|
Thrombectomy Solentomni
|
Facility
|
IP
|
$4,346.00
|
|
|
Service Code
|
HCPCS C1724
|
| Hospital Charge Code |
2550920
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,214.72 |
| Max. Negotiated Rate |
$4,158.25 |
| Rate for Payer: Aetna Commercial |
$4,067.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,887.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,395.52
|
| Rate for Payer: Cash Price |
$1,303.80
|
| Rate for Payer: Cigna Commercial |
$4,158.25
|
| Rate for Payer: Health EOS Commercial |
$4,022.66
|
| Rate for Payer: HFN Commercial |
$4,158.25
|
| Rate for Payer: Multiplan Commercial |
$3,615.87
|
| Rate for Payer: Preferred Network Access Commercial |
$4,158.25
|
| Rate for Payer: Quartz Beloit One Network |
$2,214.72
|
| Rate for Payer: Quartz Commercial |
$2,711.90
|
| Rate for Payer: WEA Trust Commercial |
$2,485.91
|
| Rate for Payer: WPS Commercial |
$3,347.72
|
|
|
Thrombectomy Solentomni
|
Professional
|
Both
|
$4,346.00
|
|
|
Service Code
|
HCPCS C1724
|
| Hospital Charge Code |
2550920
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,988.73 |
| Max. Negotiated Rate |
$4,293.85 |
| Rate for Payer: Aetna Commercial |
$4,293.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,887.06
|
| Rate for Payer: Cash Price |
$1,303.80
|
| Rate for Payer: Cigna Commercial |
$4,293.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,259.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,711.90
|
| Rate for Payer: Health EOS Commercial |
$4,113.05
|
| Rate for Payer: HFN Commercial |
$4,293.85
|
| Rate for Payer: Multiplan Commercial |
$3,615.87
|
| Rate for Payer: Preferred Network Access Commercial |
$4,293.85
|
| Rate for Payer: Quartz Beloit One Network |
$1,988.73
|
| Rate for Payer: Quartz Commercial |
$2,576.31
|
| Rate for Payer: The Alliance Commercial |
$2,259.92
|
| Rate for Payer: WEA Trust Commercial |
$2,485.91
|
| Rate for Payer: WPS Commercial |
$3,347.72
|
|
|
Thrombectomy Solentomni
|
Facility
|
OP
|
$4,346.00
|
|
|
Service Code
|
HCPCS C1724
|
| Hospital Charge Code |
2550920
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,265.56 |
| Max. Negotiated Rate |
$4,158.25 |
| Rate for Payer: Aetna Commercial |
$4,067.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,887.06
|
| Rate for Payer: Aetna Managed Medicare |
$1,265.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,937.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,259.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,169.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,395.52
|
| Rate for Payer: Cash Price |
$1,303.80
|
| Rate for Payer: Cigna Commercial |
$4,158.25
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,529.37
|
| Rate for Payer: Health EOS Commercial |
$4,022.66
|
| Rate for Payer: HFN Commercial |
$4,158.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,389.88
|
| Rate for Payer: Multiplan Commercial |
$3,615.87
|
| Rate for Payer: NAPHCARE Commercial |
$2,711.90
|
| Rate for Payer: Preferred Network Access Commercial |
$4,158.25
|
| Rate for Payer: Quartz Beloit One Network |
$2,214.72
|
| Rate for Payer: Quartz Commercial |
$2,937.90
|
| Rate for Payer: Quartz Medicare Advantage |
$2,711.90
|
| Rate for Payer: The Alliance Commercial |
$2,259.92
|
| Rate for Payer: WEA Trust Commercial |
$2,485.91
|
| Rate for Payer: WPS Commercial |
$3,347.72
|
|
|
Thrombectomy-Solent Omni
|
Facility
|
IP
|
$6,916.00
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
4139316
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,524.39 |
| Max. Negotiated Rate |
$6,617.23 |
| Rate for Payer: Aetna Commercial |
$6,473.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,185.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,812.10
|
| Rate for Payer: Cash Price |
$2,074.80
|
| Rate for Payer: Cigna Commercial |
$6,617.23
|
| Rate for Payer: Health EOS Commercial |
$6,401.45
|
| Rate for Payer: HFN Commercial |
$6,617.23
|
| Rate for Payer: Multiplan Commercial |
$5,754.11
|
| Rate for Payer: Preferred Network Access Commercial |
$6,617.23
|
| Rate for Payer: Quartz Beloit One Network |
$3,524.39
|
| Rate for Payer: Quartz Commercial |
$4,315.58
|
| Rate for Payer: WEA Trust Commercial |
$3,955.95
|
| Rate for Payer: WPS Commercial |
$5,327.39
|
