|
BCE VL Echo Stress Contrast +
|
Facility
|
OP
|
$425.00
|
|
|
Service Code
|
CPT 93352 TC
|
| Hospital Charge Code |
4592618
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$119.00 |
| Max. Negotiated Rate |
$1,700.00 |
| Rate for Payer: Aetna Commercial |
$382.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$365.50
|
| Rate for Payer: Aetna Managed Medicare |
$119.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$276.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$212.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$204.00
|
| 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: Dean Health DHI/DHP/ASO |
$237.83
|
| Rate for Payer: Health EOS Commercial |
$378.25
|
| Rate for Payer: HFN Commercial |
$391.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$318.75
|
| 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 |
$276.25
|
| Rate for Payer: Quartz Medicare Advantage |
$255.00
|
| Rate for Payer: The Alliance Commercial |
$1,700.00
|
| Rate for Payer: United Healthcare PPO |
$318.75
|
| Rate for Payer: WEA Trust Commercial |
$233.75
|
| Rate for Payer: WPS Commercial |
$314.80
|
|
|
BCE VL Echo Stress Test
|
Facility
|
IP
|
$4,308.00
|
|
|
Service Code
|
CPT 93350 TC
|
| Hospital Charge Code |
3114958
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$2,110.92 |
| Max. Negotiated Rate |
$3,963.36 |
| Rate for Payer: Aetna Commercial |
$3,877.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,704.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,283.24
|
| Rate for Payer: Cash Price |
$1,292.40
|
| Rate for Payer: Cigna Commercial |
$3,963.36
|
| Rate for Payer: Health EOS Commercial |
$3,834.12
|
| Rate for Payer: HFN Commercial |
$3,963.36
|
| Rate for Payer: Multiplan Commercial |
$3,446.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,584.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,963.36
|
| Rate for Payer: Quartz Beloit One Network |
$2,110.92
|
| Rate for Payer: Quartz Commercial |
$2,584.80
|
| Rate for Payer: WEA Trust Commercial |
$2,369.40
|
| Rate for Payer: WPS Commercial |
$3,190.94
|
|
|
BCE VL Echo Stress Test
|
Facility
|
OP
|
$4,308.00
|
|
|
Service Code
|
CPT 93350 TC
|
| Hospital Charge Code |
3114958
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$1,206.24 |
| Max. Negotiated Rate |
$17,232.00 |
| Rate for Payer: Aetna Commercial |
$3,877.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,704.88
|
| Rate for Payer: Aetna Managed Medicare |
$1,206.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,800.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,154.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,067.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,283.24
|
| Rate for Payer: Cash Price |
$1,292.40
|
| Rate for Payer: Cigna Commercial |
$3,963.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,410.76
|
| Rate for Payer: Health EOS Commercial |
$3,834.12
|
| Rate for Payer: HFN Commercial |
$3,963.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,231.00
|
| Rate for Payer: Multiplan Commercial |
$3,446.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,584.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,963.36
|
| Rate for Payer: Quartz Beloit One Network |
$2,110.92
|
| Rate for Payer: Quartz Commercial |
$2,800.20
|
| Rate for Payer: Quartz Medicare Advantage |
$2,584.80
|
| Rate for Payer: The Alliance Commercial |
$17,232.00
|
| Rate for Payer: United Healthcare PPO |
$3,231.00
|
| Rate for Payer: WEA Trust Commercial |
$2,369.40
|
| Rate for Payer: WPS Commercial |
$3,190.94
|
|
|
BCE VL Echo Stress Test
|
Professional
|
Both
|
$4,308.00
|
|
|
Service Code
|
CPT 93350 TC
|
| Hospital Charge Code |
3114958
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$417.28 |
| Max. Negotiated Rate |
$4,092.60 |
| Rate for Payer: Aetna Commercial |
$4,092.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,704.88
