|
Biopsy Of Cervix, Single Or Multiple 57500
|
Professional
|
Both
|
$526.00
|
|
|
Service Code
|
CPT 57500
|
| Hospital Charge Code |
1188883
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$56.76 |
| Max. Negotiated Rate |
$499.70 |
| Rate for Payer: Aetna Commercial |
$499.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$452.36
|
| Rate for Payer: Cash Price |
$157.80
|
| Rate for Payer: Cash Price |
$157.80
|
| Rate for Payer: Cigna Commercial |
$499.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$56.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$315.60
|
| Rate for Payer: Health EOS Commercial |
$478.66
|
| Rate for Payer: HFN Commercial |
$499.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$247.91
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$247.91
|
| Rate for Payer: Multiplan Commercial |
$420.80
|
| Rate for Payer: Preferred Network Access Commercial |
$499.70
|
| Rate for Payer: Quartz Beloit One Network |
$231.44
|
| Rate for Payer: Quartz Commercial |
$299.82
|
| Rate for Payer: The Alliance Commercial |
$263.00
|
| Rate for Payer: United Healthcare Medicaid |
$56.76
|
| Rate for Payer: WEA Trust Commercial |
$289.30
|
| Rate for Payer: WPS Commercial |
$389.61
|
|
|
BIOPSY OF CERVIX, SINGLE OR MULTIPLE, OR LOCAL EXCISION OF LESION, WITH OR WITHOUT FULGURATION (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$4,218.22
|
|
|
Service Code
|
CPT 57500
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$794.59 |
| Max. Negotiated Rate |
$4,218.22 |
| Rate for Payer: Aetna Managed Medicare |
$794.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,914.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,297.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,183.00
|
| Rate for Payer: Anthem Medicare Advantage |
$794.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$794.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$794.59
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$794.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$794.59
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,955.87
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$794.59
|
| Rate for Payer: Independent Care Health Plan Medicare |
$794.59
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$794.59
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$794.59
|
| Rate for Payer: NAPHCARE Commercial |
$1,191.88
|
| Rate for Payer: Quartz Medicare Advantage |
$794.59
|
| Rate for Payer: The Alliance Commercial |
$3,178.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$794.59
|
| Rate for Payer: United Healthcare PPO |
$2,257.00
|
| Rate for Payer: Wellcare Medicare |
$794.59
|
|
|
Biopsy of External Ear 69100
|
Professional
|
Both
|
$280.00
|
|
|
Service Code
|
CPT 69100
|
| Hospital Charge Code |
1190826
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$45.18 |
| Max. Negotiated Rate |
$266.00 |
| Rate for Payer: Aetna Commercial |
$266.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$240.80
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cigna Commercial |
$266.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$45.18
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$168.00
|
| Rate for Payer: Health EOS Commercial |
$254.80
|
| Rate for Payer: HFN Commercial |
$266.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$156.41
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$156.41
|
| Rate for Payer: Multiplan Commercial |
$224.00
|
| Rate for Payer: Preferred Network Access Commercial |
$266.00
|
| Rate for Payer: Quartz Beloit One Network |
$123.20
|
| Rate for Payer: Quartz Commercial |
$159.60
|
| Rate for Payer: The Alliance Commercial |
$140.00
|
| Rate for Payer: United Healthcare Medicaid |
$45.18
|
| Rate for Payer: WEA Trust Commercial |
$154.00
|
| Rate for Payer: WPS Commercial |
$207.40
|
|
|
BIOPSY OF EXTERNAL EAR CANAL 69105
|
Professional
|
Both
|
$324.00
|
|
|
Service Code
|
CPT 69105
|
| Hospital Charge Code |
3015261
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$45.18 |
| Max. Negotiated Rate |
$307.80 |
| Rate for Payer: Aetna Commercial |
$307.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$278.64
|
| Rate for Payer: Cash Price |
$97.20
|
| Rate for Payer: Cash Price |
$97.20
|
| Rate for Payer: Cigna Commercial |
$307.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$45.18
