|
VL Carotid Duplex Bilateral
|
Facility
|
IP
|
$1,791.00
|
|
|
Service Code
|
CPT 93880 TC
|
| Hospital Charge Code |
1482841
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$912.69 |
| Max. Negotiated Rate |
$1,713.63 |
| Rate for Payer: Aetna Commercial |
$1,676.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,601.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$987.20
|
| Rate for Payer: Cash Price |
$537.30
|
| Rate for Payer: Cigna Commercial |
$1,713.63
|
| Rate for Payer: Health EOS Commercial |
$1,657.75
|
| Rate for Payer: HFN Commercial |
$1,713.63
|
| Rate for Payer: Multiplan Commercial |
$1,490.11
|
| Rate for Payer: Preferred Network Access Commercial |
$1,713.63
|
| Rate for Payer: Quartz Beloit One Network |
$912.69
|
| Rate for Payer: Quartz Commercial |
$1,117.58
|
| Rate for Payer: WEA Trust Commercial |
$1,024.45
|
| Rate for Payer: WPS Commercial |
$1,379.61
|
|
|
VL Carotid Duplex Left or Limited
|
Professional
|
Both
|
$739.00
|
|
|
Service Code
|
CPT 93882 TC,LT
|
| Hospital Charge Code |
5288657
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$134.51 |
| Max. Negotiated Rate |
$730.13 |
| Rate for Payer: Aetna Commercial |
$730.13
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$660.96
|
| Rate for Payer: Cash Price |
$221.70
|
| Rate for Payer: Cash Price |
$221.70
|
| Rate for Payer: Cash Price |
$221.70
|
| Rate for Payer: Cigna Commercial |
$730.13
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$134.51
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$461.14
|
| Rate for Payer: Health EOS Commercial |
$699.39
|
| Rate for Payer: HFN Commercial |
$730.13
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$456.84
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$456.84
|
| Rate for Payer: Multiplan Commercial |
$614.85
|
| Rate for Payer: Preferred Network Access Commercial |
$730.13
|
| Rate for Payer: Quartz Beloit One Network |
$338.17
|
| Rate for Payer: Quartz Commercial |
$438.08
|
| Rate for Payer: The Alliance Commercial |
$384.28
|
| Rate for Payer: United Healthcare Medicaid |
$134.51
|
| Rate for Payer: WEA Trust Commercial |
$422.71
|
| Rate for Payer: WPS Commercial |
$569.25
|
|
|
VL Carotid Duplex Left or Limited
|
Facility
|
IP
|
$739.00
|
|
|
Service Code
|
CPT 93882 TC,LT
|
| Hospital Charge Code |
5288657
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$376.59 |
| Max. Negotiated Rate |
$707.08 |
| Rate for Payer: Aetna Commercial |
$691.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$660.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$407.34
|
| Rate for Payer: Cash Price |
$221.70
|
| Rate for Payer: Cigna Commercial |
$707.08
|
| Rate for Payer: Health EOS Commercial |
$684.02
|
| Rate for Payer: HFN Commercial |
$707.08
|
| Rate for Payer: Multiplan Commercial |
$614.85
|
| Rate for Payer: Preferred Network Access Commercial |
$707.08
|
| Rate for Payer: Quartz Beloit One Network |
$376.59
|
| Rate for Payer: Quartz Commercial |
$461.14
|
| Rate for Payer: WEA Trust Commercial |
$422.71
|
| Rate for Payer: WPS Commercial |
$569.25
|
|
|
VL Carotid Duplex Left or Limited
|
Facility
|
OP
|
$739.00
|
|
|
Service Code
|
CPT 93882 TC,LT
|
| Hospital Charge Code |
5288657
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$215.20 |
| Max. Negotiated Rate |
$707.08 |
| Rate for Payer: Aetna Commercial |
$691.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$660.96
|
| Rate for Payer: Aetna Managed Medicare |
$215.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$499.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$384.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$368.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$407.34
|
| Rate for Payer: Cash Price |
$221.70
|
| Rate for Payer: Cigna Commercial |
$707.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$430.10
|
| Rate for Payer: Health EOS Commercial |
$684.02
|
| Rate for Payer: HFN Commercial |
$707.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$576.42
|
| Rate for Payer: Multiplan Commercial |
$614.85
|
| Rate for Payer: NAPHCARE Commercial |
$461.14
|
| Rate for Payer: Preferred Network Access Commercial |
