.00 |
| Rate for Payer: Aetna Commercial |
$1,876.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,793.10
|
| Rate for Payer: Aetna Managed Medicare |
$583.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,355.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,042.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,000.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,105.05
|
| Rate for Payer: Cash Price |
$625.50
|
| Rate for Payer: Cigna Commercial |
$1,918.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,166.77
|
| Rate for Payer: Health EOS Commercial |
$1,855.65
|
| Rate for Payer: HFN Commercial |
$1,918.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,563.75
|
| Rate for Payer: Multiplan Commercial |
$1,668.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,251.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,918.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,021.65
|
| Rate for Payer: Quartz Commercial |
$1,355.25
|
| Rate for Payer: Quartz Medicare Advantage |
$1,251.00
|
| Rate for Payer: The Alliance Commercial |
$8,340.00
|
| Rate for Payer: United Healthcare PPO |
$1,563.75
|
| Rate for Payer: WEA Trust Commercial |
$1,146.75
|
| Rate for Payer: WPS Commercial |
$1,544.36
|
|
|
BCE VL LE Venous Duplex Bilateral
|
Facility
IP
|
$2,085.00
|
|
|
Service Code
|
CPT 93970 TC
|
| Hospital Charge Code |
3114967
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$1,021.65 |
| Max. Negotiated Rate |
$1,918.20 |
| Rate for Payer: Aetna Commercial |
$1,876.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,105.05
|
| Rate for Payer: Cash Price |
$625.50
|
| Rate for Payer: Cigna Commercial |
$1,918.20
|
| Rate for Payer: Health EOS Commercial |
$1,855.65
|
| Rate for Payer: HFN Commercial |
$1,918.20
|
| Rate for Payer: Multiplan Commercial |
$1,668.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,251.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,918.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,021.65
|
| Rate for Payer: Quartz Commercial |
$1,251.00
|
| Rate for Payer: WEA Trust Commercial |
$1,146.75
|
| Rate for Payer: WPS Commercial |
$1,544.36
|
|
|
BCE VL LE Venous Duplex Bilateral
|
Professional
|
$2,085.00
|
|
|
Service Code
|
CPT 93970 TC
|
| Hospital Charge Code |
3114967
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$149.48 |
| Max. Negotiated Rate |
$1,980.75 |
| Rate for Payer: Aetna Commercial |
$1,980.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,793.10
|
| Rate for Payer: Aetna Managed Medicare |
$149.48
|
| Rate for Payer: Anthem Medicare Advantage |
$149.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$149.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$149.48
|
| Rate for Payer: Cash Price |
$625.50
|
| Rate for Payer: Cash Price |
$625.50
|
| Rate for Payer: Cigna Commercial |
$1,980.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,042.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$149.48
|
| Rate for Payer: Health EOS Commercial |
$1,897.35
|
| 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: Independent Care Health Plan Medicare |
$149.48
|
| Rate for Payer: Multiplan Commercial |
$1,668.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,980.75
|
| Rate for Payer: Quartz Beloit One Network |
$917.40
|
| Rate for Payer: Quartz Commercial |
$1,188.45
|
| Rate for Payer: Quartz Medicare Advantage |
$149.48
|
| Rate for Payer: The Alliance Commercial |
$373.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$149.48
|
| Rate for Payer: WEA Trust Commercial |
$1,146.75
|
| Rate for Payer: WPS Commercial |
$597.92
|
|
|
BCE VL LE Venous Duplex Left
|
Facility
IP
|
$1,234.00
|
|
|
Service Code
|
CPT 93971 TC,LT
|
| Hospital Charge Code |
3114968
|
|
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
|
|
