|
Destruction, malignant lesion (scalp, neck, hands, feet, genitalia)†>4.0cm 17276
|
Professional
|
$972.00
|
|
|
Service Code
|
CPT 17276
|
| Hospital Charge Code |
3013667
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$190.80 |
| Max. Negotiated Rate |
$923.40 |
| Rate for Payer: Aetna Commercial |
$923.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$835.92
|
| Rate for Payer: Aetna Managed Medicare |
$190.80
|
| Rate for Payer: Anthem Medicare Advantage |
$190.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$190.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$190.80
|
| Rate for Payer: Cash Price |
$291.60
|
| Rate for Payer: Cash Price |
$291.60
|
| Rate for Payer: Cigna Commercial |
$923.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$486.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$190.80
|
| Rate for Payer: Health EOS Commercial |
$884.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$676.17
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$676.17
|
| Rate for Payer: Independent Care Health Plan Medicare |
$190.80
|
| Rate for Payer: Multiplan Commercial |
$777.60
|
| Rate for Payer: Preferred Network Access Commercial |
$923.40
|
| Rate for Payer: Quartz Beloit One Network |
$427.68
|
| Rate for Payer: Quartz Commercial |
$554.04
|
| Rate for Payer: Quartz Medicare Advantage |
$190.80
|
| Rate for Payer: The Alliance Commercial |
$810.90
|
| Rate for Payer: United Healthcare Medicaid |
$251.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$190.80
|
| Rate for Payer: WEA Trust Commercial |
$534.60
|
| Rate for Payer: WPS Commercial |
$858.60
|
|
|
Destruction Malignant Lesion S/N/H/F/G 3.1-4.0cm 17274
|
Professional
|
$997.00
|
|
|
Service Code
|
CPT 17274
|
| Hospital Charge Code |
4558611
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$158.65 |
| Max. Negotiated Rate |
$947.15 |
| Rate for Payer: Aetna Commercial |
$947.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$857.42
|
| Rate for Payer: Aetna Managed Medicare |
$158.65
|
| Rate for Payer: Anthem Medicare Advantage |
$158.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$158.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$158.65
|
| Rate for Payer: Cash Price |
$299.10
|
| Rate for Payer: Cash Price |
$299.10
|
| Rate for Payer: Cigna Commercial |
$947.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$498.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$158.65
|
| Rate for Payer: Health EOS Commercial |
$907.27
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$561.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$561.69
|
| Rate for Payer: Independent Care Health Plan Medicare |
$158.65
|
| Rate for Payer: Multiplan Commercial |
$797.60
|
| Rate for Payer: Preferred Network Access Commercial |
$947.15
|
| Rate for Payer: Quartz Beloit One Network |
$438.68
|
| Rate for Payer: Quartz Commercial |
$568.29
|
| Rate for Payer: Quartz Medicare Advantage |
$158.65
|
| Rate for Payer: The Alliance Commercial |
$674.26
|
| Rate for Payer: United Healthcare Medicaid |
$202.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$158.65
|
| Rate for Payer: WEA Trust Commercial |
$548.35
|
| Rate for Payer: WPS Commercial |
$713.92
|
|
|
Destruction, malignant lesion (trunk, arms, legs)†<=0.5cm 17260
|
Professional
|
$359.00
|
|
|
Service Code
|
CPT 17260
|
| Hospital Charge Code |
3013657
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$67.08 |
| Max. Negotiated Rate |
$341.05 |
| Rate for Payer: Aetna Commercial |
$341.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$308.74
|
| Rate for Payer: Aetna Managed Medicare |
$67.08
|
| Rate for Payer: Anthem Medicare Advantage |
$67.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$67.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$67.08
|
| Rate for Payer: Cash Price |
$107.70
|
| Rate for Payer: Cash Price |
$107.70
|
| Rate for Payer: Cigna Commercial |
$341.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$179.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$67.08
|
| Rate for Payer: Health EOS Commercial |
$326.69
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$236.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$236.40
|
| Rate for Payer: Independent Care Health Plan Medicare |
$67.08
|
| Rate for Payer: Multiplan Commercial |
$287.20
|
| Rate for Payer: Preferred Network Access Commercial |