$707.08
|
| Rate for Payer: Quartz Beloit One Network |
$376.59
|
| Rate for Payer: Quartz Commercial |
$499.56
|
| Rate for Payer: Quartz Medicare Advantage |
$461.14
|
| Rate for Payer: The Alliance Commercial |
$384.28
|
| Rate for Payer: United Healthcare PPO |
$576.42
|
| Rate for Payer: WEA Trust Commercial |
$422.71
|
| Rate for Payer: WPS Commercial |
$569.25
|
|
|
VL Carotid Duplex Right or Limited
|
Facility
|
IP
|
$739.00
|
|
|
Service Code
|
CPT 93882 TC,RT
|
| Hospital Charge Code |
5288655
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$376.59 |
| Max. Negotiated Rate |
$707.08 |
| Rate for Payer: Aetna Commercial |
$691.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$660.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$407.34
|
| Rate for Payer: Cash Price |
$221.70
|
| Rate for Payer: Cigna Commercial |
$707.08
|
| Rate for Payer: Health EOS Commercial |
$684.02
|
| Rate for Payer: HFN Commercial |
$707.08
|
| Rate for Payer: Multiplan Commercial |
$614.85
|
| Rate for Payer: Preferred Network Access Commercial |
$707.08
|
| Rate for Payer: Quartz Beloit One Network |
$376.59
|
| Rate for Payer: Quartz Commercial |
$461.14
|
| Rate for Payer: WEA Trust Commercial |
$422.71
|
| Rate for Payer: WPS Commercial |
$569.25
|
|
|
VL Carotid Duplex Right or Limited
|
Facility
|
OP
|
$739.00
|
|
|
Service Code
|
CPT 93882 TC,RT
|
| Hospital Charge Code |
5288655
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$215.20 |
| Max. Negotiated Rate |
$707.08 |
| Rate for Payer: Aetna Commercial |
$691.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$660.96
|
| Rate for Payer: Aetna Managed Medicare |
$215.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$499.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$384.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$368.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$407.34
|
| Rate for Payer: Cash Price |
$221.70
|
| Rate for Payer: Cigna Commercial |
$707.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$430.10
|
| Rate for Payer: Health EOS Commercial |
$684.02
|
| Rate for Payer: HFN Commercial |
$707.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$576.42
|
| Rate for Payer: Multiplan Commercial |
$614.85
|
| Rate for Payer: NAPHCARE Commercial |
$461.14
|
| Rate for Payer: Preferred Network Access Commercial |
$707.08
|
| Rate for Payer: Quartz Beloit One Network |
$376.59
|
| Rate for Payer: Quartz Commercial |
$499.56
|
| Rate for Payer: Quartz Medicare Advantage |
$461.14
|
| Rate for Payer: The Alliance Commercial |
$384.28
|
| Rate for Payer: United Healthcare PPO |
$576.42
|
| Rate for Payer: WEA Trust Commercial |
$422.71
|
| Rate for Payer: WPS Commercial |
$569.25
|
|
|
VL Carotid Duplex Right or Limited
|
Professional
|
Both
|
$739.00
|
|
|
Service Code
|
CPT 93882 TC,RT
|
| Hospital Charge Code |
5288655
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$134.51 |
| Max. Negotiated Rate |
$730.13 |
| Rate for Payer: Aetna Commercial |
$730.13
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$660.96
|
| Rate for Payer: Cash Price |
$221.70
|
| Rate for Payer: Cash Price |
$221.70
|
| Rate for Payer: Cash Price |
$221.70
|
| Rate for Payer: Cigna Commercial |
$730.13
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$134.51
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$461.14
|
| Rate for Payer: Health EOS Commercial |
$699.39
|
| Rate for Payer: HFN Commercial |
$730.13
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$456.84
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$456.84
|
| Rate for Payer: Multiplan Commercial |
$614.85
|
| Rate for Payer: Preferred Network Access Commercial |
$730.13
|
| Rate for Payer: Quartz Beloit One Network |
$338.17
|
| Rate for Payer: Quartz Commercial |
$438.08
|
| Rate for Payer: The Alliance Commercial |
$384.28
|
| Rate for Payer: United Healthcare Medicaid |
$134.51
|
| Rate for Payer: WEA Trust Commercial |
$422.71
|
| Rate for Payer: WPS Commercial |
$569.25
|
|
|
VL Duplex Arterial/Venous Visceral
|
Professional
|
Both
|
$1,539.00
|
|
|
Service Code
|
CPT 93975 TC
|
| Hospital Charge Code |
