|
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 |
$182.02 |
| Max. Negotiated Rate |
$2,167.67 |
| Rate for Payer: Aetna Commercial |
$2,167.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,962.31
|
| Rate for Payer: Aetna Managed Medicare |
$199.10
|
| Rate for Payer: Anthem Medicare Advantage |
$199.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$199.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$199.10
|
| Rate for Payer: Cash Price |
$658.20
|
| Rate for Payer: Cash Price |
$658.20
|
| Rate for Payer: Cash Price |
$658.20
|
| Rate for Payer: Cigna Commercial |
$2,167.67
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$182.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$199.10
|
| Rate for Payer: Health EOS Commercial |
$2,076.40
|
| Rate for Payer: HFN Commercial |
$2,167.67
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$762.94
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$762.94
|
| Rate for Payer: Independent Care Health Plan Medicare |
$199.10
|
| Rate for Payer: Multiplan Commercial |
$1,825.41
|
| Rate for Payer: NAPHCARE Commercial |
$298.65
|
| Rate for Payer: Preferred Network Access Commercial |
$2,167.67
|
| Rate for Payer: Quartz Beloit One Network |
$1,003.97
|
| Rate for Payer: Quartz Commercial |
$1,300.60
|
| Rate for Payer: Quartz Medicare Advantage |
$199.10
|
| Rate for Payer: The Alliance Commercial |
$497.74
|
| Rate for Payer: United Healthcare Medicaid |
$182.02
|
| Rate for Payer: United Healthcare Medicare Advantage |
$199.10
|
| Rate for Payer: WEA Trust Commercial |
$1,254.97
|
| Rate for Payer: WPS Commercial |
$796.39
|
|
|
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 |
$151.61 |
| Max. Negotiated Rate |
$1,212.28 |
| Rate for Payer: Aetna Commercial |
$1,212.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,097.43
|
| Rate for Payer: Cash Price |
$368.10
|
| Rate for Payer: Cash Price |
$368.10
|
| Rate for Payer: Cash Price |
$368.10
|
| Rate for Payer: Cigna Commercial |
$1,212.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$151.61
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$765.65
|
| Rate for Payer: Health EOS Commercial |
$1,161.23
|
| Rate for Payer: HFN Commercial |
$1,212.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$527.66
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$527.66
|
| Rate for Payer: Multiplan Commercial |
$1,020.86
|
| Rate for Payer: Preferred Network Access Commercial |
$1,212.28
|
| Rate for Payer: Quartz Beloit One Network |
$561.48
|
| Rate for Payer: Quartz Commercial |
$727.37
|
| Rate for Payer: The Alliance Commercial |
$638.04
|
| Rate for Payer: United Healthcare Medicaid |
$151.61
|
| Rate for Payer: WEA Trust Commercial |
$701.84
|
| Rate for Payer: WPS Commercial |
$945.16
|
|
|
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 |
$357.30 |
| Max. Negotiated Rate |
$1,173.99 |
| Rate for Payer: Aetna Commercial |
$1,148.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,097.43
|
| Rate for Payer: Aetna Managed Medicare |
$357.30
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$829.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$638.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$612.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$676.32
|
| Rate for Payer: Cash Price |
$368.10
|
| Rate for Payer: Cigna Commercial |
$1,173.99
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$714.11
|
| Rate for Payer: Health EOS Commercial |
$1,135.71
|
| Rate for Payer: HFN Commercial |
$1,173.99
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$957.06
|
| Rate for Payer: Multiplan Commercial |
$1,020.86
|
| Rate for Payer: NAPHCARE Commercial |
$765.65
|
| Rate for Payer: Preferred Network Access Commercial |
$1,173.99
|
| Rate for Payer: Quartz Beloit One Network |
$625.28
|
| Rate for Payer: Quartz Commercial |
$829.45
|
| Rate for Payer: Quartz Medicare Advantage |
$765.65
|
| Rate for Payer: The Alliance Commercial |
