|
VL UE Venous Duplex Bilat - Right
|
Facility
|
IP
|
$1,975.00
|
|
|
Service Code
|
CPT 93970 TC,RT
|
| Hospital Charge Code |
3100141
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$1,006.46 |
| Max. Negotiated Rate |
$1,889.68 |
| Rate for Payer: Aetna Commercial |
$1,848.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,766.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,088.62
|
| Rate for Payer: Cash Price |
$592.50
|
| Rate for Payer: Cigna Commercial |
$1,889.68
|
| Rate for Payer: Health EOS Commercial |
$1,828.06
|
| Rate for Payer: HFN Commercial |
$1,889.68
|
| Rate for Payer: Multiplan Commercial |
$1,643.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,889.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,006.46
|
| Rate for Payer: Quartz Commercial |
$1,232.40
|
| Rate for Payer: WEA Trust Commercial |
$1,129.70
|
| Rate for Payer: WPS Commercial |
$1,521.34
|
|
|
VL UE Venous Duplex Bilat - Right
|
Professional
|
Both
|
$1,975.00
|
|
|
Service Code
|
CPT 93970 TC,RT
|
| Hospital Charge Code |
3100141
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$175.81 |
| Max. Negotiated Rate |
$1,951.30 |
| Rate for Payer: Aetna Commercial |
$1,951.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,766.44
|
| Rate for Payer: Cash Price |
$592.50
|
| Rate for Payer: Cash Price |
$592.50
|
| Rate for Payer: Cash Price |
$592.50
|
| Rate for Payer: Cigna Commercial |
$1,951.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$175.81
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,232.40
|
| Rate for Payer: Health EOS Commercial |
$1,869.14
|
| Rate for Payer: HFN Commercial |
$1,951.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$692.06
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$692.06
|
| Rate for Payer: Multiplan Commercial |
$1,643.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,951.30
|
| Rate for Payer: Quartz Beloit One Network |
$903.76
|
| Rate for Payer: Quartz Commercial |
$1,170.78
|
| Rate for Payer: The Alliance Commercial |
$1,027.00
|
| Rate for Payer: United Healthcare Medicaid |
$175.81
|
| Rate for Payer: WEA Trust Commercial |
$1,129.70
|
| Rate for Payer: WPS Commercial |
$1,521.34
|
|
|
VL UE Venous Duplex Bilat - Right
|
Facility
|
OP
|
$1,975.00
|
|
|
Service Code
|
CPT 93970 TC,RT
|
| Hospital Charge Code |
3100141
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$575.12 |
| Max. Negotiated Rate |
$1,889.68 |
| Rate for Payer: Aetna Commercial |
$1,848.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,766.44
|
| Rate for Payer: Aetna Managed Medicare |
$575.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,335.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,027.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$985.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,088.62
|
| Rate for Payer: Cash Price |
$592.50
|
| Rate for Payer: Cigna Commercial |
$1,889.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,149.45
|
| Rate for Payer: Health EOS Commercial |
$1,828.06
|
| Rate for Payer: HFN Commercial |
$1,889.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,540.50
|
| Rate for Payer: Multiplan Commercial |
$1,643.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,232.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,889.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,006.46
|
| Rate for Payer: Quartz Commercial |
$1,335.10
|
| Rate for Payer: Quartz Medicare Advantage |
$1,232.40
|
| Rate for Payer: The Alliance Commercial |
$1,027.00
|
| Rate for Payer: United Healthcare PPO |
$1,540.50
|
| Rate for Payer: WEA Trust Commercial |
$1,129.70
|
| Rate for Payer: WPS Commercial |
$1,521.34
|
|
|
VL UE Venous Duplex Left
|
Facility
|
IP
|
$1,234.00
|
|
|
Service Code
|
CPT 93971 TC
|
| Hospital Charge Code |
1483384
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$628.85 |
| Max. Negotiated Rate |
$1,180.69 |
| Rate for Payer: Aetna Commercial |
$1,155.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,103.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$680.18
|
| Rate for Payer: Cash Price |
$370.20
|
| Rate for Payer: Cigna Commercial |
$1,180.69
|
| Rate for Payer: Health EOS Commercial |
$1,142.19
|