|
| Rate for Payer: Cash Price |
$1,292.40
|
| Rate for Payer: Cash Price |
$1,292.40
|
| Rate for Payer: Cigna Commercial |
$4,092.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,154.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,584.80
|
| Rate for Payer: Health EOS Commercial |
$3,920.28
|
| Rate for Payer: HFN Commercial |
$4,092.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$417.28
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$417.28
|
| Rate for Payer: Multiplan Commercial |
$3,446.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,092.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,895.52
|
| Rate for Payer: Quartz Commercial |
$2,455.56
|
| Rate for Payer: The Alliance Commercial |
$2,154.00
|
| Rate for Payer: WEA Trust Commercial |
$2,369.40
|
| Rate for Payer: WPS Commercial |
$3,190.94
|
|
|
BCE VL Echo Stress Test Chemical
|
Professional
|
Both
|
$4,308.00
|
|
|
Service Code
|
CPT 93350 TC
|
| Hospital Charge Code |
3114959
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$417.28 |
| Max. Negotiated Rate |
$4,092.60 |
| Rate for Payer: Aetna Commercial |
$4,092.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,704.88
|
| Rate for Payer: Cash Price |
$1,292.40
|
| Rate for Payer: Cash Price |
$1,292.40
|
| Rate for Payer: Cigna Commercial |
$4,092.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,154.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,584.80
|
| Rate for Payer: Health EOS Commercial |
$3,920.28
|
| Rate for Payer: HFN Commercial |
$4,092.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$417.28
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$417.28
|
| Rate for Payer: Multiplan Commercial |
$3,446.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,092.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,895.52
|
| Rate for Payer: Quartz Commercial |
$2,455.56
|
| Rate for Payer: The Alliance Commercial |
$2,154.00
|
| Rate for Payer: WEA Trust Commercial |
$2,369.40
|
| Rate for Payer: WPS Commercial |
$3,190.94
|
|
|
BCE VL Echo Stress Test Chemical
|
Facility
|
OP
|
$4,308.00
|
|
|
Service Code
|
CPT 93350 TC
|
| Hospital Charge Code |
3114959
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$1,206.24 |
| Max. Negotiated Rate |
$17,232.00 |
| Rate for Payer: Aetna Commercial |
$3,877.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,704.88
|
| Rate for Payer: Aetna Managed Medicare |
$1,206.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,800.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,154.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,067.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,283.24
|
| Rate for Payer: Cash Price |
$1,292.40
|
| Rate for Payer: Cigna Commercial |
$3,963.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,410.76
|
| Rate for Payer: Health EOS Commercial |
$3,834.12
|
| Rate for Payer: HFN Commercial |
$3,963.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,231.00
|
| Rate for Payer: Multiplan Commercial |
$3,446.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,584.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,963.36
|
| Rate for Payer: Quartz Beloit One Network |
$2,110.92
|
| Rate for Payer: Quartz Commercial |
$2,800.20
|
| Rate for Payer: Quartz Medicare Advantage |
$2,584.80
|
| Rate for Payer: The Alliance Commercial |
$17,232.00
|
| Rate for Payer: United Healthcare PPO |
$3,231.00
|
| Rate for Payer: WEA Trust Commercial |
$2,369.40
|
| Rate for Payer: WPS Commercial |
$3,190.94
|
|
|
BCE VL Echo Stress Test Chemical
|
Facility
|
IP
|
$4,308.00
|
|
|
Service Code
|
CPT 93350 TC
|
| Hospital Charge Code |
3114959
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$2,110.92 |
| Max. Negotiated Rate |
$3,963.36 |
| Rate for Payer: Aetna Commercial |
$3,877.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,704.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,283.24
