|
BCE VL Lower Extremity PVR w Excerise
|
Facility
|
IP
|
$1,924.00
|
|
|
Service Code
|
CPT 93924 TC
|
| Hospital Charge Code |
3114971
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$942.76 |
| Max. Negotiated Rate |
$1,770.08 |
| Rate for Payer: Aetna Commercial |
$1,731.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,654.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,019.72
|
| Rate for Payer: Cash Price |
$577.20
|
| Rate for Payer: Cigna Commercial |
$1,770.08
|
| Rate for Payer: Health EOS Commercial |
$1,712.36
|
| Rate for Payer: HFN Commercial |
$1,770.08
|
| Rate for Payer: Multiplan Commercial |
$1,539.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,154.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,770.08
|
| Rate for Payer: Quartz Beloit One Network |
$942.76
|
| Rate for Payer: Quartz Commercial |
$1,154.40
|
| Rate for Payer: WEA Trust Commercial |
$1,058.20
|
| Rate for Payer: WPS Commercial |
$1,425.11
|
|
|
BCE VL Lower Extremity PVR w Excerise
|
Facility
|
OP
|
$1,924.00
|
|
|
Service Code
|
CPT 93924 TC
|
| Hospital Charge Code |
3114971
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$538.72 |
| Max. Negotiated Rate |
$7,696.00 |
| Rate for Payer: Aetna Commercial |
$1,731.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,654.64
|
| Rate for Payer: Aetna Managed Medicare |
$538.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,250.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$962.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$923.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,019.72
|
| Rate for Payer: Cash Price |
$577.20
|
| Rate for Payer: Cigna Commercial |
$1,770.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,076.67
|
| Rate for Payer: Health EOS Commercial |
$1,712.36
|
| Rate for Payer: HFN Commercial |
$1,770.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,443.00
|
| Rate for Payer: Multiplan Commercial |
$1,539.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,154.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,770.08
|
| Rate for Payer: Quartz Beloit One Network |
$942.76
|
| Rate for Payer: Quartz Commercial |
$1,250.60
|
| Rate for Payer: Quartz Medicare Advantage |
$1,154.40
|
| Rate for Payer: The Alliance Commercial |
$7,696.00
|
| Rate for Payer: United Healthcare PPO |
$1,443.00
|
| Rate for Payer: WEA Trust Commercial |
$1,058.20
|
| Rate for Payer: WPS Commercial |
$1,425.11
|
|
|
BCE VL TEE Adult
|
Facility
|
IP
|
$3,327.00
|
|
|
Service Code
|
CPT 93312 TC
|
| Hospital Charge Code |
3114972
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$1,630.23 |
| Max. Negotiated Rate |
$3,060.84 |
| Rate for Payer: Aetna Commercial |
$2,994.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,861.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,763.31
|
| Rate for Payer: Cash Price |
$998.10
|
| Rate for Payer: Cigna Commercial |
$3,060.84
|
| Rate for Payer: Health EOS Commercial |
$2,961.03
|
| Rate for Payer: HFN Commercial |
$3,060.84
|
| Rate for Payer: Multiplan Commercial |
$2,661.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,996.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,060.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,630.23
|
| Rate for Payer: Quartz Commercial |
$1,996.20
|
| Rate for Payer: WEA Trust Commercial |
$1,829.85
|
| Rate for Payer: WPS Commercial |
$2,464.31
|
|
|
BCE VL TEE Adult
|
Professional
|
Both
|
$3,327.00
|
|
|
Service Code
|
CPT 93312 TC
|
| Hospital Charge Code |
3114972
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$474.11 |
| Max. Negotiated Rate |
$3,160.65 |
| Rate for Payer: Aetna Commercial |
$3,160.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,861.22
|
| Rate for Payer: Cash Price |
$998.10
|
| Rate for Payer: Cash Price |
$998.10
|
| Rate for Payer: Cigna Commercial |
$3,160.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,663.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,996.20
|
| Rate for Payer: Health EOS Commercial |
$3,027.57
|
| Rate for Payer: HFN Commercial |
$3,160.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$474.11
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$474.11
|
| Rate for Payer: Multiplan Commercial |
$2,661.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,160.65
