|
BCE VL Lower Extremity PVR Resting
|
Professional
|
Both
|
$859.00
|
|
|
Service Code
|
CPT 93923 TC
|
| Hospital Charge Code |
3114970
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$111.13 |
| Max. Negotiated Rate |
$848.69 |
| Rate for Payer: Aetna Commercial |
$848.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$768.29
|
| Rate for Payer: Aetna Managed Medicare |
$111.13
|
| Rate for Payer: Anthem Medicare Advantage |
$111.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$111.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$111.13
|
| Rate for Payer: Cash Price |
$257.70
|
| Rate for Payer: Cash Price |
$257.70
|
| Rate for Payer: Cash Price |
$257.70
|
| Rate for Payer: Cigna Commercial |
$848.69
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$111.30
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$111.13
|
| Rate for Payer: Health EOS Commercial |
$812.96
|
| Rate for Payer: HFN Commercial |
$848.69
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$389.33
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$389.33
|
| Rate for Payer: Independent Care Health Plan Medicare |
$111.13
|
| Rate for Payer: Multiplan Commercial |
$714.69
|
| Rate for Payer: NAPHCARE Commercial |
$166.70
|
| Rate for Payer: Preferred Network Access Commercial |
$848.69
|
| Rate for Payer: Quartz Beloit One Network |
$393.08
|
| Rate for Payer: Quartz Commercial |
$509.22
|
| Rate for Payer: Quartz Medicare Advantage |
$111.13
|
| Rate for Payer: The Alliance Commercial |
$277.84
|
| Rate for Payer: United Healthcare Medicaid |
$111.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$111.13
|
| Rate for Payer: WEA Trust Commercial |
$491.35
|
| Rate for Payer: WPS Commercial |
$444.54
|
|
|
BCE VL Lower Extremity PVR Resting
|
Facility
|
OP
|
$859.00
|
|
|
Service Code
|
CPT 93923 TC
|
| Hospital Charge Code |
3114970
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$250.14 |
| Max. Negotiated Rate |
$821.89 |
| Rate for Payer: Aetna Commercial |
$804.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$768.29
|
| Rate for Payer: Aetna Managed Medicare |
$250.14
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$580.68
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$446.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$428.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$473.48
|
| Rate for Payer: Cash Price |
$257.70
|
| Rate for Payer: Cash Price |
$257.70
|
| Rate for Payer: Cigna Commercial |
$821.89
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$499.94
|
| Rate for Payer: Health EOS Commercial |
$795.09
|
| Rate for Payer: HFN Commercial |
$821.89
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$670.02
|
| Rate for Payer: Multiplan Commercial |
$714.69
|
| Rate for Payer: NAPHCARE Commercial |
$536.02
|
| Rate for Payer: Preferred Network Access Commercial |
$821.89
|
| Rate for Payer: Quartz Beloit One Network |
$437.75
|
| Rate for Payer: Quartz Commercial |
$580.68
|
| Rate for Payer: Quartz Medicare Advantage |
$536.02
|
| Rate for Payer: The Alliance Commercial |
$444.54
|
| Rate for Payer: United Healthcare PPO |
$670.02
|
| Rate for Payer: WEA Trust Commercial |
$491.35
|
| Rate for Payer: WPS Commercial |
$661.69
|
|
|
BCE VL Lower Extremity PVR Resting
|
Facility
|
IP
|
$859.00
|
|
|
Service Code
|
CPT 93923 TC
|
| Hospital Charge Code |
3114970
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$437.75 |
| Max. Negotiated Rate |
$821.89 |
| Rate for Payer: Aetna Commercial |
$804.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$768.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$473.48
|
| Rate for Payer: Cash Price |
$257.70
|
| Rate for Payer: Cigna Commercial |
$821.89
|
| Rate for Payer: Health EOS Commercial |
$795.09
|
| Rate for Payer: HFN Commercial |
$821.89
|
| Rate for Payer: Multiplan Commercial |
$714.69
|
| Rate for Payer: Preferred Network Access Commercial |
