|
Thrombectomy Solentomni
|
Facility
|
OP
|
$4,346.00
|
|
|
Service Code
|
HCPCS C1724
|
| Hospital Charge Code |
2550920
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,216.88 |
| Max. Negotiated Rate |
$17,384.00 |
| Rate for Payer: Aetna Commercial |
$3,911.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,737.56
|
| Rate for Payer: Aetna Managed Medicare |
$1,216.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,824.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,173.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,086.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,303.38
|
| Rate for Payer: Cash Price |
$1,303.80
|
| Rate for Payer: Cigna Commercial |
$3,998.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,432.02
|
| Rate for Payer: Health EOS Commercial |
$3,867.94
|
| Rate for Payer: HFN Commercial |
$3,998.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,259.50
|
| Rate for Payer: Multiplan Commercial |
$3,476.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,607.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,998.32
|
| Rate for Payer: Quartz Beloit One Network |
$2,129.54
|
| Rate for Payer: Quartz Commercial |
$2,824.90
|
| Rate for Payer: Quartz Medicare Advantage |
$2,607.60
|
| Rate for Payer: The Alliance Commercial |
$17,384.00
|
| Rate for Payer: WEA Trust Commercial |
$2,390.30
|
| Rate for Payer: WPS Commercial |
$3,219.08
|
|
|
Thrombectomy Solentomni
|
Facility
|
IP
|
$4,346.00
|
|
|
Service Code
|
HCPCS C1724
|
| Hospital Charge Code |
2550920
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,129.54 |
| Max. Negotiated Rate |
$3,998.32 |
| Rate for Payer: Aetna Commercial |
$3,911.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,737.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,303.38
|
| Rate for Payer: Cash Price |
$1,303.80
|
| Rate for Payer: Cigna Commercial |
$3,998.32
|
| Rate for Payer: Health EOS Commercial |
$3,867.94
|
| Rate for Payer: HFN Commercial |
$3,998.32
|
| Rate for Payer: Multiplan Commercial |
$3,476.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,607.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,998.32
|
| Rate for Payer: Quartz Beloit One Network |
$2,129.54
|
| Rate for Payer: Quartz Commercial |
$2,607.60
|
| Rate for Payer: WEA Trust Commercial |
$2,390.30
|
| Rate for Payer: WPS Commercial |
$3,219.08
|
|
|
Thrombectomy-Solent Omni
|
Facility
|
OP
|
$6,916.00
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
4139316
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,936.48 |
| Max. Negotiated Rate |
$27,664.00 |
| Rate for Payer: Aetna Commercial |
$6,224.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,947.76
|
| Rate for Payer: Aetna Managed Medicare |
$1,936.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,495.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,458.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,319.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,665.48
|
| Rate for Payer: Cash Price |
$2,074.80
|
| Rate for Payer: Cigna Commercial |
$6,362.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,870.19
|
| Rate for Payer: Health EOS Commercial |
$6,155.24
|
| Rate for Payer: HFN Commercial |
$6,362.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,187.00
|
| Rate for Payer: Multiplan Commercial |
$5,532.80
|
| Rate for Payer: NAPHCARE Commercial |
$4,149.60
|
| Rate for Payer: Preferred Network Access Commercial |
$6,362.72
|
| Rate for Payer: Quartz Beloit One Network |
$3,388.84
|
| Rate for Payer: Quartz Commercial |
$4,495.40
|
| Rate for Payer: Quartz Medicare Advantage |
$4,149.60
|
| Rate for Payer: The Alliance Commercial |
$27,664.00
|
| Rate for Payer: WEA Trust Commercial |
$3,803.80
|
| Rate for Payer: WPS Commercial |
$5,122.68
|
|
|
Thrombectomy-Solent Omni
|
Facility
|
IP
|
$6,916.00
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
4139316
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,388.84 |
| Max. Negotiated Rate |
$6,362.72 |
| Rate for Payer: Aetna Commercial |
$6,224.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,947.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,665.48
|
| Rate for Payer: Cash Price |
$2,074.80
|
| Rate for Payer: Cigna Commercial |
$6,362.72
|
| Rate for Payer: Health EOS Commercial |
$6,155.24
|
| Rate for Payer: HFN Commercial |
$6,362.72
|
| Rate for Payer: Multiplan Commercial |