|
| Rate for Payer: Quartz Beloit One Network |
$1,463.88
|
| Rate for Payer: Quartz Commercial |
$1,896.39
|
| Rate for Payer: The Alliance Commercial |
$1,663.50
|
| Rate for Payer: WEA Trust Commercial |
$1,829.85
|
| Rate for Payer: WPS Commercial |
$2,464.31
|
|
|
BCE VL TEE Adult
|
Facility
|
OP
|
$3,327.00
|
|
|
Service Code
|
CPT 93312 TC
|
| Hospital Charge Code |
3114972
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$931.56 |
| Max. Negotiated Rate |
$13,308.00 |
| Rate for Payer: Aetna Commercial |
$2,994.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,861.22
|
| Rate for Payer: Aetna Managed Medicare |
$931.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,162.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,663.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,596.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,763.31
|
| Rate for Payer: Cash Price |
$998.10
|
| Rate for Payer: Cigna Commercial |
$3,060.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,861.79
|
| Rate for Payer: Health EOS Commercial |
$2,961.03
|
| Rate for Payer: HFN Commercial |
$3,060.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,495.25
|
| Rate for Payer: Multiplan Commercial |
$2,661.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,996.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,060.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,630.23
|
| Rate for Payer: Quartz Commercial |
$2,162.55
|
| Rate for Payer: Quartz Medicare Advantage |
$1,996.20
|
| Rate for Payer: The Alliance Commercial |
$13,308.00
|
| Rate for Payer: United Healthcare PPO |
$2,495.25
|
| Rate for Payer: WEA Trust Commercial |
$1,829.85
|
| Rate for Payer: WPS Commercial |
$2,464.31
|
|
|
BCE VL TEE Congenital Cardiac Abnormalities
|
Professional
|
Both
|
$4,666.00
|
|
|
Service Code
|
CPT 93315 TC
|
| Hospital Charge Code |
3114973
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$527.38 |
| Max. Negotiated Rate |
$4,432.70 |
| Rate for Payer: Aetna Commercial |
$4,432.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,012.76
|
| Rate for Payer: Cash Price |
$1,399.80
|
| Rate for Payer: Cash Price |
$1,399.80
|
| Rate for Payer: Cigna Commercial |
$4,432.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,333.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,799.60
|
| Rate for Payer: Health EOS Commercial |
$4,246.06
|
| Rate for Payer: HFN Commercial |
$4,432.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$527.38
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$527.38
|
| Rate for Payer: Multiplan Commercial |
$3,732.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,432.70
|
| Rate for Payer: Quartz Beloit One Network |
$2,053.04
|
| Rate for Payer: Quartz Commercial |
$2,659.62
|
| Rate for Payer: The Alliance Commercial |
$2,333.00
|
| Rate for Payer: WEA Trust Commercial |
$2,566.30
|
| Rate for Payer: WPS Commercial |
$3,456.11
|
|
|
BCE VL TEE Congenital Cardiac Abnormalities
|
Facility
|
IP
|
$4,666.00
|
|
|
Service Code
|
CPT 93315 TC
|
| Hospital Charge Code |
3114973
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$2,286.34 |
| Max. Negotiated Rate |
$4,292.72 |
| Rate for Payer: Aetna Commercial |
$4,199.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,012.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,472.98
|
| Rate for Payer: Cash Price |
$1,399.80
|
| Rate for Payer: Cigna Commercial |
$4,292.72
|
| Rate for Payer: Health EOS Commercial |
$4,152.74
|
| Rate for Payer: HFN Commercial |
$4,292.72
|
| Rate for Payer: Multiplan Commercial |
$3,732.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,799.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,292.72
|
| Rate for Payer: Quartz Beloit One Network |
$2,286.34
|
| Rate for Payer: Quartz Commercial |
$2,799.60
|
| Rate for Payer: WEA Trust Commercial |
$2,566.30
|
| Rate for Payer: WPS Commercial |
$3,456.11
|
|
|
BCE VL TEE Congenital Cardiac Abnormalities
|
Facility
|
OP
|
$4,666.00
|
|
|
Service Code
|
CPT 93315 TC
|
| Hospital Charge Code |
3114973
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$1,306.48 |
| Max. Negotiated Rate |
$18,664.00 |
| Rate for Payer: Aetna Commercial |
$4,199.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,012.76
|