$821.89
|
| Rate for Payer: Quartz Beloit One Network |
$437.75
|
| Rate for Payer: Quartz Commercial |
$536.02
|
| Rate for Payer: WEA Trust Commercial |
$491.35
|
| Rate for Payer: WPS Commercial |
$661.69
|
|
|
BCE VL Lower Extremity PVR w Excerise
|
Professional
|
Both
|
$1,924.00
|
|
|
Service Code
|
CPT 93924 TC
|
| Hospital Charge Code |
3114971
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$139.29 |
| Max. Negotiated Rate |
$1,900.91 |
| Rate for Payer: Aetna Commercial |
$1,900.91
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,720.83
|
| Rate for Payer: Aetna Managed Medicare |
$140.42
|
| Rate for Payer: Anthem Medicare Advantage |
$140.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$140.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$140.42
|
| Rate for Payer: Cash Price |
$577.20
|
| Rate for Payer: Cash Price |
$577.20
|
| Rate for Payer: Cash Price |
$577.20
|
| Rate for Payer: Cigna Commercial |
$1,900.91
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$139.29
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$140.42
|
| Rate for Payer: Health EOS Commercial |
$1,820.87
|
| Rate for Payer: HFN Commercial |
$1,900.91
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$493.12
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$493.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$140.42
|
| Rate for Payer: Multiplan Commercial |
$1,600.77
|
| Rate for Payer: NAPHCARE Commercial |
$210.63
|
| Rate for Payer: Preferred Network Access Commercial |
$1,900.91
|
| Rate for Payer: Quartz Beloit One Network |
$880.42
|
| Rate for Payer: Quartz Commercial |
$1,140.55
|
| Rate for Payer: Quartz Medicare Advantage |
$140.42
|
| Rate for Payer: The Alliance Commercial |
$351.05
|
| Rate for Payer: United Healthcare Medicaid |
$139.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$140.42
|
| Rate for Payer: WEA Trust Commercial |
$1,100.53
|
| Rate for Payer: WPS Commercial |
$561.68
|
|
|
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 |
$560.27 |
| Max. Negotiated Rate |
$1,840.88 |
| Rate for Payer: Aetna Commercial |
$1,800.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,720.83
|
| Rate for Payer: Aetna Managed Medicare |
$560.27
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,300.62
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,000.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$960.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,060.51
|
| Rate for Payer: Cash Price |
$577.20
|
| Rate for Payer: Cash Price |
$577.20
|
| Rate for Payer: Cigna Commercial |
$1,840.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,119.77
|
| Rate for Payer: Health EOS Commercial |
$1,780.85
|
| Rate for Payer: HFN Commercial |
$1,840.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,500.72
|
| Rate for Payer: Multiplan Commercial |
$1,600.77
|
| Rate for Payer: NAPHCARE Commercial |
$1,200.58
|
| Rate for Payer: Preferred Network Access Commercial |
$1,840.88
|
| Rate for Payer: Quartz Beloit One Network |
$980.47
|
| Rate for Payer: Quartz Commercial |
$1,300.62
|
| Rate for Payer: Quartz Medicare Advantage |
$1,200.58
|
| Rate for Payer: The Alliance Commercial |
$561.68
|
| Rate for Payer: United Healthcare PPO |
$1,500.72
|
| Rate for Payer: WEA Trust Commercial |
$1,100.53
|
| Rate for Payer: WPS Commercial |
$1,482.06
|
|
|
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 |
$980.47 |
| Max. Negotiated Rate |
$1,840.88 |
| Rate for Payer: Aetna Commercial |
$1,800.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,720.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,060.51
|
| Rate for Payer: Cash Price |
$577.20
|
| Rate for Payer: Cigna Commercial |
$1,840.88
|
| Rate for Payer: Health EOS Commercial |
$1,780.85
|
| Rate for Payer: HFN Commercial |
$1,840.88
|
| Rate for Payer: Multiplan Commercial |
$1,600.77
|
