|
Destroy Nerve, Face Muscle 6461250
|
Professional
|
$1,285.00
|
|
|
Service Code
|
CPT 64612 50
|
| Hospital Charge Code |
5482703
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$565.40 |
| Max. Negotiated Rate |
$1,220.75 |
| Rate for Payer: Aetna Commercial |
$1,220.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,105.10
|
| Rate for Payer: Cash Price |
$385.50
|
| Rate for Payer: Cash Price |
$385.50
|
| Rate for Payer: Cigna Commercial |
$1,220.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$642.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$771.00
|
| Rate for Payer: Health EOS Commercial |
$1,169.35
|
| Rate for Payer: Multiplan Commercial |
$1,028.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,220.75
|
| Rate for Payer: Quartz Beloit One Network |
$565.40
|
| Rate for Payer: Quartz Commercial |
$732.45
|
| Rate for Payer: The Alliance Commercial |
$642.50
|
| Rate for Payer: WEA Trust Commercial |
$706.75
|
| Rate for Payer: WPS Commercial |
$951.80
|
|
|
DESTROY NERVE L/S FACET EACH +
|
Facility
OP
|
$566.00
|
|
| Hospital Charge Code |
5262695
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$158.48 |
| Max. Negotiated Rate |
$2,264.00 |
| Rate for Payer: Aetna Commercial |
$509.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$486.76
|
| Rate for Payer: Aetna Managed Medicare |
$158.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$367.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$283.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$271.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$299.98
|
| Rate for Payer: Cash Price |
$169.80
|
| Rate for Payer: Cigna Commercial |
$520.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$316.73
|
| Rate for Payer: Health EOS Commercial |
$503.74
|
| Rate for Payer: HFN Commercial |
$520.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$424.50
|
| Rate for Payer: Multiplan Commercial |
$452.80
|
| Rate for Payer: NAPHCARE Commercial |
$339.60
|
| Rate for Payer: Preferred Network Access Commercial |
$520.72
|
| Rate for Payer: Quartz Beloit One Network |
$277.34
|
| Rate for Payer: Quartz Commercial |
$367.90
|
| Rate for Payer: Quartz Medicare Advantage |
$339.60
|
| Rate for Payer: The Alliance Commercial |
$2,264.00
|
| Rate for Payer: WEA Trust Commercial |
$311.30
|
| Rate for Payer: WPS Commercial |
$419.24
|
|
|
DESTROY NERVE L/S FACET EACH +
|
Facility
IP
|
$566.00
|
|
| Hospital Charge Code |
5262695
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$277.34 |
| Max. Negotiated Rate |
$520.72 |
| Rate for Payer: Aetna Commercial |
$509.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$299.98
|
| Rate for Payer: Cash Price |
$169.80
|
| Rate for Payer: Cigna Commercial |
$520.72
|
| Rate for Payer: Health EOS Commercial |
$503.74
|
| Rate for Payer: HFN Commercial |
$520.72
|
| Rate for Payer: Multiplan Commercial |
$452.80
|
| Rate for Payer: NAPHCARE Commercial |
$339.60
|
| Rate for Payer: Preferred Network Access Commercial |
$520.72
|
| Rate for Payer: Quartz Beloit One Network |
$277.34
|
| Rate for Payer: Quartz Commercial |
$339.60
|
| Rate for Payer: WEA Trust Commercial |
$311.30
|
| Rate for Payer: WPS Commercial |
$419.24
|
|
|
DESTROY NERVE L/S FACET SINGLE
|
Facility
OP
|
$2,971.00
|
|
| Hospital Charge Code |
5262694
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$831.88 |
| Max. Negotiated Rate |
$11,884.00 |
| Rate for Payer: Aetna Commercial |
$2,673.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,555.06
|
| Rate for Payer: Aetna Managed Medicare |
$831.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,931.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,485.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,426.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,574.63
|
| Rate for Payer: Cash Price |
$891.30
|
| Rate for Payer: Cigna Commercial |
$2,733.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,662.57
|
| Rate for Payer: Health EOS Commercial |
$2,644.19
|
| Rate for Payer: HFN Commercial |
$2,733.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,228.25
|
| Rate for Payer: Multiplan Commercial |
