|
BCE VL Duplex Hemodialysis Access Flow
|
Facility
|
OP
|
$1,207.00
|
|
|
Service Code
|
CPT 93990 TC
|
| Hospital Charge Code |
3114950
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$337.96 |
| Max. Negotiated Rate |
$4,828.00 |
| Rate for Payer: Aetna Commercial |
$1,086.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,038.02
|
| Rate for Payer: Aetna Managed Medicare |
$337.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$784.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$603.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$579.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$639.71
|
| Rate for Payer: Cash Price |
$362.10
|
| Rate for Payer: Cigna Commercial |
$1,110.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$675.44
|
| Rate for Payer: Health EOS Commercial |
$1,074.23
|
| Rate for Payer: HFN Commercial |
$1,110.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$905.25
|
| Rate for Payer: Multiplan Commercial |
$965.60
|
| Rate for Payer: NAPHCARE Commercial |
$724.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,110.44
|
| Rate for Payer: Quartz Beloit One Network |
$591.43
|
| Rate for Payer: Quartz Commercial |
$784.55
|
| Rate for Payer: Quartz Medicare Advantage |
$724.20
|
| Rate for Payer: The Alliance Commercial |
$4,828.00
|
| Rate for Payer: United Healthcare PPO |
$905.25
|
| Rate for Payer: WEA Trust Commercial |
$663.85
|
| Rate for Payer: WPS Commercial |
$894.02
|
|
|
BCE VL Duplex Hemodialysis Access Flow
|
Professional
|
Both
|
$1,207.00
|
|
|
Service Code
|
CPT 93990 TC
|
| Hospital Charge Code |
3114950
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$440.47 |
| Max. Negotiated Rate |
$1,146.65 |
| Rate for Payer: Aetna Commercial |
$1,146.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,038.02
|
| Rate for Payer: Cash Price |
$362.10
|
| Rate for Payer: Cash Price |
$362.10
|
| Rate for Payer: Cigna Commercial |
$1,146.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$603.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$724.20
|
| Rate for Payer: Health EOS Commercial |
$1,098.37
|
| Rate for Payer: HFN Commercial |
$1,146.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$440.47
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$440.47
|
| Rate for Payer: Multiplan Commercial |
$965.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,146.65
|
| Rate for Payer: Quartz Beloit One Network |
$531.08
|
| Rate for Payer: Quartz Commercial |
$687.99
|
| Rate for Payer: The Alliance Commercial |
$603.50
|
| Rate for Payer: WEA Trust Commercial |
$663.85
|
| Rate for Payer: WPS Commercial |
$894.02
|
|
|
BCE VL Echo 2D w M Mode w Doppler
|
Facility
|
IP
|
$3,701.00
|
|
|
Service Code
|
CPT 93306 TC
|
| Hospital Charge Code |
3114951
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$1,813.49 |
| Max. Negotiated Rate |
$3,404.92 |
| Rate for Payer: Aetna Commercial |
$3,330.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,182.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,961.53
|
| Rate for Payer: Cash Price |
$1,110.30
|
| Rate for Payer: Cigna Commercial |
$3,404.92
|
| Rate for Payer: Health EOS Commercial |
$3,293.89
|
| Rate for Payer: HFN Commercial |
$3,404.92
|
| Rate for Payer: Multiplan Commercial |
$2,960.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,220.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,404.92
|
| Rate for Payer: Quartz Beloit One Network |
$1,813.49
|
| Rate for Payer: Quartz Commercial |
$2,220.60
|
| Rate for Payer: WEA Trust Commercial |
$2,035.55
|
| Rate for Payer: WPS Commercial |
$2,741.33
|
|
|
BCE VL Echo 2D w M Mode w Doppler
|
Facility
|
OP
|
$3,701.00
|
|
|
Service Code
|
CPT 93306 TC
|
| Hospital Charge Code |
3114951
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$1,036.28 |
| Max. Negotiated Rate |
$14,804.00 |
| Rate for Payer: Aetna Commercial |
$3,330.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,182.86
|
| Rate for Payer: Aetna Managed Medicare |
$1,036.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,405.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,850.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,776.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,961.53
|
| Rate for Payer: Cash Price |