| Rate for Payer: Preferred Network Access Commercial |
$1,840.88
|
| Rate for Payer: Quartz Beloit One Network |
$980.47
|
| Rate for Payer: Quartz Commercial |
$1,200.58
|
| Rate for Payer: WEA Trust Commercial |
$1,100.53
|
| Rate for Payer: WPS Commercial |
$1,482.06
|
|
|
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 |
$532.40 |
| Max. Negotiated Rate |
$3,183.27 |
| Rate for Payer: Aetna Commercial |
$3,114.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,975.67
|
| Rate for Payer: Aetna Managed Medicare |
$968.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,249.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,730.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,660.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,833.84
|
| Rate for Payer: Cash Price |
$998.10
|
| Rate for Payer: Cash Price |
$998.10
|
| Rate for Payer: Cigna Commercial |
$3,183.27
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,936.31
|
| Rate for Payer: Health EOS Commercial |
$3,079.47
|
| Rate for Payer: HFN Commercial |
$3,183.27
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,595.06
|
| Rate for Payer: Multiplan Commercial |
$2,768.06
|
| Rate for Payer: NAPHCARE Commercial |
$2,076.05
|
| Rate for Payer: Preferred Network Access Commercial |
$3,183.27
|
| Rate for Payer: Quartz Beloit One Network |
$1,695.44
|
| Rate for Payer: Quartz Commercial |
$2,249.05
|
| Rate for Payer: Quartz Medicare Advantage |
$2,076.05
|
| Rate for Payer: The Alliance Commercial |
$532.40
|
| Rate for Payer: United Healthcare PPO |
$2,595.06
|
| Rate for Payer: WEA Trust Commercial |
$1,903.04
|
| Rate for Payer: WPS Commercial |
$2,562.79
|
|
|
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 |
$133.10 |
| Max. Negotiated Rate |
$3,287.08 |
| Rate for Payer: Aetna Commercial |
$3,287.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,975.67
|
| Rate for Payer: Aetna Managed Medicare |
$133.10
|
| Rate for Payer: Anthem Medicare Advantage |
$133.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$133.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$133.10
|
| Rate for Payer: Cash Price |
$998.10
|
| Rate for Payer: Cash Price |
$998.10
|
| Rate for Payer: Cash Price |
$998.10
|
| Rate for Payer: Cigna Commercial |
$3,287.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$147.93
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$133.10
|
| Rate for Payer: Health EOS Commercial |
$3,148.67
|
| Rate for Payer: HFN Commercial |
$3,287.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$493.07
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$493.07
|
| Rate for Payer: Independent Care Health Plan Medicare |
$133.10
|
| Rate for Payer: Multiplan Commercial |
$2,768.06
|
| Rate for Payer: NAPHCARE Commercial |
$199.65
|
| Rate for Payer: Preferred Network Access Commercial |
$3,287.08
|
| Rate for Payer: Quartz Beloit One Network |
$1,522.44
|
| Rate for Payer: Quartz Commercial |
$1,972.25
|
| Rate for Payer: Quartz Medicare Advantage |
$133.10
|
| Rate for Payer: The Alliance Commercial |
$505.78
|
| Rate for Payer: United Healthcare Medicaid |
$147.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$133.10
|
| Rate for Payer: WEA Trust Commercial |
$1,903.04
|
| Rate for Payer: WPS Commercial |
$532.40
|
|
|
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 |
$1,695.44 |
| Max. Negotiated Rate |
$3,183.27 |
| Rate for Payer: Aetna Commercial |
$3,114.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,975.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,833.84
|
| Rate for Payer: Cash Price |
$998.10
|
| Rate for Payer: Cigna Commercial |
$3,183.27
|
| Rate for Payer: Health EOS Commercial |
$3,079.47
|
| Rate for Payer: HFN Commercial |
$3,183.27
|
| Rate for Payer: Multiplan Commercial |
$2,768.06
|
| Rate for Payer: Preferred Network Access Commercial |
$3,183.27
|
| Rate for Payer: Quartz Beloit One Network |