| Rate for Payer: HFN Commercial |
$1,180.69
|
| Rate for Payer: Multiplan Commercial |
$1,026.69
|
| Rate for Payer: Preferred Network Access Commercial |
$1,180.69
|
| Rate for Payer: Quartz Beloit One Network |
$628.85
|
| Rate for Payer: Quartz Commercial |
$770.02
|
| Rate for Payer: WEA Trust Commercial |
$705.85
|
| Rate for Payer: WPS Commercial |
$950.55
|
|
|
VL UE Venous Duplex Left
|
Professional
|
Both
|
$1,234.00
|
|
|
Service Code
|
CPT 93971 TC
|
| Hospital Charge Code |
1483384
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$90.17 |
| Max. Negotiated Rate |
$1,219.19 |
| Rate for Payer: Aetna Commercial |
$1,219.19
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,103.69
|
| Rate for Payer: Aetna Managed Medicare |
$95.06
|
| Rate for Payer: Anthem Medicare Advantage |
$95.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$95.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$95.06
|
| Rate for Payer: Cash Price |
$370.20
|
| Rate for Payer: Cash Price |
$370.20
|
| Rate for Payer: Cash Price |
$370.20
|
| Rate for Payer: Cigna Commercial |
$1,219.19
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$90.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$95.06
|
| Rate for Payer: Health EOS Commercial |
$1,167.86
|
| Rate for Payer: HFN Commercial |
$1,219.19
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$358.75
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$358.75
|
| Rate for Payer: Independent Care Health Plan Medicare |
$95.06
|
| Rate for Payer: Multiplan Commercial |
$1,026.69
|
| Rate for Payer: NAPHCARE Commercial |
$142.58
|
| Rate for Payer: Preferred Network Access Commercial |
$1,219.19
|
| Rate for Payer: Quartz Beloit One Network |
$564.68
|
| Rate for Payer: Quartz Commercial |
$731.52
|
| Rate for Payer: Quartz Medicare Advantage |
$95.06
|
| Rate for Payer: The Alliance Commercial |
$237.64
|
| Rate for Payer: United Healthcare Medicaid |
$90.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$95.06
|
| Rate for Payer: WEA Trust Commercial |
$705.85
|
| Rate for Payer: WPS Commercial |
$380.22
|
|
|
VL UE Venous Duplex Left
|
Facility
|
OP
|
$1,234.00
|
|
|
Service Code
|
CPT 93971 TC
|
| Hospital Charge Code |
1483384
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$359.34 |
| Max. Negotiated Rate |
$1,180.69 |
| Rate for Payer: Aetna Commercial |
$1,155.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,103.69
|
| Rate for Payer: Aetna Managed Medicare |
$359.34
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$834.18
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$641.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$616.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$680.18
|
| Rate for Payer: Cash Price |
$370.20
|
| Rate for Payer: Cash Price |
$370.20
|
| Rate for Payer: Cigna Commercial |
$1,180.69
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$718.19
|
| Rate for Payer: Health EOS Commercial |
$1,142.19
|
| Rate for Payer: HFN Commercial |
$1,180.69
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$962.52
|
| Rate for Payer: Multiplan Commercial |
$1,026.69
|
| Rate for Payer: NAPHCARE Commercial |
$770.02
|
| Rate for Payer: Preferred Network Access Commercial |
$1,180.69
|
| Rate for Payer: Quartz Beloit One Network |
$628.85
|
| Rate for Payer: Quartz Commercial |
$834.18
|
| Rate for Payer: Quartz Medicare Advantage |
$770.02
|
| Rate for Payer: The Alliance Commercial |
$380.22
|
| Rate for Payer: United Healthcare PPO |
$962.52
|
| Rate for Payer: WEA Trust Commercial |
$705.85
|
| Rate for Payer: WPS Commercial |
$950.55
|
|
|
VL UE Venous Duplex Right
|
Professional
|
Both
|
$1,234.00
|
|
|
Service Code
|
CPT 93971 TC
|
| Hospital Charge Code |
1483387
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$90.17 |
| Max. Negotiated Rate |
$1,219.19 |
| Rate for Payer: Aetna Commercial |
$1,219.19
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,103.69
|
| Rate for Payer: Aetna Managed Medicare |
$95.06
|
| Rate for Payer: Anthem Medicare Advantage |
$95.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$95.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$95.06
|
| Rate for Payer: Cash Price |
$370.20
|
| Rate for Payer: Cash Price |