$5,532.80
|
| Rate for Payer: NAPHCARE Commercial |
$4,149.60
|
| Rate for Payer: Preferred Network Access Commercial |
$6,362.72
|
| Rate for Payer: Quartz Beloit One Network |
$3,388.84
|
| Rate for Payer: Quartz Commercial |
$4,149.60
|
| Rate for Payer: WEA Trust Commercial |
$3,803.80
|
| Rate for Payer: WPS Commercial |
$5,122.68
|
|
|
Thrombectomy Solentproxi
|
Professional
|
Both
|
$4,346.00
|
|
|
Service Code
|
HCPCS C1724
|
| Hospital Charge Code |
2550918
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,912.24 |
| Max. Negotiated Rate |
$4,128.70 |
| Rate for Payer: Aetna Commercial |
$4,128.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,737.56
|
| Rate for Payer: Cash Price |
$1,303.80
|
| Rate for Payer: Cigna Commercial |
$4,128.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,173.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,607.60
|
| Rate for Payer: Health EOS Commercial |
$3,954.86
|
| Rate for Payer: HFN Commercial |
$4,128.70
|
| Rate for Payer: Multiplan Commercial |
$3,476.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,128.70
|
| Rate for Payer: Quartz Beloit One Network |
$1,912.24
|
| Rate for Payer: Quartz Commercial |
$2,477.22
|
| Rate for Payer: The Alliance Commercial |
$2,173.00
|
| Rate for Payer: WEA Trust Commercial |
$2,390.30
|
| Rate for Payer: WPS Commercial |
$3,219.08
|
|
|
Thrombectomy Solentproxi
|
Facility
|
IP
|
$4,346.00
|
|
|
Service Code
|
HCPCS C1724
|
| Hospital Charge Code |
2550918
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,129.54 |
| Max. Negotiated Rate |
$3,998.32 |
| Rate for Payer: Aetna Commercial |
$3,911.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,737.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,303.38
|
| Rate for Payer: Cash Price |
$1,303.80
|
| Rate for Payer: Cigna Commercial |
$3,998.32
|
| Rate for Payer: Health EOS Commercial |
$3,867.94
|
| Rate for Payer: HFN Commercial |
$3,998.32
|
| Rate for Payer: Multiplan Commercial |
$3,476.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,607.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,998.32
|
| Rate for Payer: Quartz Beloit One Network |
$2,129.54
|
| Rate for Payer: Quartz Commercial |
$2,607.60
|
| Rate for Payer: WEA Trust Commercial |
$2,390.30
|
| Rate for Payer: WPS Commercial |
$3,219.08
|
|
|
Thrombectomy Solentproxi
|
Facility
|
OP
|
$4,346.00
|
|
|
Service Code
|
HCPCS C1724
|
| Hospital Charge Code |
2550918
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,216.88 |
| Max. Negotiated Rate |
$17,384.00 |
| Rate for Payer: Aetna Commercial |
$3,911.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,737.56
|
| Rate for Payer: Aetna Managed Medicare |
$1,216.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,824.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,173.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,086.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,303.38
|
| Rate for Payer: Cash Price |
$1,303.80
|
| Rate for Payer: Cigna Commercial |
$3,998.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,432.02
|
| Rate for Payer: Health EOS Commercial |
$3,867.94
|
| Rate for Payer: HFN Commercial |
$3,998.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,259.50
|
| Rate for Payer: Multiplan Commercial |
$3,476.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,607.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,998.32
|
| Rate for Payer: Quartz Beloit One Network |
$2,129.54
|
| Rate for Payer: Quartz Commercial |
$2,824.90
|
| Rate for Payer: Quartz Medicare Advantage |
$2,607.60
|
| Rate for Payer: The Alliance Commercial |
$17,384.00
|
| Rate for Payer: WEA Trust Commercial |
$2,390.30
|
| Rate for Payer: WPS Commercial |
$3,219.08
|
|
|
Thrombectomy Solent Proxi
|
Facility
|
OP
|
$9,740.00
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
4139313
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,727.20 |
| Max. Negotiated Rate |
$38,960.00 |
| Rate for Payer: Aetna Commercial |
$8,766.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,376.40
|
| Rate for Payer: Aetna Managed Medicare |
$2,727.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,331.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,870.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,675.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,162.20
|
| Rate for Payer: Cash Price |
$2,922.00
|