$1,695.44
|
| Rate for Payer: Quartz Commercial |
$2,076.05
|
| Rate for Payer: WEA Trust Commercial |
$1,903.04
|
| Rate for Payer: WPS Commercial |
$2,562.79
|
|
|
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 |
$2,377.79 |
| Max. Negotiated Rate |
$4,464.43 |
| Rate for Payer: Aetna Commercial |
$4,367.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,173.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,571.90
|
| Rate for Payer: Cash Price |
$1,399.80
|
| Rate for Payer: Cigna Commercial |
$4,464.43
|
| Rate for Payer: Health EOS Commercial |
$4,318.85
|
| Rate for Payer: HFN Commercial |
$4,464.43
|
| Rate for Payer: Multiplan Commercial |
$3,882.11
|
| Rate for Payer: Preferred Network Access Commercial |
$4,464.43
|
| Rate for Payer: Quartz Beloit One Network |
$2,377.79
|
| Rate for Payer: Quartz Commercial |
$2,911.58
|
| Rate for Payer: WEA Trust Commercial |
$2,668.95
|
| Rate for Payer: WPS Commercial |
$3,594.22
|
|
|
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 |
$139.64 |
| Max. Negotiated Rate |
$4,610.01 |
| Rate for Payer: Aetna Commercial |
$4,610.01
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,173.27
|
| Rate for Payer: Cash Price |
$1,399.80
|
| Rate for Payer: Cash Price |
$1,399.80
|
| Rate for Payer: Cash Price |
$1,399.80
|
| Rate for Payer: Cigna Commercial |
$4,610.01
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$139.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,911.58
|
| Rate for Payer: Health EOS Commercial |
$4,415.90
|
| Rate for Payer: HFN Commercial |
$4,610.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$548.48
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$548.48
|
| Rate for Payer: Multiplan Commercial |
$3,882.11
|
| Rate for Payer: Preferred Network Access Commercial |
$4,610.01
|
| Rate for Payer: Quartz Beloit One Network |
$2,135.16
|
| Rate for Payer: Quartz Commercial |
$2,766.00
|
| Rate for Payer: The Alliance Commercial |
$2,426.32
|
| Rate for Payer: United Healthcare Medicaid |
$139.64
|
| Rate for Payer: WEA Trust Commercial |
$2,668.95
|
| Rate for Payer: WPS Commercial |
$3,594.22
|
|
|
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 |
$1,358.74 |
| Max. Negotiated Rate |
$4,464.43 |
| Rate for Payer: Aetna Commercial |
$4,367.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,173.27
|
| Rate for Payer: Aetna Managed Medicare |
$1,358.74
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,154.22
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,426.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,329.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,571.90
|
| Rate for Payer: Cash Price |
$1,399.80
|
| Rate for Payer: Cigna Commercial |
$4,464.43
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,715.61
|
| Rate for Payer: Health EOS Commercial |
$4,318.85
|
| Rate for Payer: HFN Commercial |
$4,464.43
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,639.48
|
| Rate for Payer: Multiplan Commercial |
$3,882.11
|
| Rate for Payer: NAPHCARE Commercial |
$2,911.58
|
| Rate for Payer: Preferred Network Access Commercial |
$4,464.43
|
| Rate for Payer: Quartz Beloit One Network |
$2,377.79
|
| Rate for Payer: Quartz Commercial |
$3,154.22
|
| Rate for Payer: Quartz Medicare Advantage |
$2,911.58
|
| Rate for Payer: The Alliance Commercial |
$2,426.32
|
| Rate for Payer: United Healthcare PPO |
$3,639.48
|
| Rate for Payer: WEA Trust Commercial |
$2,668.95
|
| Rate for Payer: WPS Commercial |
$3,594.22
|
|
|
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 |
$567.01 |
| Max. Negotiated Rate |
$3,747.79 |
| Rate for Payer: Aetna Commercial |
$3,666.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,503.36
|
| Rate for Payer: Aetna Managed Medicare |
$1,140.63
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,647.89
