|
VL Echo Congenital Limited
|
Facility
|
IP
|
$1,819.00
|
|
|
Service Code
|
CPT 93304 TC
|
| Hospital Charge Code |
1482979
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$926.96 |
| Max. Negotiated Rate |
$1,740.42 |
| Rate for Payer: Aetna Commercial |
$1,702.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,626.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,002.63
|
| Rate for Payer: Cash Price |
$545.70
|
| Rate for Payer: Cigna Commercial |
$1,740.42
|
| Rate for Payer: Health EOS Commercial |
$1,683.67
|
| Rate for Payer: HFN Commercial |
$1,740.42
|
| Rate for Payer: Multiplan Commercial |
$1,513.41
|
| Rate for Payer: Preferred Network Access Commercial |
$1,740.42
|
| Rate for Payer: Quartz Beloit One Network |
$926.96
|
| Rate for Payer: Quartz Commercial |
$1,135.06
|
| Rate for Payer: WEA Trust Commercial |
$1,040.47
|
| Rate for Payer: WPS Commercial |
$1,401.18
|
|
|
VL Echo Congenital Limited
|
Facility
|
OP
|
$1,819.00
|
|
|
Service Code
|
CPT 93304 TC
|
| Hospital Charge Code |
1482979
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$472.08 |
| Max. Negotiated Rate |
$1,740.42 |
| Rate for Payer: Aetna Commercial |
$1,702.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,626.91
|
| Rate for Payer: Aetna Managed Medicare |
$529.69
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,229.64
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$945.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$908.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,002.63
|
| Rate for Payer: Cash Price |
$545.70
|
| Rate for Payer: Cash Price |
$545.70
|
| Rate for Payer: Cigna Commercial |
$1,740.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,058.66
|
| Rate for Payer: Health EOS Commercial |
$1,683.67
|
| Rate for Payer: HFN Commercial |
$1,740.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,418.82
|
| Rate for Payer: Multiplan Commercial |
$1,513.41
|
| Rate for Payer: NAPHCARE Commercial |
$1,135.06
|
| Rate for Payer: Preferred Network Access Commercial |
$1,740.42
|
| Rate for Payer: Quartz Beloit One Network |
$926.96
|
| Rate for Payer: Quartz Commercial |
$1,229.64
|
| Rate for Payer: Quartz Medicare Advantage |
$1,135.06
|
| Rate for Payer: The Alliance Commercial |
$472.08
|
| Rate for Payer: United Healthcare PPO |
$1,418.82
|
| Rate for Payer: WEA Trust Commercial |
$1,040.47
|
| Rate for Payer: WPS Commercial |
$1,401.18
|
|
|
VL Echo Congenital Limited
|
Professional
|
Both
|
$1,819.00
|
|
|
Service Code
|
CPT 93304 TC
|
| Hospital Charge Code |
1482979
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$75.46 |
| Max. Negotiated Rate |
$1,797.17 |
| Rate for Payer: WPS Commercial |
$472.08
|
| Rate for Payer: Aetna Commercial |
$1,797.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,626.91
|
| 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 |
$545.70
|
| Rate for Payer: Cash Price |
$545.70
|
| Rate for Payer: Cash Price |
$545.70
|
| Rate for Payer: Cigna Commercial |
$1,797.17
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$75.46
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$118.02
|
| Rate for Payer: Health EOS Commercial |
$1,721.50
|
| Rate for Payer: HFN Commercial |
$1,797.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$447.22
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$447.22
|
| Rate for Payer: Independent Care Health Plan Medicare |
$118.02
|
| Rate for Payer: Multiplan Commercial |
$1,513.41
|
| Rate for Payer: NAPHCARE Commercial |
$177.03
|
| Rate for Payer: Preferred Network Access Commercial |
$1,797.17
|
| Rate for Payer: Quartz Beloit One Network |
$832.37
|
| Rate for Payer: Quartz Commercial |
$1,078.30
|
| Rate for Payer: Quartz Medicare Advantage |
$118.02
|
| Rate for Payer: The Alliance Commercial |
$448.47
|
| Rate for Payer: United Healthcare Medicaid |
$75.46
|
| Rate for Payer: United Healthcare Medicare Advantage |
$118.02
|
| Rate for Payer: WEA Trust Commercial |
$1,040.47
|
|
|
VL Echo Doppler
|
Facility
|
IP
|
$905.00
|
|
|
Service Code
|
CPT 93320 TC
|
| Hospital Charge Code |
1482982
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$461.19 |
| Max. Negotiated Rate |
