|
BCE VL Upper Extremity PVR w Excercise
|
Facility
IP
|
$992.00
|
|
|
Service Code
|
CPT 93922 TC
|
| Hospital Charge Code |
3114983
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$486.08 |
| Max. Negotiated Rate |
$912.64 |
| Rate for Payer: Aetna Commercial |
$892.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$525.76
|
| Rate for Payer: Cash Price |
$297.60
|
| Rate for Payer: Cigna Commercial |
$912.64
|
| Rate for Payer: Health EOS Commercial |
$882.88
|
| Rate for Payer: HFN Commercial |
$912.64
|
| Rate for Payer: Multiplan Commercial |
$793.60
|
| Rate for Payer: NAPHCARE Commercial |
$595.20
|
| Rate for Payer: Preferred Network Access Commercial |
$912.64
|
| Rate for Payer: Quartz Beloit One Network |
$486.08
|
| Rate for Payer: Quartz Commercial |
$595.20
|
| Rate for Payer: WEA Trust Commercial |
$545.60
|
| Rate for Payer: WPS Commercial |
$734.77
|
|
|
BCE VL Upper Extremity PVR w Excercise
|
Facility
OP
|
$992.00
|
|
|
Service Code
|
CPT 93922 TC
|
| Hospital Charge Code |
3114983
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$277.76 |
| Max. Negotiated Rate |
$3,968.00 |
| Rate for Payer: Aetna Commercial |
$892.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$853.12
|
| Rate for Payer: Aetna Managed Medicare |
$277.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$644.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$496.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$476.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$525.76
|
| Rate for Payer: Cash Price |
$297.60
|
| Rate for Payer: Cigna Commercial |
$912.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$555.12
|
| Rate for Payer: Health EOS Commercial |
$882.88
|
| Rate for Payer: HFN Commercial |
$912.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$744.00
|
| Rate for Payer: Multiplan Commercial |
$793.60
|
| Rate for Payer: NAPHCARE Commercial |
$595.20
|
| Rate for Payer: Preferred Network Access Commercial |
$912.64
|
| Rate for Payer: Quartz Beloit One Network |
$486.08
|
| Rate for Payer: Quartz Commercial |
$644.80
|
| Rate for Payer: Quartz Medicare Advantage |
$595.20
|
| Rate for Payer: The Alliance Commercial |
$3,968.00
|
| Rate for Payer: United Healthcare PPO |
$744.00
|
| Rate for Payer: WEA Trust Commercial |
$545.60
|
| Rate for Payer: WPS Commercial |
$734.77
|
|
|
BCE VL Upper Extremity PVR w Excercise
|
Professional
|
$992.00
|
|
|
Service Code
|
CPT 93922 TC
|
| Hospital Charge Code |
3114983
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$67.17 |
| Max. Negotiated Rate |
$942.40 |
| Rate for Payer: Aetna Commercial |
$942.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$853.12
|
| Rate for Payer: Aetna Managed Medicare |
$67.17
|
| Rate for Payer: Anthem Medicare Advantage |
$67.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$67.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$67.17
|
| Rate for Payer: Cash Price |
$297.60
|
| Rate for Payer: Cash Price |
$297.60
|
| Rate for Payer: Cigna Commercial |
$942.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$496.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$67.17
|
| Rate for Payer: Health EOS Commercial |
$902.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$246.32
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$246.32
|
| Rate for Payer: Independent Care Health Plan Medicare |
$67.17
|
| Rate for Payer: Multiplan Commercial |
$793.60
|
| Rate for Payer: Preferred Network Access Commercial |
$942.40
|
| Rate for Payer: Quartz Beloit One Network |
$436.48
|
| Rate for Payer: Quartz Commercial |
$565.44
|
| Rate for Payer: Quartz Medicare Advantage |
$67.17
|
| Rate for Payer: The Alliance Commercial |
$167.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$67.17
|
| Rate for Payer: WEA Trust Commercial |
$545.60
|
| Rate for Payer: WPS Commercial |
$268.68
|
|
|
BCE VL Upper Extremity PVR w Resting
|
Facility
OP
|
$836.00
|
|
|
Service Code
|
CPT 93922 TC
|