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$194.40
|
| Rate for Payer: Health EOS Commercial |
$294.84
|
| Rate for Payer: HFN Commercial |
$307.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$206.89
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$206.89
|
| Rate for Payer: Multiplan Commercial |
$259.20
|
| Rate for Payer: Preferred Network Access Commercial |
$307.80
|
| Rate for Payer: Quartz Beloit One Network |
$142.56
|
| Rate for Payer: Quartz Commercial |
$184.68
|
| Rate for Payer: The Alliance Commercial |
$162.00
|
| Rate for Payer: United Healthcare Medicaid |
$45.18
|
| Rate for Payer: WEA Trust Commercial |
$178.20
|
| Rate for Payer: WPS Commercial |
$239.99
|
|
|
Biopsy Of Eye Lid 67810
|
Professional
|
Both
|
$617.00
|
|
|
Service Code
|
CPT 67810
|
| Hospital Charge Code |
1190829
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$71.82 |
| Max. Negotiated Rate |
$586.15 |
| Rate for Payer: Aetna Commercial |
$586.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$530.62
|
| Rate for Payer: Cash Price |
$185.10
|
| Rate for Payer: Cash Price |
$185.10
|
| Rate for Payer: Cigna Commercial |
$586.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$71.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$370.20
|
| Rate for Payer: Health EOS Commercial |
$561.47
|
| Rate for Payer: HFN Commercial |
$586.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$230.58
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$230.58
|
| Rate for Payer: Multiplan Commercial |
$493.60
|
| Rate for Payer: Preferred Network Access Commercial |
$586.15
|
| Rate for Payer: Quartz Beloit One Network |
$271.48
|
| Rate for Payer: Quartz Commercial |
$351.69
|
| Rate for Payer: The Alliance Commercial |
$308.50
|
| Rate for Payer: United Healthcare Medicaid |
$71.82
|
| Rate for Payer: WEA Trust Commercial |
$339.35
|
| Rate for Payer: WPS Commercial |
$457.01
|
|
|
BIOPSY OF FLOOR OF MOUTH 41108
|
Professional
|
Both
|
$386.00
|
|
|
Service Code
|
CPT 41108
|
| Hospital Charge Code |
3014612
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$75.33 |
| Max. Negotiated Rate |
$366.70 |
| Rate for Payer: Aetna Commercial |
$366.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$331.96
|
| Rate for Payer: Cash Price |
$115.80
|
| Rate for Payer: Cash Price |
$115.80
|
| Rate for Payer: Cigna Commercial |
$366.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$75.33
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$231.60
|
| Rate for Payer: Health EOS Commercial |
$351.26
|
| Rate for Payer: HFN Commercial |
$366.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$304.57
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$304.57
|
| Rate for Payer: Multiplan Commercial |
$308.80
|
| Rate for Payer: Preferred Network Access Commercial |
$366.70
|
| Rate for Payer: Quartz Beloit One Network |
$169.84
|
| Rate for Payer: Quartz Commercial |
$220.02
|
| Rate for Payer: The Alliance Commercial |
$193.00
|
| Rate for Payer: United Healthcare Medicaid |
$75.33
|
| Rate for Payer: WEA Trust Commercial |
$212.30
|
| Rate for Payer: WPS Commercial |
$285.91
|
|
|
BIOPSY OF FOOT JOINT LINING 28052
|
Professional
|
Both
|
$1,696.00
|
|
|
Service Code
|
CPT 28052
|
| Hospital Charge Code |
3014188
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$271.17 |
| Max. Negotiated Rate |
$1,611.20 |
| Rate for Payer: Aetna Commercial |
$1,611.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,458.56
|
| Rate for Payer: Cash Price |
$508.80
|
| Rate for Payer: Cash Price |
$508.80
|
| Rate for Payer: Cigna Commercial |
$1,611.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$271.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,017.60
|
| Rate for Payer: Health EOS Commercial |
$1,543.36
|
| Rate for Payer: HFN Commercial |
$1,611.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$954.26
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$954.26
|
| Rate for Payer: Multiplan Commercial |
$1,356.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,611.20
|
| Rate for Payer: Quartz Beloit One Network |
$746.24
|
| Rate for Payer: Quartz Commercial |
$966.72
|
| Rate for Payer: The Alliance Commercial |
$848.00
|
| Rate for Payer: United Healthcare Medicaid |
$271.17
|
| Rate for Payer: WEA Trust Commercial |