$341.05
|
| Rate for Payer: Quartz Beloit One Network |
$157.96
|
| Rate for Payer: Quartz Commercial |
$204.63
|
| Rate for Payer: Quartz Medicare Advantage |
$67.08
|
| Rate for Payer: The Alliance Commercial |
$285.09
|
| Rate for Payer: United Healthcare Medicaid |
$72.43
|
| Rate for Payer: United Healthcare Medicare Advantage |
$67.08
|
| Rate for Payer: WEA Trust Commercial |
$197.45
|
| Rate for Payer: WPS Commercial |
$301.86
|
|
|
Destruction, malignant lesion (trunk, arms, legs)†0.6-1.0cm 17261
|
Professional
|
$269.00
|
|
|
Service Code
|
CPT 17261
|
| Hospital Charge Code |
3013658
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$82.22 |
| Max. Negotiated Rate |
$369.99 |
| Rate for Payer: Aetna Commercial |
$255.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$231.34
|
| Rate for Payer: Aetna Managed Medicare |
$82.22
|
| Rate for Payer: Anthem Medicare Advantage |
$82.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$82.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$82.22
|
| Rate for Payer: Cash Price |
$80.70
|
| Rate for Payer: Cash Price |
$80.70
|
| Rate for Payer: Cigna Commercial |
$255.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$134.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$82.22
|
| Rate for Payer: Health EOS Commercial |
$244.79
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$290.77
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$290.77
|
| Rate for Payer: Independent Care Health Plan Medicare |
$82.22
|
| Rate for Payer: Multiplan Commercial |
$215.20
|
| Rate for Payer: Preferred Network Access Commercial |
$255.55
|
| Rate for Payer: Quartz Beloit One Network |
$118.36
|
| Rate for Payer: Quartz Commercial |
$153.33
|
| Rate for Payer: Quartz Medicare Advantage |
$82.22
|
| Rate for Payer: The Alliance Commercial |
$349.44
|
| Rate for Payer: United Healthcare Medicaid |
$91.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$82.22
|
| Rate for Payer: WEA Trust Commercial |
$147.95
|
| Rate for Payer: WPS Commercial |
$369.99
|
|
|
Destruction, malignant lesion (trunk, arms, legs)†1.1-2.0cm 17262
|
Professional
|
$348.00
|
|
|
Service Code
|
CPT 17262
|
| Hospital Charge Code |
3013659
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$104.47 |
| Max. Negotiated Rate |
$470.12 |
| Rate for Payer: Aetna Commercial |
$330.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$299.28
|
| Rate for Payer: Aetna Managed Medicare |
$104.47
|
| Rate for Payer: Anthem Medicare Advantage |
$104.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$104.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$104.47
|
| Rate for Payer: Cash Price |
$104.40
|
| Rate for Payer: Cash Price |
$104.40
|
| Rate for Payer: Cigna Commercial |
$330.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$174.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$104.47
|
| Rate for Payer: Health EOS Commercial |
$316.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$368.67
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$368.67
|
| Rate for Payer: Independent Care Health Plan Medicare |
$104.47
|
| Rate for Payer: Multiplan Commercial |
$278.40
|
| Rate for Payer: Preferred Network Access Commercial |
$330.60
|
| Rate for Payer: Quartz Beloit One Network |
$153.12
|
| Rate for Payer: Quartz Commercial |
$198.36
|
| Rate for Payer: Quartz Medicare Advantage |
$104.47
|
| Rate for Payer: The Alliance Commercial |
$444.00
|
| Rate for Payer: United Healthcare Medicaid |
$121.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$104.47
|
| Rate for Payer: WEA Trust Commercial |
$191.40
|
| Rate for Payer: WPS Commercial |
$470.12
|
|
|
Destruction, malignant lesion (trunk, arms, legs)†2.1-3.0cm 17263
|
Professional
|
$457.00
|
|
|
Service Code
|
CPT 17263
|
| Hospital Charge Code |
3013660
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$115.56 |
| Max. Negotiated Rate |
$520.02 |
| Rate for Payer: Aetna Commercial |
$434.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$393.02
|
| Rate for Payer: Aetna Managed Medicare |
$115.56
|
| Rate for Payer: Anthem Medicare Advantage |
$115.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$115.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$115.56
|
| Rate for Payer: Cash Price |
$137.10
|
| Rate for Payer: Cash Price |
$137.10
|
| Rate for Payer: Cigna Commercial |