$2,376.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,782.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,733.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,455.79
|
| Rate for Payer: Quartz Commercial |
$1,931.15
|
| Rate for Payer: Quartz Medicare Advantage |
$1,782.60
|
| Rate for Payer: The Alliance Commercial |
$11,884.00
|
| Rate for Payer: WEA Trust Commercial |
$1,634.05
|
| Rate for Payer: WPS Commercial |
$2,200.62
|
|
|
DESTROY NERVE L/S FACET SINGLE
|
Facility
IP
|
$2,971.00
|
|
| Hospital Charge Code |
5262694
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,455.79 |
| Max. Negotiated Rate |
$2,733.32 |
| Rate for Payer: Aetna Commercial |
$2,673.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,574.63
|
| Rate for Payer: Cash Price |
$891.30
|
| Rate for Payer: Cigna Commercial |
$2,733.32
|
| Rate for Payer: Health EOS Commercial |
$2,644.19
|
| Rate for Payer: HFN Commercial |
$2,733.32
|
| Rate for Payer: Multiplan Commercial |
$2,376.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,782.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,733.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,455.79
|
| Rate for Payer: Quartz Commercial |
$1,782.60
|
| Rate for Payer: WEA Trust Commercial |
$1,634.05
|
| Rate for Payer: WPS Commercial |
$2,200.62
|
|
|
DESTROY NERVE, NECK MUSCLE 64613
|
Professional
|
$796.00
|
|
| Hospital Charge Code |
3015197
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$350.24 |
| Max. Negotiated Rate |
$756.20 |
| Rate for Payer: Aetna Commercial |
$756.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$684.56
|
| Rate for Payer: Cash Price |
$238.80
|
| Rate for Payer: Cigna Commercial |
$756.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$398.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$477.60
|
| Rate for Payer: Health EOS Commercial |
$724.36
|
| Rate for Payer: Multiplan Commercial |
$636.80
|
| Rate for Payer: Preferred Network Access Commercial |
$756.20
|
| Rate for Payer: Quartz Beloit One Network |
$350.24
|
| Rate for Payer: Quartz Commercial |
$453.72
|
| Rate for Payer: The Alliance Commercial |
$398.00
|
| Rate for Payer: WEA Trust Commercial |
$437.80
|
| Rate for Payer: WPS Commercial |
$589.60
|
|
|
DESTROY NERVE OTHER PERIPHERAL
|
Facility
IP
|
$210.00
|
|
| Hospital Charge Code |
5262696
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$102.90 |
| Max. Negotiated Rate |
$193.20 |
| Rate for Payer: Aetna Commercial |
$189.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$111.30
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cigna Commercial |
$193.20
|
| Rate for Payer: Health EOS Commercial |
$186.90
|
| Rate for Payer: HFN Commercial |
$193.20
|
| Rate for Payer: Multiplan Commercial |
$168.00
|
| Rate for Payer: NAPHCARE Commercial |
$126.00
|
| Rate for Payer: Preferred Network Access Commercial |
$193.20
|
| Rate for Payer: Quartz Beloit One Network |
$102.90
|
| Rate for Payer: Quartz Commercial |
$126.00
|
| Rate for Payer: WEA Trust Commercial |
$115.50
|
| Rate for Payer: WPS Commercial |
$155.55
|
|
|
DESTROY NERVE OTHER PERIPHERAL
|
Facility
OP
|
$210.00
|
|
| Hospital Charge Code |
5262696
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$58.80 |
| Max. Negotiated Rate |
$840.00 |
| Rate for Payer: Aetna Commercial |
$189.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$180.60
|
| Rate for Payer: Aetna Managed Medicare |
$58.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$136.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$105.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$100.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$111.30
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cigna Commercial |
$193.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$117.52
|
| Rate for Payer: Health EOS Commercial |
$186.90
|
| Rate for Payer: HFN Commercial |
$193.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$157.50
|
| Rate for Payer: Multiplan Commercial |
$168.00
|
| Rate for Payer: NAPHCARE Commercial |
$126.00
|
| Rate for Payer: Preferred Network Access Commercial |
$193.20
|
| Rate for Payer: Quartz Beloit One Network |
$102.90
|
| Rate for Payer: Quartz Commercial |
$136.50
|