$865.90 |
| Rate for Payer: Aetna Commercial |
$847.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$809.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$498.84
|
| Rate for Payer: Cash Price |
$271.50
|
| Rate for Payer: Cigna Commercial |
$865.90
|
| Rate for Payer: Health EOS Commercial |
$837.67
|
| Rate for Payer: HFN Commercial |
$865.90
|
| Rate for Payer: Multiplan Commercial |
$752.96
|
| Rate for Payer: Preferred Network Access Commercial |
$865.90
|
| Rate for Payer: Quartz Beloit One Network |
$461.19
|
| Rate for Payer: Quartz Commercial |
$564.72
|
| Rate for Payer: WEA Trust Commercial |
$517.66
|
| Rate for Payer: WPS Commercial |
$697.12
|
|
|
VL Echo Doppler
|
Professional
|
Both
|
$905.00
|
|
|
Service Code
|
CPT 93320 TC
|
| Hospital Charge Code |
1482982
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$33.72 |
| Max. Negotiated Rate |
$894.14 |
| Rate for Payer: Aetna Commercial |
$894.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$809.43
|
| Rate for Payer: Aetna Managed Medicare |
$33.72
|
| Rate for Payer: Anthem Medicare Advantage |
$33.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$33.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$33.72
|
| Rate for Payer: Cash Price |
$271.50
|
| Rate for Payer: Cash Price |
$271.50
|
| Rate for Payer: Cash Price |
$271.50
|
| Rate for Payer: Cigna Commercial |
$894.14
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$66.75
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$33.72
|
| Rate for Payer: Health EOS Commercial |
$856.49
|
| Rate for Payer: HFN Commercial |
$894.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$124.63
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$124.63
|
| Rate for Payer: Independent Care Health Plan Medicare |
$33.72
|
| Rate for Payer: Multiplan Commercial |
$752.96
|
| Rate for Payer: NAPHCARE Commercial |
$50.58
|
| Rate for Payer: Preferred Network Access Commercial |
$894.14
|
| Rate for Payer: Quartz Beloit One Network |
$414.13
|
| Rate for Payer: Quartz Commercial |
$536.48
|
| Rate for Payer: Quartz Medicare Advantage |
$33.72
|
| Rate for Payer: The Alliance Commercial |
$128.12
|
| Rate for Payer: United Healthcare Medicaid |
$66.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$33.72
|
| Rate for Payer: WEA Trust Commercial |
$517.66
|
| Rate for Payer: WPS Commercial |
$134.87
|
|
|
VL Echo Doppler
|
Facility
|
OP
|
$905.00
|
|
|
Service Code
|
CPT 93320 TC
|
| Hospital Charge Code |
1482982
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$134.87 |
| Max. Negotiated Rate |
$865.90 |
| Rate for Payer: Aetna Commercial |
$847.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$809.43
|
| Rate for Payer: Aetna Managed Medicare |
$263.54
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$611.78
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$470.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$451.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$498.84
|
| Rate for Payer: Cash Price |
$271.50
|
| Rate for Payer: Cash Price |
$271.50
|
| Rate for Payer: Cigna Commercial |
$865.90
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$526.71
|
| Rate for Payer: Health EOS Commercial |
$837.67
|
| Rate for Payer: HFN Commercial |
$865.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$705.90
|
| Rate for Payer: Multiplan Commercial |
$752.96
|
| Rate for Payer: NAPHCARE Commercial |
$564.72
|
| Rate for Payer: Preferred Network Access Commercial |
$865.90
|
| Rate for Payer: Quartz Beloit One Network |
$461.19
|
| Rate for Payer: Quartz Commercial |
$611.78
|
| Rate for Payer: Quartz Medicare Advantage |
$564.72
|
| Rate for Payer: The Alliance Commercial |
$134.87
|
| Rate for Payer: United Healthcare PPO |
$705.90
|
| Rate for Payer: WEA Trust Commercial |
$517.66
|
| Rate for Payer: WPS Commercial |
$697.12
|
|
|
VL Echo During Therap/Diag Intervention
|
Facility
|
OP
|
$1,753.00
|
|
|
Service Code
|
CPT 93662 TC
|
| Hospital Charge Code |
2944148
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$510.47 |
| Max. Negotiated Rate |
$1,677.27 |
| Rate for Payer: Aetna Commercial |
$1,640.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,567.88