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,036.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,955.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,159.05
|
| Rate for Payer: Cash Price |
$1,175.10
|
| Rate for Payer: Cash Price |
$1,175.10
|
| Rate for Payer: Cigna Commercial |
$3,747.79
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,279.69
|
| Rate for Payer: Health EOS Commercial |
$3,625.58
|
| Rate for Payer: HFN Commercial |
$3,747.79
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,055.26
|
| Rate for Payer: Multiplan Commercial |
$3,258.94
|
| Rate for Payer: NAPHCARE Commercial |
$2,444.21
|
| Rate for Payer: Preferred Network Access Commercial |
$3,747.79
|
| Rate for Payer: Quartz Beloit One Network |
$1,996.10
|
| Rate for Payer: Quartz Commercial |
$2,647.89
|
| Rate for Payer: Quartz Medicare Advantage |
$2,444.21
|
| Rate for Payer: The Alliance Commercial |
$567.01
|
| Rate for Payer: United Healthcare PPO |
$3,055.26
|
| Rate for Payer: WEA Trust Commercial |
$2,240.52
|
| Rate for Payer: WPS Commercial |
$3,017.27
|
|
|
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 |
$1,996.10 |
| Max. Negotiated Rate |
$3,747.79 |
| Rate for Payer: Aetna Commercial |
$3,666.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,503.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,159.05
|
| Rate for Payer: Cash Price |
$1,175.10
|
| Rate for Payer: Cigna Commercial |
$3,747.79
|
| Rate for Payer: Health EOS Commercial |
$3,625.58
|
| Rate for Payer: HFN Commercial |
$3,747.79
|
| Rate for Payer: Multiplan Commercial |
$3,258.94
|
| Rate for Payer: Preferred Network Access Commercial |
$3,747.79
|
| Rate for Payer: Quartz Beloit One Network |
$1,996.10
|
| Rate for Payer: Quartz Commercial |
$2,444.21
|
| Rate for Payer: WEA Trust Commercial |
$2,240.52
|
| Rate for Payer: WPS Commercial |
$3,017.27
|
|
|
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 |
$141.75 |
| Max. Negotiated Rate |
$3,870.00 |
| Rate for Payer: Aetna Commercial |
$3,870.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,503.36
|
| Rate for Payer: Aetna Managed Medicare |
$141.75
|
| Rate for Payer: Anthem Medicare Advantage |
$141.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$141.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$141.75
|
| Rate for Payer: Cash Price |
$1,175.10
|
| Rate for Payer: Cash Price |
$1,175.10
|
| Rate for Payer: Cash Price |
$1,175.10
|
| Rate for Payer: Cigna Commercial |
$3,870.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$147.93
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$141.75
|
| Rate for Payer: Health EOS Commercial |
$3,707.05
|
| Rate for Payer: HFN Commercial |
$3,870.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$524.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$524.43
|
| Rate for Payer: Independent Care Health Plan Medicare |
$141.75
|
| Rate for Payer: Multiplan Commercial |
$3,258.94
|
| Rate for Payer: NAPHCARE Commercial |
$212.63
|
| Rate for Payer: Preferred Network Access Commercial |
$3,870.00
|
| Rate for Payer: Quartz Beloit One Network |
$1,792.42
|
| Rate for Payer: Quartz Commercial |
$2,322.00
|
| Rate for Payer: Quartz Medicare Advantage |
$141.75
|
| Rate for Payer: The Alliance Commercial |
$538.66
|
| Rate for Payer: United Healthcare Medicaid |
$147.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$141.75
|
| Rate for Payer: WEA Trust Commercial |
$2,240.52
|
| Rate for Payer: WPS Commercial |
$567.01
|
|
|
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 |
$1,817.96 |
| Max. Negotiated Rate |
$5,973.30 |
| Rate for Payer: Aetna Commercial |
$5,843.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,583.74
|
| Rate for Payer: Aetna Managed Medicare |
$1,817.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,220.27
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,246.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,116.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,441.14