| Rate for Payer: Cigna Commercial |
$8,960.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,450.50
|
| Rate for Payer: Health EOS Commercial |
$8,668.60
|
| Rate for Payer: HFN Commercial |
$8,960.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,305.00
|
| Rate for Payer: Multiplan Commercial |
$7,792.00
|
| Rate for Payer: NAPHCARE Commercial |
$5,844.00
|
| Rate for Payer: Preferred Network Access Commercial |
$8,960.80
|
| Rate for Payer: Quartz Beloit One Network |
$4,772.60
|
| Rate for Payer: Quartz Commercial |
$6,331.00
|
| Rate for Payer: Quartz Medicare Advantage |
$5,844.00
|
| Rate for Payer: The Alliance Commercial |
$38,960.00
|
| Rate for Payer: WEA Trust Commercial |
$5,357.00
|
| Rate for Payer: WPS Commercial |
$7,214.42
|
|
|
Thrombectomy Solent Proxi
|
Facility
|
IP
|
$9,740.00
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
4139313
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,772.60 |
| Max. Negotiated Rate |
$8,960.80 |
| Rate for Payer: Aetna Commercial |
$8,766.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,376.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,162.20
|
| Rate for Payer: Cash Price |
$2,922.00
|
| Rate for Payer: Cigna Commercial |
$8,960.80
|
| Rate for Payer: Health EOS Commercial |
$8,668.60
|
| Rate for Payer: HFN Commercial |
$8,960.80
|
| Rate for Payer: Multiplan Commercial |
$7,792.00
|
| Rate for Payer: NAPHCARE Commercial |
$5,844.00
|
| Rate for Payer: Preferred Network Access Commercial |
$8,960.80
|
| Rate for Payer: Quartz Beloit One Network |
$4,772.60
|
| Rate for Payer: Quartz Commercial |
$5,844.00
|
| Rate for Payer: WEA Trust Commercial |
$5,357.00
|
| Rate for Payer: WPS Commercial |
$7,214.42
|
|
|
Thrombectomy Spiroflex
|
Facility
|
OP
|
$11,504.00
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
4139314
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,221.12 |
| Max. Negotiated Rate |
$46,016.00 |
| Rate for Payer: Aetna Commercial |
$10,353.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,893.44
|
| Rate for Payer: Aetna Managed Medicare |
$3,221.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,477.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,752.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,521.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,097.12
|
| Rate for Payer: Cash Price |
$3,451.20
|
| Rate for Payer: Cigna Commercial |
$10,583.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,437.64
|
| Rate for Payer: Health EOS Commercial |
$10,238.56
|
| Rate for Payer: HFN Commercial |
$10,583.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,628.00
|
| Rate for Payer: Multiplan Commercial |
$9,203.20
|
| Rate for Payer: NAPHCARE Commercial |
$6,902.40
|
| Rate for Payer: Preferred Network Access Commercial |
$10,583.68
|
| Rate for Payer: Quartz Beloit One Network |
$5,636.96
|
| Rate for Payer: Quartz Commercial |
$7,477.60
|
| Rate for Payer: Quartz Medicare Advantage |
$6,902.40
|
| Rate for Payer: The Alliance Commercial |
$46,016.00
|
| Rate for Payer: WEA Trust Commercial |
$6,327.20
|
| Rate for Payer: WPS Commercial |
$8,521.01
|
|
|
Thrombectomy Spiroflex
|
Facility
|
IP
|
$11,504.00
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
4139314
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$5,636.96 |
| Max. Negotiated Rate |
$10,583.68 |
| Rate for Payer: Aetna Commercial |
$10,353.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,893.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,097.12
|
| Rate for Payer: Cash Price |
$3,451.20
|
| Rate for Payer: Cigna Commercial |
$10,583.68
|
| Rate for Payer: Health EOS Commercial |
$10,238.56
|
| Rate for Payer: HFN Commercial |
$10,583.68
|
| Rate for Payer: Multiplan Commercial |
$9,203.20
|
| Rate for Payer: NAPHCARE Commercial |
$6,902.40
|
| Rate for Payer: Preferred Network Access Commercial |
$10,583.68
|
| Rate for Payer: Quartz Beloit One Network |
$5,636.96
|
| Rate for Payer: Quartz Commercial |
$6,902.40
|
| Rate for Payer: WEA Trust Commercial |
$6,327.20
|
| Rate for Payer: WPS Commercial |
$8,521.01
|
|
|
Thrombectomy Spiroflrx
|
Facility
|
IP
|
$4,346.00
|
|
|
Service Code
|
HCPCS C1724
|
| Hospital Charge Code |
2550916
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,129.54 |
| Max. Negotiated Rate |
$3,998.32 |
| Rate for Payer: Aetna Commercial |
