|
Thrombectomy Intracran and/or Thrombolysis Infusion
|
Facility
IP
|
$14,254.00
|
|
|
Service Code
|
CPT 61645
|
| Hospital Charge Code |
4596685
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$6,984.46 |
| Max. Negotiated Rate |
$13,113.68 |
| Rate for Payer: Aetna Commercial |
$12,828.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,554.62
|
| Rate for Payer: Cash Price |
$4,276.20
|
| Rate for Payer: Cigna Commercial |
$13,113.68
|
| Rate for Payer: Health EOS Commercial |
$12,686.06
|
| Rate for Payer: HFN Commercial |
$13,113.68
|
| Rate for Payer: Multiplan Commercial |
$11,403.20
|
| Rate for Payer: NAPHCARE Commercial |
$8,552.40
|
| Rate for Payer: Preferred Network Access Commercial |
$13,113.68
|
| Rate for Payer: Quartz Beloit One Network |
$6,984.46
|
| Rate for Payer: Quartz Commercial |
$8,552.40
|
| Rate for Payer: WEA Trust Commercial |
$7,839.70
|
| Rate for Payer: WPS Commercial |
$10,557.94
|
|
|
Thrombectomy Intracran and/or Thrombolysis Infusion
|
Facility
OP
|
$14,254.00
|
|
|
Service Code
|
CPT 61645
|
| Hospital Charge Code |
4596685
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,991.12 |
| Max. Negotiated Rate |
$57,016.00 |
| Rate for Payer: Aetna Commercial |
$12,828.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$12,258.44
|
| Rate for Payer: Aetna Managed Medicare |
$3,991.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,265.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7,127.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,841.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,554.62
|
| Rate for Payer: Cash Price |
$4,276.20
|
| Rate for Payer: Cash Price |
$4,276.20
|
| Rate for Payer: Cigna Commercial |
$13,113.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,874.87
|
| Rate for Payer: Health EOS Commercial |
$12,686.06
|
| Rate for Payer: HFN Commercial |
$13,113.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$10,690.50
|
| Rate for Payer: Multiplan Commercial |
$11,403.20
|
| Rate for Payer: NAPHCARE Commercial |
$8,552.40
|
| Rate for Payer: Preferred Network Access Commercial |
$13,113.68
|
| Rate for Payer: Quartz Beloit One Network |
$6,984.46
|
| Rate for Payer: Quartz Commercial |
$9,265.10
|
| Rate for Payer: Quartz Medicare Advantage |
$8,552.40
|
| Rate for Payer: The Alliance Commercial |
$57,016.00
|
| Rate for Payer: WEA Trust Commercial |
$7,839.70
|
| Rate for Payer: WPS Commercial |
$10,557.94
|
|
|
Thrombectomy NC Post Intervention +
|
Facility
OP
|
$3,749.00
|
|
|
Service Code
|
CPT 37186
|
| Hospital Charge Code |
3921344
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,049.72 |
| Max. Negotiated Rate |
$20,943.68 |
| Rate for Payer: Aetna Commercial |
$3,374.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,224.14
|
| Rate for Payer: Aetna Managed Medicare |
$1,049.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,436.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,874.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,799.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,986.97
|
| Rate for Payer: Cash Price |
$1,124.70
|
| Rate for Payer: Cash Price |
$1,124.70
|
| Rate for Payer: Cigna Commercial |
$3,449.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,874.87
|
| Rate for Payer: Health EOS Commercial |
$3,336.61
|
| Rate for Payer: HFN Commercial |
$3,449.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,811.75
|
| Rate for Payer: Multiplan Commercial |
$2,999.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,249.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,449.08
|
| Rate for Payer: Quartz Beloit One Network |
$1,837.01
|
| Rate for Payer: Quartz Commercial |
$2,436.85
|
| Rate for Payer: Quartz Medicare Advantage |
$2,249.40
|
| Rate for Payer: The Alliance Commercial |
$20,943.68
|
| Rate for Payer: WEA Trust Commercial |
$2,061.95
|
| Rate for Payer: WPS Commercial |
$2,776.88
|
|
|
Thrombectomy NC Post Intervention +
|
Facility
IP
|
$3,749.00
|
|
|
Service Code
|
CPT 37186
|
| Hospital Charge Code |
3921344
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,837.01 |
| Max. Negotiated Rate |
$3,449.08 |
| Rate for Payer: Aetna Commercial |
$3,374.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,986.97
|
| Rate for Payer: Cash Price |
$1,124.70
|
| Rate for Payer: Cigna Commercial |
$3,449.08
|
| Rate for Payer: Health EOS Commercial |
$3,336.61
|
| Rate for Payer: HFN Commercial |
$3,449.08
|
| Rate for Payer: Multiplan Commercial |
$2,999.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,249.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,449.08
|
| Rate for Payer: Quartz Beloit One Network |
$1,837.01
|
| Rate for Payer: Quartz Commercial |
$2,249.40
|
| Rate for Payer: WEA Trust Commercial |
$2,061.95
|
| Rate for Payer: WPS Commercial |
$2,776.88
|
|
|
Thrombectomy Non Coronary Ea Add +
|
Facility
OP
|
$4,553.00
|
|
|
Service Code
|
CPT 37185
|
| Hospital Charge Code |
3921343
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,274.84 |
| Max. Negotiated Rate |
$12,148.04 |
| Rate for Payer: Aetna Commercial |
$4,097.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,915.58
|
| Rate for Payer: Aetna Managed Medicare |
$1,274.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,959.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,276.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,185.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,413.09