$434.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$228.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$115.56
|
| Rate for Payer: Health EOS Commercial |
$415.87
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$409.20
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$409.20
|
| Rate for Payer: Independent Care Health Plan Medicare |
$115.56
|
| Rate for Payer: Multiplan Commercial |
$365.60
|
| Rate for Payer: Preferred Network Access Commercial |
$434.15
|
| Rate for Payer: Quartz Beloit One Network |
$201.08
|
| Rate for Payer: Quartz Commercial |
$260.49
|
| Rate for Payer: Quartz Medicare Advantage |
$115.56
|
| Rate for Payer: The Alliance Commercial |
$491.13
|
| Rate for Payer: United Healthcare Medicaid |
$145.53
|
| Rate for Payer: United Healthcare Medicare Advantage |
$115.56
|
| Rate for Payer: WEA Trust Commercial |
$251.35
|
| Rate for Payer: WPS Commercial |
$520.02
|
|
|
Destruction, malignant lesion (trunk, arms, legs)†3.1-4.0cm 17264
|
Professional
|
$804.00
|
|
|
Service Code
|
CPT 17264
|
| Hospital Charge Code |
3013661
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$123.33 |
| Max. Negotiated Rate |
$763.80 |
| Rate for Payer: Aetna Commercial |
$763.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$691.44
|
| Rate for Payer: Aetna Managed Medicare |
$123.33
|
| Rate for Payer: Anthem Medicare Advantage |
$123.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$123.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$123.33
|
| Rate for Payer: Cash Price |
$241.20
|
| Rate for Payer: Cash Price |
$241.20
|
| Rate for Payer: Cigna Commercial |
$763.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$402.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$123.33
|
| Rate for Payer: Health EOS Commercial |
$731.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$437.68
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$437.68
|
| Rate for Payer: Independent Care Health Plan Medicare |
$123.33
|
| Rate for Payer: Multiplan Commercial |
$643.20
|
| Rate for Payer: Preferred Network Access Commercial |
$763.80
|
| Rate for Payer: Quartz Beloit One Network |
$353.76
|
| Rate for Payer: Quartz Commercial |
$458.28
|
| Rate for Payer: Quartz Medicare Advantage |
$123.33
|
| Rate for Payer: The Alliance Commercial |
$524.15
|
| Rate for Payer: United Healthcare Medicaid |
$164.16
|
| Rate for Payer: United Healthcare Medicare Advantage |
$123.33
|
| Rate for Payer: WEA Trust Commercial |
$442.20
|
| Rate for Payer: WPS Commercial |
$554.98
|
|
|
Destruction, malignant lesion (trunk, arms, legs)†> 4.0cm 17266
|
Professional
|
$1,182.00
|
|
|
Service Code
|
CPT 17266
|
| Hospital Charge Code |
3013662
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$145.14 |
| Max. Negotiated Rate |
$1,122.90 |
| Rate for Payer: Aetna Commercial |
$1,122.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,016.52
|
| Rate for Payer: Aetna Managed Medicare |
$145.14
|
| Rate for Payer: Anthem Medicare Advantage |
$145.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$145.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$145.14
|
| Rate for Payer: Cash Price |
$354.60
|
| Rate for Payer: Cash Price |
$354.60
|
| Rate for Payer: Cigna Commercial |
$1,122.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$591.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$145.14
|
| Rate for Payer: Health EOS Commercial |
$1,075.62
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$513.93
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$513.93
|
| Rate for Payer: Independent Care Health Plan Medicare |
$145.14
|
| Rate for Payer: Multiplan Commercial |
$945.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,122.90
|
| Rate for Payer: Quartz Beloit One Network |
$520.08
|
| Rate for Payer: Quartz Commercial |
$673.74
|
| Rate for Payer: Quartz Medicare Advantage |
$145.14
|
| Rate for Payer: The Alliance Commercial |
$616.84
|
| Rate for Payer: United Healthcare Medicaid |
$204.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$145.14
|
| Rate for Payer: WEA Trust Commercial |
$650.10
|
| Rate for Payer: WPS Commercial |
$653.13
|
|
|
DESTRUCTION NEURLTC AGENT GENIC NERV W/IMAG 64624
|
Professional
|
$3,789.00
|
|
|
Service Code
|
CPT 64624
|
| Hospital Charge Code |
5608019
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$138.03 |