$370.20
|
| Rate for Payer: Cash Price |
$370.20
|
| Rate for Payer: Cigna Commercial |
$1,219.19
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$90.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$95.06
|
| Rate for Payer: Health EOS Commercial |
$1,167.86
|
| Rate for Payer: HFN Commercial |
$1,219.19
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$358.75
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$358.75
|
| Rate for Payer: Independent Care Health Plan Medicare |
$95.06
|
| Rate for Payer: Multiplan Commercial |
$1,026.69
|
| Rate for Payer: NAPHCARE Commercial |
$142.58
|
| Rate for Payer: Preferred Network Access Commercial |
$1,219.19
|
| Rate for Payer: Quartz Beloit One Network |
$564.68
|
| Rate for Payer: Quartz Commercial |
$731.52
|
| Rate for Payer: Quartz Medicare Advantage |
$95.06
|
| Rate for Payer: The Alliance Commercial |
$237.64
|
| Rate for Payer: United Healthcare Medicaid |
$90.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$95.06
|
| Rate for Payer: WEA Trust Commercial |
$705.85
|
| Rate for Payer: WPS Commercial |
$380.22
|
|
|
VL UE Venous Duplex Right
|
Facility
|
OP
|
$1,234.00
|
|
|
Service Code
|
CPT 93971 TC
|
| Hospital Charge Code |
1483387
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$359.34 |
| Max. Negotiated Rate |
$1,180.69 |
| Rate for Payer: Aetna Commercial |
$1,155.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,103.69
|
| Rate for Payer: Aetna Managed Medicare |
$359.34
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$834.18
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$641.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$616.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$680.18
|
| Rate for Payer: Cash Price |
$370.20
|
| Rate for Payer: Cash Price |
$370.20
|
| Rate for Payer: Cigna Commercial |
$1,180.69
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$718.19
|
| Rate for Payer: Health EOS Commercial |
$1,142.19
|
| Rate for Payer: HFN Commercial |
$1,180.69
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$962.52
|
| Rate for Payer: Multiplan Commercial |
$1,026.69
|
| Rate for Payer: NAPHCARE Commercial |
$770.02
|
| Rate for Payer: Preferred Network Access Commercial |
$1,180.69
|
| Rate for Payer: Quartz Beloit One Network |
$628.85
|
| Rate for Payer: Quartz Commercial |
$834.18
|
| Rate for Payer: Quartz Medicare Advantage |
$770.02
|
| Rate for Payer: The Alliance Commercial |
$380.22
|
| Rate for Payer: United Healthcare PPO |
$962.52
|
| Rate for Payer: WEA Trust Commercial |
$705.85
|
| Rate for Payer: WPS Commercial |
$950.55
|
|
|
VL UE Venous Duplex Right
|
Facility
|
IP
|
$1,234.00
|
|
|
Service Code
|
CPT 93971 TC
|
| Hospital Charge Code |
1483387
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$628.85 |
| Max. Negotiated Rate |
$1,180.69 |
| Rate for Payer: Aetna Commercial |
$1,155.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,103.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$680.18
|
| Rate for Payer: Cash Price |
$370.20
|
| Rate for Payer: Cigna Commercial |
$1,180.69
|
| Rate for Payer: Health EOS Commercial |
$1,142.19
|
| Rate for Payer: HFN Commercial |
$1,180.69
|
| Rate for Payer: Multiplan Commercial |
$1,026.69
|
| Rate for Payer: Preferred Network Access Commercial |
$1,180.69
|
| Rate for Payer: Quartz Beloit One Network |
$628.85
|
| Rate for Payer: Quartz Commercial |
$770.02
|
| Rate for Payer: WEA Trust Commercial |
$705.85
|
| Rate for Payer: WPS Commercial |
$950.55
|
|
|
VL Upper Extremity PVR w Excercise
|
Facility
|
OP
|
$992.00
|
|
|
Service Code
|
CPT 93922 TC
|
| Hospital Charge Code |
2530812
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$283.05 |
| Max. Negotiated Rate |
$949.15 |
| Rate for Payer: Aetna Commercial |
$928.51
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$887.24
|
| Rate for Payer: Aetna Managed Medicare |
$288.87
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$670.59
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$515.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$495.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$546.79
|
| Rate for Payer: Cash Price |
$297.60
|
| Rate for Payer: Cash Price |