$638.04
|
| Rate for Payer: United Healthcare PPO |
$957.06
|
| Rate for Payer: WEA Trust Commercial |
$701.84
|
| Rate for Payer: WPS Commercial |
$945.16
|
|
|
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 |
$625.28 |
| Max. Negotiated Rate |
$1,173.99 |
| Rate for Payer: Aetna Commercial |
$1,148.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,097.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$676.32
|
| Rate for Payer: Cash Price |
$368.10
|
| Rate for Payer: Cigna Commercial |
$1,173.99
|
| Rate for Payer: Health EOS Commercial |
$1,135.71
|
| Rate for Payer: HFN Commercial |
$1,173.99
|
| Rate for Payer: Multiplan Commercial |
$1,020.86
|
| Rate for Payer: Preferred Network Access Commercial |
$1,173.99
|
| Rate for Payer: Quartz Beloit One Network |
$625.28
|
| Rate for Payer: Quartz Commercial |
$765.65
|
| Rate for Payer: WEA Trust Commercial |
$701.84
|
| Rate for Payer: WPS Commercial |
$945.16
|
|
|
BCE VL LE Arterial Duplex Right
|
Professional
|
Both
|
$1,227.00
|
|
|
Service Code
|
CPT 93926 TC,RT
|
| Hospital Charge Code |
3114966
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$151.61 |
| Max. Negotiated Rate |
$1,212.28 |
| Rate for Payer: Aetna Commercial |
$1,212.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,097.43
|
| Rate for Payer: Cash Price |
$368.10
|
| Rate for Payer: Cash Price |
$368.10
|
| Rate for Payer: Cash Price |
$368.10
|
| Rate for Payer: Cigna Commercial |
$1,212.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$151.61
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$765.65
|
| Rate for Payer: Health EOS Commercial |
$1,161.23
|
| Rate for Payer: HFN Commercial |
$1,212.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$527.66
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$527.66
|
| Rate for Payer: Multiplan Commercial |
$1,020.86
|
| Rate for Payer: Preferred Network Access Commercial |
$1,212.28
|
| Rate for Payer: Quartz Beloit One Network |
$561.48
|
| Rate for Payer: Quartz Commercial |
$727.37
|
| Rate for Payer: The Alliance Commercial |
$638.04
|
| Rate for Payer: United Healthcare Medicaid |
$151.61
|
| Rate for Payer: WEA Trust Commercial |
$701.84
|
| Rate for Payer: WPS Commercial |
$945.16
|
|
|
BCE VL LE Arterial Duplex Right
|
Facility
|
IP
|
$1,227.00
|
|
|
Service Code
|
CPT 93926 TC,RT
|
| Hospital Charge Code |
3114966
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$625.28 |
| Max. Negotiated Rate |
$1,173.99 |
| Rate for Payer: Aetna Commercial |
$1,148.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,097.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$676.32
|
| Rate for Payer: Cash Price |
$368.10
|
| Rate for Payer: Cigna Commercial |
$1,173.99
|
| Rate for Payer: Health EOS Commercial |
$1,135.71
|
| Rate for Payer: HFN Commercial |
$1,173.99
|
| Rate for Payer: Multiplan Commercial |
$1,020.86
|
| Rate for Payer: Preferred Network Access Commercial |
$1,173.99
|
| Rate for Payer: Quartz Beloit One Network |
$625.28
|
| Rate for Payer: Quartz Commercial |
$765.65
|
| Rate for Payer: WEA Trust Commercial |
$701.84
|
| Rate for Payer: WPS Commercial |
$945.16
|
|
|
BCE VL LE Arterial Duplex Right
|
Facility
|
OP
|
$1,227.00
|
|
|
Service Code
|
CPT 93926 TC,RT
|
| Hospital Charge Code |
3114966
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$357.30 |
| Max. Negotiated Rate |
$1,173.99 |
| Rate for Payer: Aetna Commercial |
$1,148.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,097.43
|
| Rate for Payer: Aetna Managed Medicare |
$357.30
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$829.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$638.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$612.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$676.32
|
| Rate for Payer: Cash Price |
$368.10
|
| Rate for Payer: Cigna Commercial |
$1,173.99
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$714.11
|
| Rate for Payer: Health EOS Commercial |
$1,135.71