|
|
Thrombectomy-Solent Omni
|
Facility
|
OP
|
$6,916.00
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
4139316
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,013.94 |
| Max. Negotiated Rate |
$6,617.23 |
| Rate for Payer: Aetna Commercial |
$6,473.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,185.67
|
| Rate for Payer: Aetna Managed Medicare |
$2,013.94
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,675.22
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,596.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,452.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,812.10
|
| Rate for Payer: Cash Price |
$2,074.80
|
| Rate for Payer: Cigna Commercial |
$6,617.23
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,025.11
|
| Rate for Payer: Health EOS Commercial |
$6,401.45
|
| Rate for Payer: HFN Commercial |
$6,617.23
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,394.48
|
| Rate for Payer: Multiplan Commercial |
$5,754.11
|
| Rate for Payer: NAPHCARE Commercial |
$4,315.58
|
| Rate for Payer: Preferred Network Access Commercial |
$6,617.23
|
| Rate for Payer: Quartz Beloit One Network |
$3,524.39
|
| Rate for Payer: Quartz Commercial |
$4,675.22
|
| Rate for Payer: Quartz Medicare Advantage |
$4,315.58
|
| Rate for Payer: The Alliance Commercial |
$3,596.32
|
| Rate for Payer: WEA Trust Commercial |
$3,955.95
|
| Rate for Payer: WPS Commercial |
$5,327.39
|
|
|
Thrombectomy Solentproxi
|
Professional
|
Both
|
$4,346.00
|
|
|
Service Code
|
HCPCS C1724
|
| Hospital Charge Code |
2550918
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,988.73 |
| Max. Negotiated Rate |
$4,293.85 |
| Rate for Payer: Aetna Commercial |
$4,293.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,887.06
|
| Rate for Payer: Cash Price |
$1,303.80
|
| Rate for Payer: Cigna Commercial |
$4,293.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,259.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,711.90
|
| Rate for Payer: Health EOS Commercial |
$4,113.05
|
| Rate for Payer: HFN Commercial |
$4,293.85
|
| Rate for Payer: Multiplan Commercial |
$3,615.87
|
| Rate for Payer: Preferred Network Access Commercial |
$4,293.85
|
| Rate for Payer: Quartz Beloit One Network |
$1,988.73
|
| Rate for Payer: Quartz Commercial |
$2,576.31
|
| Rate for Payer: The Alliance Commercial |
$2,259.92
|
| Rate for Payer: WEA Trust Commercial |
$2,485.91
|
| Rate for Payer: WPS Commercial |
$3,347.72
|
|
|
Thrombectomy Solentproxi
|
Facility
|
IP
|
$4,346.00
|
|
|
Service Code
|
HCPCS C1724
|
| Hospital Charge Code |
2550918
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,214.72 |
| Max. Negotiated Rate |
$4,158.25 |
| Rate for Payer: Aetna Commercial |
$4,067.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,887.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,395.52
|
| Rate for Payer: Cash Price |
$1,303.80
|
| Rate for Payer: Cigna Commercial |
$4,158.25
|
| Rate for Payer: Health EOS Commercial |
$4,022.66
|
| Rate for Payer: HFN Commercial |
$4,158.25
|
| Rate for Payer: Multiplan Commercial |
$3,615.87
|
| Rate for Payer: Preferred Network Access Commercial |
$4,158.25
|
| Rate for Payer: Quartz Beloit One Network |
$2,214.72
|
| Rate for Payer: Quartz Commercial |
$2,711.90
|
| Rate for Payer: WEA Trust Commercial |
$2,485.91
|
| Rate for Payer: WPS Commercial |
$3,347.72
|
|
|
Thrombectomy Solentproxi
|
Facility
|
OP
|
$4,346.00
|
|
|
Service Code
|
HCPCS C1724
|
| Hospital Charge Code |
2550918
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,265.56 |
| Max. Negotiated Rate |
$4,158.25 |
| Rate for Payer: Aetna Commercial |
$4,067.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,887.06
|
| Rate for Payer: Aetna Managed Medicare |
$1,265.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,937.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,259.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,169.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,395.52
|
| Rate for Payer: Cash Price |
$1,303.80
|
| Rate for Payer: Cigna Commercial |
$4,158.25
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,529.37
|
| Rate for Payer: Health EOS Commercial |
$4,022.66
|
| Rate for Payer: HFN Commercial |
$4,158.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,389.88