$297.60
|
| Rate for Payer: Cigna Commercial |
$949.15
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$577.34
|
| Rate for Payer: Health EOS Commercial |
$918.20
|
| Rate for Payer: HFN Commercial |
$949.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$773.76
|
| Rate for Payer: Multiplan Commercial |
$825.34
|
| Rate for Payer: NAPHCARE Commercial |
$619.01
|
| Rate for Payer: Preferred Network Access Commercial |
$949.15
|
| Rate for Payer: Quartz Beloit One Network |
$505.52
|
| Rate for Payer: Quartz Commercial |
$670.59
|
| Rate for Payer: Quartz Medicare Advantage |
$619.01
|
| Rate for Payer: The Alliance Commercial |
$283.05
|
| Rate for Payer: United Healthcare PPO |
$773.76
|
| Rate for Payer: WEA Trust Commercial |
$567.42
|
| Rate for Payer: WPS Commercial |
$764.14
|
|
|
VL Upper Extremity PVR w Excercise
|
Professional
|
Both
|
$992.00
|
|
|
Service Code
|
CPT 93922 TC
|
| Hospital Charge Code |
2530812
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$70.76 |
| Max. Negotiated Rate |
$980.10 |
| Rate for Payer: Aetna Commercial |
$980.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$887.24
|
| Rate for Payer: Aetna Managed Medicare |
$70.76
|
| Rate for Payer: Anthem Medicare Advantage |
$70.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$70.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$70.76
|
| Rate for Payer: Cash Price |
$297.60
|
| Rate for Payer: Cash Price |
$297.60
|
| Rate for Payer: Cash Price |
$297.60
|
| Rate for Payer: Cigna Commercial |
$980.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$71.45
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$70.76
|
| Rate for Payer: Health EOS Commercial |
$938.83
|
| Rate for Payer: HFN Commercial |
$980.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$256.17
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$256.17
|
| Rate for Payer: Independent Care Health Plan Medicare |
$70.76
|
| Rate for Payer: Multiplan Commercial |
$825.34
|
| Rate for Payer: NAPHCARE Commercial |
$106.14
|
| Rate for Payer: Preferred Network Access Commercial |
$980.10
|
| Rate for Payer: Quartz Beloit One Network |
$453.94
|
| Rate for Payer: Quartz Commercial |
$588.06
|
| Rate for Payer: Quartz Medicare Advantage |
$70.76
|
| Rate for Payer: The Alliance Commercial |
$176.90
|
| Rate for Payer: United Healthcare Medicaid |
$71.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$70.76
|
| Rate for Payer: WEA Trust Commercial |
$567.42
|
| Rate for Payer: WPS Commercial |
$283.05
|
|
|
VL Upper Extremity PVR w Excercise
|
Facility
|
IP
|
$992.00
|
|
|
Service Code
|
CPT 93922 TC
|
| Hospital Charge Code |
2530812
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$505.52 |
| Max. Negotiated Rate |
$949.15 |
| Rate for Payer: Aetna Commercial |
$928.51
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$887.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$546.79
|
| Rate for Payer: Cash Price |
$297.60
|
| Rate for Payer: Cigna Commercial |
$949.15
|
| Rate for Payer: Health EOS Commercial |
$918.20
|
| Rate for Payer: HFN Commercial |
$949.15
|
| Rate for Payer: Multiplan Commercial |
$825.34
|
| Rate for Payer: Preferred Network Access Commercial |
$949.15
|
| Rate for Payer: Quartz Beloit One Network |
$505.52
|
| Rate for Payer: Quartz Commercial |
$619.01
|
| Rate for Payer: WEA Trust Commercial |
$567.42
|
| Rate for Payer: WPS Commercial |
$764.14
|
|
|
VL Upper Extremity PVR w Resting
|
Professional
|
Both
|
$836.00
|
|
|
Service Code
|
CPT 93922 TC
|
| Hospital Charge Code |
2530809
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$70.76 |
| Max. Negotiated Rate |
$825.97 |
| Rate for Payer: Aetna Commercial |
$825.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$747.72
|
| Rate for Payer: Aetna Managed Medicare |
$70.76
|
| Rate for Payer: Anthem Medicare Advantage |
$70.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$70.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$70.76
|
| Rate for Payer: Cash Price |
$250.80
|
| Rate for Payer: Cash Price |
$250.80
|
| Rate for Payer: Cash Price |
$250.80
|
| Rate for Payer: Cigna Commercial |
$825.97
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$71.45