$1,110.30
|
| Rate for Payer: Cigna Commercial |
$3,404.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,071.08
|
| Rate for Payer: Health EOS Commercial |
$3,293.89
|
| Rate for Payer: HFN Commercial |
$3,404.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,775.75
|
| Rate for Payer: Multiplan Commercial |
$2,960.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,220.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,404.92
|
| Rate for Payer: Quartz Beloit One Network |
$1,813.49
|
| Rate for Payer: Quartz Commercial |
$2,405.65
|
| Rate for Payer: Quartz Medicare Advantage |
$2,220.60
|
| Rate for Payer: The Alliance Commercial |
$14,804.00
|
| Rate for Payer: United Healthcare PPO |
$2,775.75
|
| Rate for Payer: WEA Trust Commercial |
$2,035.55
|
| Rate for Payer: WPS Commercial |
$2,741.33
|
|
|
BCE VL Echo 2D w M Mode w Doppler
|
Professional
|
Both
|
$3,701.00
|
|
|
Service Code
|
CPT 93306 TC
|
| Hospital Charge Code |
3114951
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$454.42 |
| Max. Negotiated Rate |
$3,515.95 |
| Rate for Payer: Aetna Commercial |
$3,515.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,182.86
|
| Rate for Payer: Cash Price |
$1,110.30
|
| Rate for Payer: Cash Price |
$1,110.30
|
| Rate for Payer: Cigna Commercial |
$3,515.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,850.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,220.60
|
| Rate for Payer: Health EOS Commercial |
$3,367.91
|
| Rate for Payer: HFN Commercial |
$3,515.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$454.42
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$454.42
|
| Rate for Payer: Multiplan Commercial |
$2,960.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,515.95
|
| Rate for Payer: Quartz Beloit One Network |
$1,628.44
|
| Rate for Payer: Quartz Commercial |
$2,109.57
|
| Rate for Payer: The Alliance Commercial |
$1,850.50
|
| Rate for Payer: WEA Trust Commercial |
$2,035.55
|
| Rate for Payer: WPS Commercial |
$2,741.33
|
|
|
BCE VL Echo Color Flow Velocity Mapping
|
Facility
|
IP
|
$917.00
|
|
|
Service Code
|
CPT 93325 TC
|
| Hospital Charge Code |
3114952
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$449.33 |
| Max. Negotiated Rate |
$843.64 |
| Rate for Payer: Aetna Commercial |
$825.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$788.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$486.01
|
| Rate for Payer: Cash Price |
$275.10
|
| Rate for Payer: Cigna Commercial |
$843.64
|
| Rate for Payer: Health EOS Commercial |
$816.13
|
| Rate for Payer: HFN Commercial |
$843.64
|
| Rate for Payer: Multiplan Commercial |
$733.60
|
| Rate for Payer: NAPHCARE Commercial |
$550.20
|
| Rate for Payer: Preferred Network Access Commercial |
$843.64
|
| Rate for Payer: Quartz Beloit One Network |
$449.33
|
| Rate for Payer: Quartz Commercial |
$550.20
|
| Rate for Payer: WEA Trust Commercial |
$504.35
|
| Rate for Payer: WPS Commercial |
$679.22
|
|
|
BCE VL Echo Color Flow Velocity Mapping
|
Facility
|
OP
|
$917.00
|
|
|
Service Code
|
CPT 93325 TC
|
| Hospital Charge Code |
3114952
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$256.76 |
| Max. Negotiated Rate |
$3,668.00 |
| Rate for Payer: Aetna Commercial |
$825.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$788.62
|
| Rate for Payer: Aetna Managed Medicare |
$256.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$596.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$458.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$440.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$486.01
|
| Rate for Payer: Cash Price |
$275.10
|
| Rate for Payer: Cigna Commercial |
$843.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$513.15
|
| Rate for Payer: Health EOS Commercial |
$816.13
|
| Rate for Payer: HFN Commercial |
$843.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$687.75
|
| Rate for Payer: Multiplan Commercial |
$733.60
|
| Rate for Payer: NAPHCARE Commercial |
$550.20
|
| Rate for Payer: Preferred Network Access Commercial |
$843.64
|
| Rate for Payer: Quartz Beloit One Network |
$449.33
|
| Rate for Payer: Quartz Commercial |
$596.05
|
| Rate for Payer: Quartz Medicare Advantage |
$550.20
|
| Rate for Payer: The Alliance Commercial |