|
| Rate for Payer: Aetna Managed Medicare |
$510.47
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,185.03
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$911.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$875.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$966.25
|
| Rate for Payer: Cash Price |
$525.90
|
| Rate for Payer: Cigna Commercial |
$1,677.27
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,020.25
|
| Rate for Payer: Health EOS Commercial |
$1,622.58
|
| Rate for Payer: HFN Commercial |
$1,677.27
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,367.34
|
| Rate for Payer: Multiplan Commercial |
$1,458.50
|
| Rate for Payer: NAPHCARE Commercial |
$1,093.87
|
| Rate for Payer: Preferred Network Access Commercial |
$1,677.27
|
| Rate for Payer: Quartz Beloit One Network |
$893.33
|
| Rate for Payer: Quartz Commercial |
$1,185.03
|
| Rate for Payer: Quartz Medicare Advantage |
$1,093.87
|
| Rate for Payer: The Alliance Commercial |
$911.56
|
| Rate for Payer: United Healthcare PPO |
$1,367.34
|
| Rate for Payer: WEA Trust Commercial |
$1,002.72
|
| Rate for Payer: WPS Commercial |
$1,350.34
|
|
|
VL Echo During Therap/Diag Intervention
|
Professional
|
Both
|
$1,753.00
|
|
|
Service Code
|
CPT 93662 TC
|
| Hospital Charge Code |
2944148
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$802.17 |
| Max. Negotiated Rate |
$1,731.96 |
| Rate for Payer: Aetna Commercial |
$1,731.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,567.88
|
| Rate for Payer: Cash Price |
$525.90
|
| Rate for Payer: Cash Price |
$525.90
|
| Rate for Payer: Cash Price |
$525.90
|
| Rate for Payer: Cigna Commercial |
$1,731.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$911.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,093.87
|
| Rate for Payer: Health EOS Commercial |
$1,659.04
|
| Rate for Payer: HFN Commercial |
$1,731.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$843.39
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$843.39
|
| Rate for Payer: Multiplan Commercial |
$1,458.50
|
| Rate for Payer: Preferred Network Access Commercial |
$1,731.96
|
| Rate for Payer: Quartz Beloit One Network |
$802.17
|
| Rate for Payer: Quartz Commercial |
$1,039.18
|
| Rate for Payer: The Alliance Commercial |
$911.56
|
| Rate for Payer: WEA Trust Commercial |
$1,002.72
|
| Rate for Payer: WPS Commercial |
$1,350.34
|
|
|
VL Echo During Therap/Diag Intervention
|
Facility
|
IP
|
$1,753.00
|
|
|
Service Code
|
CPT 93662 TC
|
| Hospital Charge Code |
2944148
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$893.33 |
| Max. Negotiated Rate |
$1,677.27 |
| Rate for Payer: Aetna Commercial |
$1,640.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,567.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$966.25
|
| Rate for Payer: Cash Price |
$525.90
|
| Rate for Payer: Cigna Commercial |
$1,677.27
|
| Rate for Payer: Health EOS Commercial |
$1,622.58
|
| Rate for Payer: HFN Commercial |
$1,677.27
|
| Rate for Payer: Multiplan Commercial |
$1,458.50
|
| Rate for Payer: Preferred Network Access Commercial |
$1,677.27
|
| Rate for Payer: Quartz Beloit One Network |
$893.33
|
| Rate for Payer: Quartz Commercial |
$1,093.87
|
| Rate for Payer: WEA Trust Commercial |
$1,002.72
|
| Rate for Payer: WPS Commercial |
$1,350.34
|
|
|
VL Echo Limited
|
Facility
|
OP
|
$1,524.00
|
|
|
Service Code
|
CPT 93308 TC
|
| Hospital Charge Code |
1482988
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$303.01 |
| Max. Negotiated Rate |
$1,458.16 |
| Rate for Payer: Aetna Commercial |
$1,426.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,363.07
|
| Rate for Payer: Aetna Managed Medicare |
$443.79
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,030.22
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$792.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$760.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$840.03
|
| Rate for Payer: Cash Price |
$457.20
|
| Rate for Payer: Cash Price |
$457.20
|
| Rate for Payer: Cigna Commercial |
$1,458.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$886.97
|
| Rate for Payer: Health EOS Commercial |