|
| Rate for Payer: Cash Price |
$1,292.40
|
| Rate for Payer: Cigna Commercial |
$3,963.36
|
| Rate for Payer: Health EOS Commercial |
$3,834.12
|
| Rate for Payer: HFN Commercial |
$3,963.36
|
| Rate for Payer: Multiplan Commercial |
$3,446.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,584.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,963.36
|
| Rate for Payer: Quartz Beloit One Network |
$2,110.92
|
| Rate for Payer: Quartz Commercial |
$2,584.80
|
| Rate for Payer: WEA Trust Commercial |
$2,369.40
|
| Rate for Payer: WPS Commercial |
$3,190.94
|
|
|
BCE VL Guided Needle Placement
|
Professional
|
Both
|
$1,493.00
|
|
|
Service Code
|
CPT 76942 TC
|
| Hospital Charge Code |
5374692
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$90.86 |
| Max. Negotiated Rate |
$1,418.35 |
| Rate for Payer: Aetna Commercial |
$1,418.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,283.98
|
| Rate for Payer: Cash Price |
$447.90
|
| Rate for Payer: Cash Price |
$447.90
|
| Rate for Payer: Cigna Commercial |
$1,418.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$746.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$895.80
|
| Rate for Payer: Health EOS Commercial |
$1,358.63
|
| Rate for Payer: HFN Commercial |
$1,418.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$90.86
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$90.86
|
| Rate for Payer: Multiplan Commercial |
$1,194.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,418.35
|
| Rate for Payer: Quartz Beloit One Network |
$656.92
|
| Rate for Payer: Quartz Commercial |
$851.01
|
| Rate for Payer: The Alliance Commercial |
$746.50
|
| Rate for Payer: WEA Trust Commercial |
$821.15
|
| Rate for Payer: WPS Commercial |
$1,105.87
|
|
|
BCE VL Guided Needle Placement
|
Facility
|
IP
|
$1,493.00
|
|
|
Service Code
|
CPT 76942 TC
|
| Hospital Charge Code |
5374692
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$731.57 |
| Max. Negotiated Rate |
$1,373.56 |
| Rate for Payer: Aetna Commercial |
$1,343.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,283.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$791.29
|
| Rate for Payer: Cash Price |
$447.90
|
| Rate for Payer: Cigna Commercial |
$1,373.56
|
| Rate for Payer: Health EOS Commercial |
$1,328.77
|
| Rate for Payer: HFN Commercial |
$1,373.56
|
| Rate for Payer: Multiplan Commercial |
$1,194.40
|
| Rate for Payer: NAPHCARE Commercial |
$895.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,373.56
|
| Rate for Payer: Quartz Beloit One Network |
$731.57
|
| Rate for Payer: Quartz Commercial |
$895.80
|
| Rate for Payer: WEA Trust Commercial |
$821.15
|
| Rate for Payer: WPS Commercial |
$1,105.87
|
|
|
BCE VL Guided Needle Placement
|
Facility
|
OP
|
$1,493.00
|
|
|
Service Code
|
CPT 76942 TC
|
| Hospital Charge Code |
5374692
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$5,972.00 |
| Rate for Payer: Aetna Commercial |
$1,343.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,283.98
|
| Rate for Payer: Aetna Managed Medicare |
$418.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$970.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$746.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$716.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$791.29
|
| Rate for Payer: Cash Price |
$447.90
|
| Rate for Payer: Cash Price |
$447.90
|
| Rate for Payer: Cigna Commercial |
$1,373.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$835.48
|
| Rate for Payer: Health EOS Commercial |
$1,328.77
|
| Rate for Payer: HFN Commercial |
$1,373.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,119.75
|
| Rate for Payer: Multiplan Commercial |
$1,194.40
|
| Rate for Payer: NAPHCARE Commercial |
$895.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,373.56
|
| Rate for Payer: Quartz Beloit One Network |
$731.57