$932.80
|
| Rate for Payer: WPS Commercial |
$1,256.23
|
|
|
Biopsy of Lip 40490
|
Professional
|
Both
|
$356.00
|
|
|
Service Code
|
CPT 40490
|
| Hospital Charge Code |
1190863
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$45.18 |
| Max. Negotiated Rate |
$338.20 |
| Rate for Payer: Aetna Commercial |
$338.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$306.16
|
| Rate for Payer: Cash Price |
$106.80
|
| Rate for Payer: Cash Price |
$106.80
|
| Rate for Payer: Cigna Commercial |
$338.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$45.18
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$213.60
|
| Rate for Payer: Health EOS Commercial |
$323.96
|
| Rate for Payer: HFN Commercial |
$338.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$233.90
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$233.90
|
| Rate for Payer: Multiplan Commercial |
$284.80
|
| Rate for Payer: Preferred Network Access Commercial |
$338.20
|
| Rate for Payer: Quartz Beloit One Network |
$156.64
|
| Rate for Payer: Quartz Commercial |
$202.92
|
| Rate for Payer: The Alliance Commercial |
$178.00
|
| Rate for Payer: United Healthcare Medicaid |
$45.18
|
| Rate for Payer: WEA Trust Commercial |
$195.80
|
| Rate for Payer: WPS Commercial |
$263.69
|
|
|
BIOPSY OF LIVER, NEEDLE; PERCUTANEOUS
|
Facility
|
OP
|
$6,409.96
|
|
|
Service Code
|
CPT 47000
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,602.49 |
| Max. Negotiated Rate |
$6,409.96 |
| Rate for Payer: Aetna Managed Medicare |
$1,602.49
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,496.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,871.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,726.00
|
| Rate for Payer: Anthem Medicare Advantage |
$1,602.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,602.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,602.49
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,602.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,602.49
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,961.26
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,602.49
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,602.49
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,602.49
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,602.49
|
| Rate for Payer: NAPHCARE Commercial |
$2,403.74
|
| Rate for Payer: Quartz Medicare Advantage |
$1,602.49
|
| Rate for Payer: The Alliance Commercial |
$6,409.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,602.49
|
| Rate for Payer: United Healthcare PPO |
$3,583.00
|
| Rate for Payer: Wellcare Medicare |
$1,602.49
|
|
|
Biopsy of Nail unit 11755
|
Professional
|
Both
|
$318.00
|
|
|
Service Code
|
CPT 11755
|
| Hospital Charge Code |
3013572
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$98.86 |
| Max. Negotiated Rate |
$302.10 |
| Rate for Payer: Aetna Commercial |
$302.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$273.48
|
| Rate for Payer: Cash Price |
$95.40
|
| Rate for Payer: Cash Price |
$95.40
|
| Rate for Payer: Cigna Commercial |
$302.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$98.86
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$190.80
|
| Rate for Payer: Health EOS Commercial |
$289.38
|
| Rate for Payer: HFN Commercial |
$302.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$207.49
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$207.49
|
| Rate for Payer: Multiplan Commercial |
$254.40
|
| Rate for Payer: Preferred Network Access Commercial |
$302.10
|
| Rate for Payer: Quartz Beloit One Network |
$139.92
|
| Rate for Payer: Quartz Commercial |
$181.26
|
| Rate for Payer: The Alliance Commercial |
$159.00
|
| Rate for Payer: United Healthcare Medicaid |
$98.86
|
| Rate for Payer: WEA Trust Commercial |
$174.90
|
| Rate for Payer: WPS Commercial |
$235.54
|
|
|
BIOPSY OF NECK/CHEST 21550
|
Professional
|
Both
|
$588.00
|
|
|
Service Code
|
CPT 21550
|
| Hospital Charge Code |
3013736
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$49.81 |
| Max. Negotiated Rate |
$558.60 |
| Rate for Payer: Aetna Commercial |
$558.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$505.68
|
| Rate for Payer: Cash Price |
$176.40
|
| Rate for Payer: Cash Price |
$176.40
|
| Rate for Payer: Cigna Commercial |
$558.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$49.81