|
| Rate for Payer: Multiplan Commercial |
$3,615.87
|
| Rate for Payer: NAPHCARE Commercial |
$2,711.90
|
| Rate for Payer: Preferred Network Access Commercial |
$4,158.25
|
| Rate for Payer: Quartz Beloit One Network |
$2,214.72
|
| Rate for Payer: Quartz Commercial |
$2,937.90
|
| Rate for Payer: Quartz Medicare Advantage |
$2,711.90
|
| Rate for Payer: The Alliance Commercial |
$2,259.92
|
| Rate for Payer: WEA Trust Commercial |
$2,485.91
|
| Rate for Payer: WPS Commercial |
$3,347.72
|
|
|
Thrombectomy Solent Proxi
|
Facility
|
OP
|
$9,740.00
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
4139313
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,836.29 |
| Max. Negotiated Rate |
$9,319.23 |
| Rate for Payer: Aetna Commercial |
$9,116.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,711.46
|
| Rate for Payer: Aetna Managed Medicare |
$2,836.29
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,584.24
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,064.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,862.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,368.69
|
| Rate for Payer: Cash Price |
$2,922.00
|
| Rate for Payer: Cigna Commercial |
$9,319.23
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,668.68
|
| Rate for Payer: Health EOS Commercial |
$9,015.34
|
| Rate for Payer: HFN Commercial |
$9,319.23
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,597.20
|
| Rate for Payer: Multiplan Commercial |
$8,103.68
|
| Rate for Payer: NAPHCARE Commercial |
$6,077.76
|
| Rate for Payer: Preferred Network Access Commercial |
$9,319.23
|
| Rate for Payer: Quartz Beloit One Network |
$4,963.50
|
| Rate for Payer: Quartz Commercial |
$6,584.24
|
| Rate for Payer: Quartz Medicare Advantage |
$6,077.76
|
| Rate for Payer: The Alliance Commercial |
$5,064.80
|
| Rate for Payer: WEA Trust Commercial |
$5,571.28
|
| Rate for Payer: WPS Commercial |
$7,502.72
|
|
|
Thrombectomy Solent Proxi
|
Facility
|
IP
|
$9,740.00
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
4139313
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,963.50 |
| Max. Negotiated Rate |
$9,319.23 |
| Rate for Payer: Aetna Commercial |
$9,116.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,711.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,368.69
|
| Rate for Payer: Cash Price |
$2,922.00
|
| Rate for Payer: Cigna Commercial |
$9,319.23
|
| Rate for Payer: Health EOS Commercial |
$9,015.34
|
| Rate for Payer: HFN Commercial |
$9,319.23
|
| Rate for Payer: Multiplan Commercial |
$8,103.68
|
| Rate for Payer: Preferred Network Access Commercial |
$9,319.23
|
| Rate for Payer: Quartz Beloit One Network |
$4,963.50
|
| Rate for Payer: Quartz Commercial |
$6,077.76
|
| Rate for Payer: WEA Trust Commercial |
$5,571.28
|
| Rate for Payer: WPS Commercial |
$7,502.72
|
|
|
Thrombectomy Spiroflex
|
Facility
|
IP
|
$11,504.00
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
4139314
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$5,862.44 |
| Max. Negotiated Rate |
$11,007.03 |
| Rate for Payer: Aetna Commercial |
$10,767.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,289.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,341.00
|
| Rate for Payer: Cash Price |
$3,451.20
|
| Rate for Payer: Cigna Commercial |
$11,007.03
|
| Rate for Payer: Health EOS Commercial |
$10,648.10
|
| Rate for Payer: HFN Commercial |
$11,007.03
|
| Rate for Payer: Multiplan Commercial |
$9,571.33
|
| Rate for Payer: Preferred Network Access Commercial |
$11,007.03
|
| Rate for Payer: Quartz Beloit One Network |
$5,862.44
|
| Rate for Payer: Quartz Commercial |
$7,178.50
|
| Rate for Payer: WEA Trust Commercial |
$6,580.29
|
| Rate for Payer: WPS Commercial |
$8,861.53
|
|
|
Thrombectomy Spiroflex
|
Facility
|
OP
|
$11,504.00
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
4139314
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,349.96 |
| Max. Negotiated Rate |
$11,007.03 |
| Rate for Payer: Aetna Commercial |
$10,767.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,289.18
|
| Rate for Payer: Aetna Managed Medicare |
$3,349.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,776.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,982.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,742.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,341.00