|
| Rate for Payer: Cash Price |
$1,872.90
|
| Rate for Payer: Cigna Commercial |
$5,973.30
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,633.43
|
| Rate for Payer: Health EOS Commercial |
$5,778.52
|
| Rate for Payer: HFN Commercial |
$5,973.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,869.54
|
| Rate for Payer: Multiplan Commercial |
$5,194.18
|
| Rate for Payer: NAPHCARE Commercial |
$3,895.63
|
| Rate for Payer: Preferred Network Access Commercial |
$5,973.30
|
| Rate for Payer: Quartz Beloit One Network |
$3,181.43
|
| Rate for Payer: Quartz Commercial |
$4,220.27
|
| Rate for Payer: Quartz Medicare Advantage |
$3,895.63
|
| Rate for Payer: The Alliance Commercial |
$3,246.36
|
| Rate for Payer: United Healthcare PPO |
$4,869.54
|
| Rate for Payer: WEA Trust Commercial |
$3,571.00
|
| Rate for Payer: WPS Commercial |
$4,808.98
|
|
|
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 |
$3,181.43 |
| Max. Negotiated Rate |
$5,973.30 |
| Rate for Payer: Aetna Commercial |
$5,843.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,583.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,441.14
|
| Rate for Payer: Cash Price |
$1,872.90
|
| Rate for Payer: Cigna Commercial |
$5,973.30
|
| Rate for Payer: Health EOS Commercial |
$5,778.52
|
| Rate for Payer: HFN Commercial |
$5,973.30
|
| Rate for Payer: Multiplan Commercial |
$5,194.18
|
| Rate for Payer: Preferred Network Access Commercial |
$5,973.30
|
| Rate for Payer: Quartz Beloit One Network |
$3,181.43
|
| Rate for Payer: Quartz Commercial |
$3,895.63
|
| Rate for Payer: WEA Trust Commercial |
$3,571.00
|
| Rate for Payer: WPS Commercial |
$4,808.98
|
|
|
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 |
$1,092.77 |
| Max. Negotiated Rate |
$6,168.08 |
| Rate for Payer: Aetna Commercial |
$6,168.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,583.74
|
| Rate for Payer: Cash Price |
$1,872.90
|
| Rate for Payer: Cash Price |
$1,872.90
|
| Rate for Payer: Cash Price |
$1,872.90
|
| Rate for Payer: Cigna Commercial |
$6,168.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,246.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,895.63
|
| Rate for Payer: Health EOS Commercial |
$5,908.38
|
| Rate for Payer: HFN Commercial |
$6,168.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,092.77
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,092.77
|
| Rate for Payer: Multiplan Commercial |
$5,194.18
|
| Rate for Payer: Preferred Network Access Commercial |
$6,168.08
|
| Rate for Payer: Quartz Beloit One Network |
$2,856.80
|
| Rate for Payer: Quartz Commercial |
$3,700.85
|
| Rate for Payer: The Alliance Commercial |
$3,246.36
|
| Rate for Payer: WEA Trust Commercial |
$3,571.00
|
| Rate for Payer: WPS Commercial |
$4,808.98
|
|
|
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 |
$411.76 |
| Max. Negotiated Rate |
$773.09 |
| Rate for Payer: Aetna Commercial |
$756.29
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$722.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$445.37
|
| Rate for Payer: Cash Price |
$242.40
|
| Rate for Payer: Cigna Commercial |
$773.09
|
| Rate for Payer: Health EOS Commercial |
$747.88
|
| Rate for Payer: HFN Commercial |
$773.09
|
| Rate for Payer: Multiplan Commercial |
$672.26
|
| Rate for Payer: Preferred Network Access Commercial |
$773.09
|
| Rate for Payer: Quartz Beloit One Network |
$411.76
|
| Rate for Payer: Quartz Commercial |
$504.19
|
| Rate for Payer: WEA Trust Commercial |
$462.18
|
| Rate for Payer: WPS Commercial |
$622.40
|
|
|
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 |
$235.29 |
| Max. Negotiated Rate |
$773.09 |
| Rate for Payer: Aetna Commercial |
$756.29
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$722.68
|
| Rate for Payer: Aetna Managed Medicare |
$235.29
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$546.21