|
| Rate for Payer: Quartz Commercial |
$970.45
|
| Rate for Payer: Quartz Medicare Advantage |
$895.80
|
| Rate for Payer: The Alliance Commercial |
$5,972.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$821.15
|
| Rate for Payer: WPS Commercial |
$1,105.87
|
|
|
BCE VL Iliac Vasculature Duplex Comp Bilat
|
Facility
|
OP
|
$1,975.00
|
|
|
Service Code
|
CPT 93978 TC
|
| Hospital Charge Code |
3114961
|
|
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 Iliac Vasculature Duplex Comp Bilat
|
Facility
|
IP
|
$1,975.00
|
|
|
Service Code
|
CPT 93978 TC
|
| Hospital Charge Code |
3114961
|
|
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: Aetna Gatekeeper/Not Gatekeeper |
$1,698.50
|
| 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 Iliac Vasculature Duplex Comp Bilat
|
Professional
|
Both
|
$1,975.00
|
|
|
Service Code
|
CPT 93978 TC
|
| Hospital Charge Code |
3114961
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$508.92 |
| 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: 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 |
$1,185.00
|
| Rate for Payer: Health EOS Commercial |
$1,797.25
|
| Rate for Payer: HFN Commercial |
$1,876.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$508.92
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$508.92
|
| 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: The Alliance Commercial |
$987.50
|
| Rate for Payer: WEA Trust Commercial |
$1,086.25
|
| Rate for Payer: WPS Commercial |
$1,462.88
|
|
|
BCE VL Iliac Vasculature Duplex Left
|
Facility
|
IP
|
$1,234.00
|
|
|
Service Code
|
CPT 93979 TC,LT
|
| Hospital Charge Code |
3114962
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$604.66 |
| Max. Negotiated Rate |
$1,135.28 |
| Rate for Payer: Aetna Commercial |
$1,110.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,061.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$654.02
|
| Rate for Payer: Cash Price |
$370.20
|
| Rate for Payer: Cigna Commercial |
$1,135.28
|
| Rate for Payer: Health EOS Commercial |
$1,098.26
|
| Rate for Payer: HFN Commercial |
$1,135.28
|
| Rate for Payer: Multiplan Commercial |
$987.20
|
| Rate for Payer: NAPHCARE Commercial |
$740.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,135.28
|
| Rate for Payer: Quartz Beloit One Network |
$604.66
|
| Rate for Payer: Quartz Commercial |
$740.40
|
| Rate for Payer: WEA Trust Commercial |
$678.70
|
| Rate for Payer: WPS Commercial |
$914.02
|
|
|
BCE VL Iliac Vasculature Duplex Left
|
Professional
|
Both
|
$1,234.00
|
|
|
Service Code
|
CPT 93979 TC,LT
|
| Hospital Charge Code |
3114962
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$542.96 |
| Max. Negotiated Rate |
$1,172.30 |
| Rate for Payer: Aetna Commercial |
$1,172.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,061.24
|
| Rate for Payer: Cash Price |
$370.20
|
| Rate for Payer: Cash Price |
$370.20
|
| Rate for Payer: Cigna Commercial |
$1,172.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$617.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$740.40
|
| Rate for Payer: Health EOS Commercial |
$1,122.94
|
| Rate for Payer: HFN Commercial |
$1,172.30
|
| Rate for Payer: Multiplan Commercial |
$987.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,172.30
|
| Rate for Payer: Quartz Beloit One Network |
$542.96
|
| Rate for Payer: Quartz Commercial |
$703.38
|
| Rate for Payer: The Alliance Commercial |
$617.00
|
| Rate for Payer: WEA Trust Commercial |
$678.70
|
| Rate for Payer: WPS Commercial |
$914.02
|
|
|
BCE VL Iliac Vasculature Duplex Left
|
Facility
|
OP
|
$1,234.00
|
|
|
Service Code
|
CPT 93979 TC,LT
|
| Hospital Charge Code |
3114962
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$345.52 |
| Max. Negotiated Rate |
$4,936.00 |
| Rate for Payer: Aetna Commercial |
$1,110.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,061.24
|
| Rate for Payer: Aetna Managed Medicare |