$1,410.61
|
| Rate for Payer: HFN Commercial |
$1,458.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,188.72
|
| Rate for Payer: Multiplan Commercial |
$1,267.97
|
| Rate for Payer: NAPHCARE Commercial |
$950.98
|
| Rate for Payer: Preferred Network Access Commercial |
$1,458.16
|
| Rate for Payer: Quartz Beloit One Network |
$776.63
|
| Rate for Payer: Quartz Commercial |
$1,030.22
|
| Rate for Payer: Quartz Medicare Advantage |
$950.98
|
| Rate for Payer: The Alliance Commercial |
$303.01
|
| Rate for Payer: United Healthcare PPO |
$1,188.72
|
| Rate for Payer: WEA Trust Commercial |
$871.73
|
| Rate for Payer: WPS Commercial |
$1,173.94
|
|
|
VL Echo Limited
|
Facility
|
IP
|
$1,524.00
|
|
|
Service Code
|
CPT 93308 TC
|
| Hospital Charge Code |
1482988
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$776.63 |
| Max. Negotiated Rate |
$1,458.16 |
| Rate for Payer: Aetna Commercial |
$1,426.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,363.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$840.03
|
| Rate for Payer: Cash Price |
$457.20
|
| Rate for Payer: Cigna Commercial |
$1,458.16
|
| Rate for Payer: Health EOS Commercial |
$1,410.61
|
| Rate for Payer: HFN Commercial |
$1,458.16
|
| Rate for Payer: Multiplan Commercial |
$1,267.97
|
| Rate for Payer: Preferred Network Access Commercial |
$1,458.16
|
| Rate for Payer: Quartz Beloit One Network |
$776.63
|
| Rate for Payer: Quartz Commercial |
$950.98
|
| Rate for Payer: WEA Trust Commercial |
$871.73
|
| Rate for Payer: WPS Commercial |
$1,173.94
|
|
|
VL Echo Limited
|
Professional
|
Both
|
$1,524.00
|
|
|
Service Code
|
CPT 93308 TC
|
| Hospital Charge Code |
1482988
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$75.46 |
| Max. Negotiated Rate |
$1,505.71 |
| Rate for Payer: Aetna Commercial |
$1,505.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,363.07
|
| Rate for Payer: Aetna Managed Medicare |
$75.75
|
| Rate for Payer: Anthem Medicare Advantage |
$75.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$75.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$75.75
|
| Rate for Payer: Cash Price |
$457.20
|
| Rate for Payer: Cash Price |
$457.20
|
| Rate for Payer: Cash Price |
$457.20
|
| Rate for Payer: Cigna Commercial |
$1,505.71
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$75.46
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$75.75
|
| Rate for Payer: Health EOS Commercial |
$1,442.31
|
| Rate for Payer: HFN Commercial |
$1,505.71
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$267.04
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$267.04
|
| Rate for Payer: Independent Care Health Plan Medicare |
$75.75
|
| Rate for Payer: Multiplan Commercial |
$1,267.97
|
| Rate for Payer: NAPHCARE Commercial |
$113.63
|
| Rate for Payer: Preferred Network Access Commercial |
$1,505.71
|
| Rate for Payer: Quartz Beloit One Network |
$697.38
|
| Rate for Payer: Quartz Commercial |
$903.43
|
| Rate for Payer: Quartz Medicare Advantage |
$75.75
|
| Rate for Payer: The Alliance Commercial |
$287.86
|
| Rate for Payer: United Healthcare Medicaid |
$75.46
|
| Rate for Payer: United Healthcare Medicare Advantage |
$75.75
|
| Rate for Payer: WEA Trust Commercial |
$871.73
|
| Rate for Payer: WPS Commercial |
$303.01
|
|
|
VL Echo Limited w/ Contrast
|
Professional
|
Both
|
$1,524.00
|
|
|
Service Code
|
CPT 93308 TC
|
| Hospital Charge Code |
4628611
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$75.46 |
| Max. Negotiated Rate |
$1,505.71 |
| Rate for Payer: Aetna Commercial |
$1,505.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,363.07
|
| Rate for Payer: Aetna Managed Medicare |
$75.75
|
| Rate for Payer: Anthem Medicare Advantage |
$75.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$75.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$75.75
|
| Rate for Payer: Cash Price |
$457.20
|
| Rate for Payer: Cash Price |
$457.20
|
| Rate for Payer: Cash Price |
$457.20
|
| Rate for Payer: Cigna Commercial |
$1,505.71
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$75.46
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$75.75
|
| Rate for Payer: Health EOS Commercial |