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$70.76
|
| Rate for Payer: Health EOS Commercial |
$791.19
|
| Rate for Payer: HFN Commercial |
$825.97
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$256.17
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$256.17
|
| Rate for Payer: Independent Care Health Plan Medicare |
$70.76
|
| Rate for Payer: Multiplan Commercial |
$695.55
|
| Rate for Payer: NAPHCARE Commercial |
$106.14
|
| Rate for Payer: Preferred Network Access Commercial |
$825.97
|
| Rate for Payer: Quartz Beloit One Network |
$382.55
|
| Rate for Payer: Quartz Commercial |
$495.58
|
| Rate for Payer: Quartz Medicare Advantage |
$70.76
|
| Rate for Payer: The Alliance Commercial |
$176.90
|
| Rate for Payer: United Healthcare Medicaid |
$71.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$70.76
|
| Rate for Payer: WEA Trust Commercial |
$478.19
|
| Rate for Payer: WPS Commercial |
$283.05
|
|
|
VL Upper Extremity PVR w Resting
|
Facility
|
OP
|
$836.00
|
|
|
Service Code
|
CPT 93922 TC
|
| Hospital Charge Code |
2530809
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$243.44 |
| Max. Negotiated Rate |
$799.88 |
| Rate for Payer: Aetna Commercial |
$782.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$747.72
|
| Rate for Payer: Aetna Managed Medicare |
$243.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$565.14
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$434.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$417.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$460.80
|
| Rate for Payer: Cash Price |
$250.80
|
| Rate for Payer: Cash Price |
$250.80
|
| Rate for Payer: Cigna Commercial |
$799.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$486.55
|
| Rate for Payer: Health EOS Commercial |
$773.80
|
| Rate for Payer: HFN Commercial |
$799.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$652.08
|
| Rate for Payer: Multiplan Commercial |
$695.55
|
| Rate for Payer: NAPHCARE Commercial |
$521.66
|
| Rate for Payer: Preferred Network Access Commercial |
$799.88
|
| Rate for Payer: Quartz Beloit One Network |
$426.03
|
| Rate for Payer: Quartz Commercial |
$565.14
|
| Rate for Payer: Quartz Medicare Advantage |
$521.66
|
| Rate for Payer: The Alliance Commercial |
$283.05
|
| Rate for Payer: United Healthcare PPO |
$652.08
|
| Rate for Payer: WEA Trust Commercial |
$478.19
|
| Rate for Payer: WPS Commercial |
$643.97
|
|
|
VL Upper Extremity PVR w Resting
|
Facility
|
IP
|
$836.00
|
|
|
Service Code
|
CPT 93922 TC
|
| Hospital Charge Code |
2530809
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$426.03 |
| Max. Negotiated Rate |
$799.88 |
| Rate for Payer: Aetna Commercial |
$782.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$747.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$460.80
|
| Rate for Payer: Cash Price |
$250.80
|
| Rate for Payer: Cigna Commercial |
$799.88
|
| Rate for Payer: Health EOS Commercial |
$773.80
|
| Rate for Payer: HFN Commercial |
$799.88
|
| Rate for Payer: Multiplan Commercial |
$695.55
|
| Rate for Payer: Preferred Network Access Commercial |
$799.88
|
| Rate for Payer: Quartz Beloit One Network |
$426.03
|
| Rate for Payer: Quartz Commercial |
$521.66
|
| Rate for Payer: WEA Trust Commercial |
$478.19
|
| Rate for Payer: WPS Commercial |
$643.97
|
|
|
VL Vascular Guidance Intraop
|
Facility
|
IP
|
$1,955.00
|
|
|
Service Code
|
CPT 76937
|
| Hospital Charge Code |
1483402
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$996.27 |
| Max. Negotiated Rate |
$1,870.54 |
| Rate for Payer: Aetna Commercial |
$1,829.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,748.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,077.60
|
| Rate for Payer: Cash Price |
$586.50
|
| Rate for Payer: Cigna Commercial |
$1,870.54
|
| Rate for Payer: Health EOS Commercial |
$1,809.55
|
| Rate for Payer: HFN Commercial |
$1,870.54
|
| Rate for Payer: Multiplan Commercial |
$1,626.56
|
| Rate for Payer: Preferred Network Access Commercial |
$1,870.54
|
| Rate for Payer: Quartz Beloit One Network |
$996.27
|
| Rate for Payer: Quartz Commercial |
$1,219.92
|
| Rate for Payer: WEA Trust Commercial |
$1,118.26
|
| Rate for Payer: WPS Commercial |
$1,505.94
|
|
|