| Hospital Charge Code |
3114984
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$234.08 |
| Max. Negotiated Rate |
$3,344.00 |
| Rate for Payer: Aetna Commercial |
$752.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$718.96
|
| Rate for Payer: Aetna Managed Medicare |
$234.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$543.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$418.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$401.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$443.08
|
| Rate for Payer: Cash Price |
$250.80
|
| Rate for Payer: Cigna Commercial |
$769.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$467.83
|
| Rate for Payer: Health EOS Commercial |
$744.04
|
| Rate for Payer: HFN Commercial |
$769.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$627.00
|
| Rate for Payer: Multiplan Commercial |
$668.80
|
| Rate for Payer: NAPHCARE Commercial |
$501.60
|
| Rate for Payer: Preferred Network Access Commercial |
$769.12
|
| Rate for Payer: Quartz Beloit One Network |
$409.64
|
| Rate for Payer: Quartz Commercial |
$543.40
|
| Rate for Payer: Quartz Medicare Advantage |
$501.60
|
| Rate for Payer: The Alliance Commercial |
$3,344.00
|
| Rate for Payer: United Healthcare PPO |
$627.00
|
| Rate for Payer: WEA Trust Commercial |
$459.80
|
| Rate for Payer: WPS Commercial |
$619.23
|
|
|
BCE VL Upper Extremity PVR w Resting
|
Facility
IP
|
$836.00
|
|
|
Service Code
|
CPT 93922 TC
|
| Hospital Charge Code |
3114984
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$409.64 |
| Max. Negotiated Rate |
$769.12 |
| Rate for Payer: Aetna Commercial |
$752.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$443.08
|
| Rate for Payer: Cash Price |
$250.80
|
| Rate for Payer: Cigna Commercial |
$769.12
|
| Rate for Payer: Health EOS Commercial |
$744.04
|
| Rate for Payer: HFN Commercial |
$769.12
|
| Rate for Payer: Multiplan Commercial |
$668.80
|
| Rate for Payer: NAPHCARE Commercial |
$501.60
|
| Rate for Payer: Preferred Network Access Commercial |
$769.12
|
| Rate for Payer: Quartz Beloit One Network |
$409.64
|
| Rate for Payer: Quartz Commercial |
$501.60
|
| Rate for Payer: WEA Trust Commercial |
$459.80
|
| Rate for Payer: WPS Commercial |
$619.23
|
|
|
BCE VL Upper Extremity PVR w Resting
|
Professional
|
$836.00
|
|
|
Service Code
|
CPT 93922 TC
|
| Hospital Charge Code |
3114984
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$67.17 |
| Max. Negotiated Rate |
$794.20 |
| Rate for Payer: Aetna Commercial |
$794.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$718.96
|
| Rate for Payer: Aetna Managed Medicare |
$67.17
|
| Rate for Payer: Anthem Medicare Advantage |
$67.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$67.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$67.17
|
| Rate for Payer: Cash Price |
$250.80
|
| Rate for Payer: Cash Price |
$250.80
|
| Rate for Payer: Cigna Commercial |
$794.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$418.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$67.17
|
| Rate for Payer: Health EOS Commercial |
$760.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$246.32
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$246.32
|
| Rate for Payer: Independent Care Health Plan Medicare |
$67.17
|
| Rate for Payer: Multiplan Commercial |
$668.80
|
| Rate for Payer: Preferred Network Access Commercial |
$794.20
|
| Rate for Payer: Quartz Beloit One Network |
$367.84
|
| Rate for Payer: Quartz Commercial |
$476.52
|
| Rate for Payer: Quartz Medicare Advantage |
$67.17
|
| Rate for Payer: The Alliance Commercial |
$167.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$67.17
|
| Rate for Payer: WEA Trust Commercial |
$459.80
|
| Rate for Payer: WPS Commercial |
$268.68
|
|
|
BCE VL Vascular Access Guidance
|
Facility
OP
|
$243.00
|
|
|
Service Code
|
CPT 76937 TC
|
| Hospital Charge Code |
4052743
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$68.04 |
| Max. Negotiated Rate |