|
| Rate for Payer: HFN Commercial |
$1,173.99
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$957.06
|
| Rate for Payer: Multiplan Commercial |
$1,020.86
|
| Rate for Payer: NAPHCARE Commercial |
$765.65
|
| Rate for Payer: Preferred Network Access Commercial |
$1,173.99
|
| Rate for Payer: Quartz Beloit One Network |
$625.28
|
| Rate for Payer: Quartz Commercial |
$829.45
|
| Rate for Payer: Quartz Medicare Advantage |
$765.65
|
| Rate for Payer: The Alliance Commercial |
$638.04
|
| Rate for Payer: United Healthcare PPO |
$957.06
|
| Rate for Payer: WEA Trust Commercial |
$701.84
|
| Rate for Payer: WPS Commercial |
$945.16
|
|
|
BCE VL LE Arterial Graft Patency Bilateral
|
Professional
|
Both
|
$2,194.00
|
|
|
Service Code
|
CPT 93925 TC
|
| Hospital Charge Code |
5238950
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$182.02 |
| Max. Negotiated Rate |
$2,167.67 |
| Rate for Payer: Aetna Commercial |
$2,167.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,962.31
|
| Rate for Payer: Aetna Managed Medicare |
$199.10
|
| Rate for Payer: Anthem Medicare Advantage |
$199.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$199.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$199.10
|
| Rate for Payer: Cash Price |
$658.20
|
| Rate for Payer: Cash Price |
$658.20
|
| Rate for Payer: Cash Price |
$658.20
|
| Rate for Payer: Cigna Commercial |
$2,167.67
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$182.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$199.10
|
| Rate for Payer: Health EOS Commercial |
$2,076.40
|
| Rate for Payer: HFN Commercial |
$2,167.67
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$762.94
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$762.94
|
| Rate for Payer: Independent Care Health Plan Medicare |
$199.10
|
| Rate for Payer: Multiplan Commercial |
$1,825.41
|
| Rate for Payer: NAPHCARE Commercial |
$298.65
|
| Rate for Payer: Preferred Network Access Commercial |
$2,167.67
|
| Rate for Payer: Quartz Beloit One Network |
$1,003.97
|
| Rate for Payer: Quartz Commercial |
$1,300.60
|
| Rate for Payer: Quartz Medicare Advantage |
$199.10
|
| Rate for Payer: The Alliance Commercial |
$497.74
|
| Rate for Payer: United Healthcare Medicaid |
$182.02
|
| Rate for Payer: United Healthcare Medicare Advantage |
$199.10
|
| Rate for Payer: WEA Trust Commercial |
$1,254.97
|
| Rate for Payer: WPS Commercial |
$796.39
|
|
|
BCE VL LE Arterial Graft Patency Bilateral
|
Facility
|
IP
|
$2,194.00
|
|
|
Service Code
|
CPT 93925 TC
|
| Hospital Charge Code |
5238950
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$1,118.06 |
| Max. Negotiated Rate |
$2,099.22 |
| Rate for Payer: Aetna Commercial |
$2,053.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,962.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,209.33
|
| Rate for Payer: Cash Price |
$658.20
|
| Rate for Payer: Cigna Commercial |
$2,099.22
|
| Rate for Payer: Health EOS Commercial |
$2,030.77
|
| Rate for Payer: HFN Commercial |
$2,099.22
|
| Rate for Payer: Multiplan Commercial |
$1,825.41
|
| Rate for Payer: Preferred Network Access Commercial |
$2,099.22
|
| Rate for Payer: Quartz Beloit One Network |
$1,118.06
|
| Rate for Payer: Quartz Commercial |
$1,369.06
|
| Rate for Payer: WEA Trust Commercial |
$1,254.97
|
| Rate for Payer: WPS Commercial |
$1,690.04
|
|
|
BCE VL LE Arterial Graft Patency Bilateral
|
Facility
|
OP
|
$2,194.00
|
|
|
Service Code
|
CPT 93925 TC
|
| Hospital Charge Code |
5238950
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$638.89 |
| Max. Negotiated Rate |
$2,099.22 |
| Rate for Payer: Aetna Commercial |
$2,053.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,962.31
|
| Rate for Payer: Aetna Managed Medicare |
$638.89
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,483.14
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,140.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,095.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,209.33
