|
THROMBECTOMY CATHETER SOLENT PEOXI 109676-001
|
Facility
|
OP
|
$9,739.00
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
2973877
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,836.00 |
| Max. Negotiated Rate |
$9,318.28 |
| Rate for Payer: Aetna Commercial |
$9,115.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,710.56
|
| Rate for Payer: Aetna Managed Medicare |
$2,836.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,583.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,064.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,861.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,368.14
|
| Rate for Payer: Cash Price |
$2,921.70
|
| Rate for Payer: Cigna Commercial |
$9,318.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,668.10
|
| Rate for Payer: Health EOS Commercial |
$9,014.42
|
| Rate for Payer: HFN Commercial |
$9,318.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,596.42
|
| Rate for Payer: Multiplan Commercial |
$8,102.85
|
| Rate for Payer: NAPHCARE Commercial |
$6,077.14
|
| Rate for Payer: Preferred Network Access Commercial |
$9,318.28
|
| Rate for Payer: Quartz Beloit One Network |
$4,962.99
|
| Rate for Payer: Quartz Commercial |
$6,583.56
|
| Rate for Payer: Quartz Medicare Advantage |
$6,077.14
|
| Rate for Payer: The Alliance Commercial |
$5,064.28
|
| Rate for Payer: WEA Trust Commercial |
$5,570.71
|
| Rate for Payer: WPS Commercial |
$7,501.95
|
|
|
THROMBECTOMY, DIALYSIS
|
Facility
|
IP
|
$4,602.00
|
|
| Hospital Charge Code |
6209792
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,345.18 |
| Max. Negotiated Rate |
$4,403.19 |
| Rate for Payer: Aetna Commercial |
$4,307.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,116.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,536.62
|
| Rate for Payer: Cash Price |
$1,380.60
|
| Rate for Payer: Cigna Commercial |
$4,403.19
|
| Rate for Payer: Health EOS Commercial |
$4,259.61
|
| Rate for Payer: HFN Commercial |
$4,403.19
|
| Rate for Payer: Multiplan Commercial |
$3,828.86
|
| Rate for Payer: Preferred Network Access Commercial |
$4,403.19
|
| Rate for Payer: Quartz Beloit One Network |
$2,345.18
|
| Rate for Payer: Quartz Commercial |
$2,871.65
|
| Rate for Payer: WEA Trust Commercial |
$2,632.34
|
| Rate for Payer: WPS Commercial |
$3,544.92
|
|
|
THROMBECTOMY, DIALYSIS
|
Facility
|
OP
|
$4,602.00
|
|
| Hospital Charge Code |
6209792
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,340.10 |
| Max. Negotiated Rate |
$4,403.19 |
| Rate for Payer: Aetna Commercial |
$4,307.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,116.03
|
| Rate for Payer: Aetna Managed Medicare |
$1,340.10
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,110.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,393.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,297.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,536.62
|
| Rate for Payer: Cash Price |
$1,380.60
|
| Rate for Payer: Cigna Commercial |
$4,403.19
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,678.36
|
| Rate for Payer: Health EOS Commercial |
$4,259.61
|
| Rate for Payer: HFN Commercial |
$4,403.19
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,589.56
|
| Rate for Payer: Multiplan Commercial |
$3,828.86
|
| Rate for Payer: NAPHCARE Commercial |
$2,871.65
|
| Rate for Payer: Preferred Network Access Commercial |
$4,403.19
|
| Rate for Payer: Quartz Beloit One Network |
$2,345.18
|
| Rate for Payer: Quartz Commercial |
$3,110.95
|
| Rate for Payer: Quartz Medicare Advantage |
$2,871.65
|
| Rate for Payer: The Alliance Commercial |
$2,393.04
|
| Rate for Payer: WEA Trust Commercial |
$2,632.34
|
| Rate for Payer: WPS Commercial |
$3,544.92
|
|
|
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 |
$7,263.84 |
| Max. Negotiated Rate |
$13,638.23 |
| Rate for Payer: Aetna Commercial |
$13,341.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$12,748.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,856.80
|
| Rate for Payer: Cash Price |
$4,276.20
|
| Rate for Payer: Cigna Commercial |
$13,638.23
|
| Rate for Payer: Health EOS Commercial |
$13,193.50
|
| Rate for Payer: HFN Commercial |
$13,638.23
|
| Rate for Payer: Multiplan Commercial |
$11,859.33
|
| Rate for Payer: Preferred Network Access Commercial |
$13,638.23
|
| Rate for Payer: Quartz Beloit One Network |
$7,263.84
|
| Rate for Payer: Quartz Commercial |
$8,894.50
|
| Rate for Payer: WEA Trust Commercial |
$8,153.29
|
| Rate for Payer: WPS Commercial |
$10,979.86
|
|
|
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 |
$2,708.45 |
| Max. Negotiated Rate |
$13,638.23 |
| Rate for Payer: Aetna Commercial |