$1,442.31
|
| Rate for Payer: HFN Commercial |
$1,505.71
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$267.04
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$267.04
|
| Rate for Payer: Independent Care Health Plan Medicare |
$75.75
|
| Rate for Payer: Multiplan Commercial |
$1,267.97
|
| Rate for Payer: NAPHCARE Commercial |
$113.63
|
| Rate for Payer: Preferred Network Access Commercial |
$1,505.71
|
| Rate for Payer: Quartz Beloit One Network |
$697.38
|
| Rate for Payer: Quartz Commercial |
$903.43
|
| Rate for Payer: Quartz Medicare Advantage |
$75.75
|
| Rate for Payer: The Alliance Commercial |
$287.86
|
| Rate for Payer: United Healthcare Medicaid |
$75.46
|
| Rate for Payer: United Healthcare Medicare Advantage |
$75.75
|
| Rate for Payer: WEA Trust Commercial |
$871.73
|
| Rate for Payer: WPS Commercial |
$303.01
|
|
|
VL Echo Limited w/ Contrast
|
Facility
|
OP
|
$1,524.00
|
|
|
Service Code
|
CPT 93308 TC
|
| Hospital Charge Code |
4628611
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$303.01 |
| Max. Negotiated Rate |
$1,458.16 |
| Rate for Payer: Aetna Commercial |
$1,426.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,363.07
|
| Rate for Payer: Aetna Managed Medicare |
$443.79
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,030.22
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$792.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$760.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$840.03
|
| Rate for Payer: Cash Price |
$457.20
|
| Rate for Payer: Cash Price |
$457.20
|
| Rate for Payer: Cigna Commercial |
$1,458.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$886.97
|
| Rate for Payer: Health EOS Commercial |
$1,410.61
|
| Rate for Payer: HFN Commercial |
$1,458.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,188.72
|
| Rate for Payer: Multiplan Commercial |
$1,267.97
|
| Rate for Payer: NAPHCARE Commercial |
$950.98
|
| Rate for Payer: Preferred Network Access Commercial |
$1,458.16
|
| Rate for Payer: Quartz Beloit One Network |
$776.63
|
| Rate for Payer: Quartz Commercial |
$1,030.22
|
| Rate for Payer: Quartz Medicare Advantage |
$950.98
|
| Rate for Payer: The Alliance Commercial |
$303.01
|
| Rate for Payer: United Healthcare PPO |
$1,188.72
|
| Rate for Payer: WEA Trust Commercial |
$871.73
|
| Rate for Payer: WPS Commercial |
$1,173.94
|
|
|
VL Echo Limited w/ Contrast
|
Facility
|
IP
|
$1,524.00
|
|
|
Service Code
|
CPT 93308 TC
|
| Hospital Charge Code |
4628611
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$776.63 |
| Max. Negotiated Rate |
$1,458.16 |
| Rate for Payer: Aetna Commercial |
$1,426.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,363.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$840.03
|
| Rate for Payer: Cash Price |
$457.20
|
| Rate for Payer: Cigna Commercial |
$1,458.16
|
| Rate for Payer: Health EOS Commercial |
$1,410.61
|
| Rate for Payer: HFN Commercial |
$1,458.16
|
| Rate for Payer: Multiplan Commercial |
$1,267.97
|
| Rate for Payer: Preferred Network Access Commercial |
$1,458.16
|
| Rate for Payer: Quartz Beloit One Network |
$776.63
|
| Rate for Payer: Quartz Commercial |
$950.98
|
| Rate for Payer: WEA Trust Commercial |
$871.73
|
| Rate for Payer: WPS Commercial |
$1,173.94
|
|
|
VL Echo Stress Test
|
Facility
|
IP
|
$4,308.00
|
|
|
Service Code
|
CPT 93350 TC
|
| Hospital Charge Code |
1482805
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$2,195.36 |
| Max. Negotiated Rate |
$4,121.89 |
| Rate for Payer: Aetna Commercial |
$4,032.29
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,853.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,374.57
|
| Rate for Payer: Cash Price |
$1,292.40
|
| Rate for Payer: Cigna Commercial |
$4,121.89
|
| Rate for Payer: Health EOS Commercial |
$3,987.48
|
| Rate for Payer: HFN Commercial |
$4,121.89
|
| Rate for Payer: Multiplan Commercial |
$3,584.26
|
| Rate for Payer: Preferred Network Access Commercial |
$4,121.89
|
| Rate for Payer: Quartz Beloit One Network |
$2,195.36
|
| Rate for Payer: Quartz Commercial |
$2,688.19
|
| Rate for Payer: WEA Trust Commercial |
$2,464.18
|
| Rate for Payer: WPS Commercial |
$3,318.45
|
|
|