|
| Rate for Payer: Cash Price |
$658.20
|
| Rate for Payer: Cash Price |
$658.20
|
| Rate for Payer: Cigna Commercial |
$2,099.22
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,276.91
|
| Rate for Payer: Health EOS Commercial |
$2,030.77
|
| Rate for Payer: HFN Commercial |
$2,099.22
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,711.32
|
| Rate for Payer: Multiplan Commercial |
$1,825.41
|
| Rate for Payer: NAPHCARE Commercial |
$1,369.06
|
| Rate for Payer: Preferred Network Access Commercial |
$2,099.22
|
| Rate for Payer: Quartz Beloit One Network |
$1,118.06
|
| Rate for Payer: Quartz Commercial |
$1,483.14
|
| Rate for Payer: Quartz Medicare Advantage |
$1,369.06
|
| Rate for Payer: The Alliance Commercial |
$796.39
|
| Rate for Payer: United Healthcare PPO |
$1,711.32
|
| Rate for Payer: WEA Trust Commercial |
$1,254.97
|
| Rate for Payer: WPS Commercial |
$1,690.04
|
|
|
BCE VL LE Arterial Graft Patency Left
|
Facility
|
OP
|
$1,227.00
|
|
|
Service Code
|
CPT 93926 TC,LT
|
| Hospital Charge Code |
5238951
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$357.30 |
| Max. Negotiated Rate |
$1,173.99 |
| Rate for Payer: Aetna Commercial |
$1,148.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,097.43
|
| Rate for Payer: Aetna Managed Medicare |
$357.30
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$829.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$638.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$612.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$676.32
|
| Rate for Payer: Cash Price |
$368.10
|
| Rate for Payer: Cigna Commercial |
$1,173.99
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$714.11
|
| Rate for Payer: Health EOS Commercial |
$1,135.71
|
| Rate for Payer: HFN Commercial |
$1,173.99
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$957.06
|
| Rate for Payer: Multiplan Commercial |
$1,020.86
|
| Rate for Payer: NAPHCARE Commercial |
$765.65
|
| Rate for Payer: Preferred Network Access Commercial |
$1,173.99
|
| Rate for Payer: Quartz Beloit One Network |
$625.28
|
| Rate for Payer: Quartz Commercial |
$829.45
|
| Rate for Payer: Quartz Medicare Advantage |
$765.65
|
| Rate for Payer: The Alliance Commercial |
$638.04
|
| Rate for Payer: United Healthcare PPO |
$957.06
|
| Rate for Payer: WEA Trust Commercial |
$701.84
|
| Rate for Payer: WPS Commercial |
$945.16
|
|
|
BCE VL LE Arterial Graft Patency Left
|
Facility
|
IP
|
$1,227.00
|
|
|
Service Code
|
CPT 93926 TC,LT
|
| Hospital Charge Code |
5238951
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$625.28 |
| Max. Negotiated Rate |
$1,173.99 |
| Rate for Payer: Aetna Commercial |
$1,148.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,097.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$676.32
|
| Rate for Payer: Cash Price |
$368.10
|
| Rate for Payer: Cigna Commercial |
$1,173.99
|
| Rate for Payer: Health EOS Commercial |
$1,135.71
|
| Rate for Payer: HFN Commercial |
$1,173.99
|
| Rate for Payer: Multiplan Commercial |
$1,020.86
|
| Rate for Payer: Preferred Network Access Commercial |
$1,173.99
|
| Rate for Payer: Quartz Beloit One Network |
$625.28
|
| Rate for Payer: Quartz Commercial |
$765.65
|
| Rate for Payer: WEA Trust Commercial |
$701.84
|
| Rate for Payer: WPS Commercial |
$945.16
|
|
|
BCE VL LE Arterial Graft Patency Left
|
Professional
|
Both
|
$1,227.00
|
|
|
Service Code
|
CPT 93926 TC,LT
|
| Hospital Charge Code |
5238951
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$151.61 |
| Max. Negotiated Rate |
$1,212.28 |
| Rate for Payer: Aetna Commercial |
$1,212.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,097.43
|
| Rate for Payer: Cash Price |
$368.10
|
| Rate for Payer: Cash Price |
$368.10
|
| Rate for Payer: Cash Price |
$368.10
|
| Rate for Payer: Cigna Commercial |
$1,212.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$151.61
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$765.65
|