$972.00 |
| Rate for Payer: Aetna Commercial |
$218.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$208.98
|
| Rate for Payer: Aetna Managed Medicare |
$68.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$157.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$121.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$116.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$128.79
|
| Rate for Payer: Cash Price |
$72.90
|
| Rate for Payer: Cash Price |
$72.90
|
| Rate for Payer: Cigna Commercial |
$223.56
|
| Rate for Payer: Health EOS Commercial |
$216.27
|
| Rate for Payer: HFN Commercial |
$223.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$182.25
|
| Rate for Payer: Multiplan Commercial |
$194.40
|
| Rate for Payer: NAPHCARE Commercial |
$145.80
|
| Rate for Payer: Preferred Network Access Commercial |
$223.56
|
| Rate for Payer: Quartz Beloit One Network |
$119.07
|
| Rate for Payer: Quartz Commercial |
$157.95
|
| Rate for Payer: Quartz Medicare Advantage |
$145.80
|
| Rate for Payer: The Alliance Commercial |
$972.00
|
| Rate for Payer: United Healthcare PPO |
$182.25
|
| Rate for Payer: WEA Trust Commercial |
$133.65
|
| Rate for Payer: WPS Commercial |
$179.99
|
|
|
BCE VL Vascular Access Guidance
|
Professional
|
$243.00
|
|
|
Service Code
|
CPT 76937 TC
|
| Hospital Charge Code |
4052743
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$24.47 |
| Max. Negotiated Rate |
$230.85 |
| Rate for Payer: Aetna Commercial |
$230.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$208.98
|
| Rate for Payer: Aetna Managed Medicare |
$24.47
|
| Rate for Payer: Anthem Medicare Advantage |
$24.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$24.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$24.47
|
| Rate for Payer: Cash Price |
$72.90
|
| Rate for Payer: Cash Price |
$72.90
|
| Rate for Payer: Cigna Commercial |
$230.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$121.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$24.47
|
| Rate for Payer: Health EOS Commercial |
$221.13
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$83.56
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$83.56
|
| Rate for Payer: Independent Care Health Plan Medicare |
$24.47
|
| Rate for Payer: Multiplan Commercial |
$194.40
|
| Rate for Payer: Preferred Network Access Commercial |
$230.85
|
| Rate for Payer: Quartz Beloit One Network |
$106.92
|
| Rate for Payer: Quartz Commercial |
$138.51
|
| Rate for Payer: Quartz Medicare Advantage |
$24.47
|
| Rate for Payer: The Alliance Commercial |
$92.99
|
| Rate for Payer: United Healthcare Medicare Advantage |
$24.47
|
| Rate for Payer: WEA Trust Commercial |
$133.65
|
| Rate for Payer: WPS Commercial |
$122.35
|
|
|
BCE VL Vascular Access Guidance
|
Facility
IP
|
$243.00
|
|
|
Service Code
|
CPT 76937 TC
|
| Hospital Charge Code |
4052743
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$119.07 |
| Max. Negotiated Rate |
$223.56 |
| Rate for Payer: Aetna Commercial |
$218.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$128.79
|
| Rate for Payer: Cash Price |
$72.90
|
| Rate for Payer: Cigna Commercial |
$223.56
|
| Rate for Payer: Health EOS Commercial |
$216.27
|
| Rate for Payer: HFN Commercial |
$223.56
|
| Rate for Payer: Multiplan Commercial |
$194.40
|
| Rate for Payer: NAPHCARE Commercial |
$145.80
|
| Rate for Payer: Preferred Network Access Commercial |
$223.56
|
| Rate for Payer: Quartz Beloit One Network |
$119.07
|
| Rate for Payer: Quartz Commercial |
$145.80
|
| Rate for Payer: WEA Trust Commercial |
$133.65
|
| Rate for Payer: WPS Commercial |
$179.99
|
|
|
BCE VL Vascular Guidance Intraop
|
Facility
OP
|
$1,955.00
|
|
|
Service Code
|
CPT 76937 TC
|
| Hospital Charge Code |
3114985
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$547.40 |
| Max. Negotiated Rate |
$7,820.00 |
| Rate for Payer: Aetna Commercial |
$1,759.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,681.30
|