1482916
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$142.41 |
| Max. Negotiated Rate |
$1,520.53 |
| Rate for Payer: Aetna Commercial |
$1,520.53
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,376.48
|
| Rate for Payer: Aetna Managed Medicare |
$204.42
|
| Rate for Payer: Anthem Medicare Advantage |
$204.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$204.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$204.42
|
| Rate for Payer: Cash Price |
$461.70
|
| Rate for Payer: Cash Price |
$461.70
|
| Rate for Payer: Cash Price |
$461.70
|
| Rate for Payer: Cigna Commercial |
$1,520.53
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$142.41
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$204.42
|
| Rate for Payer: Health EOS Commercial |
$1,456.51
|
| Rate for Payer: HFN Commercial |
$1,520.53
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$782.23
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$782.23
|
| Rate for Payer: Independent Care Health Plan Medicare |
$204.42
|
| Rate for Payer: Multiplan Commercial |
$1,280.45
|
| Rate for Payer: NAPHCARE Commercial |
$306.63
|
| Rate for Payer: Preferred Network Access Commercial |
$1,520.53
|
| Rate for Payer: Quartz Beloit One Network |
$704.25
|
| Rate for Payer: Quartz Commercial |
$912.32
|
| Rate for Payer: Quartz Medicare Advantage |
$204.42
|
| Rate for Payer: The Alliance Commercial |
$511.06
|
| Rate for Payer: United Healthcare Medicaid |
$142.41
|
| Rate for Payer: United Healthcare Medicare Advantage |
$204.42
|
| Rate for Payer: WEA Trust Commercial |
$880.31
|
| Rate for Payer: WPS Commercial |
$817.69
|
|
|
VL Duplex Arterial/Venous Visceral
|
Facility
|
IP
|
$1,539.00
|
|
|
Service Code
|
CPT 93975 TC
|
| Hospital Charge Code |
1482916
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$784.27 |
| Max. Negotiated Rate |
$1,472.52 |
| Rate for Payer: Aetna Commercial |
$1,440.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,376.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$848.30
|
| Rate for Payer: Cash Price |
$461.70
|
| Rate for Payer: Cigna Commercial |
$1,472.52
|
| Rate for Payer: Health EOS Commercial |
$1,424.50
|
| Rate for Payer: HFN Commercial |
$1,472.52
|
| Rate for Payer: Multiplan Commercial |
$1,280.45
|
| Rate for Payer: Preferred Network Access Commercial |
$1,472.52
|
| Rate for Payer: Quartz Beloit One Network |
$784.27
|
| Rate for Payer: Quartz Commercial |
$960.34
|
| Rate for Payer: WEA Trust Commercial |
$880.31
|
| Rate for Payer: WPS Commercial |
$1,185.49
|
|
|
VL Duplex Arterial/Venous Visceral
|
Facility
|
OP
|
$1,539.00
|
|
|
Service Code
|
CPT 93975 TC
|
| Hospital Charge Code |
1482916
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$448.16 |
| Max. Negotiated Rate |
$1,472.52 |
| Rate for Payer: Aetna Commercial |
$1,440.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,376.48
|
| Rate for Payer: Aetna Managed Medicare |
$448.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,040.36
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$800.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$768.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$848.30
|
| Rate for Payer: Cash Price |
$461.70
|
| Rate for Payer: Cash Price |
$461.70
|
| Rate for Payer: Cigna Commercial |
$1,472.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$895.70
|
| Rate for Payer: Health EOS Commercial |
$1,424.50
|
| Rate for Payer: HFN Commercial |
$1,472.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,200.42
|
| Rate for Payer: Multiplan Commercial |
$1,280.45
|
| Rate for Payer: NAPHCARE Commercial |
$960.34
|
| Rate for Payer: Preferred Network Access Commercial |
$1,472.52
|
| Rate for Payer: Quartz Beloit One Network |
$784.27
|
| Rate for Payer: Quartz Commercial |
$1,040.36
|
| Rate for Payer: Quartz Medicare Advantage |
$960.34
|
| Rate for Payer: The Alliance Commercial |
$817.69
|
| Rate for Payer: United Healthcare PPO |
$1,200.42
|
| Rate for Payer: WEA Trust Commercial |
$880.31
|
| Rate for Payer: WPS Commercial |
$1,185.49
|
|
|
VL Duplex Arterial/Venous Visceral Limit
|
Facility
|
IP
|
$626.00
|
|
|
Service Code