$345.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$802.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$617.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$592.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$654.02
|
| Rate for Payer: Cash Price |
$370.20
|
| Rate for Payer: Cigna Commercial |
$1,135.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$690.55
|
| Rate for Payer: Health EOS Commercial |
$1,098.26
|
| Rate for Payer: HFN Commercial |
$1,135.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$925.50
|
| Rate for Payer: Multiplan Commercial |
$987.20
|
| Rate for Payer: NAPHCARE Commercial |
$740.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,135.28
|
| Rate for Payer: Quartz Beloit One Network |
$604.66
|
| Rate for Payer: Quartz Commercial |
$802.10
|
| Rate for Payer: Quartz Medicare Advantage |
$740.40
|
| Rate for Payer: The Alliance Commercial |
$4,936.00
|
| Rate for Payer: United Healthcare PPO |
$925.50
|
| Rate for Payer: WEA Trust Commercial |
$678.70
|
| Rate for Payer: WPS Commercial |
$914.02
|
|
|
BCE VL Iliac Vasculature Duplex Right
|
Professional
|
Both
|
$1,234.00
|
|
|
Service Code
|
CPT 93979 TC,RT
|
| Hospital Charge Code |
3114963
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$542.96 |
| Max. Negotiated Rate |
$1,172.30 |
| Rate for Payer: Aetna Commercial |
$1,172.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,061.24
|
| Rate for Payer: Cash Price |
$370.20
|
| Rate for Payer: Cash Price |
$370.20
|
| Rate for Payer: Cigna Commercial |
$1,172.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$617.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$740.40
|
| Rate for Payer: Health EOS Commercial |
$1,122.94
|
| Rate for Payer: HFN Commercial |
$1,172.30
|
| Rate for Payer: Multiplan Commercial |
$987.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,172.30
|
| Rate for Payer: Quartz Beloit One Network |
$542.96
|
| Rate for Payer: Quartz Commercial |
$703.38
|
| Rate for Payer: The Alliance Commercial |
$617.00
|
| Rate for Payer: WEA Trust Commercial |
$678.70
|
| Rate for Payer: WPS Commercial |
$914.02
|
|
|
BCE VL Iliac Vasculature Duplex Right
|
Facility
|
OP
|
$1,234.00
|
|
|
Service Code
|
CPT 93979 TC,RT
|
| Hospital Charge Code |
3114963
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$345.52 |
| Max. Negotiated Rate |
$4,936.00 |
| Rate for Payer: Aetna Commercial |
$1,110.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,061.24
|
| Rate for Payer: Aetna Managed Medicare |
$345.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$802.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$617.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$592.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$654.02
|
| Rate for Payer: Cash Price |
$370.20
|
| Rate for Payer: Cigna Commercial |
$1,135.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$690.55
|
| Rate for Payer: Health EOS Commercial |
$1,098.26
|
| Rate for Payer: HFN Commercial |
$1,135.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$925.50
|
| Rate for Payer: Multiplan Commercial |
$987.20
|
| Rate for Payer: NAPHCARE Commercial |
$740.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,135.28
|
| Rate for Payer: Quartz Beloit One Network |
$604.66
|
| Rate for Payer: Quartz Commercial |
$802.10
|
| Rate for Payer: Quartz Medicare Advantage |
$740.40
|
| Rate for Payer: The Alliance Commercial |
$4,936.00
|
| Rate for Payer: United Healthcare PPO |
$925.50
|
| Rate for Payer: WEA Trust Commercial |
$678.70
|
| Rate for Payer: WPS Commercial |
$914.02
|
|
|
BCE VL Iliac Vasculature Duplex Right
|
Facility
|
IP
|
$1,234.00
|
|
|
Service Code
|
CPT 93979 TC,RT
|
| Hospital Charge Code |
3114963
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$604.66 |
| Max. Negotiated Rate |
$1,135.28 |
| Rate for Payer: Aetna Commercial |