| Rate for Payer: Health EOS Commercial |
$1,161.23
|
| Rate for Payer: HFN Commercial |
$1,212.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$527.66
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$527.66
|
| Rate for Payer: Multiplan Commercial |
$1,020.86
|
| Rate for Payer: Preferred Network Access Commercial |
$1,212.28
|
| Rate for Payer: Quartz Beloit One Network |
$561.48
|
| Rate for Payer: Quartz Commercial |
$727.37
|
| Rate for Payer: The Alliance Commercial |
$638.04
|
| Rate for Payer: United Healthcare Medicaid |
$151.61
|
| Rate for Payer: WEA Trust Commercial |
$701.84
|
| Rate for Payer: WPS Commercial |
$945.16
|
|
|
BCE VL LE Arterial Graft Patency Right
|
Facility
|
IP
|
$1,227.00
|
|
|
Service Code
|
CPT 93926 TC,RT
|
| Hospital Charge Code |
5238952
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$625.28 |
| Max. Negotiated Rate |
$1,173.99 |
| Rate for Payer: Aetna Commercial |
$1,148.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,097.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$676.32
|
| Rate for Payer: Cash Price |
$368.10
|
| Rate for Payer: Cigna Commercial |
$1,173.99
|
| Rate for Payer: Health EOS Commercial |
$1,135.71
|
| Rate for Payer: HFN Commercial |
$1,173.99
|
| Rate for Payer: Multiplan Commercial |
$1,020.86
|
| Rate for Payer: Preferred Network Access Commercial |
$1,173.99
|
| Rate for Payer: Quartz Beloit One Network |
$625.28
|
| Rate for Payer: Quartz Commercial |
$765.65
|
| Rate for Payer: WEA Trust Commercial |
$701.84
|
| Rate for Payer: WPS Commercial |
$945.16
|
|
|
BCE VL LE Arterial Graft Patency Right
|
Facility
|
OP
|
$1,227.00
|
|
|
Service Code
|
CPT 93926 TC,RT
|
| Hospital Charge Code |
5238952
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$357.30 |
| Max. Negotiated Rate |
$1,173.99 |
| Rate for Payer: Aetna Commercial |
$1,148.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,097.43
|
| Rate for Payer: Aetna Managed Medicare |
$357.30
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$829.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$638.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$612.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$676.32
|
| Rate for Payer: Cash Price |
$368.10
|
| Rate for Payer: Cigna Commercial |
$1,173.99
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$714.11
|
| Rate for Payer: Health EOS Commercial |
$1,135.71
|
| Rate for Payer: HFN Commercial |
$1,173.99
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$957.06
|
| Rate for Payer: Multiplan Commercial |
$1,020.86
|
| Rate for Payer: NAPHCARE Commercial |
$765.65
|
| Rate for Payer: Preferred Network Access Commercial |
$1,173.99
|
| Rate for Payer: Quartz Beloit One Network |
$625.28
|
| Rate for Payer: Quartz Commercial |
$829.45
|
| Rate for Payer: Quartz Medicare Advantage |
$765.65
|
| Rate for Payer: The Alliance Commercial |
$638.04
|
| Rate for Payer: United Healthcare PPO |
$957.06
|
| Rate for Payer: WEA Trust Commercial |
$701.84
|
| Rate for Payer: WPS Commercial |
$945.16
|
|
|
BCE VL LE Arterial Graft Patency Right
|
Professional
|
Both
|
$1,227.00
|
|
|
Service Code
|
CPT 93926 TC,RT
|
| Hospital Charge Code |
5238952
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$151.61 |
| Max. Negotiated Rate |
$1,212.28 |
| Rate for Payer: Aetna Commercial |
$1,212.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,097.43
|
| Rate for Payer: Cash Price |
$368.10
|
| Rate for Payer: Cash Price |
$368.10
|
| Rate for Payer: Cash Price |
$368.10
|
| Rate for Payer: Cigna Commercial |
$1,212.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$151.61
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$765.65
|
| Rate for Payer: Health EOS Commercial |
$1,161.23
|
| Rate for Payer: HFN Commercial |
$1,212.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$527.66
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$527.66
|
| Rate for Payer: Multiplan Commercial |
$1,020.86
|