| Rate for Payer: Aetna Managed Medicare |
$1,306.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,032.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,333.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,239.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,472.98
|
| Rate for Payer: Cash Price |
$1,399.80
|
| Rate for Payer: Cigna Commercial |
$4,292.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,611.09
|
| Rate for Payer: Health EOS Commercial |
$4,152.74
|
| Rate for Payer: HFN Commercial |
$4,292.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,499.50
|
| Rate for Payer: Multiplan Commercial |
$3,732.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,799.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,292.72
|
| Rate for Payer: Quartz Beloit One Network |
$2,286.34
|
| Rate for Payer: Quartz Commercial |
$3,032.90
|
| Rate for Payer: Quartz Medicare Advantage |
$2,799.60
|
| Rate for Payer: The Alliance Commercial |
$18,664.00
|
| Rate for Payer: United Healthcare PPO |
$3,499.50
|
| Rate for Payer: WEA Trust Commercial |
$2,566.30
|
| Rate for Payer: WPS Commercial |
$3,456.11
|
|
|
BCE VL TEE Imaging Only
|
Professional
|
Both
|
$3,917.00
|
|
|
Service Code
|
CPT 93314 TC
|
| Hospital Charge Code |
3114975
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$504.26 |
| Max. Negotiated Rate |
$3,721.15 |
| Rate for Payer: Aetna Commercial |
$3,721.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,368.62
|
| Rate for Payer: Cash Price |
$1,175.10
|
| Rate for Payer: Cash Price |
$1,175.10
|
| Rate for Payer: Cigna Commercial |
$3,721.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,958.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,350.20
|
| Rate for Payer: Health EOS Commercial |
$3,564.47
|
| Rate for Payer: HFN Commercial |
$3,721.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$504.26
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$504.26
|
| Rate for Payer: Multiplan Commercial |
$3,133.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,721.15
|
| Rate for Payer: Quartz Beloit One Network |
$1,723.48
|
| Rate for Payer: Quartz Commercial |
$2,232.69
|
| Rate for Payer: The Alliance Commercial |
$1,958.50
|
| Rate for Payer: WEA Trust Commercial |
$2,154.35
|
| Rate for Payer: WPS Commercial |
$2,901.32
|
|
|
BCE VL TEE Imaging Only
|
Facility
|
OP
|
$3,917.00
|
|
|
Service Code
|
CPT 93314 TC
|
| Hospital Charge Code |
3114975
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$1,096.76 |
| Max. Negotiated Rate |
$15,668.00 |
| Rate for Payer: Aetna Commercial |
$3,525.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,368.62
|
| Rate for Payer: Aetna Managed Medicare |
$1,096.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,546.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,958.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,880.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,076.01
|
| Rate for Payer: Cash Price |
$1,175.10
|
| Rate for Payer: Cigna Commercial |
$3,603.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,191.95
|
| Rate for Payer: Health EOS Commercial |
$3,486.13
|
| Rate for Payer: HFN Commercial |
$3,603.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,937.75
|
| Rate for Payer: Multiplan Commercial |
$3,133.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,350.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,603.64
|
| Rate for Payer: Quartz Beloit One Network |
$1,919.33
|
| Rate for Payer: Quartz Commercial |
$2,546.05
|
| Rate for Payer: Quartz Medicare Advantage |
$2,350.20
|
| Rate for Payer: The Alliance Commercial |
$15,668.00
|
| Rate for Payer: United Healthcare PPO |
$2,937.75
|
| Rate for Payer: WEA Trust Commercial |
$2,154.35
|
| Rate for Payer: WPS Commercial |
$2,901.32
|
|
|
BCE VL TEE Imaging Only
|
Facility
|
IP
|
$3,917.00
|
|
|
Service Code
|
CPT 93314 TC
|
| Hospital Charge Code |
3114975
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$1,919.33 |
| Max. Negotiated Rate |
$3,603.64 |
| Rate for Payer: Aetna Commercial |
$3,525.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,368.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,076.01
|
| Rate for Payer: Cash Price |
$1,175.10
|
| Rate for Payer: Cigna Commercial |
$3,603.64
|
| Rate for Payer: Health EOS Commercial |