VL Echo Stress Test
|
Professional
|
Both
|
$4,308.00
|
|
|
Service Code
|
CPT 93350 TC
|
| Hospital Charge Code |
1482805
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$68.90 |
| Max. Negotiated Rate |
$4,256.30 |
| Rate for Payer: Aetna Commercial |
$4,256.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,853.08
|
| Rate for Payer: Aetna Managed Medicare |
$117.02
|
| Rate for Payer: Anthem Medicare Advantage |
$117.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$117.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$117.02
|
| Rate for Payer: Cash Price |
$1,292.40
|
| Rate for Payer: Cash Price |
$1,292.40
|
| Rate for Payer: Cash Price |
$1,292.40
|
| Rate for Payer: Cigna Commercial |
$4,256.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$68.90
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$117.02
|
| Rate for Payer: Health EOS Commercial |
$4,077.09
|
| Rate for Payer: HFN Commercial |
$4,256.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$433.97
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$433.97
|
| Rate for Payer: Independent Care Health Plan Medicare |
$117.02
|
| Rate for Payer: Multiplan Commercial |
$3,584.26
|
| Rate for Payer: NAPHCARE Commercial |
$175.53
|
| Rate for Payer: Preferred Network Access Commercial |
$4,256.30
|
| Rate for Payer: Quartz Beloit One Network |
$1,971.34
|
| Rate for Payer: Quartz Commercial |
$2,553.78
|
| Rate for Payer: Quartz Medicare Advantage |
$117.02
|
| Rate for Payer: The Alliance Commercial |
$444.68
|
| Rate for Payer: United Healthcare Medicaid |
$68.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$117.02
|
| Rate for Payer: WEA Trust Commercial |
$2,464.18
|
| Rate for Payer: WPS Commercial |
$468.08
|
|
|
VL Echo Stress Test
|
Facility
|
OP
|
$4,308.00
|
|
|
Service Code
|
CPT 93350 TC
|
| Hospital Charge Code |
1482805
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$468.08 |
| Max. Negotiated Rate |
$4,121.89 |
| Rate for Payer: Aetna Commercial |
$4,032.29
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,853.08
|
| Rate for Payer: Aetna Managed Medicare |
$1,254.49
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,912.21
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,240.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,150.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,374.57
|
| Rate for Payer: Cash Price |
$1,292.40
|
| Rate for Payer: Cash Price |
$1,292.40
|
| Rate for Payer: Cigna Commercial |
$4,121.89
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,507.26
|
| Rate for Payer: Health EOS Commercial |
$3,987.48
|
| Rate for Payer: HFN Commercial |
$4,121.89
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,360.24
|
| Rate for Payer: Multiplan Commercial |
$3,584.26
|
| Rate for Payer: NAPHCARE Commercial |
$2,688.19
|
| Rate for Payer: Preferred Network Access Commercial |
$4,121.89
|
| Rate for Payer: Quartz Beloit One Network |
$2,195.36
|
| Rate for Payer: Quartz Commercial |
$2,912.21
|
| Rate for Payer: Quartz Medicare Advantage |
$2,688.19
|
| Rate for Payer: The Alliance Commercial |
$468.08
|
| Rate for Payer: United Healthcare PPO |
$3,360.24
|
| Rate for Payer: WEA Trust Commercial |
$2,464.18
|
| Rate for Payer: WPS Commercial |
$3,318.45
|
|
|
VL Echo Stress Test Chemical
|
Professional
|
Both
|
$4,308.00
|
|
|
Service Code
|
CPT 93350 TC
|
| Hospital Charge Code |
2558804
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$68.90 |
| Max. Negotiated Rate |
$4,256.30 |
| Rate for Payer: Aetna Commercial |
$4,256.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,853.08
|
| Rate for Payer: Aetna Managed Medicare |
$117.02
|
| Rate for Payer: Anthem Medicare Advantage |
$117.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$117.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$117.02
|
| Rate for Payer: Cash Price |
$1,292.40
|
| Rate for Payer: Cash Price |
$1,292.40
|
| Rate for Payer: Cash Price |
$1,292.40
|
| Rate for Payer: Cigna Commercial |
$4,256.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$68.90
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$117.02
|
| Rate for Payer: Health EOS Commercial |
$4,077.09
|