$3,668.00
|
| Rate for Payer: United Healthcare PPO |
$687.75
|
| Rate for Payer: WEA Trust Commercial |
$504.35
|
| Rate for Payer: WPS Commercial |
$679.22
|
|
|
BCE VL Echo Color Flow Velocity Mapping
|
Professional
|
Both
|
$917.00
|
|
|
Service Code
|
CPT 93325 TC
|
| Hospital Charge Code |
3114952
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$74.27 |
| Max. Negotiated Rate |
$871.15 |
| Rate for Payer: Aetna Commercial |
$871.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$788.62
|
| Rate for Payer: Cash Price |
$275.10
|
| Rate for Payer: Cash Price |
$275.10
|
| Rate for Payer: Cigna Commercial |
$871.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$458.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$550.20
|
| Rate for Payer: Health EOS Commercial |
$834.47
|
| Rate for Payer: HFN Commercial |
$871.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$74.27
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$74.27
|
| Rate for Payer: Multiplan Commercial |
$733.60
|
| Rate for Payer: Preferred Network Access Commercial |
$871.15
|
| Rate for Payer: Quartz Beloit One Network |
$403.48
|
| Rate for Payer: Quartz Commercial |
$522.69
|
| Rate for Payer: The Alliance Commercial |
$458.50
|
| Rate for Payer: WEA Trust Commercial |
$504.35
|
| Rate for Payer: WPS Commercial |
$679.22
|
|
|
BCE VL Echo Congenital Complete
|
Facility
|
IP
|
$1,971.00
|
|
|
Service Code
|
CPT 93303 TC
|
| Hospital Charge Code |
3114953
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$965.79 |
| Max. Negotiated Rate |
$1,813.32 |
| Rate for Payer: Aetna Commercial |
$1,773.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,695.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,044.63
|
| Rate for Payer: Cash Price |
$591.30
|
| Rate for Payer: Cigna Commercial |
$1,813.32
|
| Rate for Payer: Health EOS Commercial |
$1,754.19
|
| Rate for Payer: HFN Commercial |
$1,813.32
|
| Rate for Payer: Multiplan Commercial |
$1,576.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,182.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,813.32
|
| Rate for Payer: Quartz Beloit One Network |
$965.79
|
| Rate for Payer: Quartz Commercial |
$1,182.60
|
| Rate for Payer: WEA Trust Commercial |
$1,084.05
|
| Rate for Payer: WPS Commercial |
$1,459.92
|
|
|
BCE VL Echo Congenital Complete
|
Facility
|
OP
|
$1,971.00
|
|
|
Service Code
|
CPT 93303 TC
|
| Hospital Charge Code |
3114953
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$551.88 |
| Max. Negotiated Rate |
$7,884.00 |
| Rate for Payer: Aetna Commercial |
$1,773.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,695.06
|
| Rate for Payer: Aetna Managed Medicare |
$551.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,281.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$985.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$946.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,044.63
|
| Rate for Payer: Cash Price |
$591.30
|
| Rate for Payer: Cigna Commercial |
$1,813.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,102.97
|
| Rate for Payer: Health EOS Commercial |
$1,754.19
|
| Rate for Payer: HFN Commercial |
$1,813.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,478.25
|
| Rate for Payer: Multiplan Commercial |
$1,576.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,182.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,813.32
|
| Rate for Payer: Quartz Beloit One Network |
$965.79
|
| Rate for Payer: Quartz Commercial |
$1,281.15
|
| Rate for Payer: Quartz Medicare Advantage |
$1,182.60
|
| Rate for Payer: The Alliance Commercial |
$7,884.00
|
| Rate for Payer: United Healthcare PPO |
$1,478.25
|
| Rate for Payer: WEA Trust Commercial |
$1,084.05
|
| Rate for Payer: WPS Commercial |
$1,459.92
|
|
|
BCE VL Echo Congenital Complete
|
Professional
|
Both
|
$1,971.00
|
|
|
Service Code
|
CPT 93303 TC
|
| Hospital Charge Code |
3114953
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$580.90 |
| Max. Negotiated Rate |
$1,872.45 |
| Rate for Payer: Aetna Commercial |
$1,872.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,695.06
|
| Rate for Payer: Cash Price |
$591.30
|
| Rate for Payer: Cash Price |
$591.30
|
| Rate for Payer: Cigna Commercial |