$3,486.13
|
| Rate for Payer: HFN Commercial |
$3,603.64
|
| Rate for Payer: Multiplan Commercial |
$3,133.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,350.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,603.64
|
| Rate for Payer: Quartz Beloit One Network |
$1,919.33
|
| Rate for Payer: Quartz Commercial |
$2,350.20
|
| Rate for Payer: WEA Trust Commercial |
$2,154.35
|
| Rate for Payer: WPS Commercial |
$2,901.32
|
|
|
BCE VL TEE Ongoing assess of Cardiac Pump
|
Facility
|
OP
|
$6,243.00
|
|
|
Service Code
|
CPT 93318 TC
|
| Hospital Charge Code |
3114974
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$1,748.04 |
| Max. Negotiated Rate |
$24,972.00 |
| Rate for Payer: Aetna Commercial |
$5,618.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,368.98
|
| Rate for Payer: Aetna Managed Medicare |
$1,748.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,057.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,121.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,996.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,308.79
|
| Rate for Payer: Cash Price |
$1,872.90
|
| Rate for Payer: Cigna Commercial |
$5,743.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,493.58
|
| Rate for Payer: Health EOS Commercial |
$5,556.27
|
| Rate for Payer: HFN Commercial |
$5,743.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,682.25
|
| Rate for Payer: Multiplan Commercial |
$4,994.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,745.80
|
| Rate for Payer: Preferred Network Access Commercial |
$5,743.56
|
| Rate for Payer: Quartz Beloit One Network |
$3,059.07
|
| Rate for Payer: Quartz Commercial |
$4,057.95
|
| Rate for Payer: Quartz Medicare Advantage |
$3,745.80
|
| Rate for Payer: The Alliance Commercial |
$24,972.00
|
| Rate for Payer: United Healthcare PPO |
$4,682.25
|
| Rate for Payer: WEA Trust Commercial |
$3,433.65
|
| Rate for Payer: WPS Commercial |
$4,624.19
|
|
|
BCE VL TEE Ongoing assess of Cardiac Pump
|
Professional
|
Both
|
$6,243.00
|
|
|
Service Code
|
CPT 93318 TC
|
| Hospital Charge Code |
3114974
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$1,050.74 |
| Max. Negotiated Rate |
$5,930.85 |
| Rate for Payer: Aetna Commercial |
$5,930.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,368.98
|
| Rate for Payer: Cash Price |
$1,872.90
|
| Rate for Payer: Cash Price |
$1,872.90
|
| Rate for Payer: Cigna Commercial |
$5,930.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,121.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,745.80
|
| Rate for Payer: Health EOS Commercial |
$5,681.13
|
| Rate for Payer: HFN Commercial |
$5,930.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,050.74
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,050.74
|
| Rate for Payer: Multiplan Commercial |
$4,994.40
|
| Rate for Payer: Preferred Network Access Commercial |
$5,930.85
|
| Rate for Payer: Quartz Beloit One Network |
$2,746.92
|
| Rate for Payer: Quartz Commercial |
$3,558.51
|
| Rate for Payer: The Alliance Commercial |
$3,121.50
|
| Rate for Payer: WEA Trust Commercial |
$3,433.65
|
| Rate for Payer: WPS Commercial |
$4,624.19
|
|
|
BCE VL TEE Ongoing assess of Cardiac Pump
|
Facility
|
IP
|
$6,243.00
|
|
|
Service Code
|
CPT 93318 TC
|
| Hospital Charge Code |
3114974
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$3,059.07 |
| Max. Negotiated Rate |
$5,743.56 |
| Rate for Payer: Aetna Commercial |
$5,618.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,368.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,308.79
|
| Rate for Payer: Cash Price |
$1,872.90
|
| Rate for Payer: Cigna Commercial |
$5,743.56
|
| Rate for Payer: Health EOS Commercial |
$5,556.27
|
| Rate for Payer: HFN Commercial |
$5,743.56
|
| Rate for Payer: Multiplan Commercial |
$4,994.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,745.80
|
| Rate for Payer: Preferred Network Access Commercial |
$5,743.56
|
| Rate for Payer: Quartz Beloit One Network |
$3,059.07
|
| Rate for Payer: Quartz Commercial |
$3,745.80
|
| Rate for Payer: WEA Trust Commercial |
$3,433.65
|
| Rate for Payer: WPS Commercial |
$4,624.19
|
|
|
BCE VL Thoracic Outlet Study
|
Facility
|
OP
|
$808.00
|
|
|
Service Code
|
CPT 93923 TC
|
| Hospital Charge Code |
3114976