$3,911.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,737.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,303.38
|
| Rate for Payer: Cash Price |
$1,303.80
|
| Rate for Payer: Cigna Commercial |
$3,998.32
|
| Rate for Payer: Health EOS Commercial |
$3,867.94
|
| Rate for Payer: HFN Commercial |
$3,998.32
|
| Rate for Payer: Multiplan Commercial |
$3,476.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,607.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,998.32
|
| Rate for Payer: Quartz Beloit One Network |
$2,129.54
|
| Rate for Payer: Quartz Commercial |
$2,607.60
|
| Rate for Payer: WEA Trust Commercial |
$2,390.30
|
| Rate for Payer: WPS Commercial |
$3,219.08
|
|
|
Thrombectomy Spiroflrx
|
Facility
|
OP
|
$4,346.00
|
|
|
Service Code
|
HCPCS C1724
|
| Hospital Charge Code |
2550916
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,216.88 |
| Max. Negotiated Rate |
$17,384.00 |
| Rate for Payer: Aetna Commercial |
$3,911.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,737.56
|
| Rate for Payer: Aetna Managed Medicare |
$1,216.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,824.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,173.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,086.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,303.38
|
| Rate for Payer: Cash Price |
$1,303.80
|
| Rate for Payer: Cigna Commercial |
$3,998.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,432.02
|
| Rate for Payer: Health EOS Commercial |
$3,867.94
|
| Rate for Payer: HFN Commercial |
$3,998.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,259.50
|
| Rate for Payer: Multiplan Commercial |
$3,476.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,607.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,998.32
|
| Rate for Payer: Quartz Beloit One Network |
$2,129.54
|
| Rate for Payer: Quartz Commercial |
$2,824.90
|
| Rate for Payer: Quartz Medicare Advantage |
$2,607.60
|
| Rate for Payer: The Alliance Commercial |
$17,384.00
|
| Rate for Payer: WEA Trust Commercial |
$2,390.30
|
| Rate for Payer: WPS Commercial |
$3,219.08
|
|
|
Thrombectomy Spiroflrx
|
Professional
|
Both
|
$4,346.00
|
|
|
Service Code
|
HCPCS C1724
|
| Hospital Charge Code |
2550916
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,912.24 |
| Max. Negotiated Rate |
$4,128.70 |
| Rate for Payer: Aetna Commercial |
$4,128.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,737.56
|
| Rate for Payer: Cash Price |
$1,303.80
|
| Rate for Payer: Cigna Commercial |
$4,128.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,173.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,607.60
|
| Rate for Payer: Health EOS Commercial |
$3,954.86
|
| Rate for Payer: HFN Commercial |
$4,128.70
|
| Rate for Payer: Multiplan Commercial |
$3,476.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,128.70
|
| Rate for Payer: Quartz Beloit One Network |
$1,912.24
|
| Rate for Payer: Quartz Commercial |
$2,477.22
|
| Rate for Payer: The Alliance Commercial |
$2,173.00
|
| Rate for Payer: WEA Trust Commercial |
$2,390.30
|
| Rate for Payer: WPS Commercial |
$3,219.08
|
|
|
Thrombectomy Venous
|
Facility
|
OP
|
$3,688.00
|
|
|
Service Code
|
CPT 37187
|
| Hospital Charge Code |
3921345
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,807.12 |
| Max. Negotiated Rate |
$43,494.48 |
| Rate for Payer: Aetna Commercial |
$3,319.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,171.68
|
| Rate for Payer: Aetna Managed Medicare |
$10,873.62
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$16,318.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$13,785.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$13,096.00
|
| Rate for Payer: Anthem Medicare Advantage |
$10,873.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,954.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$10,873.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$10,873.62
|
| Rate for Payer: Cash Price |
$1,106.40
|
| Rate for Payer: Cash Price |
$1,106.40
|
| Rate for Payer: Cash Price |
$1,106.40
|
| Rate for Payer: Cigna Commercial |
$3,392.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$10,873.62
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,874.87
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$10,873.62
|
| Rate for Payer: Health EOS Commercial |
$3,282.32
|
| Rate for Payer: HFN Commercial |
$3,392.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$40,449.87