$1,872.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$985.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,182.60
|
| Rate for Payer: Health EOS Commercial |
$1,793.61
|
| Rate for Payer: HFN Commercial |
$1,872.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$580.90
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$580.90
|
| Rate for Payer: Multiplan Commercial |
$1,576.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,872.45
|
| Rate for Payer: Quartz Beloit One Network |
$867.24
|
| Rate for Payer: Quartz Commercial |
$1,123.47
|
| Rate for Payer: The Alliance Commercial |
$985.50
|
| Rate for Payer: WEA Trust Commercial |
$1,084.05
|
| Rate for Payer: WPS Commercial |
$1,459.92
|
|
|
BCE VL Echo Congenital Limited
|
Facility
|
OP
|
$1,819.00
|
|
|
Service Code
|
CPT 93304 TC
|
| Hospital Charge Code |
3114954
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$509.32 |
| Max. Negotiated Rate |
$7,276.00 |
| Rate for Payer: Aetna Commercial |
$1,637.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,564.34
|
| Rate for Payer: Aetna Managed Medicare |
$509.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,182.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$909.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$873.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$964.07
|
| Rate for Payer: Cash Price |
$545.70
|
| Rate for Payer: Cigna Commercial |
$1,673.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,017.91
|
| Rate for Payer: Health EOS Commercial |
$1,618.91
|
| Rate for Payer: HFN Commercial |
$1,673.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,364.25
|
| Rate for Payer: Multiplan Commercial |
$1,455.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,091.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,673.48
|
| Rate for Payer: Quartz Beloit One Network |
$891.31
|
| Rate for Payer: Quartz Commercial |
$1,182.35
|
| Rate for Payer: Quartz Medicare Advantage |
$1,091.40
|
| Rate for Payer: The Alliance Commercial |
$7,276.00
|
| Rate for Payer: United Healthcare PPO |
$1,364.25
|
| Rate for Payer: WEA Trust Commercial |
$1,000.45
|
| Rate for Payer: WPS Commercial |
$1,347.33
|
|
|
BCE VL Echo Congenital Limited
|
Professional
|
Both
|
$1,819.00
|
|
|
Service Code
|
CPT 93304 TC
|
| Hospital Charge Code |
3114954
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$430.02 |
| Max. Negotiated Rate |
$1,728.05 |
| Rate for Payer: Aetna Commercial |
$1,728.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,564.34
|
| Rate for Payer: Cash Price |
$545.70
|
| Rate for Payer: Cash Price |
$545.70
|
| Rate for Payer: Cigna Commercial |
$1,728.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$909.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,091.40
|
| Rate for Payer: Health EOS Commercial |
$1,655.29
|
| Rate for Payer: HFN Commercial |
$1,728.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$430.02
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$430.02
|
| Rate for Payer: Multiplan Commercial |
$1,455.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,728.05
|
| Rate for Payer: Quartz Beloit One Network |
$800.36
|
| Rate for Payer: Quartz Commercial |
$1,036.83
|
| Rate for Payer: The Alliance Commercial |
$909.50
|
| Rate for Payer: WEA Trust Commercial |
$1,000.45
|
| Rate for Payer: WPS Commercial |
$1,347.33
|
|
|
BCE VL Echo Congenital Limited
|
Facility
|
IP
|
$1,819.00
|
|
|
Service Code
|
CPT 93304 TC
|
| Hospital Charge Code |
3114954
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$891.31 |
| Max. Negotiated Rate |
$1,673.48 |
| Rate for Payer: Aetna Commercial |
$1,637.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,564.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$964.07
|
| Rate for Payer: Cash Price |
$545.70
|
| Rate for Payer: Cigna Commercial |
$1,673.48
|
| Rate for Payer: Health EOS Commercial |
$1,618.91
|
| Rate for Payer: HFN Commercial |
$1,673.48
|
| Rate for Payer: Multiplan Commercial |
$1,455.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,091.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,673.48
|
| Rate for Payer: Quartz Beloit One Network |
$891.31
|
| Rate for Payer: Quartz Commercial |
$1,091.40
|
| Rate for Payer: WEA Trust Commercial |
$1,000.45