| Rate for Payer: Aetna Managed Medicare |
$547.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,270.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$977.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$938.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,036.15
|
| Rate for Payer: Cash Price |
$586.50
|
| Rate for Payer: Cash Price |
$586.50
|
| Rate for Payer: Cigna Commercial |
$1,798.60
|
| Rate for Payer: Health EOS Commercial |
$1,739.95
|
| Rate for Payer: HFN Commercial |
$1,798.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,466.25
|
| Rate for Payer: Multiplan Commercial |
$1,564.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,173.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,798.60
|
| Rate for Payer: Quartz Beloit One Network |
$957.95
|
| Rate for Payer: Quartz Commercial |
$1,270.75
|
| Rate for Payer: Quartz Medicare Advantage |
$1,173.00
|
| Rate for Payer: The Alliance Commercial |
$7,820.00
|
| Rate for Payer: United Healthcare PPO |
$1,466.25
|
| Rate for Payer: WEA Trust Commercial |
$1,075.25
|
| Rate for Payer: WPS Commercial |
$1,448.07
|
|
|
BCE VL Vascular Guidance Intraop
|
Professional
|
$1,955.00
|
|
|
Service Code
|
CPT 76937 TC
|
| Hospital Charge Code |
3114985
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$24.47 |
| Max. Negotiated Rate |
$1,857.25 |
| Rate for Payer: Aetna Commercial |
$1,857.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,681.30
|
| Rate for Payer: Aetna Managed Medicare |
$24.47
|
| Rate for Payer: Anthem Medicare Advantage |
$24.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$24.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$24.47
|
| Rate for Payer: Cash Price |
$586.50
|
| Rate for Payer: Cash Price |
$586.50
|
| Rate for Payer: Cigna Commercial |
$1,857.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$977.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$24.47
|
| Rate for Payer: Health EOS Commercial |
$1,779.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$83.56
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$83.56
|
| Rate for Payer: Independent Care Health Plan Medicare |
$24.47
|
| Rate for Payer: Multiplan Commercial |
$1,564.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,857.25
|
| Rate for Payer: Quartz Beloit One Network |
$860.20
|
| Rate for Payer: Quartz Commercial |
$1,114.35
|
| Rate for Payer: Quartz Medicare Advantage |
$24.47
|
| Rate for Payer: The Alliance Commercial |
$92.99
|
| Rate for Payer: United Healthcare Medicare Advantage |
$24.47
|
| Rate for Payer: WEA Trust Commercial |
$1,075.25
|
| Rate for Payer: WPS Commercial |
$122.35
|
|
|
BCE VL Vascular Guidance Intraop
|
Facility
IP
|
$1,955.00
|
|
|
Service Code
|
CPT 76937 TC
|
| Hospital Charge Code |
3114985
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$957.95 |
| Max. Negotiated Rate |
$1,798.60 |
| Rate for Payer: Aetna Commercial |
$1,759.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,036.15
|
| Rate for Payer: Cash Price |
$586.50
|
| Rate for Payer: Cigna Commercial |
$1,798.60
|
| Rate for Payer: Health EOS Commercial |
$1,739.95
|
| Rate for Payer: HFN Commercial |
$1,798.60
|
| Rate for Payer: Multiplan Commercial |
$1,564.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,173.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,798.60
|
| Rate for Payer: Quartz Beloit One Network |
$957.95
|
| Rate for Payer: Quartz Commercial |
$1,173.00
|
| Rate for Payer: WEA Trust Commercial |
$1,075.25
|
| Rate for Payer: WPS Commercial |
$1,448.07
|
|
|
BCE VL Vasoreactivity Testing
|
Professional
|
$1,975.00
|
|
|
Service Code
|
CPT 93890 TC
|
| Hospital Charge Code |
3114986
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$219.34 |
| Max. Negotiated Rate |
$1,876.25 |
| Rate for Payer: Aetna Commercial |
$1,876.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,698.50
|
| Rate for Payer: Aetna Managed Medicare |
$219.34
|
| Rate for Payer: Anthem Medicare Advantage |