|
| Rate for Payer: Cash Price |
$3,451.20
|
| Rate for Payer: Cigna Commercial |
$11,007.03
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,695.33
|
| Rate for Payer: Health EOS Commercial |
$10,648.10
|
| Rate for Payer: HFN Commercial |
$11,007.03
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,973.12
|
| Rate for Payer: Multiplan Commercial |
$9,571.33
|
| Rate for Payer: NAPHCARE Commercial |
$7,178.50
|
| Rate for Payer: Preferred Network Access Commercial |
$11,007.03
|
| Rate for Payer: Quartz Beloit One Network |
$5,862.44
|
| Rate for Payer: Quartz Commercial |
$7,776.70
|
| Rate for Payer: Quartz Medicare Advantage |
$7,178.50
|
| Rate for Payer: The Alliance Commercial |
$5,982.08
|
| Rate for Payer: WEA Trust Commercial |
$6,580.29
|
| Rate for Payer: WPS Commercial |
$8,861.53
|
|
|
Thrombectomy Spiroflrx
|
Facility
|
OP
|
$4,346.00
|
|
|
Service Code
|
HCPCS C1724
|
| Hospital Charge Code |
2550916
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,265.56 |
| Max. Negotiated Rate |
$4,158.25 |
| Rate for Payer: Aetna Commercial |
$4,067.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,887.06
|
| Rate for Payer: Aetna Managed Medicare |
$1,265.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,937.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,259.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,169.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,395.52
|
| Rate for Payer: Cash Price |
$1,303.80
|
| Rate for Payer: Cigna Commercial |
$4,158.25
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,529.37
|
| Rate for Payer: Health EOS Commercial |
$4,022.66
|
| Rate for Payer: HFN Commercial |
$4,158.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,389.88
|
| Rate for Payer: Multiplan Commercial |
$3,615.87
|
| Rate for Payer: NAPHCARE Commercial |
$2,711.90
|
| Rate for Payer: Preferred Network Access Commercial |
$4,158.25
|
| Rate for Payer: Quartz Beloit One Network |
$2,214.72
|
| Rate for Payer: Quartz Commercial |
$2,937.90
|
| Rate for Payer: Quartz Medicare Advantage |
$2,711.90
|
| Rate for Payer: The Alliance Commercial |
$2,259.92
|
| Rate for Payer: WEA Trust Commercial |
$2,485.91
|
| Rate for Payer: WPS Commercial |
$3,347.72
|
|
|
Thrombectomy Spiroflrx
|
Facility
|
IP
|
$4,346.00
|
|
|
Service Code
|
HCPCS C1724
|
| Hospital Charge Code |
2550916
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,214.72 |
| Max. Negotiated Rate |
$4,158.25 |
| Rate for Payer: Aetna Commercial |
$4,067.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,887.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,395.52
|
| Rate for Payer: Cash Price |
$1,303.80
|
| Rate for Payer: Cigna Commercial |
$4,158.25
|
| Rate for Payer: Health EOS Commercial |
$4,022.66
|
| Rate for Payer: HFN Commercial |
$4,158.25
|
| Rate for Payer: Multiplan Commercial |
$3,615.87
|
| Rate for Payer: Preferred Network Access Commercial |
$4,158.25
|
| Rate for Payer: Quartz Beloit One Network |
$2,214.72
|
| Rate for Payer: Quartz Commercial |
$2,711.90
|
| Rate for Payer: WEA Trust Commercial |
$2,485.91
|
| Rate for Payer: WPS Commercial |
$3,347.72
|
|
|
Thrombectomy Spiroflrx
|
Professional
|
Both
|
$4,346.00
|
|
|
Service Code
|
HCPCS C1724
|
| Hospital Charge Code |
2550916
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,988.73 |
| Max. Negotiated Rate |
$4,293.85 |
| Rate for Payer: Aetna Commercial |
$4,293.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,887.06
|
| Rate for Payer: Cash Price |
$1,303.80
|
| Rate for Payer: Cigna Commercial |
$4,293.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,259.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,711.90
|
| Rate for Payer: Health EOS Commercial |
$4,113.05
|
| Rate for Payer: HFN Commercial |
$4,293.85
|
| Rate for Payer: Multiplan Commercial |
$3,615.87
|
| Rate for Payer: Preferred Network Access Commercial |
$4,293.85
|
| Rate for Payer: Quartz Beloit One Network |
$1,988.73
|
| Rate for Payer: Quartz Commercial |
$2,576.31
|
| Rate for Payer: The Alliance Commercial |
$2,259.92
|
| Rate for Payer: WEA Trust Commercial |
$2,485.91
|
| Rate for Payer: WPS Commercial |