$13,341.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$12,748.78
|
| Rate for Payer: Aetna Managed Medicare |
$4,150.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,635.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7,412.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,115.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,856.80
|
| Rate for Payer: Cash Price |
$4,276.20
|
| Rate for Payer: Cash Price |
$4,276.20
|
| Rate for Payer: Cigna Commercial |
$13,638.23
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,349.86
|
| Rate for Payer: Health EOS Commercial |
$13,193.50
|
| Rate for Payer: HFN Commercial |
$13,638.23
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,118.12
|
| Rate for Payer: Multiplan Commercial |
$11,859.33
|
| Rate for Payer: NAPHCARE Commercial |
$8,894.50
|
| Rate for Payer: Preferred Network Access Commercial |
$13,638.23
|
| Rate for Payer: Quartz Beloit One Network |
$7,263.84
|
| Rate for Payer: Quartz Commercial |
$9,635.70
|
| Rate for Payer: Quartz Medicare Advantage |
$8,894.50
|
| Rate for Payer: The Alliance Commercial |
$2,708.45
|
| Rate for Payer: WEA Trust Commercial |
$8,153.29
|
| Rate for Payer: WPS Commercial |
$10,979.86
|
|
|
Thrombectomy NC Post Intervention +
|
Facility
|
OP
|
$3,749.00
|
|
|
Service Code
|
CPT 37186
|
| Hospital Charge Code |
3921344
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$800.18 |
| Max. Negotiated Rate |
$12,349.86 |
| Rate for Payer: Aetna Commercial |
$3,509.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,353.11
|
| Rate for Payer: Aetna Managed Medicare |
$1,091.71
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,534.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,949.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,871.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,066.45
|
| Rate for Payer: Cash Price |
$1,124.70
|
| Rate for Payer: Cash Price |
$1,124.70
|
| Rate for Payer: Cigna Commercial |
$3,587.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,349.86
|
| Rate for Payer: Health EOS Commercial |
$3,470.07
|
| Rate for Payer: HFN Commercial |
$3,587.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,924.22
|
| Rate for Payer: Multiplan Commercial |
$3,119.17
|
| Rate for Payer: NAPHCARE Commercial |
$2,339.38
|
| Rate for Payer: Preferred Network Access Commercial |
$3,587.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,910.49
|
| Rate for Payer: Quartz Commercial |
$2,534.32
|
| Rate for Payer: Quartz Medicare Advantage |
$2,339.38
|
| Rate for Payer: The Alliance Commercial |
$800.18
|
| Rate for Payer: WEA Trust Commercial |
$2,144.43
|
| Rate for Payer: WPS Commercial |
$2,887.85
|
|
|
Thrombectomy NC Post Intervention +
|
Facility
|
IP
|
$3,749.00
|
|
|
Service Code
|
CPT 37186
|
| Hospital Charge Code |
3921344
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,910.49 |
| Max. Negotiated Rate |
$3,587.04 |
| Rate for Payer: Aetna Commercial |
$3,509.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,353.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,066.45
|
| Rate for Payer: Cash Price |
$1,124.70
|
| Rate for Payer: Cigna Commercial |
$3,587.04
|
| Rate for Payer: Health EOS Commercial |
$3,470.07
|
| Rate for Payer: HFN Commercial |
$3,587.04
|
| Rate for Payer: Multiplan Commercial |
$3,119.17
|
| Rate for Payer: Preferred Network Access Commercial |
$3,587.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,910.49
|
| Rate for Payer: Quartz Commercial |
$2,339.38
|
| Rate for Payer: WEA Trust Commercial |
$2,144.43
|
| Rate for Payer: WPS Commercial |
$2,887.85
|
|
|
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 |
$528.44 |
| Max. Negotiated Rate |
$12,349.86 |
| Rate for Payer: Aetna Commercial |
$4,261.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,072.20
|
| Rate for Payer: Aetna Managed Medicare |
$1,325.83
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,077.83
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,367.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,272.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,509.61
|
| Rate for Payer: Cash Price |
$1,365.90
|
| Rate for Payer: Cash Price |
$1,365.90
|
| Rate for Payer: Cigna Commercial |
$4,356.31
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,349.86
|
| Rate for Payer: Health EOS Commercial |
$4,214.26
|
| Rate for Payer: HFN Commercial |
$4,356.31
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,551.34
|
| Rate for Payer: Multiplan Commercial |
$3,788.10
|
| Rate for Payer: NAPHCARE Commercial |
$2,841.07
|
| Rate for Payer: Preferred Network Access Commercial |
$4,356.31