|
CPT 93976 TC
|
| Hospital Charge Code |
1482919
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$319.01 |
| Max. Negotiated Rate |
$598.96 |
| Rate for Payer: Aetna Commercial |
$585.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$559.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$345.05
|
| Rate for Payer: Cash Price |
$187.80
|
| Rate for Payer: Cigna Commercial |
$598.96
|
| Rate for Payer: Health EOS Commercial |
$579.43
|
| Rate for Payer: HFN Commercial |
$598.96
|
| Rate for Payer: Multiplan Commercial |
$520.83
|
| Rate for Payer: Preferred Network Access Commercial |
$598.96
|
| Rate for Payer: Quartz Beloit One Network |
$319.01
|
| Rate for Payer: Quartz Commercial |
$390.62
|
| Rate for Payer: WEA Trust Commercial |
$358.07
|
| Rate for Payer: WPS Commercial |
$482.21
|
|
|
VL Duplex Arterial/Venous Visceral Limit
|
Facility
|
OP
|
$626.00
|
|
|
Service Code
|
CPT 93976 TC
|
| Hospital Charge Code |
1482919
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$182.29 |
| Max. Negotiated Rate |
$598.96 |
| Rate for Payer: Aetna Commercial |
$585.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$559.89
|
| Rate for Payer: Aetna Managed Medicare |
$182.29
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$423.18
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$325.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$312.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$345.05
|
| Rate for Payer: Cash Price |
$187.80
|
| Rate for Payer: Cash Price |
$187.80
|
| Rate for Payer: Cigna Commercial |
$598.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$364.33
|
| Rate for Payer: Health EOS Commercial |
$579.43
|
| Rate for Payer: HFN Commercial |
$598.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$488.28
|
| Rate for Payer: Multiplan Commercial |
$520.83
|
| Rate for Payer: NAPHCARE Commercial |
$390.62
|
| Rate for Payer: Preferred Network Access Commercial |
$598.96
|
| Rate for Payer: Quartz Beloit One Network |
$319.01
|
| Rate for Payer: Quartz Commercial |
$423.18
|
| Rate for Payer: Quartz Medicare Advantage |
$390.62
|
| Rate for Payer: The Alliance Commercial |
$472.08
|
| Rate for Payer: United Healthcare PPO |
$488.28
|
| Rate for Payer: WEA Trust Commercial |
$358.07
|
| Rate for Payer: WPS Commercial |
$482.21
|
|
|
VL Duplex Arterial/Venous Visceral Limit
|
Professional
|
Both
|
$626.00
|
|
|
Service Code
|
CPT 93976 TC
|
| Hospital Charge Code |
1482919
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$118.02 |
| Max. Negotiated Rate |
$618.49 |
| Rate for Payer: Aetna Commercial |
$618.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$559.89
|
| Rate for Payer: Aetna Managed Medicare |
$118.02
|
| Rate for Payer: Anthem Medicare Advantage |
$118.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$118.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$118.02
|
| Rate for Payer: Cash Price |
$187.80
|
| Rate for Payer: Cash Price |
$187.80
|
| Rate for Payer: Cash Price |
$187.80
|
| Rate for Payer: Cigna Commercial |
$618.49
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$121.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$118.02
|
| Rate for Payer: Health EOS Commercial |
$592.45
|
| Rate for Payer: HFN Commercial |
$618.49
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$443.63
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$443.63
|
| Rate for Payer: Independent Care Health Plan Medicare |
$118.02
|
| Rate for Payer: Multiplan Commercial |
$520.83
|
| Rate for Payer: NAPHCARE Commercial |
$177.03
|
| Rate for Payer: Preferred Network Access Commercial |
$618.49
|
| Rate for Payer: Quartz Beloit One Network |
$286.46
|
| Rate for Payer: Quartz Commercial |
$371.09
|
| Rate for Payer: Quartz Medicare Advantage |
$118.02
|
| Rate for Payer: The Alliance Commercial |
$295.05
|
| Rate for Payer: United Healthcare Medicaid |
$121.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$118.02
|
| Rate for Payer: WEA Trust Commercial |
$358.07
|
| Rate for Payer: WPS Commercial |
$472.08
|
|
|
VL Duplex Hemodialysis Access Flow
|
Facility
|
IP
|
$1,207.00
|
|
|
Service Code
|