$3,347.72
|
|
|
Thrombectomy Venous
|
Facility
|
OP
|
$3,688.00
|
|
|
Service Code
|
CPT 37187
|
| Hospital Charge Code |
3921345
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,879.40 |
| Max. Negotiated Rate |
$48,595.91 |
| Rate for Payer: Aetna Commercial |
$3,451.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,298.55
|
| Rate for Payer: Aetna Managed Medicare |
$12,148.98
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$16,970.72
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$14,336.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$13,619.84
|
| Rate for Payer: Anthem Medicare Advantage |
$12,148.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,032.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12,148.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12,148.98
|
| 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 |
$3,528.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12,148.98
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,349.86
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12,148.98
|
| Rate for Payer: Health EOS Commercial |
$3,413.61
|
| Rate for Payer: HFN Commercial |
$3,528.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$45,194.20
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12,148.98
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12,148.98
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12,148.98
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12,148.98
|
| Rate for Payer: Multiplan Commercial |
$3,068.42
|
| Rate for Payer: NAPHCARE Commercial |
$18,223.47
|
| Rate for Payer: Preferred Network Access Commercial |
$3,528.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,879.40
|
| Rate for Payer: Quartz Commercial |
$2,493.09
|
| Rate for Payer: Quartz Medicare Advantage |
$12,148.98
|
| Rate for Payer: The Alliance Commercial |
$48,595.91
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12,148.98
|
| Rate for Payer: United Healthcare PPO |
$6,400.16
|
| Rate for Payer: WEA Trust Commercial |
$2,109.54
|
| Rate for Payer: Wellcare Medicare |
$12,148.98
|
| Rate for Payer: WPS Commercial |
$2,840.87
|
|
|
Thrombectomy Venous
|
Facility
|
IP
|
$3,688.00
|
|
|
Service Code
|
CPT 37187
|
| Hospital Charge Code |
3921345
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,879.40 |
| Max. Negotiated Rate |
$3,528.68 |
| Rate for Payer: Aetna Commercial |
$3,451.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,298.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,032.83
|
| Rate for Payer: Cash Price |
$1,106.40
|
| Rate for Payer: Cigna Commercial |
$3,528.68
|
| Rate for Payer: Health EOS Commercial |
$3,413.61
|
| Rate for Payer: HFN Commercial |
$3,528.68
|
| Rate for Payer: Multiplan Commercial |
$3,068.42
|
| Rate for Payer: Preferred Network Access Commercial |
$3,528.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,879.40
|
| Rate for Payer: Quartz Commercial |
$2,301.31
|
| Rate for Payer: WEA Trust Commercial |
$2,109.54
|
| Rate for Payer: WPS Commercial |
$2,840.87
|
|
|
Thrombectomy Venous F/U
|
Facility
|
OP
|
$3,976.00
|
|
|
Service Code
|
CPT 37188
|
| Hospital Charge Code |
3921346
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,026.17 |
| Max. Negotiated Rate |
$13,291.62 |
| Rate for Payer: Aetna Commercial |
$3,721.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,556.13
|
| Rate for Payer: Aetna Managed Medicare |
$3,322.90
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$10,303.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,364.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,944.56
|
| Rate for Payer: Anthem Medicare Advantage |
$3,322.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,191.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,322.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,322.90
|
| 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 |
$3,804.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,322.90
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,349.86
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,322.90
|
| Rate for Payer: Health EOS Commercial |
$3,680.19
|
| Rate for Payer: HFN Commercial |
$3,804.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,361.20