$1,110.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,061.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$654.02
|
| Rate for Payer: Cash Price |
$370.20
|
| Rate for Payer: Cigna Commercial |
$1,135.28
|
| Rate for Payer: Health EOS Commercial |
$1,098.26
|
| Rate for Payer: HFN Commercial |
$1,135.28
|
| Rate for Payer: Multiplan Commercial |
$987.20
|
| Rate for Payer: NAPHCARE Commercial |
$740.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,135.28
|
| Rate for Payer: Quartz Beloit One Network |
$604.66
|
| Rate for Payer: Quartz Commercial |
$740.40
|
| Rate for Payer: WEA Trust Commercial |
$678.70
|
| Rate for Payer: WPS Commercial |
$914.02
|
|
|
BCE VL LE Arterial Duplex Bilateral
|
Facility
|
OP
|
$2,194.00
|
|
|
Service Code
|
CPT 93925 TC
|
| Hospital Charge Code |
3114964
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$614.32 |
| Max. Negotiated Rate |
$8,776.00 |
| Rate for Payer: Aetna Commercial |
$1,974.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,886.84
|
| Rate for Payer: Aetna Managed Medicare |
$614.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,426.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,097.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,053.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,162.82
|
| Rate for Payer: Cash Price |
$658.20
|
| Rate for Payer: Cigna Commercial |
$2,018.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,227.76
|
| Rate for Payer: Health EOS Commercial |
$1,952.66
|
| Rate for Payer: HFN Commercial |
$2,018.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,645.50
|
| Rate for Payer: Multiplan Commercial |
$1,755.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,316.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,018.48
|
| Rate for Payer: Quartz Beloit One Network |
$1,075.06
|
| Rate for Payer: Quartz Commercial |
$1,426.10
|
| Rate for Payer: Quartz Medicare Advantage |
$1,316.40
|
| Rate for Payer: The Alliance Commercial |
$8,776.00
|
| Rate for Payer: United Healthcare PPO |
$1,645.50
|
| Rate for Payer: WEA Trust Commercial |
$1,206.70
|
| Rate for Payer: WPS Commercial |
$1,625.10
|
|
|
BCE VL LE Arterial Duplex Bilateral
|
Facility
|
IP
|
$2,194.00
|
|
|
Service Code
|
CPT 93925 TC
|
| Hospital Charge Code |
3114964
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$1,075.06 |
| Max. Negotiated Rate |
$2,018.48 |
| Rate for Payer: Aetna Commercial |
$1,974.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,886.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,162.82
|
| Rate for Payer: Cash Price |
$658.20
|
| Rate for Payer: Cigna Commercial |
$2,018.48
|
| Rate for Payer: Health EOS Commercial |
$1,952.66
|
| Rate for Payer: HFN Commercial |
$2,018.48
|
| Rate for Payer: Multiplan Commercial |
$1,755.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,316.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,018.48
|
| Rate for Payer: Quartz Beloit One Network |
$1,075.06
|
| Rate for Payer: Quartz Commercial |
$1,316.40
|
| Rate for Payer: WEA Trust Commercial |
$1,206.70
|
| Rate for Payer: WPS Commercial |
$1,625.10
|
|
|
BCE VL LE Arterial Duplex Bilateral
|
Professional
|
Both
|
$2,194.00
|
|
|
Service Code
|
CPT 93925 TC
|
| Hospital Charge Code |
3114964
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$733.60 |
| Max. Negotiated Rate |
$2,084.30 |
| Rate for Payer: Aetna Commercial |
$2,084.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,886.84
|
| Rate for Payer: Cash Price |
$658.20
|
| Rate for Payer: Cash Price |
$658.20
|
| Rate for Payer: Cigna Commercial |
$2,084.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,097.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,316.40
|
| Rate for Payer: Health EOS Commercial |
$1,996.54
|
| Rate for Payer: HFN Commercial |
$2,084.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$733.60