| Rate for Payer: Quartz Medicare Advantage |
$126.00
|
| Rate for Payer: The Alliance Commercial |
$840.00
|
| Rate for Payer: WEA Trust Commercial |
$115.50
|
| Rate for Payer: WPS Commercial |
$155.55
|
|
|
DESTROY NERVE TRIGEMINAL
|
Facility
OP
|
$379.00
|
|
| Hospital Charge Code |
5262690
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$106.12 |
| Max. Negotiated Rate |
$1,516.00 |
| Rate for Payer: Aetna Commercial |
$341.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$325.94
|
| Rate for Payer: Aetna Managed Medicare |
$106.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$246.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$189.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$181.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$200.87
|
| Rate for Payer: Cash Price |
$113.70
|
| Rate for Payer: Cigna Commercial |
$348.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$212.09
|
| Rate for Payer: Health EOS Commercial |
$337.31
|
| Rate for Payer: HFN Commercial |
$348.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$284.25
|
| Rate for Payer: Multiplan Commercial |
$303.20
|
| Rate for Payer: NAPHCARE Commercial |
$227.40
|
| Rate for Payer: Preferred Network Access Commercial |
$348.68
|
| Rate for Payer: Quartz Beloit One Network |
$185.71
|
| Rate for Payer: Quartz Commercial |
$246.35
|
| Rate for Payer: Quartz Medicare Advantage |
$227.40
|
| Rate for Payer: The Alliance Commercial |
$1,516.00
|
| Rate for Payer: WEA Trust Commercial |
$208.45
|
| Rate for Payer: WPS Commercial |
$280.73
|
|
|
DESTROY NERVE TRIGEMINAL
|
Facility
IP
|
$379.00
|
|
| Hospital Charge Code |
5262690
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$185.71 |
| Max. Negotiated Rate |
$348.68 |
| Rate for Payer: Aetna Commercial |
$341.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$200.87
|
| Rate for Payer: Cash Price |
$113.70
|
| Rate for Payer: Cigna Commercial |
$348.68
|
| Rate for Payer: Health EOS Commercial |
$337.31
|
| Rate for Payer: HFN Commercial |
$348.68
|
| Rate for Payer: Multiplan Commercial |
$303.20
|
| Rate for Payer: NAPHCARE Commercial |
$227.40
|
| Rate for Payer: Preferred Network Access Commercial |
$348.68
|
| Rate for Payer: Quartz Beloit One Network |
$185.71
|
| Rate for Payer: Quartz Commercial |
$227.40
|
| Rate for Payer: WEA Trust Commercial |
$208.45
|
| Rate for Payer: WPS Commercial |
$280.73
|
|
|
DESTROY VAG LESIONS, COMPLEX 57065
|
Professional
|
$2,953.00
|
|
|
Service Code
|
CPT 57065
|
| Hospital Charge Code |
3015068
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$175.52 |
| Max. Negotiated Rate |
$2,805.35 |
| Rate for Payer: Aetna Commercial |
$2,805.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,539.58
|
| Rate for Payer: Aetna Managed Medicare |
$175.52
|
| Rate for Payer: Anthem Medicare Advantage |
$175.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$175.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$175.52
|
| Rate for Payer: Cash Price |
$885.90
|
| Rate for Payer: Cash Price |
$885.90
|
| Rate for Payer: Cigna Commercial |
$2,805.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,476.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$175.52
|
| Rate for Payer: Health EOS Commercial |
$2,687.23
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$615.99
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$615.99
|
| Rate for Payer: Independent Care Health Plan Medicare |
$175.52
|
| Rate for Payer: Multiplan Commercial |
$2,362.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,805.35
|
| Rate for Payer: Quartz Beloit One Network |
$1,299.32
|
| Rate for Payer: Quartz Commercial |
$1,683.21
|
| Rate for Payer: Quartz Medicare Advantage |
$175.52
|
| Rate for Payer: The Alliance Commercial |
$745.96
|
| Rate for Payer: United Healthcare Medicaid |
$300.23
|
| Rate for Payer: United Healthcare Medicare Advantage |
$175.52
|
| Rate for Payer: WEA Trust Commercial |
$1,624.15
|
| Rate for Payer: WPS Commercial |
$789.84
|
|
|
DESTROY VAG LESIONS, SIMPLE 57061
|
Professional
|
$375.00
|
|
|
Service Code
|
CPT 57061
|
| Hospital Charge Code |
3015067
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$43.08 |
| Max. Negotiated Rate |