|
| Rate for Payer: WPS Commercial |
$1,347.33
|
|
|
BCE VL Echo Doppler
|
Facility
|
OP
|
$905.00
|
|
|
Service Code
|
CPT 93320 TC
|
| Hospital Charge Code |
3114955
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$253.40 |
| Max. Negotiated Rate |
$3,620.00 |
| Rate for Payer: Aetna Commercial |
$814.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$778.30
|
| Rate for Payer: Aetna Managed Medicare |
$253.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$588.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$452.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$434.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$479.65
|
| Rate for Payer: Cash Price |
$271.50
|
| Rate for Payer: Cigna Commercial |
$832.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$506.44
|
| Rate for Payer: Health EOS Commercial |
$805.45
|
| Rate for Payer: HFN Commercial |
$832.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$678.75
|
| Rate for Payer: Multiplan Commercial |
$724.00
|
| Rate for Payer: NAPHCARE Commercial |
$543.00
|
| Rate for Payer: Preferred Network Access Commercial |
$832.60
|
| Rate for Payer: Quartz Beloit One Network |
$443.45
|
| Rate for Payer: Quartz Commercial |
$588.25
|
| Rate for Payer: Quartz Medicare Advantage |
$543.00
|
| Rate for Payer: The Alliance Commercial |
$3,620.00
|
| Rate for Payer: United Healthcare PPO |
$678.75
|
| Rate for Payer: WEA Trust Commercial |
$497.75
|
| Rate for Payer: WPS Commercial |
$670.33
|
|
|
BCE VL Echo Doppler
|
Facility
|
IP
|
$905.00
|
|
|
Service Code
|
CPT 93320 TC
|
| Hospital Charge Code |
3114955
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$443.45 |
| Max. Negotiated Rate |
$832.60 |
| Rate for Payer: Aetna Commercial |
$814.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$778.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$479.65
|
| Rate for Payer: Cash Price |
$271.50
|
| Rate for Payer: Cigna Commercial |
$832.60
|
| Rate for Payer: Health EOS Commercial |
$805.45
|
| Rate for Payer: HFN Commercial |
$832.60
|
| Rate for Payer: Multiplan Commercial |
$724.00
|
| Rate for Payer: NAPHCARE Commercial |
$543.00
|
| Rate for Payer: Preferred Network Access Commercial |
$832.60
|
| Rate for Payer: Quartz Beloit One Network |
$443.45
|
| Rate for Payer: Quartz Commercial |
$543.00
|
| Rate for Payer: WEA Trust Commercial |
$497.75
|
| Rate for Payer: WPS Commercial |
$670.33
|
|
|
BCE VL Echo Doppler
|
Professional
|
Both
|
$905.00
|
|
|
Service Code
|
CPT 93320 TC
|
| Hospital Charge Code |
3114955
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$119.84 |
| Max. Negotiated Rate |
$859.75 |
| Rate for Payer: Aetna Commercial |
$859.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$778.30
|
| Rate for Payer: Cash Price |
$271.50
|
| Rate for Payer: Cash Price |
$271.50
|
| Rate for Payer: Cigna Commercial |
$859.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$452.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$543.00
|
| Rate for Payer: Health EOS Commercial |
$823.55
|
| Rate for Payer: HFN Commercial |
$859.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$119.84
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$119.84
|
| Rate for Payer: Multiplan Commercial |
$724.00
|
| Rate for Payer: Preferred Network Access Commercial |
$859.75
|
| Rate for Payer: Quartz Beloit One Network |
$398.20
|
| Rate for Payer: Quartz Commercial |
$515.85
|
| Rate for Payer: The Alliance Commercial |
$452.50
|
| Rate for Payer: WEA Trust Commercial |
$497.75
|
| Rate for Payer: WPS Commercial |
$670.33
|
|
|
BCE VL Echo During Therap/Diag Intervention
|
Facility
|
IP
|
$1,753.00
|
|
|
Service Code
|
CPT 93662 TC
|
| Hospital Charge Code |
3114956
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$858.97 |
| Max. Negotiated Rate |
$1,612.76 |
| Rate for Payer: Aetna Commercial |
$1,577.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,507.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$929.09
|
| Rate for Payer: Cash Price |
$525.90
|
| Rate for Payer: Cigna Commercial |
$1,612.76
|
| Rate for Payer: Health EOS Commercial |
$1,560.17
|
| Rate for Payer: HFN Commercial |
$1,612.76
|
| Rate for Payer: Multiplan Commercial |