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,322.90
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,322.90
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,322.90
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,322.90
|
| Rate for Payer: Multiplan Commercial |
$3,308.03
|
| Rate for Payer: NAPHCARE Commercial |
$4,984.36
|
| Rate for Payer: Preferred Network Access Commercial |
$3,804.24
|
| Rate for Payer: Quartz Beloit One Network |
$2,026.17
|
| Rate for Payer: Quartz Commercial |
$2,687.78
|
| Rate for Payer: Quartz Medicare Advantage |
$3,322.90
|
| Rate for Payer: The Alliance Commercial |
$13,291.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,322.90
|
| Rate for Payer: United Healthcare PPO |
$4,267.12
|
| Rate for Payer: WEA Trust Commercial |
$2,274.27
|
| Rate for Payer: Wellcare Medicare |
$3,322.90
|
| Rate for Payer: WPS Commercial |
$3,062.71
|
|
|
Thrombectomy Venous F/U
|
Facility
|
IP
|
$3,976.00
|
|
|
Service Code
|
CPT 37188
|
| Hospital Charge Code |
3921346
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,026.17 |
| Max. Negotiated Rate |
$3,804.24 |
| Rate for Payer: Aetna Commercial |
$3,721.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,556.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,191.57
|
| Rate for Payer: Cash Price |
$1,192.80
|
| Rate for Payer: Cigna Commercial |
$3,804.24
|
| Rate for Payer: Health EOS Commercial |
$3,680.19
|
| Rate for Payer: HFN Commercial |
$3,804.24
|
| Rate for Payer: Multiplan Commercial |
$3,308.03
|
| Rate for Payer: Preferred Network Access Commercial |
$3,804.24
|
| Rate for Payer: Quartz Beloit One Network |
$2,026.17
|
| Rate for Payer: Quartz Commercial |
$2,481.02
|
| Rate for Payer: WEA Trust Commercial |
$2,274.27
|
| Rate for Payer: WPS Commercial |
$3,062.71
|
|
|
Thrombectomy Xpeedior
|
Facility
|
IP
|
$11,504.00
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
4139315
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$5,862.44 |
| Max. Negotiated Rate |
$11,007.03 |
| Rate for Payer: Aetna Commercial |
$10,767.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,289.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,341.00
|
| Rate for Payer: Cash Price |
$3,451.20
|
| Rate for Payer: Cigna Commercial |
$11,007.03
|
| Rate for Payer: Health EOS Commercial |
$10,648.10
|
| Rate for Payer: HFN Commercial |
$11,007.03
|
| Rate for Payer: Multiplan Commercial |
$9,571.33
|
| Rate for Payer: Preferred Network Access Commercial |
$11,007.03
|
| Rate for Payer: Quartz Beloit One Network |
$5,862.44
|
| Rate for Payer: Quartz Commercial |
$7,178.50
|
| Rate for Payer: WEA Trust Commercial |
$6,580.29
|
| Rate for Payer: WPS Commercial |
$8,861.53
|
|
|
Thrombectomy Xpeedior
|
Facility
|
OP
|
$11,504.00
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
4139315
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,349.96 |
| Max. Negotiated Rate |
$11,007.03 |
| Rate for Payer: Aetna Commercial |
$10,767.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,289.18
|
| Rate for Payer: Aetna Managed Medicare |
$3,349.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,776.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,982.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,742.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,341.00
|
| Rate for Payer: Cash Price |
$3,451.20
|
| Rate for Payer: Cigna Commercial |
$11,007.03
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,695.33
|
| Rate for Payer: Health EOS Commercial |
$10,648.10
|
| Rate for Payer: HFN Commercial |
$11,007.03
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,973.12
|
| Rate for Payer: Multiplan Commercial |
$9,571.33
|
| Rate for Payer: NAPHCARE Commercial |
$7,178.50
|
| Rate for Payer: Preferred Network Access Commercial |
$11,007.03
|
| Rate for Payer: Quartz Beloit One Network |
$5,862.44
|
| Rate for Payer: Quartz Commercial |
$7,776.70
|
| Rate for Payer: Quartz Medicare Advantage |
$7,178.50
|
| Rate for Payer: The Alliance Commercial |
$5,982.08
|
| Rate for Payer: WEA Trust Commercial |
$6,580.29
|
| Rate for Payer: WPS Commercial |
$8,861.53
|
|
|
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 |
$5,579.61 |
| Max. Negotiated Rate |
$10,476.00 |