|
| Rate for Payer: Quartz Beloit One Network |
$2,320.21
|
| Rate for Payer: Quartz Commercial |
$3,077.83
|
| Rate for Payer: Quartz Medicare Advantage |
$2,841.07
|
| Rate for Payer: The Alliance Commercial |
$528.44
|
| Rate for Payer: WEA Trust Commercial |
$2,604.32
|
| Rate for Payer: WPS Commercial |
$3,507.18
|
|
|
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 |
$2,320.21 |
| Max. Negotiated Rate |
$4,356.31 |
| Rate for Payer: Aetna Commercial |
$4,261.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,072.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,509.61
|
| Rate for Payer: Cash Price |
$1,365.90
|
| Rate for Payer: Cigna Commercial |
$4,356.31
|
| Rate for Payer: Health EOS Commercial |
$4,214.26
|
| Rate for Payer: HFN Commercial |
$4,356.31
|
| Rate for Payer: Multiplan Commercial |
$3,788.10
|
| Rate for Payer: Preferred Network Access Commercial |
$4,356.31
|
| Rate for Payer: Quartz Beloit One Network |
$2,320.21
|
| Rate for Payer: Quartz Commercial |
$2,841.07
|
| Rate for Payer: WEA Trust Commercial |
$2,604.32
|
| Rate for Payer: WPS Commercial |
$3,507.18
|
|
|
Thrombectomy Non Coronary Ea Add +
|
Professional
|
Both
|
$1,386.00
|
|
|
Service Code
|
CPT 37185
|
| Hospital Charge Code |
3014542
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$132.11 |
| Max. Negotiated Rate |
$1,369.37 |
| Rate for Payer: Aetna Commercial |
$1,369.37
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,239.64
|
| Rate for Payer: Aetna Managed Medicare |
$132.11
|
| Rate for Payer: Anthem Medicare Advantage |
$132.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$132.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$132.11
|
| Rate for Payer: Cash Price |
$415.80
|
| Rate for Payer: Cash Price |
$415.80
|
| Rate for Payer: Cash Price |
$415.80
|
| Rate for Payer: Cigna Commercial |
$1,369.37
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$838.38
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$132.11
|
| Rate for Payer: Health EOS Commercial |
$1,311.71
|
| Rate for Payer: HFN Commercial |
$1,369.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$542.57
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$542.57
|
| Rate for Payer: Independent Care Health Plan Medicare |
$132.11
|
| Rate for Payer: Multiplan Commercial |
$1,153.15
|
| Rate for Payer: NAPHCARE Commercial |
$198.17
|
| Rate for Payer: Preferred Network Access Commercial |
$1,369.37
|
| Rate for Payer: Quartz Beloit One Network |
$634.23
|
| Rate for Payer: Quartz Commercial |
$821.62
|
| Rate for Payer: Quartz Medicare Advantage |
$132.11
|
| Rate for Payer: The Alliance Commercial |
$561.47
|
| Rate for Payer: United Healthcare Medicaid |
$838.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$132.11
|
| Rate for Payer: WEA Trust Commercial |
$792.79
|
| Rate for Payer: WPS Commercial |
$594.50
|
|
|
Thrombectomy Non Coronary Ea Add + 3718550
|
Professional
|
Both
|
$2,775.00
|
|
|
Service Code
|
CPT 37185 50
|
| Hospital Charge Code |
5313711
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$542.57 |
| Max. Negotiated Rate |
$2,741.70 |
| Rate for Payer: Aetna Commercial |
$2,741.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,481.96
|
| Rate for Payer: Cash Price |
$832.50
|
| Rate for Payer: Cash Price |
$832.50
|
| Rate for Payer: Cash Price |
$832.50
|
| Rate for Payer: Cigna Commercial |
$2,741.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$838.38
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,731.60
|
| Rate for Payer: Health EOS Commercial |
$2,626.26
|
| Rate for Payer: HFN Commercial |
$2,741.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$542.57
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$542.57
|
| Rate for Payer: Multiplan Commercial |
$2,308.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,741.70
|
| Rate for Payer: Quartz Beloit One Network |
$1,269.84
|
| Rate for Payer: Quartz Commercial |
$1,645.02
|
| Rate for Payer: The Alliance Commercial |
$1,443.00
|
| Rate for Payer: United Healthcare Medicaid |
$838.38
|
| Rate for Payer: WEA Trust Commercial |
$1,587.30
|
| Rate for Payer: WPS Commercial |
$2,137.58
|
|
|
Thrombectomy Non Coronary Initial
|
Facility
|
IP
|
$11,253.00
|
|
|
Service Code
|
CPT 37184
|
| Hospital Charge Code |
3921342
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$5,734.53 |
| Max. Negotiated Rate |
$10,766.87 |
| Rate for Payer: Aetna Commercial |
$10,532.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,064.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,202.65
|
| Rate for Payer: Cash Price |
$3,375.90
|
| Rate for Payer: Cigna Commercial |
$10,766.87