| Rate for Payer: Preferred Network Access Commercial |
$1,212.28
|
| Rate for Payer: Quartz Beloit One Network |
$561.48
|
| Rate for Payer: Quartz Commercial |
$727.37
|
| Rate for Payer: The Alliance Commercial |
$638.04
|
| Rate for Payer: United Healthcare Medicaid |
$151.61
|
| Rate for Payer: WEA Trust Commercial |
$701.84
|
| Rate for Payer: WPS Commercial |
$945.16
|
|
|
BCE VL LE Venous Duplex Bilateral
|
Facility
|
OP
|
$2,085.00
|
|
|
Service Code
|
CPT 93970 TC
|
| Hospital Charge Code |
3114967
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$602.95 |
| Max. Negotiated Rate |
$1,994.93 |
| Rate for Payer: Aetna Commercial |
$1,951.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,864.82
|
| Rate for Payer: Aetna Managed Medicare |
$607.15
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,409.46
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,084.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,040.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,149.25
|
| Rate for Payer: Cash Price |
$625.50
|
| Rate for Payer: Cash Price |
$625.50
|
| Rate for Payer: Cigna Commercial |
$1,994.93
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,213.47
|
| Rate for Payer: Health EOS Commercial |
$1,929.88
|
| Rate for Payer: HFN Commercial |
$1,994.93
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,626.30
|
| Rate for Payer: Multiplan Commercial |
$1,734.72
|
| Rate for Payer: NAPHCARE Commercial |
$1,301.04
|
| Rate for Payer: Preferred Network Access Commercial |
$1,994.93
|
| Rate for Payer: Quartz Beloit One Network |
$1,062.52
|
| Rate for Payer: Quartz Commercial |
$1,409.46
|
| Rate for Payer: Quartz Medicare Advantage |
$1,301.04
|
| Rate for Payer: The Alliance Commercial |
$602.95
|
| Rate for Payer: United Healthcare PPO |
$1,626.30
|
| Rate for Payer: WEA Trust Commercial |
$1,192.62
|
| Rate for Payer: WPS Commercial |
$1,606.08
|
|
|
BCE VL LE Venous Duplex Bilateral
|
Professional
|
Both
|
$2,085.00
|
|
|
Service Code
|
CPT 93970 TC
|
| Hospital Charge Code |
3114967
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$141.44 |
| Max. Negotiated Rate |
$2,059.98 |
| Rate for Payer: Aetna Commercial |
$2,059.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,864.82
|
| Rate for Payer: Aetna Managed Medicare |
$150.74
|
| Rate for Payer: Anthem Medicare Advantage |
$150.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$150.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$150.74
|
| Rate for Payer: Cash Price |
$625.50
|
| Rate for Payer: Cash Price |
$625.50
|
| Rate for Payer: Cash Price |
$625.50
|
| Rate for Payer: Cigna Commercial |
$2,059.98
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$141.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$150.74
|
| Rate for Payer: Health EOS Commercial |
$1,973.24
|
| Rate for Payer: HFN Commercial |
$2,059.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$573.96
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$573.96
|
| Rate for Payer: Independent Care Health Plan Medicare |
$150.74
|
| Rate for Payer: Multiplan Commercial |
$1,734.72
|
| Rate for Payer: NAPHCARE Commercial |
$226.11
|
| Rate for Payer: Preferred Network Access Commercial |
$2,059.98
|
| Rate for Payer: Quartz Beloit One Network |
$954.10
|
| Rate for Payer: Quartz Commercial |
$1,235.99
|
| Rate for Payer: Quartz Medicare Advantage |
$150.74
|
| Rate for Payer: The Alliance Commercial |
$376.84
|
| Rate for Payer: United Healthcare Medicaid |
$141.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$150.74
|
| Rate for Payer: WEA Trust Commercial |
$1,192.62
|
| Rate for Payer: WPS Commercial |
$602.95
|
|
|
BCE VL LE Venous Duplex Bilateral
|
Facility
|
IP
|
$2,085.00
|
|
|
Service Code
|
CPT 93970 TC
|
| Hospital Charge Code |
3114967
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$1,062.52 |
| Max. Negotiated Rate |
$1,994.93 |
| Rate for Payer: Aetna Commercial |
$1,951.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,864.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,149.25