$492.70 |
| Rate for Payer: Aetna Commercial |
$356.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$322.50
|
| Rate for Payer: Aetna Managed Medicare |
$109.49
|
| Rate for Payer: Anthem Medicare Advantage |
$109.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$109.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$109.49
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cigna Commercial |
$356.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$187.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$109.49
|
| Rate for Payer: Health EOS Commercial |
$341.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$376.62
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$376.62
|
| Rate for Payer: Independent Care Health Plan Medicare |
$109.49
|
| Rate for Payer: Multiplan Commercial |
$300.00
|
| Rate for Payer: Preferred Network Access Commercial |
$356.25
|
| Rate for Payer: Quartz Beloit One Network |
$165.00
|
| Rate for Payer: Quartz Commercial |
$213.75
|
| Rate for Payer: Quartz Medicare Advantage |
$109.49
|
| Rate for Payer: The Alliance Commercial |
$465.33
|
| Rate for Payer: United Healthcare Medicaid |
$43.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$109.49
|
| Rate for Payer: WEA Trust Commercial |
$206.25
|
| Rate for Payer: WPS Commercial |
$492.70
|
|
|
DESTRUCTION, ANAL LESION(S) 46900
|
Professional
|
$495.00
|
|
|
Service Code
|
CPT 46900
|
| Hospital Charge Code |
3014846
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$26.97 |
| Max. Negotiated Rate |
$583.29 |
| Rate for Payer: Aetna Commercial |
$470.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$425.70
|
| Rate for Payer: Aetna Managed Medicare |
$129.62
|
| Rate for Payer: Anthem Medicare Advantage |
$129.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$129.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$129.62
|
| Rate for Payer: Cash Price |
$148.50
|
| Rate for Payer: Cash Price |
$148.50
|
| Rate for Payer: Cigna Commercial |
$470.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$247.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$129.62
|
| Rate for Payer: Health EOS Commercial |
$450.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$454.38
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$454.38
|
| Rate for Payer: Independent Care Health Plan Medicare |
$129.62
|
| Rate for Payer: Multiplan Commercial |
$396.00
|
| Rate for Payer: Preferred Network Access Commercial |
$470.25
|
| Rate for Payer: Quartz Beloit One Network |
$217.80
|
| Rate for Payer: Quartz Commercial |
$282.15
|
| Rate for Payer: Quartz Medicare Advantage |
$129.62
|
| Rate for Payer: The Alliance Commercial |
$550.88
|
| Rate for Payer: United Healthcare Medicaid |
$26.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$129.62
|
| Rate for Payer: WEA Trust Commercial |
$272.25
|
| Rate for Payer: WPS Commercial |
$583.29
|
|
|
DESTRUCTION, ANAL LESION(S) 46924
|
Professional
|
$2,273.00
|
|
|
Service Code
|
CPT 46924
|
| Hospital Charge Code |
3014849
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$169.01 |
| Max. Negotiated Rate |
$2,159.35 |
| Rate for Payer: Aetna Commercial |
$2,159.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,954.78
|
| Rate for Payer: Aetna Managed Medicare |
$169.01
|
| Rate for Payer: Anthem Medicare Advantage |
$169.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$169.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$169.01
|
| Rate for Payer: Cash Price |
$681.90
|
| Rate for Payer: Cash Price |
$681.90
|
| Rate for Payer: Cigna Commercial |
$2,159.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,136.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$169.01
|
| Rate for Payer: Health EOS Commercial |
$2,068.43
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$598.48
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$598.48
|
| Rate for Payer: Independent Care Health Plan Medicare |
$169.01
|
| Rate for Payer: Multiplan Commercial |
$1,818.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,159.35
|
| Rate for Payer: Quartz Beloit One Network |
$1,000.12
|
| Rate for Payer: Quartz Commercial |
$1,295.61
|
| Rate for Payer: Quartz Medicare Advantage |