VL Vascular Guidance Intraop
|
Professional
|
Both
|
$1,955.00
|
|
|
Service Code
|
CPT 76937
|
| Hospital Charge Code |
1483402
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$39.79 |
| Max. Negotiated Rate |
$1,931.54 |
| Rate for Payer: Aetna Commercial |
$1,931.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,748.55
|
| Rate for Payer: Aetna Managed Medicare |
$39.79
|
| Rate for Payer: Anthem Medicare Advantage |
$39.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$39.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$39.79
|
| Rate for Payer: Cash Price |
$586.50
|
| Rate for Payer: Cash Price |
$586.50
|
| Rate for Payer: Cash Price |
$586.50
|
| Rate for Payer: Cigna Commercial |
$1,931.54
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,016.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$39.79
|
| Rate for Payer: Health EOS Commercial |
$1,850.21
|
| Rate for Payer: HFN Commercial |
$1,931.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$135.72
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$135.72
|
| Rate for Payer: Independent Care Health Plan Medicare |
$39.79
|
| Rate for Payer: Multiplan Commercial |
$1,626.56
|
| Rate for Payer: NAPHCARE Commercial |
$59.69
|
| Rate for Payer: Preferred Network Access Commercial |
$1,931.54
|
| Rate for Payer: Quartz Beloit One Network |
$894.61
|
| Rate for Payer: Quartz Commercial |
$1,158.92
|
| Rate for Payer: Quartz Medicare Advantage |
$39.79
|
| Rate for Payer: The Alliance Commercial |
$151.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$39.79
|
| Rate for Payer: WEA Trust Commercial |
$1,118.26
|
| Rate for Payer: WPS Commercial |
$198.95
|
|
|
VL Vascular Guidance Intraop
|
Facility
|
OP
|
$1,955.00
|
|
|
Service Code
|
CPT 76937
|
| Hospital Charge Code |
1483402
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$159.16 |
| Max. Negotiated Rate |
$1,870.54 |
| Rate for Payer: Aetna Commercial |
$1,829.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,748.55
|
| Rate for Payer: Aetna Managed Medicare |
$569.30
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,321.58
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,016.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$975.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,077.60
|
| Rate for Payer: Cash Price |
$586.50
|
| Rate for Payer: Cash Price |
$586.50
|
| Rate for Payer: Cigna Commercial |
$1,870.54
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,137.81
|
| Rate for Payer: Health EOS Commercial |
$1,809.55
|
| Rate for Payer: HFN Commercial |
$1,870.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,524.90
|
| Rate for Payer: Multiplan Commercial |
$1,626.56
|
| Rate for Payer: NAPHCARE Commercial |
$1,219.92
|
| Rate for Payer: Preferred Network Access Commercial |
$1,870.54
|
| Rate for Payer: Quartz Beloit One Network |
$996.27
|
| Rate for Payer: Quartz Commercial |
$1,321.58
|
| Rate for Payer: Quartz Medicare Advantage |
$1,219.92
|
| Rate for Payer: The Alliance Commercial |
$159.16
|
| Rate for Payer: United Healthcare PPO |
$1,524.90
|
| Rate for Payer: WEA Trust Commercial |
$1,118.26
|
| Rate for Payer: WPS Commercial |
$1,505.94
|
|
|
VL Vasoreactivity Testing
|
Facility
|
IP
|
$1,975.00
|
|
|
Service Code
|
CPT 93890 TC
|
| Hospital Charge Code |
1483405
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$1,006.46 |
| Max. Negotiated Rate |
$1,889.68 |
| Rate for Payer: Aetna Commercial |
$1,848.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,766.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,088.62
|
| Rate for Payer: Cash Price |
$592.50
|
| Rate for Payer: Cigna Commercial |
$1,889.68
|
| Rate for Payer: Health EOS Commercial |
$1,828.06
|
| Rate for Payer: HFN Commercial |
$1,889.68
|
| Rate for Payer: Multiplan Commercial |
$1,643.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,889.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,006.46
|
| Rate for Payer: Quartz Commercial |
$1,232.40
|
| Rate for Payer: WEA Trust Commercial |
$1,129.70
|
| Rate for Payer: WPS Commercial |
$1,521.34
|
|
|
VL Vasoreactivity Testing
|
Facility
|
OP
|
$1,975.00
|
|
|
Service Code
|
CPT 93890 TC
|
| Hospital Charge Code |
1483405