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$10,873.62
|
| Rate for Payer: Independent Care Health Plan Medicare |
$10,873.62
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$10,873.62
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$10,873.62
|
| Rate for Payer: Multiplan Commercial |
$2,950.40
|
| Rate for Payer: NAPHCARE Commercial |
$16,310.43
|
| Rate for Payer: Preferred Network Access Commercial |
$3,392.96
|
| Rate for Payer: Quartz Beloit One Network |
$1,807.12
|
| Rate for Payer: Quartz Commercial |
$2,397.20
|
| Rate for Payer: Quartz Medicare Advantage |
$10,873.62
|
| Rate for Payer: The Alliance Commercial |
$43,494.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10,873.62
|
| Rate for Payer: United Healthcare PPO |
$6,154.00
|
| Rate for Payer: WEA Trust Commercial |
$2,028.40
|
| Rate for Payer: Wellcare Medicare |
$10,873.62
|
| Rate for Payer: WPS Commercial |
$2,731.70
|
|
|
Thrombectomy Venous
|
Facility
|
IP
|
$3,688.00
|
|
|
Service Code
|
CPT 37187
|
| Hospital Charge Code |
3921345
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,807.12 |
| Max. Negotiated Rate |
$3,392.96 |
| Rate for Payer: Aetna Commercial |
$3,319.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,171.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,954.64
|
| Rate for Payer: Cash Price |
$1,106.40
|
| Rate for Payer: Cigna Commercial |
$3,392.96
|
| Rate for Payer: Health EOS Commercial |
$3,282.32
|
| Rate for Payer: HFN Commercial |
$3,392.96
|
| Rate for Payer: Multiplan Commercial |
$2,950.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,212.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,392.96
|
| Rate for Payer: Quartz Beloit One Network |
$1,807.12
|
| Rate for Payer: Quartz Commercial |
$2,212.80
|
| Rate for Payer: WEA Trust Commercial |
$2,028.40
|
| Rate for Payer: WPS Commercial |
$2,731.70
|
|
|
Thrombectomy Venous F/U
|
Facility
|
OP
|
$3,976.00
|
|
|
Service Code
|
CPT 37188
|
| Hospital Charge Code |
3921346
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,948.24 |
| Max. Negotiated Rate |
$12,602.12 |
| Rate for Payer: Aetna Commercial |
$3,578.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,419.36
|
| Rate for Payer: Aetna Managed Medicare |
$3,150.53
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,907.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,043.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,639.00
|
| Rate for Payer: Anthem Medicare Advantage |
$3,150.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,107.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,150.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,150.53
|
| Rate for Payer: Cash Price |
$1,192.80
|
| Rate for Payer: Cash Price |
$1,192.80
|
| Rate for Payer: Cash Price |
$1,192.80
|
| Rate for Payer: Cigna Commercial |
$3,657.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,150.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,874.87
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,150.53
|
| Rate for Payer: Health EOS Commercial |
$3,538.64
|
| Rate for Payer: HFN Commercial |
$3,657.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,719.97
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,150.53
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,150.53
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,150.53
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,150.53
|
| Rate for Payer: Multiplan Commercial |
$3,180.80
|
| Rate for Payer: NAPHCARE Commercial |
$4,725.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,657.92
|
| Rate for Payer: Quartz Beloit One Network |
$1,948.24
|
| Rate for Payer: Quartz Commercial |
$2,584.40
|
| Rate for Payer: Quartz Medicare Advantage |
$3,150.53
|
| Rate for Payer: The Alliance Commercial |
$12,602.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,150.53
|
| Rate for Payer: United Healthcare PPO |
$4,103.00
|
| Rate for Payer: WEA Trust Commercial |
$2,186.80
|
| Rate for Payer: Wellcare Medicare |
$3,150.53
|
| Rate for Payer: WPS Commercial |
$2,945.02
|
|
|
Thrombectomy Venous F/U
|
Facility
|
IP
|
$3,976.00
|
|
|
Service Code
|
CPT 37188
|
| Hospital Charge Code |
3921346
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,948.24 |
| Max. Negotiated Rate |
$3,657.92 |
| Rate for Payer: Aetna Commercial |
$3,578.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,419.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,107.28
