|
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
|
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 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 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: Dean Health DHI/DHP/ASO |
$12,349.86
|
| 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 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
|
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
|
|
|
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
|
|
|
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
|
|
|
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 Time
|
Professional
|
Both
|
$276.00
|
|
|
Service Code
|
CPT 85670
|
| Hospital Charge Code |
978134
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$272.69 |
| Rate for Payer: Aetna Commercial |
$272.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$246.85
|
| Rate for Payer: Aetna Managed Medicare |
$6.00
|
| Rate for Payer: Anthem Medicare Advantage |
$6.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6.00
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cigna Commercial |
$272.69
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$143.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6.00
|
| Rate for Payer: Health EOS Commercial |
$261.21
|
| Rate for Payer: HFN Commercial |
$272.69
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$21.18
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$21.18
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6.00
|
| Rate for Payer: Multiplan Commercial |
$229.63
|
| Rate for Payer: NAPHCARE Commercial |
$9.00
|
| Rate for Payer: Preferred Network Access Commercial |
$272.69
|
| Rate for Payer: Quartz Beloit One Network |
$126.30
|
| Rate for Payer: Quartz Commercial |
$163.61
|
| Rate for Payer: Quartz Medicare Advantage |
$6.00
|
| Rate for Payer: The Alliance Commercial |
$23.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.00
|
| Rate for Payer: WEA Trust Commercial |
$157.87
|
| Rate for Payer: WPS Commercial |
$26.40
|
|
|
Thrombin Time
|
Facility
|
IP
|
$276.00
|
|
|
Service Code
|
CPT 85670
|
| Hospital Charge Code |
978134
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$140.65 |
| Max. Negotiated Rate |
$264.08 |
| Rate for Payer: Aetna Commercial |
$258.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$246.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$152.13
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cigna Commercial |
$264.08
|
| Rate for Payer: Health EOS Commercial |
$255.47
|
| Rate for Payer: HFN Commercial |
$264.08
|
| Rate for Payer: Multiplan Commercial |
$229.63
|
| Rate for Payer: Preferred Network Access Commercial |
$264.08
|
| Rate for Payer: Quartz Beloit One Network |
$140.65
|
| Rate for Payer: Quartz Commercial |
$172.22
|
| Rate for Payer: WEA Trust Commercial |
$157.87
|
| Rate for Payer: WPS Commercial |
$212.60
|
|
|
Thrombin Time
|
Facility
|
OP
|
$276.00
|
|
|
Service Code
|
CPT 85670
|
| Hospital Charge Code |
978134
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$264.08 |
| Rate for Payer: Aetna Commercial |
$258.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$246.85
|
| Rate for Payer: Aetna Managed Medicare |
$6.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$22.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$9.96
|
| Rate for Payer: Anthem Medicare Advantage |
$6.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$152.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6.00
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cigna Commercial |
$264.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$160.63
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6.00
|
| Rate for Payer: Health EOS Commercial |
$255.47
|
| Rate for Payer: HFN Commercial |
$264.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$22.32
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6.00
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6.00
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6.00
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6.00
|
| Rate for Payer: Multiplan Commercial |
$229.63
|
| Rate for Payer: NAPHCARE Commercial |
$9.00
|
| Rate for Payer: Preferred Network Access Commercial |
$264.08
|
| Rate for Payer: Quartz Beloit One Network |
$140.65
|
| Rate for Payer: Quartz Commercial |
$186.58
|
| Rate for Payer: Quartz Medicare Advantage |
$6.00
|
| Rate for Payer: The Alliance Commercial |
$24.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.00
|
| Rate for Payer: United Healthcare PPO |
$215.28
|
| Rate for Payer: WEA Trust Commercial |
$157.87
|
| Rate for Payer: Wellcare Medicare |
$6.00
|
| Rate for Payer: WPS Commercial |
$212.60
|
|
|
Thromboendarterectomy, including patch graft, if performed; common femoral
|
Facility
|
OP
|
$12,349.86
|
|
|
Service Code
|
CPT 35371
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,692.35 |
| Max. Negotiated Rate |
$12,349.86 |
| 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: Dean Health DHI/DHP/ASO |
$12,349.86
|
| Rate for Payer: The Alliance Commercial |
$2,692.35
|
| Rate for Payer: United Healthcare PPO |
$4,267.12
|
|
|
Thrombolysis (IC) Coronary
|
Facility
|
IP
|
$2,592.00
|
|
|
Service Code
|
CPT 92975
|
| Hospital Charge Code |
5238883
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,320.88 |
| Max. Negotiated Rate |
$2,480.03 |
| Rate for Payer: Aetna Commercial |
$2,426.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,318.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,428.71
|
| Rate for Payer: Cash Price |
$777.60
|
| Rate for Payer: Cigna Commercial |
$2,480.03
|
| Rate for Payer: Health EOS Commercial |
$2,399.16
|