$169.01
|
| Rate for Payer: The Alliance Commercial |
$718.29
|
| Rate for Payer: United Healthcare Medicaid |
$301.31
|
| Rate for Payer: United Healthcare Medicare Advantage |
$169.01
|
| Rate for Payer: WEA Trust Commercial |
$1,250.15
|
| Rate for Payer: WPS Commercial |
$760.54
|
|
|
DESTRUCTION BY NEUROLYTIC AGENT, PARAVERTEBRAL FACET JOINT NERVE(S), WITH IMAGING GUIDANCE (FLUOROSCOPY OR CT); LUMBAR OR SACRAL, EACH ADDITIONAL FACET JOINT (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
OP
|
$14,595.84
|
|
|
Service Code
|
CPT 64636
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,218.22 |
| Max. Negotiated Rate |
$14,595.84 |
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: The Alliance Commercial |
$14,595.84
|
|
|
DESTRUCTION BY NEUROLYTIC AGENT, PARAVERTEBRAL FACET JOINT NERVE(S), WITH IMAGING GUIDANCE (FLUOROSCOPY OR CT); LUMBAR OR SACRAL, SINGLE FACET JOINT
|
Facility
OP
|
$18,956.40
|
|
|
Service Code
|
CPT 64635
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,908.40 |
| Max. Negotiated Rate |
$18,956.40 |
| Rate for Payer: Aetna Managed Medicare |
$1,908.40
|
| 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 |
$1,908.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,908.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,908.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,908.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,908.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,099.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,908.40
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,908.40
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,908.40
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,908.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,862.60
|
| Rate for Payer: Quartz Medicare Advantage |
$1,908.40
|
| Rate for Payer: The Alliance Commercial |
$18,956.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,908.40
|
| Rate for Payer: United Healthcare PPO |
$3,583.00
|
| Rate for Payer: Wellcare Medicare |
$1,908.40
|
|
|
Destruction, malignant lesion (face, ears, eyelids, nose, lips, mucous membranes) <=0.5cm 17280
|
Professional
|
$578.00
|
|
|
Service Code
|
CPT 17280
|
| Hospital Charge Code |
3013668
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$81.89 |
| Max. Negotiated Rate |
$549.10 |
| Rate for Payer: Aetna Commercial |
$549.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$497.08
|
| Rate for Payer: Aetna Managed Medicare |
$81.89
|
| Rate for Payer: Anthem Medicare Advantage |
$81.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$81.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$81.89
|
| Rate for Payer: Cash Price |
$173.40
|
| Rate for Payer: Cash Price |
$173.40
|
| Rate for Payer: Cigna Commercial |
$549.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$289.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$81.89
|
| Rate for Payer: Health EOS Commercial |
$525.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$289.60
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$289.60
|
| Rate for Payer: Independent Care Health Plan Medicare |
$81.89
|
| Rate for Payer: Multiplan Commercial |
$462.40
|
| Rate for Payer: Preferred Network Access Commercial |
$549.10
|
| Rate for Payer: Quartz Beloit One Network |
$254.32
|
| Rate for Payer: Quartz Commercial |
$329.46
|
| Rate for Payer: Quartz Medicare Advantage |
$81.89
|
| Rate for Payer: The Alliance Commercial |
$348.03
|
| Rate for Payer: United Healthcare Medicaid |
$87.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$81.89
|
| Rate for Payer: WEA Trust Commercial |
$317.90
|
| Rate for Payer: WPS Commercial |
$368.50
|
|
|
Destruction, malignant lesion (face, ears, eyelids, nose, lips, mucous membranes)†0.6-1.0cm 17281
|
Professional
|
$829.00
|
|
|
Service Code
|
CPT 17281
|
| Hospital Charge Code |
3013669
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$111.90 |
| Max. Negotiated Rate |
$787.55 |
| Rate for Payer: Aetna Commercial |
$787.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$712.94
|
| Rate for Payer: Aetna Managed Medicare |
$111.90
|
| Rate for Payer: Anthem Medicare Advantage |