|
| Rate for Payer: Cash Price |
$1,192.80
|
| Rate for Payer: Cigna Commercial |
$3,657.92
|
| Rate for Payer: Health EOS Commercial |
$3,538.64
|
| Rate for Payer: HFN Commercial |
$3,657.92
|
| Rate for Payer: Multiplan Commercial |
$3,180.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,385.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,657.92
|
| Rate for Payer: Quartz Beloit One Network |
$1,948.24
|
| Rate for Payer: Quartz Commercial |
$2,385.60
|
| Rate for Payer: WEA Trust Commercial |
$2,186.80
|
| Rate for Payer: WPS Commercial |
$2,945.02
|
|
|
Thrombectomy Xpeedior
|
Facility
|
IP
|
$11,504.00
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
4139315
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$5,636.96 |
| Max. Negotiated Rate |
$10,583.68 |
| Rate for Payer: Aetna Commercial |
$10,353.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,893.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,097.12
|
| Rate for Payer: Cash Price |
$3,451.20
|
| Rate for Payer: Cigna Commercial |
$10,583.68
|
| Rate for Payer: Health EOS Commercial |
$10,238.56
|
| Rate for Payer: HFN Commercial |
$10,583.68
|
| Rate for Payer: Multiplan Commercial |
$9,203.20
|
| Rate for Payer: NAPHCARE Commercial |
$6,902.40
|
| Rate for Payer: Preferred Network Access Commercial |
$10,583.68
|
| Rate for Payer: Quartz Beloit One Network |
$5,636.96
|
| Rate for Payer: Quartz Commercial |
$6,902.40
|
| Rate for Payer: WEA Trust Commercial |
$6,327.20
|
| Rate for Payer: WPS Commercial |
$8,521.01
|
|
|
Thrombectomy Xpeedior
|
Facility
|
OP
|
$11,504.00
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
4139315
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,221.12 |
| Max. Negotiated Rate |
$46,016.00 |
| Rate for Payer: Aetna Commercial |
$10,353.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,893.44
|
| Rate for Payer: Aetna Managed Medicare |
$3,221.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,477.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,752.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,521.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,097.12
|
| Rate for Payer: Cash Price |
$3,451.20
|
| Rate for Payer: Cigna Commercial |
$10,583.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,437.64
|
| Rate for Payer: Health EOS Commercial |
$10,238.56
|
| Rate for Payer: HFN Commercial |
$10,583.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,628.00
|
| Rate for Payer: Multiplan Commercial |
$9,203.20
|
| Rate for Payer: NAPHCARE Commercial |
$6,902.40
|
| Rate for Payer: Preferred Network Access Commercial |
$10,583.68
|
| Rate for Payer: Quartz Beloit One Network |
$5,636.96
|
| Rate for Payer: Quartz Commercial |
$7,477.60
|
| Rate for Payer: Quartz Medicare Advantage |
$6,902.40
|
| Rate for Payer: The Alliance Commercial |
$46,016.00
|
| Rate for Payer: WEA Trust Commercial |
$6,327.20
|
| Rate for Payer: WPS Commercial |
$8,521.01
|
|
|
THROMBETOMY SET SPIROFLEX 106553-001
|
Facility
|
OP
|
$10,949.00
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
2973897
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,065.72 |
| Max. Negotiated Rate |
$43,796.00 |
| Rate for Payer: Aetna Commercial |
$9,854.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,416.14
|
| Rate for Payer: Aetna Managed Medicare |
$3,065.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,116.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,474.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,255.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,802.97
|
| Rate for Payer: Cash Price |
$3,284.70
|
| Rate for Payer: Cigna Commercial |
$10,073.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,127.06
|
| Rate for Payer: Health EOS Commercial |
$9,744.61
|
| Rate for Payer: HFN Commercial |
$10,073.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,211.75
|
| Rate for Payer: Multiplan Commercial |
$8,759.20
|
| Rate for Payer: NAPHCARE Commercial |
$6,569.40
|
| Rate for Payer: Preferred Network Access Commercial |
$10,073.08
|
| Rate for Payer: Quartz Beloit One Network |
$5,365.01
|
| Rate for Payer: Quartz Commercial |
$7,116.85
|
| Rate for Payer: Quartz Medicare Advantage |
$6,569.40
|
| Rate for Payer: The Alliance Commercial |
$43,796.00
|
| Rate for Payer: WEA Trust Commercial |
$6,021.95
|
| Rate for Payer: WPS Commercial |