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$352.80
|
| Rate for Payer: Health EOS Commercial |
$535.08
|
| Rate for Payer: HFN Commercial |
$558.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$521.52
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$521.52
|
| Rate for Payer: Multiplan Commercial |
$470.40
|
| Rate for Payer: Preferred Network Access Commercial |
$558.60
|
| Rate for Payer: Quartz Beloit One Network |
$258.72
|
| Rate for Payer: Quartz Commercial |
$335.16
|
| Rate for Payer: The Alliance Commercial |
$294.00
|
| Rate for Payer: United Healthcare Medicaid |
$49.81
|
| Rate for Payer: WEA Trust Commercial |
$323.40
|
| Rate for Payer: WPS Commercial |
$435.53
|
|
|
Biopsy Of Penis 54100
|
Professional
|
Both
|
$591.00
|
|
|
Service Code
|
CPT 54100
|
| Hospital Charge Code |
1190846
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$45.18 |
| Max. Negotiated Rate |
$561.45 |
| Rate for Payer: Aetna Commercial |
$561.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$508.26
|
| Rate for Payer: Cash Price |
$177.30
|
| Rate for Payer: Cash Price |
$177.30
|
| Rate for Payer: Cigna Commercial |
$561.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$45.18
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$354.60
|
| Rate for Payer: Health EOS Commercial |
$537.81
|
| Rate for Payer: HFN Commercial |
$561.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$406.87
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$406.87
|
| Rate for Payer: Multiplan Commercial |
$472.80
|
| Rate for Payer: Preferred Network Access Commercial |
$561.45
|
| Rate for Payer: Quartz Beloit One Network |
$260.04
|
| Rate for Payer: Quartz Commercial |
$336.87
|
| Rate for Payer: The Alliance Commercial |
$295.50
|
| Rate for Payer: United Healthcare Medicaid |
$45.18
|
| Rate for Payer: WEA Trust Commercial |
$325.05
|
| Rate for Payer: WPS Commercial |
$437.75
|
|
|
BIOPSY OF PENIS; (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$6,409.96
|
|
|
Service Code
|
CPT 54100
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,602.49 |
| Max. Negotiated Rate |
$6,409.96 |
| Rate for Payer: Aetna Managed Medicare |
$1,602.49
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,496.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,871.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,726.00
|
| Rate for Payer: Anthem Medicare Advantage |
$1,602.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,602.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,602.49
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,602.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,602.49
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,961.26
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,602.49
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,602.49
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,602.49
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,602.49
|
| Rate for Payer: NAPHCARE Commercial |
$2,403.74
|
| Rate for Payer: Quartz Medicare Advantage |
$1,602.49
|
| Rate for Payer: The Alliance Commercial |
$6,409.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,602.49
|
| Rate for Payer: United Healthcare PPO |
$3,583.00
|
| Rate for Payer: Wellcare Medicare |
$1,602.49
|
|
|
BIOPSY OF SALIVARY GLAND 42405
|
Professional
|
Both
|
$836.00
|
|
|
Service Code
|
CPT 42405
|
| Hospital Charge Code |
3014631
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$75.33 |
| Max. Negotiated Rate |
$794.20 |
| Rate for Payer: Aetna Commercial |
$794.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$718.96
|
| Rate for Payer: Cash Price |
$250.80
|
| Rate for Payer: Cash Price |
$250.80
|
| Rate for Payer: Cigna Commercial |
$794.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$75.33
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$501.60
|
| Rate for Payer: Health EOS Commercial |
$760.76
|
| Rate for Payer: HFN Commercial |
$794.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$752.67
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$752.67
|
| Rate for Payer: Multiplan Commercial |
$668.80
|
| Rate for Payer: Preferred Network Access Commercial |
$794.20
|
| Rate for Payer: Quartz Beloit One Network |
$367.84
|
| Rate for Payer: Quartz Commercial |
$476.52
|