$219.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$219.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$219.34
|
| Rate for Payer: Cash Price |
$592.50
|
| Rate for Payer: Cash Price |
$592.50
|
| Rate for Payer: Cigna Commercial |
$1,876.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$987.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$219.34
|
| Rate for Payer: Health EOS Commercial |
$1,797.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$796.26
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$796.26
|
| Rate for Payer: Independent Care Health Plan Medicare |
$219.34
|
| Rate for Payer: Multiplan Commercial |
$1,580.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,876.25
|
| Rate for Payer: Quartz Beloit One Network |
$869.00
|
| Rate for Payer: Quartz Commercial |
$1,125.75
|
| Rate for Payer: Quartz Medicare Advantage |
$219.34
|
| Rate for Payer: The Alliance Commercial |
$548.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$219.34
|
| Rate for Payer: WEA Trust Commercial |
$1,086.25
|
| Rate for Payer: WPS Commercial |
$877.36
|
|
|
BCE VL Vasoreactivity Testing
|
Facility
OP
|
$1,975.00
|
|
|
Service Code
|
CPT 93890 TC
|
| Hospital Charge Code |
3114986
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$553.00 |
| Max. Negotiated Rate |
$7,900.00 |
| Rate for Payer: Aetna Commercial |
$1,777.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,698.50
|
| Rate for Payer: Aetna Managed Medicare |
$553.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,283.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$987.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$948.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,046.75
|
| Rate for Payer: Cash Price |
$592.50
|
| Rate for Payer: Cigna Commercial |
$1,817.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,105.21
|
| Rate for Payer: Health EOS Commercial |
$1,757.75
|
| Rate for Payer: HFN Commercial |
$1,817.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,481.25
|
| Rate for Payer: Multiplan Commercial |
$1,580.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,185.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,817.00
|
| Rate for Payer: Quartz Beloit One Network |
$967.75
|
| Rate for Payer: Quartz Commercial |
$1,283.75
|
| Rate for Payer: Quartz Medicare Advantage |
$1,185.00
|
| Rate for Payer: The Alliance Commercial |
$7,900.00
|
| Rate for Payer: United Healthcare PPO |
$1,481.25
|
| Rate for Payer: WEA Trust Commercial |
$1,086.25
|
| Rate for Payer: WPS Commercial |
$1,462.88
|
|
|
BCE VL Vasoreactivity Testing
|
Facility
IP
|
$1,975.00
|
|
|
Service Code
|
CPT 93890 TC
|
| Hospital Charge Code |
3114986
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$967.75 |
| Max. Negotiated Rate |
$1,817.00 |
| Rate for Payer: Aetna Commercial |
$1,777.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,046.75
|
| Rate for Payer: Cash Price |
$592.50
|
| Rate for Payer: Cigna Commercial |
$1,817.00
|
| Rate for Payer: Health EOS Commercial |
$1,757.75
|
| Rate for Payer: HFN Commercial |
$1,817.00
|
| Rate for Payer: Multiplan Commercial |
$1,580.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,185.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,817.00
|
| Rate for Payer: Quartz Beloit One Network |
$967.75
|
| Rate for Payer: Quartz Commercial |
$1,185.00
|
| Rate for Payer: WEA Trust Commercial |
$1,086.25
|
| Rate for Payer: WPS Commercial |
$1,462.88
|
|
|
BCE VL Vein Mapping Bilateral
|
Facility
OP
|
$2,473.00
|
|
|
Service Code
|
CPT 93971 TC
|
| Hospital Charge Code |
3114987
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$692.44 |
| Max. Negotiated Rate |
$9,892.00 |
| Rate for Payer: Aetna Commercial |
$2,225.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,126.78
|
| Rate for Payer: Aetna Managed Medicare |
$692.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,607.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,236.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,187.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,310.69