$1,402.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,051.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,612.76
|
| Rate for Payer: Quartz Beloit One Network |
$858.97
|
| Rate for Payer: Quartz Commercial |
$1,051.80
|
| Rate for Payer: WEA Trust Commercial |
$964.15
|
| Rate for Payer: WPS Commercial |
$1,298.45
|
|
|
BCE VL Echo During Therap/Diag Intervention
|
Facility
|
OP
|
$1,753.00
|
|
|
Service Code
|
CPT 93662 TC
|
| Hospital Charge Code |
3114956
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$490.84 |
| Max. Negotiated Rate |
$7,012.00 |
| Rate for Payer: Aetna Commercial |
$1,577.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,507.58
|
| Rate for Payer: Aetna Managed Medicare |
$490.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,139.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$876.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$841.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$929.09
|
| Rate for Payer: Cash Price |
$525.90
|
| Rate for Payer: Cigna Commercial |
$1,612.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$980.98
|
| Rate for Payer: Health EOS Commercial |
$1,560.17
|
| Rate for Payer: HFN Commercial |
$1,612.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,314.75
|
| Rate for Payer: Multiplan Commercial |
$1,402.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,051.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,612.76
|
| Rate for Payer: Quartz Beloit One Network |
$858.97
|
| Rate for Payer: Quartz Commercial |
$1,139.45
|
| Rate for Payer: Quartz Medicare Advantage |
$1,051.80
|
| Rate for Payer: The Alliance Commercial |
$7,012.00
|
| Rate for Payer: United Healthcare PPO |
$1,314.75
|
| Rate for Payer: WEA Trust Commercial |
$964.15
|
| Rate for Payer: WPS Commercial |
$1,298.45
|
|
|
BCE VL Echo During Therap/Diag Intervention
|
Professional
|
Both
|
$1,753.00
|
|
|
Service Code
|
CPT 93662 TC
|
| Hospital Charge Code |
3114956
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$771.32 |
| Max. Negotiated Rate |
$1,665.35 |
| Rate for Payer: Aetna Commercial |
$1,665.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,507.58
|
| Rate for Payer: Cash Price |
$525.90
|
| Rate for Payer: Cash Price |
$525.90
|
| Rate for Payer: Cigna Commercial |
$1,665.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$876.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,051.80
|
| Rate for Payer: Health EOS Commercial |
$1,595.23
|
| Rate for Payer: HFN Commercial |
$1,665.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$810.95
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$810.95
|
| Rate for Payer: Multiplan Commercial |
$1,402.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,665.35
|
| Rate for Payer: Quartz Beloit One Network |
$771.32
|
| Rate for Payer: Quartz Commercial |
$999.21
|
| Rate for Payer: The Alliance Commercial |
$876.50
|
| Rate for Payer: WEA Trust Commercial |
$964.15
|
| Rate for Payer: WPS Commercial |
$1,298.45
|
|
|
BCE VL Echo Limited
|
Professional
|
Both
|
$1,756.00
|
|
|
Service Code
|
CPT 93308 TC
|
| Hospital Charge Code |
3114957
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$256.77 |
| Max. Negotiated Rate |
$1,668.20 |
| Rate for Payer: Aetna Commercial |
$1,668.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,510.16
|
| Rate for Payer: Cash Price |
$526.80
|
| Rate for Payer: Cash Price |
$526.80
|
| Rate for Payer: Cigna Commercial |
$1,668.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$878.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,053.60
|
| Rate for Payer: Health EOS Commercial |
$1,597.96
|
| Rate for Payer: HFN Commercial |
$1,668.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$256.77
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$256.77
|
| Rate for Payer: Multiplan Commercial |
$1,404.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,668.20
|
| Rate for Payer: Quartz Beloit One Network |
$772.64
|
| Rate for Payer: Quartz Commercial |
$1,000.92
|
| Rate for Payer: The Alliance Commercial |
$878.00
|
| Rate for Payer: WEA Trust Commercial |
$965.80
|
| Rate for Payer: WPS Commercial |
$1,300.67
|
|
|
BCE VL Echo Limited
|
Facility
|
OP
|
$1,756.00
|
|
|
Service Code
|
CPT 93308 TC
|
| Hospital Charge Code |
3114957