| Rate for Payer: The Alliance Commercial |
$418.00
|
| Rate for Payer: United Healthcare Medicaid |
$75.33
|
| Rate for Payer: WEA Trust Commercial |
$459.80
|
| Rate for Payer: WPS Commercial |
$619.23
|
|
|
BIOPSY OF SOFT TISSUES 27040
|
Professional
|
Both
|
$924.00
|
|
|
Service Code
|
CPT 27040
|
| Hospital Charge Code |
3014007
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$39.10 |
| Max. Negotiated Rate |
$877.80 |
| Rate for Payer: Aetna Commercial |
$877.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$794.64
|
| Rate for Payer: Cash Price |
$277.20
|
| Rate for Payer: Cash Price |
$277.20
|
| Rate for Payer: Cigna Commercial |
$877.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$39.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$554.40
|
| Rate for Payer: Health EOS Commercial |
$840.84
|
| Rate for Payer: HFN Commercial |
$877.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$663.46
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$663.46
|
| Rate for Payer: Multiplan Commercial |
$739.20
|
| Rate for Payer: Preferred Network Access Commercial |
$877.80
|
| Rate for Payer: Quartz Beloit One Network |
$406.56
|
| Rate for Payer: Quartz Commercial |
$526.68
|
| Rate for Payer: The Alliance Commercial |
$462.00
|
| Rate for Payer: United Healthcare Medicaid |
$39.10
|
| Rate for Payer: WEA Trust Commercial |
$508.20
|
| Rate for Payer: WPS Commercial |
$684.41
|
|
|
BIOPSY OF THYROID 60100
|
Professional
|
Both
|
$893.00
|
|
|
Service Code
|
CPT 60100
|
| Hospital Charge Code |
3015174
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$87.19 |
| Max. Negotiated Rate |
$848.35 |
| Rate for Payer: Aetna Commercial |
$848.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$767.98
|
| Rate for Payer: Cash Price |
$267.90
|
| Rate for Payer: Cash Price |
$267.90
|
| Rate for Payer: Cigna Commercial |
$848.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$87.19
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$535.80
|
| Rate for Payer: Health EOS Commercial |
$812.63
|
| Rate for Payer: HFN Commercial |
$848.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$260.27
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$260.27
|
| Rate for Payer: Multiplan Commercial |
$714.40
|
| Rate for Payer: Preferred Network Access Commercial |
$848.35
|
| Rate for Payer: Quartz Beloit One Network |
$392.92
|
| Rate for Payer: Quartz Commercial |
$509.01
|
| Rate for Payer: The Alliance Commercial |
$446.50
|
| Rate for Payer: United Healthcare Medicaid |
$87.19
|
| Rate for Payer: WEA Trust Commercial |
$491.15
|
| Rate for Payer: WPS Commercial |
$661.45
|
|
|
BIOPSY OF TOE JOINT LINING 28054
|
Professional
|
Both
|
$1,671.00
|
|
|
Service Code
|
CPT 28054
|
| Hospital Charge Code |
3014189
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$226.00 |
| Max. Negotiated Rate |
$1,587.45 |
| Rate for Payer: Aetna Commercial |
$1,587.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,437.06
|
| Rate for Payer: Cash Price |
$501.30
|
| Rate for Payer: Cash Price |
$501.30
|
| Rate for Payer: Cigna Commercial |
$1,587.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$226.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,002.60
|
| Rate for Payer: Health EOS Commercial |
$1,520.61
|
| Rate for Payer: HFN Commercial |
$1,587.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$793.01
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$793.01
|
| Rate for Payer: Multiplan Commercial |
$1,336.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,587.45
|
| Rate for Payer: Quartz Beloit One Network |
$735.24
|
| Rate for Payer: Quartz Commercial |
$952.47
|
| Rate for Payer: The Alliance Commercial |
$835.50
|
| Rate for Payer: United Healthcare Medicaid |
$226.00
|
| Rate for Payer: WEA Trust Commercial |
$919.05
|
| Rate for Payer: WPS Commercial |
$1,237.71
|
|
|
Biopsy of Tongue; Anterior Two-Thirds
|
Professional
|
Both
|
$510.00
|
|
|
Service Code
|
CPT 41100
|
| Hospital Charge Code |
1190858
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$45.18 |
| Max. Negotiated Rate |
$484.50 |
| Rate for Payer: Aetna Commercial |
$484.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$438.60
|
| Rate for Payer: Cash Price |
$153.00
|
| Rate for Payer: Cash Price |
$153.00
|
| Rate for Payer: Cigna Commercial |