|
| Rate for Payer: Cash Price |
$741.90
|
| Rate for Payer: Cigna Commercial |
$2,275.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,383.89
|
| Rate for Payer: Health EOS Commercial |
$2,200.97
|
| Rate for Payer: HFN Commercial |
$2,275.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,854.75
|
| Rate for Payer: Multiplan Commercial |
$1,978.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,483.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,275.16
|
| Rate for Payer: Quartz Beloit One Network |
$1,211.77
|
| Rate for Payer: Quartz Commercial |
$1,607.45
|
| Rate for Payer: Quartz Medicare Advantage |
$1,483.80
|
| Rate for Payer: The Alliance Commercial |
$9,892.00
|
| Rate for Payer: United Healthcare PPO |
$1,854.75
|
| Rate for Payer: WEA Trust Commercial |
$1,360.15
|
| Rate for Payer: WPS Commercial |
$1,831.75
|
|
|
BCE VL Vein Mapping Bilateral
|
Facility
IP
|
$2,473.00
|
|
|
Service Code
|
CPT 93971 TC
|
| Hospital Charge Code |
3114987
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$1,211.77 |
| Max. Negotiated Rate |
$2,275.16 |
| Rate for Payer: Aetna Commercial |
$2,225.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,310.69
|
| Rate for Payer: Cash Price |
$741.90
|
| Rate for Payer: Cigna Commercial |
$2,275.16
|
| Rate for Payer: Health EOS Commercial |
$2,200.97
|
| Rate for Payer: HFN Commercial |
$2,275.16
|
| Rate for Payer: Multiplan Commercial |
$1,978.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,483.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,275.16
|
| Rate for Payer: Quartz Beloit One Network |
$1,211.77
|
| Rate for Payer: Quartz Commercial |
$1,483.80
|
| Rate for Payer: WEA Trust Commercial |
$1,360.15
|
| Rate for Payer: WPS Commercial |
$1,831.75
|
|
|
BCE VL Vein Mapping Bilateral
|
Professional
|
$2,473.00
|
|
|
Service Code
|
CPT 93971 TC
|
| Hospital Charge Code |
3114987
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$94.54 |
| Max. Negotiated Rate |
$2,349.35 |
| Rate for Payer: Aetna Commercial |
$2,349.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,126.78
|
| Rate for Payer: Aetna Managed Medicare |
$94.54
|
| Rate for Payer: Anthem Medicare Advantage |
$94.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$94.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$94.54
|
| Rate for Payer: Cash Price |
$741.90
|
| Rate for Payer: Cash Price |
$741.90
|
| Rate for Payer: Cigna Commercial |
$2,349.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,236.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$94.54
|
| Rate for Payer: Health EOS Commercial |
$2,250.43
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$344.95
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$344.95
|
| Rate for Payer: Independent Care Health Plan Medicare |
$94.54
|
| Rate for Payer: Multiplan Commercial |
$1,978.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,349.35
|
| Rate for Payer: Quartz Beloit One Network |
$1,088.12
|
| Rate for Payer: Quartz Commercial |
$1,409.61
|
| Rate for Payer: Quartz Medicare Advantage |
$94.54
|
| Rate for Payer: The Alliance Commercial |
$236.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$94.54
|
| Rate for Payer: WEA Trust Commercial |
$1,360.15
|
| Rate for Payer: WPS Commercial |
$378.16
|
|
|
BCE VL Vein Mapping Unilateral
|
Facility
OP
|
$1,435.00
|
|
|
Service Code
|
CPT 93971 TC
|
| Hospital Charge Code |
3114988
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$401.80 |
| Max. Negotiated Rate |
$5,740.00 |
| Rate for Payer: Aetna Commercial |
$1,291.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,234.10
|
| Rate for Payer: Aetna Managed Medicare |
$401.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$932.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$717.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$688.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$760.55