$111.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$111.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$111.90
|
| Rate for Payer: Cash Price |
$248.70
|
| Rate for Payer: Cash Price |
$248.70
|
| Rate for Payer: Cigna Commercial |
$787.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$414.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$111.90
|
| Rate for Payer: Health EOS Commercial |
$754.39
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$395.57
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$395.57
|
| Rate for Payer: Independent Care Health Plan Medicare |
$111.90
|
| Rate for Payer: Multiplan Commercial |
$663.20
|
| Rate for Payer: Preferred Network Access Commercial |
$787.55
|
| Rate for Payer: Quartz Beloit One Network |
$364.76
|
| Rate for Payer: Quartz Commercial |
$472.53
|
| Rate for Payer: Quartz Medicare Advantage |
$111.90
|
| Rate for Payer: The Alliance Commercial |
$475.58
|
| Rate for Payer: United Healthcare Medicaid |
$188.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$111.90
|
| Rate for Payer: WEA Trust Commercial |
$455.95
|
| Rate for Payer: WPS Commercial |
$503.55
|
|
|
Destruction, malignant lesion (face, ears, eyelids, nose, lips, mucous membranes)†1.1-2.0cm 17282
|
Professional
|
$1,025.00
|
|
|
Service Code
|
CPT 17282
|
| Hospital Charge Code |
3013670
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$129.18 |
| Max. Negotiated Rate |
$973.75 |
| Rate for Payer: Aetna Commercial |
$973.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$881.50
|
| Rate for Payer: Aetna Managed Medicare |
$129.18
|
| Rate for Payer: Anthem Medicare Advantage |
$129.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$129.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$129.18
|
| Rate for Payer: Cash Price |
$307.50
|
| Rate for Payer: Cash Price |
$307.50
|
| Rate for Payer: Cigna Commercial |
$973.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$512.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$129.18
|
| Rate for Payer: Health EOS Commercial |
$932.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$457.70
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$457.70
|
| Rate for Payer: Independent Care Health Plan Medicare |
$129.18
|
| Rate for Payer: Multiplan Commercial |
$820.00
|
| Rate for Payer: Preferred Network Access Commercial |
$973.75
|
| Rate for Payer: Quartz Beloit One Network |
$451.00
|
| Rate for Payer: Quartz Commercial |
$584.25
|
| Rate for Payer: Quartz Medicare Advantage |
$129.18
|
| Rate for Payer: The Alliance Commercial |
$549.02
|
| Rate for Payer: United Healthcare Medicaid |
$257.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$129.18
|
| Rate for Payer: WEA Trust Commercial |
$563.75
|
| Rate for Payer: WPS Commercial |
$581.31
|
|
|
Destruction, malignant lesion (face, ears, eyelids, nose, lips, mucous membranes)†2.1-3.0cm 17283
|
Professional
|
$1,336.00
|
|
|
Service Code
|
CPT 17283
|
| Hospital Charge Code |
3013671
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$160.99 |
| Max. Negotiated Rate |
$1,269.20 |
| Rate for Payer: Aetna Commercial |
$1,269.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,148.96
|
| Rate for Payer: Aetna Managed Medicare |
$160.99
|
| Rate for Payer: Anthem Medicare Advantage |
$160.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$160.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$160.99
|
| Rate for Payer: Cash Price |
$400.80
|
| Rate for Payer: Cash Price |
$400.80
|
| Rate for Payer: Cigna Commercial |
$1,269.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$668.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$160.99
|
| Rate for Payer: Health EOS Commercial |
$1,215.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$571.72
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$571.72
|
| Rate for Payer: Independent Care Health Plan Medicare |
$160.99
|
| Rate for Payer: Multiplan Commercial |
$1,068.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,269.20
|
| Rate for Payer: Quartz Beloit One Network |
$587.84
|
| Rate for Payer: Quartz Commercial |
$761.52
|
| Rate for Payer: Quartz Medicare Advantage |
$160.99
|
| Rate for Payer: The Alliance Commercial |