$8,109.92
|
|
|
THROMBETOMY SET SPIROFLEX 106553-001
|
Facility
|
IP
|
$10,949.00
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
2973897
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5,365.01 |
| Max. Negotiated Rate |
$10,073.08 |
| Rate for Payer: Aetna Commercial |
$9,854.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,416.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,802.97
|
| Rate for Payer: Cash Price |
$3,284.70
|
| Rate for Payer: Cigna Commercial |
$10,073.08
|
| Rate for Payer: Health EOS Commercial |
$9,744.61
|
| Rate for Payer: HFN Commercial |
$10,073.08
|
| Rate for Payer: Multiplan Commercial |
$8,759.20
|
| Rate for Payer: NAPHCARE Commercial |
$6,569.40
|
| Rate for Payer: Preferred Network Access Commercial |
$10,073.08
|
| Rate for Payer: Quartz Beloit One Network |
$5,365.01
|
| Rate for Payer: Quartz Commercial |
$6,569.40
|
| Rate for Payer: WEA Trust Commercial |
$6,021.95
|
| Rate for Payer: WPS Commercial |
$8,109.92
|
|
|
Thrombin 20,000 units vial [Med]
|
Facility
|
IP
|
$1,725.00
|
|
| Hospital Charge Code |
2974987
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$845.25 |
| Max. Negotiated Rate |
$1,587.00 |
| Rate for Payer: Aetna Commercial |
$1,552.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,483.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$914.25
|
| Rate for Payer: Cash Price |
$517.50
|
| Rate for Payer: Cigna Commercial |
$1,587.00
|
| Rate for Payer: Health EOS Commercial |
$1,535.25
|
| Rate for Payer: HFN Commercial |
$1,587.00
|
| Rate for Payer: Multiplan Commercial |
$1,380.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,035.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,587.00
|
| Rate for Payer: Quartz Beloit One Network |
$845.25
|
| Rate for Payer: Quartz Commercial |
$1,035.00
|
| Rate for Payer: WEA Trust Commercial |
$948.75
|
| Rate for Payer: WPS Commercial |
$1,277.71
|
|
|
Thrombin 20,000 units vial [Med]
|
Facility
|
OP
|
$1,725.00
|
|
| Hospital Charge Code |
2974987
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$483.00 |
| Max. Negotiated Rate |
$6,900.00 |
| Rate for Payer: Aetna Commercial |
$1,552.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,483.50
|
| Rate for Payer: Aetna Managed Medicare |
$483.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,121.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$862.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$828.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$914.25
|
| Rate for Payer: Cash Price |
$517.50
|
| Rate for Payer: Cigna Commercial |
$1,587.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$965.31
|
| Rate for Payer: Health EOS Commercial |
$1,535.25
|
| Rate for Payer: HFN Commercial |
$1,587.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,293.75
|
| Rate for Payer: Multiplan Commercial |
$1,380.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,035.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,587.00
|
| Rate for Payer: Quartz Beloit One Network |
$845.25
|
| Rate for Payer: Quartz Commercial |
$1,121.25
|
| Rate for Payer: Quartz Medicare Advantage |
$1,035.00
|
| Rate for Payer: The Alliance Commercial |
$6,900.00
|
| Rate for Payer: WEA Trust Commercial |
$948.75
|
| Rate for Payer: WPS Commercial |
$1,277.71
|
|
|
Thrombin Time
|
Professional
|
Both
|
$276.00
|
|
|
Service Code
|
CPT 85670
|
| Hospital Charge Code |
978134
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.37 |
| Max. Negotiated Rate |
$262.20 |
| Rate for Payer: Aetna Commercial |
$262.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$237.36
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cigna Commercial |
$262.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$138.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$165.60
|
| Rate for Payer: Health EOS Commercial |
$251.16
|
| Rate for Payer: HFN Commercial |
$262.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$20.37
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$20.37
|
| Rate for Payer: Multiplan Commercial |
$220.80
|
| Rate for Payer: Preferred Network Access Commercial |
$262.20
|
| Rate for Payer: Quartz Beloit One Network |
$121.44
|
| Rate for Payer: Quartz Commercial |
$157.32
|
| Rate for Payer: The Alliance Commercial |
$138.00
|
| Rate for Payer: WEA Trust Commercial |
$151.80
|
| Rate for Payer: WPS Commercial |
$204.43
|
|