|
| Rate for Payer: Cash Price |
$430.50
|
| Rate for Payer: Cigna Commercial |
$1,320.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$803.03
|
| Rate for Payer: Health EOS Commercial |
$1,277.15
|
| Rate for Payer: HFN Commercial |
$1,320.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,076.25
|
| Rate for Payer: Multiplan Commercial |
$1,148.00
|
| Rate for Payer: NAPHCARE Commercial |
$861.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,320.20
|
| Rate for Payer: Quartz Beloit One Network |
$703.15
|
| Rate for Payer: Quartz Commercial |
$932.75
|
| Rate for Payer: Quartz Medicare Advantage |
$861.00
|
| Rate for Payer: The Alliance Commercial |
$5,740.00
|
| Rate for Payer: United Healthcare PPO |
$1,076.25
|
| Rate for Payer: WEA Trust Commercial |
$789.25
|
| Rate for Payer: WPS Commercial |
$1,062.90
|
|
|
BCE VL Vein Mapping Unilateral
|
Facility
IP
|
$1,435.00
|
|
|
Service Code
|
CPT 93971 TC
|
| Hospital Charge Code |
3114988
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$703.15 |
| Max. Negotiated Rate |
$1,320.20 |
| Rate for Payer: Aetna Commercial |
$1,291.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$760.55
|
| Rate for Payer: Cash Price |
$430.50
|
| Rate for Payer: Cigna Commercial |
$1,320.20
|
| Rate for Payer: Health EOS Commercial |
$1,277.15
|
| Rate for Payer: HFN Commercial |
$1,320.20
|
| Rate for Payer: Multiplan Commercial |
$1,148.00
|
| Rate for Payer: NAPHCARE Commercial |
$861.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,320.20
|
| Rate for Payer: Quartz Beloit One Network |
$703.15
|
| Rate for Payer: Quartz Commercial |
$861.00
|
| Rate for Payer: WEA Trust Commercial |
$789.25
|
| Rate for Payer: WPS Commercial |
$1,062.90
|
|
|
BCE VL Vein Mapping Unilateral
|
Professional
|
$1,435.00
|
|
|
Service Code
|
CPT 93971 TC
|
| Hospital Charge Code |
3114988
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$94.54 |
| Max. Negotiated Rate |
$1,363.25 |
| Rate for Payer: Aetna Commercial |
$1,363.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,234.10
|
| Rate for Payer: Aetna Managed Medicare |
$94.54
|
| Rate for Payer: Anthem Medicare Advantage |
$94.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$94.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$94.54
|
| Rate for Payer: Cash Price |
$430.50
|
| Rate for Payer: Cash Price |
$430.50
|
| Rate for Payer: Cigna Commercial |
$1,363.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$717.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$94.54
|
| Rate for Payer: Health EOS Commercial |
$1,305.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$344.95
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$344.95
|
| Rate for Payer: Independent Care Health Plan Medicare |
$94.54
|
| Rate for Payer: Multiplan Commercial |
$1,148.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,363.25
|
| Rate for Payer: Quartz Beloit One Network |
$631.40
|
| Rate for Payer: Quartz Commercial |
$817.95
|
| Rate for Payer: Quartz Medicare Advantage |
$94.54
|
| Rate for Payer: The Alliance Commercial |
$236.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$94.54
|
| Rate for Payer: WEA Trust Commercial |
$789.25
|
| Rate for Payer: WPS Commercial |
$378.16
|
|
|
BCE XR Abdomen AP
|
Facility
OP
|
$531.00
|
|
|
Service Code
|
CPT 74018 TC
|
| Hospital Charge Code |
3091480
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$148.68 |
| Max. Negotiated Rate |
$2,124.00 |
| Rate for Payer: Aetna Commercial |
$477.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$456.66
|
| Rate for Payer: Aetna Managed Medicare |
$148.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$345.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$265.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$254.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$281.43
|
| Rate for Payer: Cash Price |
$159.30
|
| Rate for Payer: Cash Price |
$159.30
|