|
| Rate for Payer: Health EOS Commercial |
$10,415.78
|
| Rate for Payer: HFN Commercial |
$10,766.87
|
| Rate for Payer: Multiplan Commercial |
$9,362.50
|
| Rate for Payer: Preferred Network Access Commercial |
$10,766.87
|
| Rate for Payer: Quartz Beloit One Network |
$5,734.53
|
| Rate for Payer: Quartz Commercial |
$7,021.87
|
| Rate for Payer: WEA Trust Commercial |
$6,436.72
|
| Rate for Payer: WPS Commercial |
$8,668.19
|
|
|
Thrombectomy Non Coronary Initial
|
Facility
|
OP
|
$11,253.00
|
|
|
Service Code
|
CPT 37184
|
| Hospital Charge Code |
3921342
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$5,734.53 |
| Max. Negotiated Rate |
$77,168.08 |
| Rate for Payer: Aetna Commercial |
$10,532.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,064.68
|
| Rate for Payer: Aetna Managed Medicare |
$19,292.02
|
| 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 |
$19,292.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,202.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$19,292.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19,292.02
|
| 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 |
$10,766.87
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$19,292.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,349.86
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$19,292.02
|
| Rate for Payer: Health EOS Commercial |
$10,415.78
|
| Rate for Payer: HFN Commercial |
$10,766.87
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$71,766.32
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$19,292.02
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19,292.02
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$19,292.02
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$19,292.02
|
| Rate for Payer: Multiplan Commercial |
$9,362.50
|
| Rate for Payer: NAPHCARE Commercial |
$28,938.03
|
| Rate for Payer: Preferred Network Access Commercial |
$10,766.87
|
| Rate for Payer: Quartz Beloit One Network |
$5,734.53
|
| Rate for Payer: Quartz Commercial |
$7,607.03
|
| Rate for Payer: Quartz Medicare Advantage |
$19,292.02
|
| Rate for Payer: The Alliance Commercial |
$77,168.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19,292.02
|
| Rate for Payer: United Healthcare PPO |
$6,400.16
|
| Rate for Payer: WEA Trust Commercial |
$6,436.72
|
| Rate for Payer: Wellcare Medicare |
$19,292.02
|
| Rate for Payer: WPS Commercial |
$8,668.19
|
|
|
Thrombectomy, open, arteriovenous fistula without revision, autogenous or nonautogenous dialysis graft (separate procedure)
|
Facility
|
OP
|
$23,424.04
|
|
|
Service Code
|
CPT 36831
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,409.60 |
| Max. Negotiated Rate |
$23,424.04 |
| Rate for Payer: Aetna Managed Medicare |
$5,856.01
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$12,727.52
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$11,350.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10,781.68
|
| Rate for Payer: Anthem Medicare Advantage |
$5,856.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5,856.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5,856.01
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5,856.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,349.86
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5,856.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$21,784.36
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5,856.01
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5,856.01
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5,856.01
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5,856.01
|
| Rate for Payer: NAPHCARE Commercial |
$8,784.02
|
| Rate for Payer: Quartz Medicare Advantage |
$5,856.01
|
| Rate for Payer: The Alliance Commercial |
$23,424.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,856.01
|
| Rate for Payer: United Healthcare PPO |
$4,409.60
|
| Rate for Payer: Wellcare Medicare |
$5,856.01
|
|
|
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 |
$3,188.35 |
| 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
|
|
|
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 |
$5,579.61 |
| 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
|
|
|
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
|
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
|
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
|
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-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 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 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 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
|
|