CPT 93990 TC
|
| Hospital Charge Code |
1482922
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$615.09 |
| Max. Negotiated Rate |
$1,154.86 |
| Rate for Payer: Aetna Commercial |
$1,129.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,079.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$665.30
|
| Rate for Payer: Cash Price |
$362.10
|
| Rate for Payer: Cigna Commercial |
$1,154.86
|
| Rate for Payer: Health EOS Commercial |
$1,117.20
|
| Rate for Payer: HFN Commercial |
$1,154.86
|
| Rate for Payer: Multiplan Commercial |
$1,004.22
|
| Rate for Payer: Preferred Network Access Commercial |
$1,154.86
|
| Rate for Payer: Quartz Beloit One Network |
$615.09
|
| Rate for Payer: Quartz Commercial |
$753.17
|
| Rate for Payer: WEA Trust Commercial |
$690.40
|
| Rate for Payer: WPS Commercial |
$929.75
|
|
|
VL Duplex Hemodialysis Access Flow
|
Professional
|
Both
|
$1,207.00
|
|
|
Service Code
|
CPT 93990 TC
|
| Hospital Charge Code |
1482922
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$120.79 |
| Max. Negotiated Rate |
$1,192.52 |
| Rate for Payer: Aetna Commercial |
$1,192.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,079.54
|
| Rate for Payer: Aetna Managed Medicare |
$120.79
|
| Rate for Payer: Anthem Medicare Advantage |
$120.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$120.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$120.79
|
| Rate for Payer: Cash Price |
$362.10
|
| Rate for Payer: Cash Price |
$362.10
|
| Rate for Payer: Cash Price |
$362.10
|
| Rate for Payer: Cigna Commercial |
$1,192.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$129.13
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$120.79
|
| Rate for Payer: Health EOS Commercial |
$1,142.30
|
| Rate for Payer: HFN Commercial |
$1,192.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$458.09
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$458.09
|
| Rate for Payer: Independent Care Health Plan Medicare |
$120.79
|
| Rate for Payer: Multiplan Commercial |
$1,004.22
|
| Rate for Payer: NAPHCARE Commercial |
$181.18
|
| Rate for Payer: Preferred Network Access Commercial |
$1,192.52
|
| Rate for Payer: Quartz Beloit One Network |
$552.32
|
| Rate for Payer: Quartz Commercial |
$715.51
|
| Rate for Payer: Quartz Medicare Advantage |
$120.79
|
| Rate for Payer: The Alliance Commercial |
$301.96
|
| Rate for Payer: United Healthcare Medicaid |
$129.13
|
| Rate for Payer: United Healthcare Medicare Advantage |
$120.79
|
| Rate for Payer: WEA Trust Commercial |
$690.40
|
| Rate for Payer: WPS Commercial |
$483.14
|
|
|
VL Duplex Hemodialysis Access Flow
|
Facility
|
OP
|
$1,207.00
|
|
|
Service Code
|
CPT 93990 TC
|
| Hospital Charge Code |
1482922
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$351.48 |
| Max. Negotiated Rate |
$1,154.86 |
| Rate for Payer: Aetna Commercial |
$1,129.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,079.54
|
| Rate for Payer: Aetna Managed Medicare |
$351.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$815.93
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$627.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$602.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$665.30
|
| Rate for Payer: Cash Price |
$362.10
|
| Rate for Payer: Cash Price |
$362.10
|
| Rate for Payer: Cigna Commercial |
$1,154.86
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$702.47
|
| Rate for Payer: Health EOS Commercial |
$1,117.20
|
| Rate for Payer: HFN Commercial |
$1,154.86
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$941.46
|
| Rate for Payer: Multiplan Commercial |
$1,004.22
|
| Rate for Payer: NAPHCARE Commercial |
$753.17
|
| Rate for Payer: Preferred Network Access Commercial |
$1,154.86
|
| Rate for Payer: Quartz Beloit One Network |
$615.09
|
| Rate for Payer: Quartz Commercial |
$815.93
|
| Rate for Payer: Quartz Medicare Advantage |
$753.17
|
| Rate for Payer: The Alliance Commercial |
$483.14
|
| Rate for Payer: United Healthcare PPO |
$941.46
|
| Rate for Payer: WEA Trust Commercial |
$690.40
|
| Rate for Payer: WPS Commercial |
$929.75
|
|
|
VL Echo 2D w M Mode w Doppler w/ Con
|
Facility
|
IP
|
$3,456.00