$684.21
|
| Rate for Payer: United Healthcare Medicaid |
$268.71
|
| Rate for Payer: United Healthcare Medicare Advantage |
$160.99
|
| Rate for Payer: WEA Trust Commercial |
$734.80
|
| Rate for Payer: WPS Commercial |
$724.46
|
|
|
Destruction, malignant lesion (face, ears, eyelids, nose, lips, mucous membranes)†3.1-4.0cm 17284
|
Professional
|
$1,042.00
|
|
|
Service Code
|
CPT 17284
|
| Hospital Charge Code |
3013672
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$187.71 |
| Max. Negotiated Rate |
$989.90 |
| Rate for Payer: Aetna Commercial |
$989.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$896.12
|
| Rate for Payer: Aetna Managed Medicare |
$187.71
|
| Rate for Payer: Anthem Medicare Advantage |
$187.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$187.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$187.71
|
| Rate for Payer: Cash Price |
$312.60
|
| Rate for Payer: Cash Price |
$312.60
|
| Rate for Payer: Cigna Commercial |
$989.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$521.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$187.71
|
| Rate for Payer: Health EOS Commercial |
$948.22
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$667.66
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$667.66
|
| Rate for Payer: Independent Care Health Plan Medicare |
$187.71
|
| Rate for Payer: Multiplan Commercial |
$833.60
|
| Rate for Payer: Preferred Network Access Commercial |
$989.90
|
| Rate for Payer: Quartz Beloit One Network |
$458.48
|
| Rate for Payer: Quartz Commercial |
$593.94
|
| Rate for Payer: Quartz Medicare Advantage |
$187.71
|
| Rate for Payer: The Alliance Commercial |
$797.77
|
| Rate for Payer: United Healthcare Medicaid |
$423.22
|
| Rate for Payer: United Healthcare Medicare Advantage |
$187.71
|
| Rate for Payer: WEA Trust Commercial |
$573.10
|
| Rate for Payer: WPS Commercial |
$844.70
|
|
|
Destruction, malignant lesion (scalp, neck, hands, feet, genitalia)†<=0.5cm 17270
|
Professional
|
$616.00
|
|
|
Service Code
|
CPT 17270
|
| Hospital Charge Code |
3013663
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$76.57 |
| Max. Negotiated Rate |
$585.20 |
| Rate for Payer: Aetna Commercial |
$585.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$529.76
|
| Rate for Payer: Aetna Managed Medicare |
$90.09
|
| Rate for Payer: Anthem Medicare Advantage |
$90.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$90.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$90.09
|
| Rate for Payer: Cash Price |
$184.80
|
| Rate for Payer: Cash Price |
$184.80
|
| Rate for Payer: Cigna Commercial |
$585.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$308.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$90.09
|
| Rate for Payer: Health EOS Commercial |
$560.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$317.74
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$317.74
|
| Rate for Payer: Independent Care Health Plan Medicare |
$90.09
|
| Rate for Payer: Multiplan Commercial |
$492.80
|
| Rate for Payer: Preferred Network Access Commercial |
$585.20
|
| Rate for Payer: Quartz Beloit One Network |
$271.04
|
| Rate for Payer: Quartz Commercial |
$351.12
|
| Rate for Payer: Quartz Medicare Advantage |
$90.09
|
| Rate for Payer: The Alliance Commercial |
$382.88
|
| Rate for Payer: United Healthcare Medicaid |
$76.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$90.09
|
| Rate for Payer: WEA Trust Commercial |
$338.80
|
| Rate for Payer: WPS Commercial |
$405.40
|
|
|
Destruction, malignant lesion (scalp, neck, hands, feet, genitalia)†0.6-1.0cm 17271
|
Professional
|
$390.00
|
|
|
Service Code
|
CPT 17271
|
| Hospital Charge Code |
3013664
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$99.71 |
| Max. Negotiated Rate |
$448.70 |
| Rate for Payer: Aetna Commercial |
$370.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$335.40
|
| Rate for Payer: Aetna Managed Medicare |
$99.71
|
| Rate for Payer: Anthem Medicare Advantage |
$99.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$99.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$99.71
|
| Rate for Payer: Cash Price |
$117.00
|
| Rate for Payer: Cash Price |
$117.00
|