|
| Rate for Payer: Cash Price |
$625.50
|
| Rate for Payer: Cigna Commercial |
$1,994.93
|
| Rate for Payer: Health EOS Commercial |
$1,929.88
|
| Rate for Payer: HFN Commercial |
$1,994.93
|
| Rate for Payer: Multiplan Commercial |
$1,734.72
|
| Rate for Payer: Preferred Network Access Commercial |
$1,994.93
|
| Rate for Payer: Quartz Beloit One Network |
$1,062.52
|
| Rate for Payer: Quartz Commercial |
$1,301.04
|
| Rate for Payer: WEA Trust Commercial |
$1,192.62
|
| Rate for Payer: WPS Commercial |
$1,606.08
|
|
|
BCE VL LE Venous Duplex Left
|
Facility
|
OP
|
$1,234.00
|
|
|
Service Code
|
CPT 93971 TC,LT
|
| Hospital Charge Code |
3114968
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$359.34 |
| Max. Negotiated Rate |
$1,180.69 |
| Rate for Payer: Aetna Commercial |
$1,155.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,103.69
|
| Rate for Payer: Aetna Managed Medicare |
$359.34
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$834.18
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$641.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$616.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$680.18
|
| Rate for Payer: Cash Price |
$370.20
|
| Rate for Payer: Cigna Commercial |
$1,180.69
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$718.19
|
| Rate for Payer: Health EOS Commercial |
$1,142.19
|
| Rate for Payer: HFN Commercial |
$1,180.69
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$962.52
|
| Rate for Payer: Multiplan Commercial |
$1,026.69
|
| Rate for Payer: NAPHCARE Commercial |
$770.02
|
| Rate for Payer: Preferred Network Access Commercial |
$1,180.69
|
| Rate for Payer: Quartz Beloit One Network |
$628.85
|
| Rate for Payer: Quartz Commercial |
$834.18
|
| Rate for Payer: Quartz Medicare Advantage |
$770.02
|
| Rate for Payer: The Alliance Commercial |
$641.68
|
| Rate for Payer: United Healthcare PPO |
$962.52
|
| Rate for Payer: WEA Trust Commercial |
$705.85
|
| Rate for Payer: WPS Commercial |
$950.55
|
|
|
BCE VL LE Venous Duplex Left
|
Professional
|
Both
|
$1,234.00
|
|
|
Service Code
|
CPT 93971 TC,LT
|
| Hospital Charge Code |
3114968
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$113.03 |
| Max. Negotiated Rate |
$1,219.19 |
| Rate for Payer: Aetna Commercial |
$1,219.19
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,103.69
|
| Rate for Payer: Cash Price |
$370.20
|
| Rate for Payer: Cash Price |
$370.20
|
| Rate for Payer: Cash Price |
$370.20
|
| Rate for Payer: Cigna Commercial |
$1,219.19
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$113.03
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$770.02
|
| Rate for Payer: Health EOS Commercial |
$1,167.86
|
| Rate for Payer: HFN Commercial |
$1,219.19
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$434.81
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$434.81
|
| Rate for Payer: Multiplan Commercial |
$1,026.69
|
| Rate for Payer: Preferred Network Access Commercial |
$1,219.19
|
| Rate for Payer: Quartz Beloit One Network |
$564.68
|
| Rate for Payer: Quartz Commercial |
$731.52
|
| Rate for Payer: The Alliance Commercial |
$641.68
|
| Rate for Payer: United Healthcare Medicaid |
$113.03
|
| Rate for Payer: WEA Trust Commercial |
$705.85
|
| Rate for Payer: WPS Commercial |
$950.55
|
|
|
BCE VL LE Venous Duplex Left
|
Facility
|
IP
|
$1,234.00
|
|
|
Service Code
|
CPT 93971 TC,LT
|
| Hospital Charge Code |
3114968
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$628.85 |
| Max. Negotiated Rate |
$1,180.69 |
| Rate for Payer: Aetna Commercial |
$1,155.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,103.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$680.18
|
| Rate for Payer: Cash Price |
$370.20
|
| Rate for Payer: Cigna Commercial |
$1,180.69
|
| Rate for Payer: Health EOS Commercial |
$1,142.19
|
| Rate for Payer: HFN Commercial |
$1,180.69
|
| Rate for Payer: Multiplan Commercial |