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$226.24 |
| Max. Negotiated Rate |
$3,232.00 |
| Rate for Payer: Aetna Commercial |
$727.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$694.88
|
| Rate for Payer: Aetna Managed Medicare |
$226.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$525.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$404.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$387.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$428.24
|
| Rate for Payer: Cash Price |
$242.40
|
| Rate for Payer: Cigna Commercial |
$743.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$452.16
|
| Rate for Payer: Health EOS Commercial |
$719.12
|
| Rate for Payer: HFN Commercial |
$743.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$606.00
|
| Rate for Payer: Multiplan Commercial |
$646.40
|
| Rate for Payer: NAPHCARE Commercial |
$484.80
|
| Rate for Payer: Preferred Network Access Commercial |
$743.36
|
| Rate for Payer: Quartz Beloit One Network |
$395.92
|
| Rate for Payer: Quartz Commercial |
$525.20
|
| Rate for Payer: Quartz Medicare Advantage |
$484.80
|
| Rate for Payer: The Alliance Commercial |
$3,232.00
|
| Rate for Payer: United Healthcare PPO |
$606.00
|
| Rate for Payer: WEA Trust Commercial |
$444.40
|
| Rate for Payer: WPS Commercial |
$598.49
|
|
|
BCE VL Thoracic Outlet Study
|
Professional
|
Both
|
$808.00
|
|
|
Service Code
|
CPT 93923 TC
|
| Hospital Charge Code |
3114976
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$355.52 |
| Max. Negotiated Rate |
$767.60 |
| Rate for Payer: Aetna Commercial |
$767.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$694.88
|
| Rate for Payer: Cash Price |
$242.40
|
| Rate for Payer: Cash Price |
$242.40
|
| Rate for Payer: Cigna Commercial |
$767.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$404.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$484.80
|
| Rate for Payer: Health EOS Commercial |
$735.28
|
| Rate for Payer: HFN Commercial |
$767.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$374.36
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$374.36
|
| Rate for Payer: Multiplan Commercial |
$646.40
|
| Rate for Payer: Preferred Network Access Commercial |
$767.60
|
| Rate for Payer: Quartz Beloit One Network |
$355.52
|
| Rate for Payer: Quartz Commercial |
$460.56
|
| Rate for Payer: The Alliance Commercial |
$404.00
|
| Rate for Payer: WEA Trust Commercial |
$444.40
|
| Rate for Payer: WPS Commercial |
$598.49
|
|
|
BCE VL Thoracic Outlet Study
|
Facility
|
IP
|
$808.00
|
|
|
Service Code
|
CPT 93923 TC
|
| Hospital Charge Code |
3114976
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$395.92 |
| Max. Negotiated Rate |
$743.36 |
| Rate for Payer: Aetna Commercial |
$727.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$694.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$428.24
|
| Rate for Payer: Cash Price |
$242.40
|
| Rate for Payer: Cigna Commercial |
$743.36
|
| Rate for Payer: Health EOS Commercial |
$719.12
|
| Rate for Payer: HFN Commercial |
$743.36
|
| Rate for Payer: Multiplan Commercial |
$646.40
|
| Rate for Payer: NAPHCARE Commercial |
$484.80
|
| Rate for Payer: Preferred Network Access Commercial |
$743.36
|
| Rate for Payer: Quartz Beloit One Network |
$395.92
|
| Rate for Payer: Quartz Commercial |
$484.80
|
| Rate for Payer: WEA Trust Commercial |
$444.40
|
| Rate for Payer: WPS Commercial |
$598.49
|
|
|
BCE VL UE Arterial Duplex Bilateral
|
Professional
|
Both
|
$1,630.00
|
|
|
Service Code
|
CPT 93930 TC
|
| Hospital Charge Code |
3114977
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$566.53 |
| Max. Negotiated Rate |
$1,548.50 |
| Rate for Payer: Aetna Commercial |
$1,548.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,401.80
|
| Rate for Payer: Cash Price |
$489.00
|
| Rate for Payer: Cash Price |
$489.00
|
| Rate for Payer: Cigna Commercial |
$1,548.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$815.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$978.00
|
| Rate for Payer: Health EOS Commercial |
$1,483.30
|
| Rate for Payer: HFN Commercial |
$1,548.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$566.53
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$566.53
|
| Rate for Payer: Multiplan Commercial |