| Rate for Payer: HFN Commercial |
$4,256.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$433.97
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$433.97
|
| Rate for Payer: Independent Care Health Plan Medicare |
$117.02
|
| Rate for Payer: Multiplan Commercial |
$3,584.26
|
| Rate for Payer: NAPHCARE Commercial |
$175.53
|
| Rate for Payer: Preferred Network Access Commercial |
$4,256.30
|
| Rate for Payer: Quartz Beloit One Network |
$1,971.34
|
| Rate for Payer: Quartz Commercial |
$2,553.78
|
| Rate for Payer: Quartz Medicare Advantage |
$117.02
|
| Rate for Payer: The Alliance Commercial |
$444.68
|
| Rate for Payer: United Healthcare Medicaid |
$68.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$117.02
|
| Rate for Payer: WEA Trust Commercial |
$2,464.18
|
| Rate for Payer: WPS Commercial |
$468.08
|
|
|
VL Echo Stress Test Chemical
|
Facility
|
OP
|
$4,308.00
|
|
|
Service Code
|
CPT 93350 TC
|
| Hospital Charge Code |
2558804
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$468.08 |
| Max. Negotiated Rate |
$4,121.89 |
| Rate for Payer: Aetna Commercial |
$4,032.29
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,853.08
|
| Rate for Payer: Aetna Managed Medicare |
$1,254.49
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,912.21
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,240.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,150.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,374.57
|
| Rate for Payer: Cash Price |
$1,292.40
|
| Rate for Payer: Cash Price |
$1,292.40
|
| Rate for Payer: Cigna Commercial |
$4,121.89
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,507.26
|
| Rate for Payer: Health EOS Commercial |
$3,987.48
|
| Rate for Payer: HFN Commercial |
$4,121.89
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,360.24
|
| Rate for Payer: Multiplan Commercial |
$3,584.26
|
| Rate for Payer: NAPHCARE Commercial |
$2,688.19
|
| Rate for Payer: Preferred Network Access Commercial |
$4,121.89
|
| Rate for Payer: Quartz Beloit One Network |
$2,195.36
|
| Rate for Payer: Quartz Commercial |
$2,912.21
|
| Rate for Payer: Quartz Medicare Advantage |
$2,688.19
|
| Rate for Payer: The Alliance Commercial |
$468.08
|
| Rate for Payer: United Healthcare PPO |
$3,360.24
|
| Rate for Payer: WEA Trust Commercial |
$2,464.18
|
| Rate for Payer: WPS Commercial |
$3,318.45
|
|
|
VL Echo Stress Test Chemical
|
Facility
|
IP
|
$4,308.00
|
|
|
Service Code
|
CPT 93350 TC
|
| Hospital Charge Code |
2558804
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$2,195.36 |
| Max. Negotiated Rate |
$4,121.89 |
| Rate for Payer: Aetna Commercial |
$4,032.29
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,853.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,374.57
|
| Rate for Payer: Cash Price |
$1,292.40
|
| Rate for Payer: Cigna Commercial |
$4,121.89
|
| Rate for Payer: Health EOS Commercial |
$3,987.48
|
| Rate for Payer: HFN Commercial |
$4,121.89
|
| Rate for Payer: Multiplan Commercial |
$3,584.26
|
| Rate for Payer: Preferred Network Access Commercial |
$4,121.89
|
| Rate for Payer: Quartz Beloit One Network |
$2,195.36
|
| Rate for Payer: Quartz Commercial |
$2,688.19
|
| Rate for Payer: WEA Trust Commercial |
$2,464.18
|
| Rate for Payer: WPS Commercial |
$3,318.45
|
|
|
VL Guided Needle Placement 7694226
|
Professional
|
Both
|
$376.00
|
|
|
Service Code
|
CPT 76942 26
|
| Hospital Charge Code |
5374702
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$31.55 |
| Max. Negotiated Rate |
$371.49 |
| Rate for Payer: Aetna Commercial |
$371.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$336.29
|
| Rate for Payer: Aetna Managed Medicare |
$31.55
|
| Rate for Payer: Anthem Medicare Advantage |
$31.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$31.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$31.55
|
| Rate for Payer: Cash Price |
$112.80
|
| Rate for Payer: Cash Price |
$112.80
|
| Rate for Payer: Cash Price |
$112.80
|
| Rate for Payer: Cigna Commercial |
$371.49
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$195.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$31.55
|
| Rate for Payer: Health EOS Commercial |