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$575.12 |
| Max. Negotiated Rate |
$1,889.68 |
| Rate for Payer: Aetna Commercial |
$1,848.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,766.44
|
| Rate for Payer: Aetna Managed Medicare |
$575.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,335.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,027.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$985.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,088.62
|
| Rate for Payer: Cash Price |
$592.50
|
| Rate for Payer: Cigna Commercial |
$1,889.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,149.45
|
| Rate for Payer: Health EOS Commercial |
$1,828.06
|
| Rate for Payer: HFN Commercial |
$1,889.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,540.50
|
| Rate for Payer: Multiplan Commercial |
$1,643.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,232.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,889.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,006.46
|
| Rate for Payer: Quartz Commercial |
$1,335.10
|
| Rate for Payer: Quartz Medicare Advantage |
$1,232.40
|
| Rate for Payer: The Alliance Commercial |
$1,027.00
|
| Rate for Payer: United Healthcare PPO |
$1,540.50
|
| Rate for Payer: WEA Trust Commercial |
$1,129.70
|
| Rate for Payer: WPS Commercial |
$1,521.34
|
|
|
VL Vasoreactivity Testing
|
Professional
|
Both
|
$1,975.00
|
|
|
Service Code
|
CPT 93890 TC
|
| Hospital Charge Code |
1483405
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$828.11 |
| Max. Negotiated Rate |
$1,951.30 |
| Rate for Payer: Aetna Commercial |
$1,951.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,766.44
|
| Rate for Payer: Cash Price |
$592.50
|
| Rate for Payer: Cash Price |
$592.50
|
| Rate for Payer: Cash Price |
$592.50
|
| Rate for Payer: Cigna Commercial |
$1,951.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,027.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,232.40
|
| Rate for Payer: Health EOS Commercial |
$1,869.14
|
| Rate for Payer: HFN Commercial |
$1,951.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$828.11
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$828.11
|
| Rate for Payer: Multiplan Commercial |
$1,643.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,951.30
|
| Rate for Payer: Quartz Beloit One Network |
$903.76
|
| Rate for Payer: Quartz Commercial |
$1,170.78
|
| Rate for Payer: The Alliance Commercial |
$1,027.00
|
| Rate for Payer: WEA Trust Commercial |
$1,129.70
|
| Rate for Payer: WPS Commercial |
$1,521.34
|
|
|
VL Vein Mapping Bilateral
|
Facility
|
OP
|
$2,473.00
|
|
|
Service Code
|
CPT 93971 TC
|
| Hospital Charge Code |
1483408
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$380.22 |
| Max. Negotiated Rate |
$2,366.17 |
| Rate for Payer: Aetna Commercial |
$2,314.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,211.85
|
| Rate for Payer: Aetna Managed Medicare |
$720.14
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,671.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,285.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,234.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,363.12
|
| Rate for Payer: Cash Price |
$741.90
|
| Rate for Payer: Cash Price |
$741.90
|
| Rate for Payer: Cigna Commercial |
$2,366.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,439.29
|
| Rate for Payer: Health EOS Commercial |
$2,289.01
|
| Rate for Payer: HFN Commercial |
$2,366.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,928.94
|
| Rate for Payer: Multiplan Commercial |
$2,057.54
|
| Rate for Payer: NAPHCARE Commercial |
$1,543.15
|
| Rate for Payer: Preferred Network Access Commercial |
$2,366.17
|
| Rate for Payer: Quartz Beloit One Network |
$1,260.24
|
| Rate for Payer: Quartz Commercial |
$1,671.75
|
| Rate for Payer: Quartz Medicare Advantage |
$1,543.15
|
| Rate for Payer: The Alliance Commercial |
$380.22
|
| Rate for Payer: United Healthcare PPO |
$1,928.94
|
| Rate for Payer: WEA Trust Commercial |
$1,414.56
|
| Rate for Payer: WPS Commercial |
$1,904.95
|
|
|
VL Vein Mapping Bilateral
|
Facility
|
IP
|
$2,473.00
|
|
|
Service Code
|
CPT 93971 TC
|
| Hospital Charge Code |
1483408