|
|
|
Service Code
|
CPT 93306 TC
|
| Hospital Charge Code |
4628608
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$1,761.18 |
| Max. Negotiated Rate |
$3,306.70 |
| Rate for Payer: Aetna Commercial |
$3,234.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,091.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,904.95
|
| Rate for Payer: Cash Price |
$1,036.80
|
| Rate for Payer: Cigna Commercial |
$3,306.70
|
| Rate for Payer: Health EOS Commercial |
$3,198.87
|
| Rate for Payer: HFN Commercial |
$3,306.70
|
| Rate for Payer: Multiplan Commercial |
$2,875.39
|
| Rate for Payer: Preferred Network Access Commercial |
$3,306.70
|
| Rate for Payer: Quartz Beloit One Network |
$1,761.18
|
| Rate for Payer: Quartz Commercial |
$2,156.54
|
| Rate for Payer: WEA Trust Commercial |
$1,976.83
|
| Rate for Payer: WPS Commercial |
$2,662.16
|
|
|
VL Echo 2D w M Mode w Doppler w/ Con
|
Professional
|
Both
|
$3,456.00
|
|
|
Service Code
|
CPT 93306 TC
|
| Hospital Charge Code |
4628608
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$128.11 |
| Max. Negotiated Rate |
$3,414.53 |
| Rate for Payer: Aetna Commercial |
$3,414.53
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,091.05
|
| Rate for Payer: Aetna Managed Medicare |
$128.11
|
| Rate for Payer: Anthem Medicare Advantage |
$128.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$128.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$128.11
|
| Rate for Payer: Cash Price |
$1,036.80
|
| Rate for Payer: Cash Price |
$1,036.80
|
| Rate for Payer: Cash Price |
$1,036.80
|
| Rate for Payer: Cigna Commercial |
$3,414.53
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$163.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$128.11
|
| Rate for Payer: Health EOS Commercial |
$3,270.76
|
| Rate for Payer: HFN Commercial |
$3,414.53
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$472.60
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$472.60
|
| Rate for Payer: Independent Care Health Plan Medicare |
$128.11
|
| Rate for Payer: Multiplan Commercial |
$2,875.39
|
| Rate for Payer: NAPHCARE Commercial |
$192.16
|
| Rate for Payer: Preferred Network Access Commercial |
$3,414.53
|
| Rate for Payer: Quartz Beloit One Network |
$1,581.47
|
| Rate for Payer: Quartz Commercial |
$2,048.72
|
| Rate for Payer: Quartz Medicare Advantage |
$128.11
|
| Rate for Payer: The Alliance Commercial |
$486.81
|
| Rate for Payer: United Healthcare Medicaid |
$163.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$128.11
|
| Rate for Payer: WEA Trust Commercial |
$1,976.83
|
| Rate for Payer: WPS Commercial |
$512.43
|
|
|
VL Echo 2D w M Mode w Doppler w/ Con
|
Facility
|
OP
|
$3,456.00
|
|
|
Service Code
|
CPT 93306 TC
|
| Hospital Charge Code |
4628608
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$512.43 |
| Max. Negotiated Rate |
$3,306.70 |
| Rate for Payer: Aetna Commercial |
$3,234.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,091.05
|
| Rate for Payer: Aetna Managed Medicare |
$1,006.39
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,336.26
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,797.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,725.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,904.95
|
| Rate for Payer: Cash Price |
$1,036.80
|
| Rate for Payer: Cash Price |
$1,036.80
|
| Rate for Payer: Cigna Commercial |
$3,306.70
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,011.39
|
| Rate for Payer: Health EOS Commercial |
$3,198.87
|
| Rate for Payer: HFN Commercial |
$3,306.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,695.68
|
| Rate for Payer: Multiplan Commercial |
$2,875.39
|
| Rate for Payer: NAPHCARE Commercial |
$2,156.54
|
| Rate for Payer: Preferred Network Access Commercial |
$3,306.70
|
| Rate for Payer: Quartz Beloit One Network |
$1,761.18
|
| Rate for Payer: Quartz Commercial |
$2,336.26
|
| Rate for Payer: Quartz Medicare Advantage |
$2,156.54
|
| Rate for Payer: The Alliance Commercial |
$512.43
|
| Rate for Payer: United Healthcare PPO |
$2,695.68
|
| Rate for Payer: WEA Trust Commercial |
$1,976.83
|
| Rate for Payer: WPS Commercial |