| Rate for Payer: Cigna Commercial |
$370.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$195.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$99.71
|
| Rate for Payer: Health EOS Commercial |
$354.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$351.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$351.80
|
| Rate for Payer: Independent Care Health Plan Medicare |
$99.71
|
| Rate for Payer: Multiplan Commercial |
$312.00
|
| Rate for Payer: Preferred Network Access Commercial |
$370.50
|
| Rate for Payer: Quartz Beloit One Network |
$171.60
|
| Rate for Payer: Quartz Commercial |
$222.30
|
| Rate for Payer: Quartz Medicare Advantage |
$99.71
|
| Rate for Payer: The Alliance Commercial |
$423.77
|
| Rate for Payer: United Healthcare Medicaid |
$116.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$99.71
|
| Rate for Payer: WEA Trust Commercial |
$214.50
|
| Rate for Payer: WPS Commercial |
$448.70
|
|
|
Destruction, malignant lesion (scalp, neck, hands, feet, genitalia)†1.1-2.0cm 17272
|
Professional
|
$866.00
|
|
|
Service Code
|
CPT 17272
|
| Hospital Charge Code |
3013665
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$114.56 |
| Max. Negotiated Rate |
$822.70 |
| Rate for Payer: Aetna Commercial |
$822.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$744.76
|
| Rate for Payer: Aetna Managed Medicare |
$114.56
|
| Rate for Payer: Anthem Medicare Advantage |
$114.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$114.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$114.56
|
| Rate for Payer: Cash Price |
$259.80
|
| Rate for Payer: Cash Price |
$259.80
|
| Rate for Payer: Cigna Commercial |
$822.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$433.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$114.56
|
| Rate for Payer: Health EOS Commercial |
$788.06
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$405.56
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$405.56
|
| Rate for Payer: Independent Care Health Plan Medicare |
$114.56
|
| Rate for Payer: Multiplan Commercial |
$692.80
|
| Rate for Payer: Preferred Network Access Commercial |
$822.70
|
| Rate for Payer: Quartz Beloit One Network |
$381.04
|
| Rate for Payer: Quartz Commercial |
$493.62
|
| Rate for Payer: Quartz Medicare Advantage |
$114.56
|
| Rate for Payer: The Alliance Commercial |
$486.88
|
| Rate for Payer: United Healthcare Medicaid |
$119.71
|
| Rate for Payer: United Healthcare Medicare Advantage |
$114.56
|
| Rate for Payer: WEA Trust Commercial |
$476.30
|
| Rate for Payer: WPS Commercial |
$515.52
|
|
|
Destruction, malignant lesion (scalp, neck, hands, feet, genitalia)†2.1-3.0cm 17273
|
Professional
|
$995.00
|
|
|
Service Code
|
CPT 17273
|
| Hospital Charge Code |
3013666
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$129.52 |
| Max. Negotiated Rate |
$945.25 |
| Rate for Payer: Aetna Commercial |
$945.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$855.70
|
| Rate for Payer: Aetna Managed Medicare |
$129.52
|
| Rate for Payer: Anthem Medicare Advantage |
$129.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$129.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$129.52
|
| Rate for Payer: Cash Price |
$298.50
|
| Rate for Payer: Cash Price |
$298.50
|
| Rate for Payer: Cigna Commercial |
$945.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$497.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$129.52
|
| Rate for Payer: Health EOS Commercial |
$905.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$460.10
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$460.10
|
| Rate for Payer: Independent Care Health Plan Medicare |
$129.52
|
| Rate for Payer: Multiplan Commercial |
$796.00
|
| Rate for Payer: Preferred Network Access Commercial |
$945.25
|
| Rate for Payer: Quartz Beloit One Network |
$437.80
|
| Rate for Payer: Quartz Commercial |
$567.15
|
| Rate for Payer: Quartz Medicare Advantage |
$129.52
|
| Rate for Payer: The Alliance Commercial |
$550.46
|
| Rate for Payer: United Healthcare Medicaid |
$164.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$129.52
|
| Rate for Payer: WEA Trust Commercial |
$547.25
|
| Rate for Payer: WPS Commercial |
$582.84
|
|