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$491.68 |
| Max. Negotiated Rate |
$7,024.00 |
| Rate for Payer: Aetna Commercial |
$1,580.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,510.16
|
| Rate for Payer: Aetna Managed Medicare |
$491.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,141.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$878.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$842.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$930.68
|
| Rate for Payer: Cash Price |
$526.80
|
| Rate for Payer: Cigna Commercial |
$1,615.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$982.66
|
| Rate for Payer: Health EOS Commercial |
$1,562.84
|
| Rate for Payer: HFN Commercial |
$1,615.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,317.00
|
| Rate for Payer: Multiplan Commercial |
$1,404.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,053.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,615.52
|
| Rate for Payer: Quartz Beloit One Network |
$860.44
|
| Rate for Payer: Quartz Commercial |
$1,141.40
|
| Rate for Payer: Quartz Medicare Advantage |
$1,053.60
|
| Rate for Payer: The Alliance Commercial |
$7,024.00
|
| Rate for Payer: United Healthcare PPO |
$1,317.00
|
| Rate for Payer: WEA Trust Commercial |
$965.80
|
| Rate for Payer: WPS Commercial |
$1,300.67
|
|
|
BCE VL Echo Limited
|
Facility
|
IP
|
$1,756.00
|
|
|
Service Code
|
CPT 93308 TC
|
| Hospital Charge Code |
3114957
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$860.44 |
| Max. Negotiated Rate |
$1,615.52 |
| Rate for Payer: Aetna Commercial |
$1,580.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,510.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$930.68
|
| Rate for Payer: Cash Price |
$526.80
|
| Rate for Payer: Cigna Commercial |
$1,615.52
|
| Rate for Payer: Health EOS Commercial |
$1,562.84
|
| Rate for Payer: HFN Commercial |
$1,615.52
|
| Rate for Payer: Multiplan Commercial |
$1,404.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,053.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,615.52
|
| Rate for Payer: Quartz Beloit One Network |
$860.44
|
| Rate for Payer: Quartz Commercial |
$1,053.60
|
| Rate for Payer: WEA Trust Commercial |
$965.80
|
| Rate for Payer: WPS Commercial |
$1,300.67
|
|
|
BCE VL Echo Stress Contrast +
|
Professional
|
Both
|
$425.00
|
|
|
Service Code
|
CPT 93352 TC
|
| Hospital Charge Code |
4592618
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$187.00 |
| Max. Negotiated Rate |
$403.75 |
| Rate for Payer: Aetna Commercial |
$403.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$365.50
|
| Rate for Payer: Cash Price |
$127.50
|
| Rate for Payer: Cash Price |
$127.50
|
| Rate for Payer: Cigna Commercial |
$403.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$212.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$255.00
|
| Rate for Payer: Health EOS Commercial |
$386.75
|
| Rate for Payer: HFN Commercial |
$403.75
|
| Rate for Payer: Multiplan Commercial |
$340.00
|
| Rate for Payer: Preferred Network Access Commercial |
$403.75
|
| Rate for Payer: Quartz Beloit One Network |
$187.00
|
| Rate for Payer: Quartz Commercial |
$242.25
|
| Rate for Payer: The Alliance Commercial |
$212.50
|
| Rate for Payer: WEA Trust Commercial |
$233.75
|
| Rate for Payer: WPS Commercial |
$314.80
|
|
|
BCE VL Echo Stress Contrast +
|
Facility
|
IP
|
$425.00
|
|
|
Service Code
|
CPT 93352 TC
|
| Hospital Charge Code |
4592618
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$208.25 |
| Max. Negotiated Rate |
$391.00 |
| Rate for Payer: Aetna Commercial |
$382.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$365.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$225.25
|
| Rate for Payer: Cash Price |
$127.50
|
| Rate for Payer: Cigna Commercial |
$391.00
|
| Rate for Payer: Health EOS Commercial |
$378.25
|
| Rate for Payer: HFN Commercial |
$391.00
|
| Rate for Payer: Multiplan Commercial |
$340.00
|
| Rate for Payer: NAPHCARE Commercial |
$255.00
|
| Rate for Payer: Preferred Network Access Commercial |
$391.00
|
| Rate for Payer: Quartz Beloit One Network |
$208.25
|
| Rate for Payer: Quartz Commercial |
$255.00
|
| Rate for Payer: WEA Trust Commercial |
$233.75
|
| Rate for Payer: WPS Commercial |
$314.80
|
|