$1,304.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,548.50
|
| Rate for Payer: Quartz Beloit One Network |
$717.20
|
| Rate for Payer: Quartz Commercial |
$929.10
|
| Rate for Payer: The Alliance Commercial |
$815.00
|
| Rate for Payer: WEA Trust Commercial |
$896.50
|
| Rate for Payer: WPS Commercial |
$1,207.34
|
|
|
BCE VL UE Arterial Duplex Bilateral
|
Facility
|
OP
|
$1,630.00
|
|
|
Service Code
|
CPT 93930 TC
|
| Hospital Charge Code |
3114977
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$456.40 |
| Max. Negotiated Rate |
$6,520.00 |
| Rate for Payer: Aetna Commercial |
$1,467.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,401.80
|
| Rate for Payer: Aetna Managed Medicare |
$456.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,059.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$815.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$782.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$863.90
|
| Rate for Payer: Cash Price |
$489.00
|
| Rate for Payer: Cigna Commercial |
$1,499.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$912.15
|
| Rate for Payer: Health EOS Commercial |
$1,450.70
|
| Rate for Payer: HFN Commercial |
$1,499.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,222.50
|
| Rate for Payer: Multiplan Commercial |
$1,304.00
|
| Rate for Payer: NAPHCARE Commercial |
$978.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,499.60
|
| Rate for Payer: Quartz Beloit One Network |
$798.70
|
| Rate for Payer: Quartz Commercial |
$1,059.50
|
| Rate for Payer: Quartz Medicare Advantage |
$978.00
|
| Rate for Payer: The Alliance Commercial |
$6,520.00
|
| Rate for Payer: United Healthcare PPO |
$1,222.50
|
| Rate for Payer: WEA Trust Commercial |
$896.50
|
| Rate for Payer: WPS Commercial |
$1,207.34
|
|
|
BCE VL UE Arterial Duplex Bilateral
|
Facility
|
IP
|
$1,630.00
|
|
|
Service Code
|
CPT 93930 TC
|
| Hospital Charge Code |
3114977
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$798.70 |
| Max. Negotiated Rate |
$1,499.60 |
| Rate for Payer: Aetna Commercial |
$1,467.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,401.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$863.90
|
| Rate for Payer: Cash Price |
$489.00
|
| Rate for Payer: Cigna Commercial |
$1,499.60
|
| Rate for Payer: Health EOS Commercial |
$1,450.70
|
| Rate for Payer: HFN Commercial |
$1,499.60
|
| Rate for Payer: Multiplan Commercial |
$1,304.00
|
| Rate for Payer: NAPHCARE Commercial |
$978.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,499.60
|
| Rate for Payer: Quartz Beloit One Network |
$798.70
|
| Rate for Payer: Quartz Commercial |
$978.00
|
| Rate for Payer: WEA Trust Commercial |
$896.50
|
| Rate for Payer: WPS Commercial |
$1,207.34
|
|
|
BCE VL UE Arterial Duplex Left
|
Facility
|
IP
|
$1,135.00
|
|
|
Service Code
|
CPT 93931 TC,LT
|
| Hospital Charge Code |
3114978
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$556.15 |
| Max. Negotiated Rate |
$1,044.20 |
| Rate for Payer: Aetna Commercial |
$1,021.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$976.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$601.55
|
| Rate for Payer: Cash Price |
$340.50
|
| Rate for Payer: Cigna Commercial |
$1,044.20
|
| Rate for Payer: Health EOS Commercial |
$1,010.15
|
| Rate for Payer: HFN Commercial |
$1,044.20
|
| Rate for Payer: Multiplan Commercial |
$908.00
|
| Rate for Payer: NAPHCARE Commercial |
$681.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,044.20
|
| Rate for Payer: Quartz Beloit One Network |
$556.15
|
| Rate for Payer: Quartz Commercial |
$681.00
|
| Rate for Payer: WEA Trust Commercial |
$624.25
|
| Rate for Payer: WPS Commercial |
$840.69
|
|
|
BCE VL UE Arterial Duplex Left
|
Facility
|
OP
|
$1,135.00
|
|
|
Service Code
|
CPT 93931 TC,LT
|
| Hospital Charge Code |
3114978
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$317.80 |
| Max. Negotiated Rate |
$4,540.00 |
| Rate for Payer: Aetna Commercial |
$1,021.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$976.10
|
| Rate for Payer: Aetna Managed Medicare |
$317.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$737.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$567.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$544.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$601.55
|