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$420.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$403.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$445.37
|
| Rate for Payer: Cash Price |
$242.40
|
| Rate for Payer: Cash Price |
$242.40
|
| Rate for Payer: Cigna Commercial |
$773.09
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$470.26
|
| Rate for Payer: Health EOS Commercial |
$747.88
|
| Rate for Payer: HFN Commercial |
$773.09
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$630.24
|
| Rate for Payer: Multiplan Commercial |
$672.26
|
| Rate for Payer: NAPHCARE Commercial |
$504.19
|
| Rate for Payer: Preferred Network Access Commercial |
$773.09
|
| Rate for Payer: Quartz Beloit One Network |
$411.76
|
| Rate for Payer: Quartz Commercial |
$546.21
|
| Rate for Payer: Quartz Medicare Advantage |
$504.19
|
| Rate for Payer: The Alliance Commercial |
$444.54
|
| Rate for Payer: United Healthcare PPO |
$630.24
|
| Rate for Payer: WEA Trust Commercial |
$462.18
|
| Rate for Payer: WPS Commercial |
$622.40
|
|
|
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 |
$111.13 |
| Max. Negotiated Rate |
$798.30 |
| Rate for Payer: Aetna Commercial |
$798.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$722.68
|
| Rate for Payer: Aetna Managed Medicare |
$111.13
|
| Rate for Payer: Anthem Medicare Advantage |
$111.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$111.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$111.13
|
| Rate for Payer: Cash Price |
$242.40
|
| Rate for Payer: Cash Price |
$242.40
|
| Rate for Payer: Cash Price |
$242.40
|
| Rate for Payer: Cigna Commercial |
$798.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$111.30
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$111.13
|
| Rate for Payer: Health EOS Commercial |
$764.69
|
| Rate for Payer: HFN Commercial |
$798.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$389.33
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$389.33
|
| Rate for Payer: Independent Care Health Plan Medicare |
$111.13
|
| Rate for Payer: Multiplan Commercial |
$672.26
|
| Rate for Payer: NAPHCARE Commercial |
$166.70
|
| Rate for Payer: Preferred Network Access Commercial |
$798.30
|
| Rate for Payer: Quartz Beloit One Network |
$369.74
|
| Rate for Payer: Quartz Commercial |
$478.98
|
| Rate for Payer: Quartz Medicare Advantage |
$111.13
|
| Rate for Payer: The Alliance Commercial |
$277.84
|
| Rate for Payer: United Healthcare Medicaid |
$111.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$111.13
|
| Rate for Payer: WEA Trust Commercial |
$462.18
|
| Rate for Payer: WPS Commercial |
$444.54
|
|
|
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 |
$474.66 |
| Max. Negotiated Rate |
$1,559.58 |
| Rate for Payer: Aetna Commercial |
$1,525.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,457.87
|
| Rate for Payer: Aetna Managed Medicare |
$474.66
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,101.88
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$847.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$813.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$898.46
|
| Rate for Payer: Cash Price |
$489.00
|
| Rate for Payer: Cash Price |
$489.00
|
| Rate for Payer: Cigna Commercial |
$1,559.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$948.66
|
| Rate for Payer: Health EOS Commercial |
$1,508.73
|
| Rate for Payer: HFN Commercial |
$1,559.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,271.40
|
| Rate for Payer: Multiplan Commercial |
$1,356.16
|
| Rate for Payer: NAPHCARE Commercial |
$1,017.12
|
| Rate for Payer: Preferred Network Access Commercial |
$1,559.58
|
| Rate for Payer: Quartz Beloit One Network |
$830.65
|
| Rate for Payer: Quartz Commercial |
$1,101.88
|
| Rate for Payer: Quartz Medicare Advantage |
$1,017.12
|
| Rate for Payer: The Alliance Commercial |
$641.56
|