| Rate for Payer: HFN Commercial |
$2,480.03
|
| Rate for Payer: Multiplan Commercial |
$2,156.54
|
| Rate for Payer: Preferred Network Access Commercial |
$2,480.03
|
| Rate for Payer: Quartz Beloit One Network |
$1,320.88
|
| Rate for Payer: Quartz Commercial |
$1,617.41
|
| Rate for Payer: WEA Trust Commercial |
$1,482.62
|
| Rate for Payer: WPS Commercial |
$1,996.62
|
|
|
Thrombolysis (IC) Coronary
|
Facility
|
OP
|
$2,592.00
|
|
|
Service Code
|
CPT 92975
|
| Hospital Charge Code |
5238883
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$754.79 |
| Max. Negotiated Rate |
$3,030.56 |
| Rate for Payer: Aetna Commercial |
$2,426.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,318.28
|
| Rate for Payer: Aetna Managed Medicare |
$754.79
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,030.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,388.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,270.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,428.71
|
| Rate for Payer: Cash Price |
$777.60
|
| Rate for Payer: Cash Price |
$777.60
|
| Rate for Payer: Cash Price |
$777.60
|
| Rate for Payer: Cigna Commercial |
$2,480.03
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,508.54
|
| Rate for Payer: Health EOS Commercial |
$2,399.16
|
| Rate for Payer: HFN Commercial |
$2,480.03
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,021.76
|
| Rate for Payer: Multiplan Commercial |
$2,156.54
|
| Rate for Payer: NAPHCARE Commercial |
$1,617.41
|
| Rate for Payer: Preferred Network Access Commercial |
$2,480.03
|
| Rate for Payer: Quartz Beloit One Network |
$1,320.88
|
| Rate for Payer: Quartz Commercial |
$1,752.19
|
| Rate for Payer: Quartz Medicare Advantage |
$1,617.41
|
| Rate for Payer: The Alliance Commercial |
$1,347.84
|
| Rate for Payer: United Healthcare PPO |
$2,347.28
|
| Rate for Payer: WEA Trust Commercial |
$1,482.62
|
| Rate for Payer: WPS Commercial |
$1,996.62
|
|
|
Thrombolytic Therapy Arterial, Initial
|
Facility
|
OP
|
$15,109.00
|
|
|
Service Code
|
CPT 37211
|
| Hospital Charge Code |
3052437
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,409.60 |
| Max. Negotiated Rate |
$23,424.04 |
| Rate for Payer: Aetna Commercial |
$14,142.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$13,513.49
|
| 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 Blue Cross PPO |
$8,328.08
|
| 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: Cash Price |
$4,532.70
|
| Rate for Payer: Cash Price |
$4,532.70
|
| Rate for Payer: Cash Price |
$4,532.70
|
| Rate for Payer: Cigna Commercial |
$14,456.29
|
| 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: Health EOS Commercial |
$13,984.89
|
| Rate for Payer: HFN Commercial |
$14,456.29
|
| 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: Multiplan Commercial |
$12,570.69
|
| Rate for Payer: NAPHCARE Commercial |
$8,784.02
|
| Rate for Payer: Preferred Network Access Commercial |
$14,456.29
|
| Rate for Payer: Quartz Beloit One Network |
$7,699.55
|
| Rate for Payer: Quartz Commercial |
$10,213.68
|
| 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: WEA Trust Commercial |
$8,642.35
|
| Rate for Payer: Wellcare Medicare |
$5,856.01
|
| Rate for Payer: WPS Commercial |
$11,638.46
|
|
|
Thrombolytic Therapy Arterial, Initial
|
Facility
|
IP
|
$15,109.00
|
|
|
Service Code
|
CPT 37211
|
| Hospital Charge Code |
3052437
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$7,699.55 |
| Max. Negotiated Rate |
$14,456.29 |
| Rate for Payer: Aetna Commercial |
$14,142.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$13,513.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,328.08
|
| Rate for Payer: Cash Price |
$4,532.70
|
| Rate for Payer: Cigna Commercial |
$14,456.29
|
| Rate for Payer: Health EOS Commercial |
$13,984.89
|
| Rate for Payer: HFN Commercial |
$14,456.29
|
| Rate for Payer: Multiplan Commercial |
$12,570.69
|
| Rate for Payer: Preferred Network Access Commercial |
$14,456.29
|
| Rate for Payer: Quartz Beloit One Network |
$7,699.55
|
| Rate for Payer: Quartz Commercial |
$9,428.02
|
| Rate for Payer: WEA Trust Commercial |
$8,642.35
|
| Rate for Payer: WPS Commercial |
$11,638.46
|
|
|
Thrombolytic Therapy Art/Vein F/U
|
Facility
|
OP
|
$7,299.00
|
|
|
Service Code
|
CPT 37213
|
| Hospital Charge Code |
3052439
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,835.04 |
| Max. Negotiated Rate |
$13,291.62 |
| Rate for Payer: Aetna Commercial |
$6,831.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,528.23
|
| Rate for Payer: Aetna Managed Medicare |
$3,322.90
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,635.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,985.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,835.04
|
| Rate for Payer: Anthem Medicare Advantage |
$3,322.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,023.21
|
| 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 |
$2,189.70
|
| Rate for Payer: Cash Price |
$2,189.70
|
| Rate for Payer: Cash Price |
$2,189.70
|
| Rate for Payer: Cigna Commercial |
$6,983.68
|
| 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 |
$6,755.95
|
| Rate for Payer: HFN Commercial |
$6,983.68
|
| 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 |
$6,072.77
|
| Rate for Payer: NAPHCARE Commercial |
$4,984.36
|
| Rate for Payer: Preferred Network Access Commercial |
$6,983.68
|
| Rate for Payer: Quartz Beloit One Network |
$3,719.57
|
| Rate for Payer: Quartz Commercial |
$4,934.12
|
| 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 |
$3,726.32
|
| Rate for Payer: WEA Trust Commercial |
$4,175.03
|
| Rate for Payer: Wellcare Medicare |
$3,322.90
|
| Rate for Payer: WPS Commercial |
$5,622.42
|
|