$355.85
|
| Rate for Payer: HFN Commercial |
$371.49
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$110.28
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$110.28
|
| Rate for Payer: Independent Care Health Plan Medicare |
$31.55
|
| Rate for Payer: Multiplan Commercial |
$312.83
|
| Rate for Payer: NAPHCARE Commercial |
$47.33
|
| Rate for Payer: Preferred Network Access Commercial |
$371.49
|
| Rate for Payer: Quartz Beloit One Network |
$172.06
|
| Rate for Payer: Quartz Commercial |
$222.89
|
| Rate for Payer: Quartz Medicare Advantage |
$31.55
|
| Rate for Payer: The Alliance Commercial |
$119.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$31.55
|
| Rate for Payer: WEA Trust Commercial |
$215.07
|
| Rate for Payer: WPS Commercial |
$157.77
|
|
|
VL Guided Pericardiocentesis
|
Facility
|
OP
|
$1,431.00
|
|
|
Service Code
|
CPT 76930
|
| Hospital Charge Code |
3077328
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$416.71 |
| Max. Negotiated Rate |
$1,369.18 |
| Rate for Payer: Aetna Commercial |
$1,339.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,279.89
|
| Rate for Payer: Aetna Managed Medicare |
$416.71
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$967.36
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$744.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$714.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$788.77
|
| Rate for Payer: Cash Price |
$429.30
|
| Rate for Payer: Cigna Commercial |
$1,369.18
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$832.84
|
| Rate for Payer: Health EOS Commercial |
$1,324.53
|
| Rate for Payer: HFN Commercial |
$1,369.18
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,116.18
|
| Rate for Payer: Multiplan Commercial |
$1,190.59
|
| Rate for Payer: NAPHCARE Commercial |
$892.94
|
| Rate for Payer: Preferred Network Access Commercial |
$1,369.18
|
| Rate for Payer: Quartz Beloit One Network |
$729.24
|
| Rate for Payer: Quartz Commercial |
$967.36
|
| Rate for Payer: Quartz Medicare Advantage |
$892.94
|
| Rate for Payer: The Alliance Commercial |
$744.12
|
| Rate for Payer: United Healthcare PPO |
$1,116.18
|
| Rate for Payer: WEA Trust Commercial |
$818.53
|
| Rate for Payer: WPS Commercial |
$1,102.30
|
|
|
VL Guided Pericardiocentesis
|
Professional
|
Both
|
$1,431.00
|
|
|
Service Code
|
CPT 76930
|
| Hospital Charge Code |
3077328
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$654.83 |
| Max. Negotiated Rate |
$1,413.83 |
| Rate for Payer: Aetna Commercial |
$1,413.83
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,279.89
|
| Rate for Payer: Cash Price |
$429.30
|
| Rate for Payer: Cigna Commercial |
$1,413.83
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$744.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$892.94
|
| Rate for Payer: Health EOS Commercial |
$1,354.30
|
| Rate for Payer: HFN Commercial |
$1,413.83
|
| Rate for Payer: Multiplan Commercial |
$1,190.59
|
| Rate for Payer: Preferred Network Access Commercial |
$1,413.83
|
| Rate for Payer: Quartz Beloit One Network |
$654.83
|
| Rate for Payer: Quartz Commercial |
$848.30
|
| Rate for Payer: The Alliance Commercial |
$744.12
|
| Rate for Payer: WEA Trust Commercial |
$818.53
|
| Rate for Payer: WPS Commercial |
$1,102.30
|
|
|
VL Guided Pericardiocentesis
|
Facility
|
IP
|
$1,431.00
|
|
|
Service Code
|
CPT 76930
|
| Hospital Charge Code |
3077328
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$729.24 |
| Max. Negotiated Rate |
$1,369.18 |
| Rate for Payer: Aetna Commercial |
$1,339.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,279.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$788.77
|
| Rate for Payer: Cash Price |
$429.30
|
| Rate for Payer: Cigna Commercial |
$1,369.18
|
| Rate for Payer: Health EOS Commercial |
$1,324.53
|
| Rate for Payer: HFN Commercial |
$1,369.18
|
| Rate for Payer: Multiplan Commercial |
$1,190.59
|
| Rate for Payer: Preferred Network Access Commercial |
$1,369.18
|
| Rate for Payer: Quartz Beloit One Network |
$729.24
|
| Rate for Payer: Quartz Commercial |
$892.94
|
| Rate for Payer: WEA Trust Commercial |
$818.53
|
| Rate for Payer: WPS Commercial |
$1,102.30
|
|