| Rate for Payer: United Healthcare PPO |
$1,271.40
|
| Rate for Payer: WEA Trust Commercial |
$932.36
|
| Rate for Payer: WPS Commercial |
$1,255.59
|
|
|
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 |
$146.99 |
| Max. Negotiated Rate |
$1,610.44 |
| Rate for Payer: Aetna Commercial |
$1,610.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,457.87
|
| Rate for Payer: Aetna Managed Medicare |
$160.39
|
| Rate for Payer: Anthem Medicare Advantage |
$160.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$160.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$160.39
|
| Rate for Payer: Cash Price |
$489.00
|
| Rate for Payer: Cash Price |
$489.00
|
| Rate for Payer: Cash Price |
$489.00
|
| Rate for Payer: Cigna Commercial |
$1,610.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$146.99
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$160.39
|
| Rate for Payer: Health EOS Commercial |
$1,542.63
|
| Rate for Payer: HFN Commercial |
$1,610.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$589.19
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$589.19
|
| Rate for Payer: Independent Care Health Plan Medicare |
$160.39
|
| Rate for Payer: Multiplan Commercial |
$1,356.16
|
| Rate for Payer: NAPHCARE Commercial |
$240.58
|
| Rate for Payer: Preferred Network Access Commercial |
$1,610.44
|
| Rate for Payer: Quartz Beloit One Network |
$745.89
|
| Rate for Payer: Quartz Commercial |
$966.26
|
| Rate for Payer: Quartz Medicare Advantage |
$160.39
|
| Rate for Payer: The Alliance Commercial |
$400.97
|
| Rate for Payer: United Healthcare Medicaid |
$146.99
|
| Rate for Payer: United Healthcare Medicare Advantage |
$160.39
|
| Rate for Payer: WEA Trust Commercial |
$932.36
|
| Rate for Payer: WPS Commercial |
$641.56
|
|
|
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 |
$830.65 |
| Max. Negotiated Rate |
$1,559.58 |
| Rate for Payer: Aetna Commercial |
$1,525.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,457.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$898.46
|
| Rate for Payer: Cash Price |
$489.00
|
| Rate for Payer: Cigna Commercial |
$1,559.58
|
| Rate for Payer: Health EOS Commercial |
$1,508.73
|
| Rate for Payer: HFN Commercial |
$1,559.58
|
| Rate for Payer: Multiplan Commercial |
$1,356.16
|
| Rate for Payer: Preferred Network Access Commercial |
$1,559.58
|
| Rate for Payer: Quartz Beloit One Network |
$830.65
|
| Rate for Payer: Quartz Commercial |
$1,017.12
|
| Rate for Payer: WEA Trust Commercial |
$932.36
|
| Rate for Payer: WPS Commercial |
$1,255.59
|
|
|
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 |
$330.51 |
| Max. Negotiated Rate |
$1,085.97 |
| Rate for Payer: Aetna Commercial |
$1,062.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,015.14
|
| Rate for Payer: Aetna Managed Medicare |
$330.51
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$767.26
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$590.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$566.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$625.61
|
| Rate for Payer: Cash Price |
$340.50
|
| Rate for Payer: Cigna Commercial |
$1,085.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$660.57
|
| Rate for Payer: Health EOS Commercial |
$1,050.56
|
| Rate for Payer: HFN Commercial |
$1,085.97
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$885.30
|
| Rate for Payer: Multiplan Commercial |
$944.32
|
| Rate for Payer: NAPHCARE Commercial |
$708.24
|
| Rate for Payer: Preferred Network Access Commercial |
$1,085.97
|
| Rate for Payer: Quartz Beloit One Network |
$578.40
|
| Rate for Payer: Quartz Commercial |
$767.26
|
| Rate for Payer: Quartz Medicare Advantage |
$708.24
|
| Rate for Payer: The Alliance Commercial |
$590.20
|
| Rate for Payer: United Healthcare PPO |
$885.30
|
| Rate for Payer: WEA Trust Commercial |
$649.22
|
| Rate for Payer: WPS Commercial |
$874.29
|
|