$1,026.69
|
| Rate for Payer: Preferred Network Access Commercial |
$1,180.69
|
| Rate for Payer: Quartz Beloit One Network |
$628.85
|
| Rate for Payer: Quartz Commercial |
$770.02
|
| Rate for Payer: WEA Trust Commercial |
$705.85
|
| Rate for Payer: WPS Commercial |
$950.55
|
|
|
BCE VL LE Venous Duplex Right
|
Facility
|
OP
|
$1,234.00
|
|
|
Service Code
|
CPT 93971 TC,RT
|
| Hospital Charge Code |
3114969
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$359.34 |
| Max. Negotiated Rate |
$1,180.69 |
| Rate for Payer: Aetna Commercial |
$1,155.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,103.69
|
| Rate for Payer: Aetna Managed Medicare |
$359.34
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$834.18
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$641.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$616.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$680.18
|
| Rate for Payer: Cash Price |
$370.20
|
| Rate for Payer: Cigna Commercial |
$1,180.69
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$718.19
|
| Rate for Payer: Health EOS Commercial |
$1,142.19
|
| Rate for Payer: HFN Commercial |
$1,180.69
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$962.52
|
| Rate for Payer: Multiplan Commercial |
$1,026.69
|
| Rate for Payer: NAPHCARE Commercial |
$770.02
|
| Rate for Payer: Preferred Network Access Commercial |
$1,180.69
|
| Rate for Payer: Quartz Beloit One Network |
$628.85
|
| Rate for Payer: Quartz Commercial |
$834.18
|
| Rate for Payer: Quartz Medicare Advantage |
$770.02
|
| Rate for Payer: The Alliance Commercial |
$641.68
|
| Rate for Payer: United Healthcare PPO |
$962.52
|
| Rate for Payer: WEA Trust Commercial |
$705.85
|
| Rate for Payer: WPS Commercial |
$950.55
|
|
|
BCE VL LE Venous Duplex Right
|
Facility
|
IP
|
$1,234.00
|
|
|
Service Code
|
CPT 93971 TC,RT
|
| Hospital Charge Code |
3114969
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$628.85 |
| Max. Negotiated Rate |
$1,180.69 |
| Rate for Payer: Aetna Commercial |
$1,155.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,103.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$680.18
|
| Rate for Payer: Cash Price |
$370.20
|
| Rate for Payer: Cigna Commercial |
$1,180.69
|
| Rate for Payer: Health EOS Commercial |
$1,142.19
|
| Rate for Payer: HFN Commercial |
$1,180.69
|
| Rate for Payer: Multiplan Commercial |
$1,026.69
|
| Rate for Payer: Preferred Network Access Commercial |
$1,180.69
|
| Rate for Payer: Quartz Beloit One Network |
$628.85
|
| Rate for Payer: Quartz Commercial |
$770.02
|
| Rate for Payer: WEA Trust Commercial |
$705.85
|
| Rate for Payer: WPS Commercial |
$950.55
|
|
|
BCE VL LE Venous Duplex Right
|
Professional
|
Both
|
$1,234.00
|
|
|
Service Code
|
CPT 93971 TC,RT
|
| Hospital Charge Code |
3114969
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$113.03 |
| Max. Negotiated Rate |
$1,219.19 |
| Rate for Payer: Aetna Commercial |
$1,219.19
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,103.69
|
| Rate for Payer: Cash Price |
$370.20
|
| Rate for Payer: Cash Price |
$370.20
|
| Rate for Payer: Cash Price |
$370.20
|
| Rate for Payer: Cigna Commercial |
$1,219.19
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$113.03
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$770.02
|
| Rate for Payer: Health EOS Commercial |
$1,167.86
|
| Rate for Payer: HFN Commercial |
$1,219.19
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$434.81
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$434.81
|
| Rate for Payer: Multiplan Commercial |
$1,026.69
|
| Rate for Payer: Preferred Network Access Commercial |
$1,219.19
|
| Rate for Payer: Quartz Beloit One Network |
$564.68
|
| Rate for Payer: Quartz Commercial |
$731.52
|
| Rate for Payer: The Alliance Commercial |
$641.68
|
| Rate for Payer: United Healthcare Medicaid |
$113.03
|
| Rate for Payer: WEA Trust Commercial |
$705.85
|
| Rate for Payer: WPS Commercial |
$950.55
|
|