|
| Rate for Payer: Cash Price |
$1,365.90
|
| Rate for Payer: Cash Price |
$1,365.90
|
| Rate for Payer: Cigna Commercial |
$4,188.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,874.87
|
| Rate for Payer: Health EOS Commercial |
$4,052.17
|
| Rate for Payer: HFN Commercial |
$4,188.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,414.75
|
| Rate for Payer: Multiplan Commercial |
$3,642.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,731.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,188.76
|
| Rate for Payer: Quartz Beloit One Network |
$2,230.97
|
| Rate for Payer: Quartz Commercial |
$2,959.45
|
| Rate for Payer: Quartz Medicare Advantage |
$2,731.80
|
| Rate for Payer: The Alliance Commercial |
$12,148.04
|
| Rate for Payer: WEA Trust Commercial |
$2,504.15
|
| Rate for Payer: WPS Commercial |
$3,372.41
|
|
|
Thrombectomy Non Coronary Ea Add +
|
Professional
|
$1,386.00
|
|
|
Service Code
|
CPT 37185
|
| Hospital Charge Code |
3014542
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$144.46 |
| Max. Negotiated Rate |
$1,316.70 |
| Rate for Payer: Aetna Commercial |
$1,316.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,191.96
|
| Rate for Payer: Aetna Managed Medicare |
$144.46
|
| Rate for Payer: Anthem Medicare Advantage |
$144.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$144.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$144.46
|
| Rate for Payer: Cash Price |
$415.80
|
| Rate for Payer: Cash Price |
$415.80
|
| Rate for Payer: Cigna Commercial |
$1,316.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$693.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$144.46
|
| Rate for Payer: Health EOS Commercial |
$1,261.26
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$521.70
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$521.70
|
| Rate for Payer: Independent Care Health Plan Medicare |
$144.46
|
| Rate for Payer: Multiplan Commercial |
$1,108.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,316.70
|
| Rate for Payer: Quartz Beloit One Network |
$609.84
|
| Rate for Payer: Quartz Commercial |
$790.02
|
| Rate for Payer: Quartz Medicare Advantage |
$144.46
|
| Rate for Payer: The Alliance Commercial |
$613.96
|
| Rate for Payer: United Healthcare Medicaid |
$806.13
|
| Rate for Payer: United Healthcare Medicare Advantage |
$144.46
|
| Rate for Payer: WEA Trust Commercial |
$762.30
|
| Rate for Payer: WPS Commercial |
$650.07
|
|
|
Thrombectomy Non Coronary Ea Add +
|
Facility
IP
|
$4,553.00
|
|
|
Service Code
|
CPT 37185
|
| Hospital Charge Code |
3921343
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,230.97 |
| Max. Negotiated Rate |
$4,188.76 |
| Rate for Payer: Aetna Commercial |
$4,097.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,413.09
|
| Rate for Payer: Cash Price |
$1,365.90
|
| Rate for Payer: Cigna Commercial |
$4,188.76
|
| Rate for Payer: Health EOS Commercial |
$4,052.17
|
| Rate for Payer: HFN Commercial |
$4,188.76
|
| Rate for Payer: Multiplan Commercial |
$3,642.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,731.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,188.76
|
| Rate for Payer: Quartz Beloit One Network |
$2,230.97
|
| Rate for Payer: Quartz Commercial |
$2,731.80
|
| Rate for Payer: WEA Trust Commercial |
$2,504.15
|
| Rate for Payer: WPS Commercial |
$3,372.41
|
|
|
Thrombectomy Non Coronary Ea Add + 3718550
|
Professional
|
$2,775.00
|
|
|
Service Code
|
CPT 37185 50
|
| Hospital Charge Code |
5313711
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$1,221.00 |
| Max. Negotiated Rate |
$2,636.25 |
| Rate for Payer: Aetna Commercial |
$2,636.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,386.50
|
| Rate for Payer: Cash Price |
$832.50
|
| Rate for Payer: Cash Price |
$832.50
|
| Rate for Payer: Cigna Commercial |
$2,636.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,387.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,665.00
|
| Rate for Payer: Health EOS Commercial |
$2,525.25
|
| Rate for Payer: Multiplan Commercial |
$2,220.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,636.25
|
| Rate for Payer: Quartz Beloit One Network |
$1,221.00
|
| Rate for Payer: Quartz Commercial |
$1,581.75
|
| Rate for Payer: The Alliance Commercial |
$1,387.50
|
| Rate for Payer: WEA Trust Commercial |
$1,526.25
|
| Rate for Payer: WPS Commercial |
$2,055.44
|
|
|
Thrombectomy Non Coronary Initial
|
Facility
IP
|
$11,253.00
|
|
|
Service Code
|
CPT 37184
|
| Hospital Charge Code |
3921342
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$5,513.97 |
| Max. Negotiated Rate |
$10,352.76 |
| Rate for Payer: Aetna Commercial |
$10,127.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,964.09
|
| Rate for Payer: Cash Price |
$3,375.90
|
| Rate for Payer: Cigna Commercial |
$10,352.76
|
| Rate for Payer: Health EOS Commercial |
$10,015.17
|
| Rate for Payer: HFN Commercial |
$10,352.76
|
| Rate for Payer: Multiplan Commercial |
$9,002.40
|
| Rate for Payer: NAPHCARE Commercial |
$6,751.80
|
| Rate for Payer: Preferred Network Access Commercial |
$10,352.76
|
| Rate for Payer: Quartz Beloit One Network |
$5,513.97
|
| Rate for Payer: Quartz Commercial |
$6,751.80
|
| Rate for Payer: WEA Trust Commercial |
$6,189.15
|
| Rate for Payer: WPS Commercial |
$8,335.10
|
|
|
Thrombectomy Non Coronary Initial
|
Facility
OP
|
$11,253.00
|
|
|
Service Code
|
CPT 37184
|
| Hospital Charge Code |
3921342