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$733.60
|
| Rate for Payer: Multiplan Commercial |
$1,755.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,084.30
|
| Rate for Payer: Quartz Beloit One Network |
$965.36
|
| Rate for Payer: Quartz Commercial |
$1,250.58
|
| Rate for Payer: The Alliance Commercial |
$1,097.00
|
| Rate for Payer: WEA Trust Commercial |
$1,206.70
|
| Rate for Payer: WPS Commercial |
$1,625.10
|
|
|
BCE VL LE Arterial Duplex Left
|
Facility
|
IP
|
$1,227.00
|
|
|
Service Code
|
CPT 93926 TC,LT
|
| Hospital Charge Code |
3114965
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$601.23 |
| Max. Negotiated Rate |
$1,128.84 |
| Rate for Payer: Aetna Commercial |
$1,104.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,055.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$650.31
|
| Rate for Payer: Cash Price |
$368.10
|
| Rate for Payer: Cigna Commercial |
$1,128.84
|
| Rate for Payer: Health EOS Commercial |
$1,092.03
|
| Rate for Payer: HFN Commercial |
$1,128.84
|
| Rate for Payer: Multiplan Commercial |
$981.60
|
| Rate for Payer: NAPHCARE Commercial |
$736.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,128.84
|
| Rate for Payer: Quartz Beloit One Network |
$601.23
|
| Rate for Payer: Quartz Commercial |
$736.20
|
| Rate for Payer: WEA Trust Commercial |
$674.85
|
| Rate for Payer: WPS Commercial |
$908.84
|
|
|
BCE VL LE Arterial Duplex Left
|
Facility
|
OP
|
$1,227.00
|
|
|
Service Code
|
CPT 93926 TC,LT
|
| Hospital Charge Code |
3114965
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$343.56 |
| Max. Negotiated Rate |
$4,908.00 |
| Rate for Payer: Aetna Commercial |
$1,104.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,055.22
|
| Rate for Payer: Aetna Managed Medicare |
$343.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$797.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$613.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$588.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$650.31
|
| Rate for Payer: Cash Price |
$368.10
|
| Rate for Payer: Cigna Commercial |
$1,128.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$686.63
|
| Rate for Payer: Health EOS Commercial |
$1,092.03
|
| Rate for Payer: HFN Commercial |
$1,128.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$920.25
|
| Rate for Payer: Multiplan Commercial |
$981.60
|
| Rate for Payer: NAPHCARE Commercial |
$736.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,128.84
|
| Rate for Payer: Quartz Beloit One Network |
$601.23
|
| Rate for Payer: Quartz Commercial |
$797.55
|
| Rate for Payer: Quartz Medicare Advantage |
$736.20
|
| Rate for Payer: The Alliance Commercial |
$4,908.00
|
| Rate for Payer: United Healthcare PPO |
$920.25
|
| Rate for Payer: WEA Trust Commercial |
$674.85
|
| Rate for Payer: WPS Commercial |
$908.84
|
|
|
BCE VL LE Arterial Duplex Left
|
Professional
|
Both
|
$1,227.00
|
|
|
Service Code
|
CPT 93926 TC,LT
|
| Hospital Charge Code |
3114965
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$539.88 |
| Max. Negotiated Rate |
$1,165.65 |
| Rate for Payer: Aetna Commercial |
$1,165.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,055.22
|
| Rate for Payer: Cash Price |
$368.10
|
| Rate for Payer: Cash Price |
$368.10
|
| Rate for Payer: Cigna Commercial |
$1,165.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$613.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$736.20
|
| Rate for Payer: Health EOS Commercial |
$1,116.57
|
| Rate for Payer: HFN Commercial |
$1,165.65
|
| Rate for Payer: Multiplan Commercial |
$981.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,165.65
|
| Rate for Payer: Quartz Beloit One Network |
$539.88
|
| Rate for Payer: Quartz Commercial |
$699.39
|
| Rate for Payer: The Alliance Commercial |
$613.50
|
| Rate for Payer: WEA Trust Commercial |
$674.85
|
| Rate for Payer: WPS Commercial |
$908.84
|
|