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$1,260.24 |
| Max. Negotiated Rate |
$2,366.17 |
| Rate for Payer: Aetna Commercial |
$2,314.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,211.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,363.12
|
| Rate for Payer: Cash Price |
$741.90
|
| Rate for Payer: Cigna Commercial |
$2,366.17
|
| Rate for Payer: Health EOS Commercial |
$2,289.01
|
| Rate for Payer: HFN Commercial |
$2,366.17
|
| Rate for Payer: Multiplan Commercial |
$2,057.54
|
| Rate for Payer: Preferred Network Access Commercial |
$2,366.17
|
| Rate for Payer: Quartz Beloit One Network |
$1,260.24
|
| Rate for Payer: Quartz Commercial |
$1,543.15
|
| Rate for Payer: WEA Trust Commercial |
$1,414.56
|
| Rate for Payer: WPS Commercial |
$1,904.95
|
|
|
VL Vein Mapping Bilateral
|
Professional
|
Both
|
$2,473.00
|
|
|
Service Code
|
CPT 93971 TC
|
| Hospital Charge Code |
1483408
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$90.17 |
| Max. Negotiated Rate |
$2,443.32 |
| Rate for Payer: Aetna Commercial |
$2,443.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,211.85
|
| Rate for Payer: Aetna Managed Medicare |
$95.06
|
| Rate for Payer: Anthem Medicare Advantage |
$95.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$95.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$95.06
|
| Rate for Payer: Cash Price |
$741.90
|
| Rate for Payer: Cash Price |
$741.90
|
| Rate for Payer: Cash Price |
$741.90
|
| Rate for Payer: Cigna Commercial |
$2,443.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$90.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$95.06
|
| Rate for Payer: Health EOS Commercial |
$2,340.45
|
| Rate for Payer: HFN Commercial |
$2,443.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$358.75
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$358.75
|
| Rate for Payer: Independent Care Health Plan Medicare |
$95.06
|
| Rate for Payer: Multiplan Commercial |
$2,057.54
|
| Rate for Payer: NAPHCARE Commercial |
$142.58
|
| Rate for Payer: Preferred Network Access Commercial |
$2,443.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,131.64
|
| Rate for Payer: Quartz Commercial |
$1,465.99
|
| Rate for Payer: Quartz Medicare Advantage |
$95.06
|
| Rate for Payer: The Alliance Commercial |
$237.64
|
| Rate for Payer: United Healthcare Medicaid |
$90.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$95.06
|
| Rate for Payer: WEA Trust Commercial |
$1,414.56
|
| Rate for Payer: WPS Commercial |
$380.22
|
|
|
VL Vein Mapping Unilateral
|
Professional
|
Both
|
$1,435.00
|
|
|
Service Code
|
CPT 93971 TC
|
| Hospital Charge Code |
1483411
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$90.17 |
| Max. Negotiated Rate |
$1,417.78 |
| Rate for Payer: Aetna Commercial |
$1,417.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,283.46
|
| Rate for Payer: Aetna Managed Medicare |
$95.06
|
| Rate for Payer: Anthem Medicare Advantage |
$95.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$95.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$95.06
|
| Rate for Payer: Cash Price |
$430.50
|
| Rate for Payer: Cash Price |
$430.50
|
| Rate for Payer: Cash Price |
$430.50
|
| Rate for Payer: Cigna Commercial |
$1,417.78
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$90.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$95.06
|
| Rate for Payer: Health EOS Commercial |
$1,358.08
|
| Rate for Payer: HFN Commercial |
$1,417.78
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$358.75
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$358.75
|
| Rate for Payer: Independent Care Health Plan Medicare |
$95.06
|
| Rate for Payer: Multiplan Commercial |
$1,193.92
|
| Rate for Payer: NAPHCARE Commercial |
$142.58
|
| Rate for Payer: Preferred Network Access Commercial |
$1,417.78
|
| Rate for Payer: Quartz Beloit One Network |
$656.66
|
| Rate for Payer: Quartz Commercial |
$850.67
|
| Rate for Payer: Quartz Medicare Advantage |
$95.06
|
| Rate for Payer: The Alliance Commercial |
$237.64
|
| Rate for Payer: United Healthcare Medicaid |
$90.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$95.06
|
| Rate for Payer: WEA Trust Commercial |
$820.82
|
| Rate for Payer: WPS Commercial |
$380.22
|
|