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$5,513.97 |
| Max. Negotiated Rate |
$64,474.41 |
| Rate for Payer: Aetna Commercial |
$10,127.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,677.58
|
| Rate for Payer: Aetna Managed Medicare |
$17,331.83
|
| 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 |
$17,331.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,964.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17,331.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17,331.83
|
| Rate for Payer: Cash Price |
$3,375.90
|
| Rate for Payer: Cash Price |
$3,375.90
|
| Rate for Payer: Cash Price |
$3,375.90
|
| Rate for Payer: Cigna Commercial |
$10,352.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17,331.83
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,874.87
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17,331.83
|
| Rate for Payer: Health EOS Commercial |
$10,015.17
|
| Rate for Payer: HFN Commercial |
$10,352.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$64,474.41
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17,331.83
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17,331.83
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17,331.83
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17,331.83
|
| Rate for Payer: Multiplan Commercial |
$9,002.40
|
| Rate for Payer: NAPHCARE Commercial |
$25,997.74
|
| Rate for Payer: Preferred Network Access Commercial |
$10,352.76
|
| Rate for Payer: Quartz Beloit One Network |
$5,513.97
|
| Rate for Payer: Quartz Commercial |
$7,314.45
|
| Rate for Payer: Quartz Medicare Advantage |
$17,331.83
|
| Rate for Payer: The Alliance Commercial |
$20,943.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17,331.83
|
| Rate for Payer: United Healthcare PPO |
$6,154.00
|
| Rate for Payer: WEA Trust Commercial |
$6,189.15
|
| Rate for Payer: Wellcare Medicare |
$17,331.83
|
| Rate for Payer: WPS Commercial |
$8,335.10
|
|
|
THROMBECTOMY, OPEN, ARTERIOVENOUS FISTULA WITHOUT REVISION, AUTOGENOUS OR NONAUTOGENOUS DIALYSIS GRAFT (SEPARATE PROCEDURE)
|
Facility
OP
|
$20,205.70
|
|
|
Service Code
|
CPT 36831
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,240.00 |
| Max. Negotiated Rate |
$20,205.70 |
| Rate for Payer: Aetna Managed Medicare |
$5,431.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$12,238.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10,914.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10,367.00
|
| Rate for Payer: Anthem Medicare Advantage |
$5,431.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5,431.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5,431.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5,431.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,874.87
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5,431.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$20,205.70
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5,431.64
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5,431.64
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5,431.64
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5,431.64
|
| Rate for Payer: NAPHCARE Commercial |
$8,147.46
|
| Rate for Payer: Quartz Medicare Advantage |
$5,431.64
|
| Rate for Payer: The Alliance Commercial |
$12,148.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,431.64
|
| Rate for Payer: United Healthcare PPO |
$4,240.00
|
| Rate for Payer: Wellcare Medicare |
$5,431.64
|
|
|
THROMBECTOMY SET SPIROFLEX VG 106608-001
|
Facility
OP
|
$10,949.00
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
2973898
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,065.72 |
| 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: 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: WEA Trust Commercial |
$6,021.95
|
| Rate for Payer: WPS Commercial |
$8,109.92
|
|
|
THROMBECTOMY SET SPIROFLEX VG 106608-001
|
Facility
IP
|
$10,949.00
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
2973898
|
|
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: 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
|
|
|
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 |
$3,998.32 |
| 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: 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: 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 Solentomni
|
Professional
|
$4,346.00
|
|
|
Service Code
|
HCPCS C1724
|
| Hospital Charge Code |
2550920
|
|
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: 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-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 |
$6,362.72 |
| 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: 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: 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
|
$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: 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: 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 |
$3,998.32 |
| 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: 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 |
$8,960.80 |
| 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: 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: 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 |
$10,583.68 |
| 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: 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: 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
|
|