$2,662.16
|
|
|
VL Echo Color Flow Velocity Mapping
|
Professional
|
Both
|
$842.00
|
|
|
Service Code
|
CPT 93325 TC
|
| Hospital Charge Code |
1482976
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$20.30 |
| Max. Negotiated Rate |
$831.90 |
| Rate for Payer: Aetna Commercial |
$831.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$753.08
|
| Rate for Payer: Aetna Managed Medicare |
$20.30
|
| Rate for Payer: Anthem Medicare Advantage |
$20.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$20.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$20.30
|
| Rate for Payer: Cash Price |
$252.60
|
| Rate for Payer: Cash Price |
$252.60
|
| Rate for Payer: Cash Price |
$252.60
|
| Rate for Payer: Cigna Commercial |
$831.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$43.98
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$20.30
|
| Rate for Payer: Health EOS Commercial |
$796.87
|
| Rate for Payer: HFN Commercial |
$831.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$77.24
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$77.24
|
| Rate for Payer: Independent Care Health Plan Medicare |
$20.30
|
| Rate for Payer: Multiplan Commercial |
$700.54
|
| Rate for Payer: NAPHCARE Commercial |
$30.45
|
| Rate for Payer: Preferred Network Access Commercial |
$831.90
|
| Rate for Payer: Quartz Beloit One Network |
$385.30
|
| Rate for Payer: Quartz Commercial |
$499.14
|
| Rate for Payer: Quartz Medicare Advantage |
$20.30
|
| Rate for Payer: The Alliance Commercial |
$77.14
|
| Rate for Payer: United Healthcare Medicaid |
$43.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20.30
|
| Rate for Payer: WEA Trust Commercial |
$481.62
|
| Rate for Payer: WPS Commercial |
$81.20
|
|
|
VL Echo Color Flow Velocity Mapping
|
Facility
|
IP
|
$842.00
|
|
|
Service Code
|
CPT 93325 TC
|
| Hospital Charge Code |
1482976
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$429.08 |
| Max. Negotiated Rate |
$805.63 |
| Rate for Payer: Aetna Commercial |
$788.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$753.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$464.11
|
| Rate for Payer: Cash Price |
$252.60
|
| Rate for Payer: Cigna Commercial |
$805.63
|
| Rate for Payer: Health EOS Commercial |
$779.36
|
| Rate for Payer: HFN Commercial |
$805.63
|
| Rate for Payer: Multiplan Commercial |
$700.54
|
| Rate for Payer: Preferred Network Access Commercial |
$805.63
|
| Rate for Payer: Quartz Beloit One Network |
$429.08
|
| Rate for Payer: Quartz Commercial |
$525.41
|
| Rate for Payer: WEA Trust Commercial |
$481.62
|
| Rate for Payer: WPS Commercial |
$648.59
|
|
|
VL Echo Color Flow Velocity Mapping
|
Facility
|
OP
|
$842.00
|
|
|
Service Code
|
CPT 93325 TC
|
| Hospital Charge Code |
1482976
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$81.20 |
| Max. Negotiated Rate |
$805.63 |
| Rate for Payer: Aetna Commercial |
$788.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$753.08
|
| Rate for Payer: Aetna Managed Medicare |
$245.19
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$569.19
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$437.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$420.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$464.11
|
| Rate for Payer: Cash Price |
$252.60
|
| Rate for Payer: Cash Price |
$252.60
|
| Rate for Payer: Cigna Commercial |
$805.63
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$490.04
|
| Rate for Payer: Health EOS Commercial |
$779.36
|
| Rate for Payer: HFN Commercial |
$805.63
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$656.76
|
| Rate for Payer: Multiplan Commercial |
$700.54
|
| Rate for Payer: NAPHCARE Commercial |
$525.41
|
| Rate for Payer: Preferred Network Access Commercial |
$805.63
|
| Rate for Payer: Quartz Beloit One Network |
$429.08
|
| Rate for Payer: Quartz Commercial |
$569.19
|
| Rate for Payer: Quartz Medicare Advantage |
$525.41
|
| Rate for Payer: The Alliance Commercial |
$81.20
|
| Rate for Payer: United Healthcare PPO |
$656.76
|
| Rate for Payer: WEA Trust Commercial |
$481.62
|
| Rate for Payer: WPS Commercial |
$648.59
|
|
|
VL Echo Congenital Complete