$484.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$45.18
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$306.00
|
| Rate for Payer: Health EOS Commercial |
$464.10
|
| Rate for Payer: HFN Commercial |
$484.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$359.78
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$359.78
|
| Rate for Payer: Multiplan Commercial |
$408.00
|
| Rate for Payer: Preferred Network Access Commercial |
$484.50
|
| Rate for Payer: Quartz Beloit One Network |
$224.40
|
| Rate for Payer: Quartz Commercial |
$290.70
|
| Rate for Payer: The Alliance Commercial |
$255.00
|
| Rate for Payer: United Healthcare Medicaid |
$45.18
|
| Rate for Payer: WEA Trust Commercial |
$280.50
|
| Rate for Payer: WPS Commercial |
$377.76
|
|
|
BIOPSY OF TONGUE; ANTERIOR TWO-THIRDS
|
Facility
|
OP
|
$4,218.22
|
|
|
Service Code
|
CPT 41100
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$543.83 |
| Max. Negotiated Rate |
$4,218.22 |
| Rate for Payer: Aetna Managed Medicare |
$543.83
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,914.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,297.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,183.00
|
| Rate for Payer: Anthem Medicare Advantage |
$543.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$543.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$543.83
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$543.83
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$543.83
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,023.05
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$543.83
|
| Rate for Payer: Independent Care Health Plan Medicare |
$543.83
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$543.83
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$543.83
|
| Rate for Payer: NAPHCARE Commercial |
$815.74
|
| Rate for Payer: Quartz Medicare Advantage |
$543.83
|
| Rate for Payer: The Alliance Commercial |
$2,175.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$543.83
|
| Rate for Payer: United Healthcare PPO |
$2,257.00
|
| Rate for Payer: Wellcare Medicare |
$543.83
|
|
|
BIOPSY OF URETHRA 53200
|
Professional
|
Both
|
$753.00
|
|
|
Service Code
|
CPT 53200
|
| Hospital Charge Code |
3015009
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$120.52 |
| Max. Negotiated Rate |
$715.35 |
| Rate for Payer: Aetna Commercial |
$715.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$647.58
|
| Rate for Payer: Cash Price |
$225.90
|
| Rate for Payer: Cash Price |
$225.90
|
| Rate for Payer: Cigna Commercial |
$715.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$120.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$451.80
|
| Rate for Payer: Health EOS Commercial |
$685.23
|
| Rate for Payer: HFN Commercial |
$715.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$471.08
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$471.08
|
| Rate for Payer: Multiplan Commercial |
$602.40
|
| Rate for Payer: Preferred Network Access Commercial |
$715.35
|
| Rate for Payer: Quartz Beloit One Network |
$331.32
|
| Rate for Payer: Quartz Commercial |
$429.21
|
| Rate for Payer: The Alliance Commercial |
$376.50
|
| Rate for Payer: United Healthcare Medicaid |
$120.52
|
| Rate for Payer: WEA Trust Commercial |
$414.15
|
| Rate for Payer: WPS Commercial |
$557.75
|
|
|
Biopsy Of Vagina
|
Professional
|
Both
|
$404.00
|
|
|
Service Code
|
CPT 57100
|
| Hospital Charge Code |
1190837
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$45.18 |
| Max. Negotiated Rate |
$383.80 |
| Rate for Payer: Aetna Commercial |
$383.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$347.44
|
| Rate for Payer: Cash Price |
$121.20
|
| Rate for Payer: Cash Price |
$121.20
|
| Rate for Payer: Cigna Commercial |
$383.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$45.18
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$242.40
|
| Rate for Payer: Health EOS Commercial |
$367.64
|
| Rate for Payer: HFN Commercial |
$383.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$217.38
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$217.38
|
| Rate for Payer: Multiplan Commercial |
$323.20
|
| Rate for Payer: Preferred Network Access Commercial |
$383.80
|
| Rate for Payer: Quartz Beloit One Network |
$177.76
|
| Rate for Payer: Quartz Commercial |
$230.28
|
| Rate for Payer: The Alliance Commercial |