| Rate for Payer: Cash Price |
$159.30
|
| Rate for Payer: Cigna Commercial |
$488.52
|
| Rate for Payer: Health EOS Commercial |
$472.59
|
| Rate for Payer: HFN Commercial |
$488.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$398.25
|
| Rate for Payer: Multiplan Commercial |
$424.80
|
| Rate for Payer: NAPHCARE Commercial |
$318.60
|
| Rate for Payer: Preferred Network Access Commercial |
$488.52
|
| Rate for Payer: Quartz Beloit One Network |
$260.19
|
| Rate for Payer: Quartz Commercial |
$345.15
|
| Rate for Payer: Quartz Medicare Advantage |
$318.60
|
| Rate for Payer: The Alliance Commercial |
$2,124.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$292.05
|
| Rate for Payer: WPS Commercial |
$393.31
|
|
|
BCE XR Abdomen AP
|
Professional
|
$531.00
|
|
|
Service Code
|
CPT 74018 TC
|
| Hospital Charge Code |
3091480
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$20.39 |
| Max. Negotiated Rate |
$504.45 |
| Rate for Payer: Aetna Commercial |
$504.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$456.66
|
| Rate for Payer: Aetna Managed Medicare |
$20.39
|
| Rate for Payer: Anthem Medicare Advantage |
$20.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$20.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$20.39
|
| Rate for Payer: Cash Price |
$159.30
|
| Rate for Payer: Cash Price |
$159.30
|
| Rate for Payer: Cigna Commercial |
$504.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$265.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$20.39
|
| Rate for Payer: Health EOS Commercial |
$483.21
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$70.00
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$70.00
|
| Rate for Payer: Independent Care Health Plan Medicare |
$20.39
|
| Rate for Payer: Multiplan Commercial |
$424.80
|
| Rate for Payer: Preferred Network Access Commercial |
$504.45
|
| Rate for Payer: Quartz Beloit One Network |
$233.64
|
| Rate for Payer: Quartz Commercial |
$302.67
|
| Rate for Payer: Quartz Medicare Advantage |
$20.39
|
| Rate for Payer: The Alliance Commercial |
$77.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20.39
|
| Rate for Payer: WEA Trust Commercial |
$292.05
|
| Rate for Payer: WPS Commercial |
$101.95
|
|
|
BCE XR Abdomen AP
|
Facility
IP
|
$531.00
|
|
|
Service Code
|
CPT 74018 TC
|
| Hospital Charge Code |
3091480
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$260.19 |
| Max. Negotiated Rate |
$488.52 |
| Rate for Payer: Aetna Commercial |
$477.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$281.43
|
| Rate for Payer: Cash Price |
$159.30
|
| Rate for Payer: Cigna Commercial |
$488.52
|
| Rate for Payer: Health EOS Commercial |
$472.59
|
| Rate for Payer: HFN Commercial |
$488.52
|
| Rate for Payer: Multiplan Commercial |
$424.80
|
| Rate for Payer: NAPHCARE Commercial |
$318.60
|
| Rate for Payer: Preferred Network Access Commercial |
$488.52
|
| Rate for Payer: Quartz Beloit One Network |
$260.19
|
| Rate for Payer: Quartz Commercial |
$318.60
|
| Rate for Payer: WEA Trust Commercial |
$292.05
|
| Rate for Payer: WPS Commercial |
$393.31
|
|
|
BCE XR Ankle 2 Views Left
|
Facility
IP
|
$499.00
|
|
|
Service Code
|
CPT 73600 TC,LT
|
| Hospital Charge Code |
3925477
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$244.51 |
| Max. Negotiated Rate |
$459.08 |
| Rate for Payer: Aetna Commercial |
$449.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$264.47
|
| Rate for Payer: Cash Price |
$149.70
|
| Rate for Payer: Cigna Commercial |
$459.08
|
| Rate for Payer: Health EOS Commercial |
$444.11
|
| Rate for Payer: HFN Commercial |
$459.08
|
| Rate for Payer: Multiplan Commercial |
$399.20
|
| Rate for Payer: NAPHCARE Commercial |
$299.40
|
| Rate for Payer: Preferred Network Access Commercial |
$459.08
|
| Rate for Payer: Quartz Beloit One Network |
$244.51
|
| Rate for Payer: Quartz Commercial |
$299.40
|
| Rate for Payer: WEA Trust Commercial |
$274.45
|
| Rate for Payer: WPS Commercial |
$369.61
|
|