| Rate for Payer: Cash Price |
$340.50
|
| Rate for Payer: Cigna Commercial |
$1,044.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$635.15
|
| Rate for Payer: Health EOS Commercial |
$1,010.15
|
| Rate for Payer: HFN Commercial |
$1,044.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$851.25
|
| Rate for Payer: Multiplan Commercial |
$908.00
|
| Rate for Payer: NAPHCARE Commercial |
$681.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,044.20
|
| Rate for Payer: Quartz Beloit One Network |
$556.15
|
| Rate for Payer: Quartz Commercial |
$737.75
|
| Rate for Payer: Quartz Medicare Advantage |
$681.00
|
| Rate for Payer: The Alliance Commercial |
$4,540.00
|
| Rate for Payer: United Healthcare PPO |
$851.25
|
| Rate for Payer: WEA Trust Commercial |
$624.25
|
| Rate for Payer: WPS Commercial |
$840.69
|
|
|
BCE VL UE Arterial Duplex Left
|
Professional
|
Both
|
$1,135.00
|
|
|
Service Code
|
CPT 93931 TC,LT
|
| Hospital Charge Code |
3114978
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$499.40 |
| Max. Negotiated Rate |
$1,078.25 |
| Rate for Payer: Aetna Commercial |
$1,078.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$976.10
|
| Rate for Payer: Cash Price |
$340.50
|
| Rate for Payer: Cash Price |
$340.50
|
| Rate for Payer: Cigna Commercial |
$1,078.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$567.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$681.00
|
| Rate for Payer: Health EOS Commercial |
$1,032.85
|
| Rate for Payer: HFN Commercial |
$1,078.25
|
| Rate for Payer: Multiplan Commercial |
$908.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,078.25
|
| Rate for Payer: Quartz Beloit One Network |
$499.40
|
| Rate for Payer: Quartz Commercial |
$646.95
|
| Rate for Payer: The Alliance Commercial |
$567.50
|
| Rate for Payer: WEA Trust Commercial |
$624.25
|
| Rate for Payer: WPS Commercial |
$840.69
|
|
|
BCE VL UE Arterial Duplex Right
|
Facility
|
IP
|
$1,135.00
|
|
|
Service Code
|
CPT 93931 TC,RT
|
| Hospital Charge Code |
3114979
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$556.15 |
| Max. Negotiated Rate |
$1,044.20 |
| Rate for Payer: Aetna Commercial |
$1,021.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$976.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$601.55
|
| Rate for Payer: Cash Price |
$340.50
|
| Rate for Payer: Cigna Commercial |
$1,044.20
|
| Rate for Payer: Health EOS Commercial |
$1,010.15
|
| Rate for Payer: HFN Commercial |
$1,044.20
|
| Rate for Payer: Multiplan Commercial |
$908.00
|
| Rate for Payer: NAPHCARE Commercial |
$681.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,044.20
|
| Rate for Payer: Quartz Beloit One Network |
$556.15
|
| Rate for Payer: Quartz Commercial |
$681.00
|
| Rate for Payer: WEA Trust Commercial |
$624.25
|
| Rate for Payer: WPS Commercial |
$840.69
|
|
|
BCE VL UE Arterial Duplex Right
|
Facility
|
OP
|
$1,135.00
|
|
|
Service Code
|
CPT 93931 TC,RT
|
| Hospital Charge Code |
3114979
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$317.80 |
| Max. Negotiated Rate |
$4,540.00 |
| Rate for Payer: Aetna Commercial |
$1,021.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$976.10
|
| Rate for Payer: Aetna Managed Medicare |
$317.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$737.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$567.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$544.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$601.55
|
| Rate for Payer: Cash Price |
$340.50
|
| Rate for Payer: Cigna Commercial |
$1,044.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$635.15
|
| Rate for Payer: Health EOS Commercial |
$1,010.15
|
| Rate for Payer: HFN Commercial |
$1,044.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$851.25
|
| Rate for Payer: Multiplan Commercial |
$908.00
|
| Rate for Payer: NAPHCARE Commercial |
$681.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,044.20
|
| Rate for Payer: Quartz Beloit One Network |
$556.15
|
| Rate for Payer: Quartz Commercial |
$737.75
|
| Rate for Payer: Quartz Medicare Advantage |
$681.00
|
| Rate for Payer: The Alliance Commercial |
$4,540.00
|
| Rate for Payer: United Healthcare PPO |
$851.25
|
| Rate for Payer: WEA Trust Commercial |
$624.25
|
| Rate for Payer: WPS Commercial |
$840.69
|
|