| Rate for Payer: Aetna Commercial |
$10,248.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,792.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,035.09
|
| Rate for Payer: Cash Price |
$3,284.70
|
| Rate for Payer: Cigna Commercial |
$10,476.00
|
| Rate for Payer: Health EOS Commercial |
$10,134.39
|
| Rate for Payer: HFN Commercial |
$10,476.00
|
| Rate for Payer: Multiplan Commercial |
$9,109.57
|
| Rate for Payer: Preferred Network Access Commercial |
$10,476.00
|
| Rate for Payer: Quartz Beloit One Network |
$5,579.61
|
| Rate for Payer: Quartz Commercial |
$6,832.18
|
| Rate for Payer: WEA Trust Commercial |
$6,262.83
|
| Rate for Payer: WPS Commercial |
$8,434.01
|
|
|
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 |
$3,188.35 |
| Max. Negotiated Rate |
$10,476.00 |
| Rate for Payer: Aetna Commercial |
$10,248.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,792.79
|
| Rate for Payer: Aetna Managed Medicare |
$3,188.35
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,401.52
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,693.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,465.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,035.09
|
| Rate for Payer: Cash Price |
$3,284.70
|
| Rate for Payer: Cigna Commercial |
$10,476.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,372.32
|
| Rate for Payer: Health EOS Commercial |
$10,134.39
|
| Rate for Payer: HFN Commercial |
$10,476.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,540.22
|
| Rate for Payer: Multiplan Commercial |
$9,109.57
|
| Rate for Payer: NAPHCARE Commercial |
$6,832.18
|
| Rate for Payer: Preferred Network Access Commercial |
$10,476.00
|
| Rate for Payer: Quartz Beloit One Network |
$5,579.61
|
| Rate for Payer: Quartz Commercial |
$7,401.52
|
| Rate for Payer: Quartz Medicare Advantage |
$6,832.18
|
| Rate for Payer: The Alliance Commercial |
$5,693.48
|
| Rate for Payer: WEA Trust Commercial |
$6,262.83
|
| Rate for Payer: WPS Commercial |
$8,434.01
|
|
|
Thrombin 20,000 units vial [Med]
|
Facility
|
IP
|
$1,725.00
|
|
| Hospital Charge Code |
2974987
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$879.06 |
| Max. Negotiated Rate |
$1,650.48 |
| Rate for Payer: Aetna Commercial |
$1,614.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,542.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$950.82
|
| Rate for Payer: Cash Price |
$517.50
|
| Rate for Payer: Cigna Commercial |
$1,650.48
|
| Rate for Payer: Health EOS Commercial |
$1,596.66
|
| Rate for Payer: HFN Commercial |
$1,650.48
|
| Rate for Payer: Multiplan Commercial |
$1,435.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,650.48
|
| Rate for Payer: Quartz Beloit One Network |
$879.06
|
| Rate for Payer: Quartz Commercial |
$1,076.40
|
| Rate for Payer: WEA Trust Commercial |
$986.70
|
| Rate for Payer: WPS Commercial |
$1,328.77
|
|
|
Thrombin 20,000 units vial [Med]
|
Facility
|
OP
|
$1,725.00
|
|
| Hospital Charge Code |
2974987
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$502.32 |
| Max. Negotiated Rate |
$1,650.48 |
| Rate for Payer: Aetna Commercial |
$1,614.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,542.84
|
| Rate for Payer: Aetna Managed Medicare |
$502.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,166.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$897.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$861.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$950.82
|
| Rate for Payer: Cash Price |
$517.50
|
| Rate for Payer: Cigna Commercial |
$1,650.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,003.95
|
| Rate for Payer: Health EOS Commercial |
$1,596.66
|
| Rate for Payer: HFN Commercial |
$1,650.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,345.50
|
| Rate for Payer: Multiplan Commercial |
$1,435.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,076.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,650.48
|
| Rate for Payer: Quartz Beloit One Network |
$879.06
|
| Rate for Payer: Quartz Commercial |
$1,166.10
|
| Rate for Payer: Quartz Medicare Advantage |
$1,076.40
|
| Rate for Payer: The Alliance Commercial |
$897.00
|
| Rate for Payer: WEA Trust Commercial |
$986.70
|
| Rate for Payer: WPS Commercial |
$1,328.77
|
|