|
Facility
|
OP
|
$2,786.00
|
|
|
Service Code
|
CPT 93303 TC
|
| Hospital Charge Code |
1482802
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$636.23 |
| Max. Negotiated Rate |
$2,665.64 |
| Rate for Payer: Aetna Commercial |
$2,607.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,491.80
|
| Rate for Payer: Aetna Managed Medicare |
$811.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,883.34
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,448.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,390.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,535.64
|
| Rate for Payer: Cash Price |
$835.80
|
| Rate for Payer: Cash Price |
$835.80
|
| Rate for Payer: Cigna Commercial |
$2,665.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,621.45
|
| Rate for Payer: Health EOS Commercial |
$2,578.72
|
| Rate for Payer: HFN Commercial |
$2,665.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,173.08
|
| Rate for Payer: Multiplan Commercial |
$2,317.95
|
| Rate for Payer: NAPHCARE Commercial |
$1,738.46
|
| Rate for Payer: Preferred Network Access Commercial |
$2,665.64
|
| Rate for Payer: Quartz Beloit One Network |
$1,419.75
|
| Rate for Payer: Quartz Commercial |
$1,883.34
|
| Rate for Payer: Quartz Medicare Advantage |
$1,738.46
|
| Rate for Payer: The Alliance Commercial |
$636.23
|
| Rate for Payer: United Healthcare PPO |
$2,173.08
|
| Rate for Payer: WEA Trust Commercial |
$1,593.59
|
| Rate for Payer: WPS Commercial |
$2,146.06
|
|
|
VL Echo Congenital Complete
|
Professional
|
Both
|
$2,786.00
|
|
|
Service Code
|
CPT 93303 TC
|
| Hospital Charge Code |
1482802
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$138.60 |
| Max. Negotiated Rate |
$2,752.57 |
| Rate for Payer: Aetna Commercial |
$2,752.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,491.80
|
| Rate for Payer: Aetna Managed Medicare |
$159.06
|
| Rate for Payer: Anthem Medicare Advantage |
$159.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$159.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$159.06
|
| Rate for Payer: Cash Price |
$835.80
|
| Rate for Payer: Cash Price |
$835.80
|
| Rate for Payer: Cash Price |
$835.80
|
| Rate for Payer: Cigna Commercial |
$2,752.57
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$138.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$159.06
|
| Rate for Payer: Health EOS Commercial |
$2,636.67
|
| Rate for Payer: HFN Commercial |
$2,752.57
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$604.14
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$604.14
|
| Rate for Payer: Independent Care Health Plan Medicare |
$159.06
|
| Rate for Payer: Multiplan Commercial |
$2,317.95
|
| Rate for Payer: NAPHCARE Commercial |
$238.59
|
| Rate for Payer: Preferred Network Access Commercial |
$2,752.57
|
| Rate for Payer: Quartz Beloit One Network |
$1,274.87
|
| Rate for Payer: Quartz Commercial |
$1,651.54
|
| Rate for Payer: Quartz Medicare Advantage |
$159.06
|
| Rate for Payer: The Alliance Commercial |
$604.42
|
| Rate for Payer: United Healthcare Medicaid |
$138.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$159.06
|
| Rate for Payer: WEA Trust Commercial |
$1,593.59
|
| Rate for Payer: WPS Commercial |
$636.23
|
|
|
VL Echo Congenital Complete
|
Facility
|
IP
|
$2,786.00
|
|
|
Service Code
|
CPT 93303 TC
|
| Hospital Charge Code |
1482802
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$1,419.75 |
| Max. Negotiated Rate |
$2,665.64 |
| Rate for Payer: Aetna Commercial |
$2,607.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,491.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,535.64
|
| Rate for Payer: Cash Price |
$835.80
|
| Rate for Payer: Cigna Commercial |
$2,665.64
|
| Rate for Payer: Health EOS Commercial |
$2,578.72
|
| Rate for Payer: HFN Commercial |
$2,665.64
|
| Rate for Payer: Multiplan Commercial |
$2,317.95
|
| Rate for Payer: Preferred Network Access Commercial |
$2,665.64
|
| Rate for Payer: Quartz Beloit One Network |
$1,419.75
|
| Rate for Payer: Quartz Commercial |
$1,738.46
|
| Rate for Payer: WEA Trust Commercial |
$1,593.59
|
| Rate for Payer: WPS Commercial |
$2,146.06
|
|