$202.00
|
| Rate for Payer: United Healthcare Medicaid |
$45.18
|
| Rate for Payer: WEA Trust Commercial |
$222.20
|
| Rate for Payer: WPS Commercial |
$299.24
|
|
|
BIOPSY OF VAGINA 57105
|
Professional
|
Both
|
$606.00
|
|
|
Service Code
|
CPT 57105
|
| Hospital Charge Code |
3015069
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$114.93 |
| Max. Negotiated Rate |
$575.70 |
| Rate for Payer: Aetna Commercial |
$575.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$521.16
|
| Rate for Payer: Cash Price |
$181.80
|
| Rate for Payer: Cash Price |
$181.80
|
| Rate for Payer: Cigna Commercial |
$575.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$114.93
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$363.60
|
| Rate for Payer: Health EOS Commercial |
$551.46
|
| Rate for Payer: HFN Commercial |
$575.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$480.22
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$480.22
|
| Rate for Payer: Multiplan Commercial |
$484.80
|
| Rate for Payer: Preferred Network Access Commercial |
$575.70
|
| Rate for Payer: Quartz Beloit One Network |
$266.64
|
| Rate for Payer: Quartz Commercial |
$345.42
|
| Rate for Payer: The Alliance Commercial |
$303.00
|
| Rate for Payer: United Healthcare Medicaid |
$114.93
|
| Rate for Payer: WEA Trust Commercial |
$333.30
|
| Rate for Payer: WPS Commercial |
$448.86
|
|
|
BIOPSY OF VULVA OR PERINEUM (SEPARATE PROCEDURE); 1 LESION
|
Facility
|
OP
|
$4,218.22
|
|
|
Service Code
|
CPT 56605
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$794.59 |
| Max. Negotiated Rate |
$4,218.22 |
| Rate for Payer: Aetna Managed Medicare |
$794.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,914.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,297.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,183.00
|
| Rate for Payer: Anthem Medicare Advantage |
$794.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$794.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$794.59
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$794.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$794.59
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,955.87
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$794.59
|
| Rate for Payer: Independent Care Health Plan Medicare |
$794.59
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$794.59
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$794.59
|
| Rate for Payer: NAPHCARE Commercial |
$1,191.88
|
| Rate for Payer: Quartz Medicare Advantage |
$794.59
|
| Rate for Payer: The Alliance Commercial |
$3,178.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$794.59
|
| Rate for Payer: United Healthcare PPO |
$2,257.00
|
| Rate for Payer: Wellcare Medicare |
$794.59
|
|
|
BIOPSY OF VULVA OR PERINEUM (SEPARATE PROCEDURE); EACH SEPARATE ADDITIONAL LESION (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$4,218.22
|
|
|
Service Code
|
CPT 56606
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,218.22 |
| Max. Negotiated Rate |
$4,218.22 |
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
|
|
Biopsy Of Vulva/Perineum, 1 Lesion 56605
|
Professional
|
Both
|
$612.00
|
|
|
Service Code
|
CPT 56605
|
| Hospital Charge Code |
1188884
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$73.81 |
| Max. Negotiated Rate |
$581.40 |
| Rate for Payer: Aetna Commercial |
$581.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$526.32
|
| Rate for Payer: Cash Price |
$183.60
|
| Rate for Payer: Cash Price |
$183.60
|
| Rate for Payer: Cigna Commercial |
$581.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$73.81
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$367.20
|
| Rate for Payer: Health EOS Commercial |
$556.92
|
| Rate for Payer: HFN Commercial |
$581.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$197.01
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$197.01
|
| Rate for Payer: Multiplan Commercial |
$489.60
|
| Rate for Payer: Preferred Network Access Commercial |
$581.40
|
| Rate for Payer: Quartz Beloit One Network |
$269.28
|
| Rate for Payer: Quartz Commercial |
$348.84
|
| Rate for Payer: The Alliance Commercial |
$306.00
|
| Rate for Payer: United Healthcare Medicaid |
$73.81
|
| Rate for Payer: WEA Trust Commercial |
$336.60
|
| Rate for Payer: WPS Commercial |
$453.31
|
|