| Max. Negotiated Rate |
$3,599.55 |
| Rate for Payer: Aetna Commercial |
$3,599.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,258.54
|
| Rate for Payer: Aetna Managed Medicare |
$138.03
|
| Rate for Payer: Anthem Medicare Advantage |
$138.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$138.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$138.03
|
| Rate for Payer: Cash Price |
$1,136.70
|
| Rate for Payer: Cash Price |
$1,136.70
|
| Rate for Payer: Cigna Commercial |
$3,599.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,894.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$138.03
|
| Rate for Payer: Health EOS Commercial |
$3,447.99
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$495.72
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$495.72
|
| Rate for Payer: Independent Care Health Plan Medicare |
$138.03
|
| Rate for Payer: Multiplan Commercial |
$3,031.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,599.55
|
| Rate for Payer: Quartz Beloit One Network |
$1,667.16
|
| Rate for Payer: Quartz Commercial |
$2,159.73
|
| Rate for Payer: Quartz Medicare Advantage |
$138.03
|
| Rate for Payer: The Alliance Commercial |
$586.63
|
| Rate for Payer: United Healthcare Medicaid |
$315.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$138.03
|
| Rate for Payer: WEA Trust Commercial |
$2,083.95
|
| Rate for Payer: WPS Commercial |
$621.14
|
|
|
Destruction of benign lesion; 1-14 lesions 17110
|
Professional
|
$144.00
|
|
|
Service Code
|
CPT 17110
|
| Hospital Charge Code |
1188868
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$25.56 |
| Max. Negotiated Rate |
$288.27 |
| Rate for Payer: Aetna Commercial |
$136.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$123.84
|
| Rate for Payer: Aetna Managed Medicare |
$64.06
|
| Rate for Payer: Anthem Medicare Advantage |
$64.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$64.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$64.06
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cigna Commercial |
$136.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$72.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$64.06
|
| Rate for Payer: Health EOS Commercial |
$131.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$221.83
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$221.83
|
| Rate for Payer: Independent Care Health Plan Medicare |
$64.06
|
| Rate for Payer: Multiplan Commercial |
$115.20
|
| Rate for Payer: Preferred Network Access Commercial |
$136.80
|
| Rate for Payer: Quartz Beloit One Network |
$63.36
|
| Rate for Payer: Quartz Commercial |
$82.08
|
| Rate for Payer: Quartz Medicare Advantage |
$64.06
|
| Rate for Payer: The Alliance Commercial |
$272.26
|
| Rate for Payer: United Healthcare Medicaid |
$25.56
|
| Rate for Payer: United Healthcare Medicare Advantage |
$64.06
|
| Rate for Payer: WEA Trust Commercial |
$79.20
|
| Rate for Payer: WPS Commercial |
$288.27
|
|
|
Destruction of benign lesions; 15 or more lesions 17111
|
Professional
|
$153.00
|
|
|
Service Code
|
CPT 17111
|
| Hospital Charge Code |
1188869
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$54.69 |
| Max. Negotiated Rate |
$352.62 |
| Rate for Payer: Aetna Commercial |
$145.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$131.58
|
| Rate for Payer: Aetna Managed Medicare |
$78.36
|
| Rate for Payer: Anthem Medicare Advantage |
$78.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$78.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$78.36
|
| Rate for Payer: Cash Price |
$45.90
|
| Rate for Payer: Cash Price |
$45.90
|
| Rate for Payer: Cigna Commercial |
$145.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$76.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$78.36
|
| Rate for Payer: Health EOS Commercial |
$139.23
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$272.45
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$272.45
|
| Rate for Payer: Independent Care Health Plan Medicare |
$78.36
|
| Rate for Payer: Multiplan Commercial |
$122.40
|
| Rate for Payer: Preferred Network Access Commercial |
$145.35
|
| Rate for Payer: Quartz Beloit One Network |
$67.32
|
| Rate for Payer: Quartz Commercial |
$87.21
|
| Rate for Payer: Quartz Medicare Advantage |
$78.36
|
| Rate for Payer: The Alliance Commercial |
$333.03
|
| Rate for Payer: United Healthcare Medicaid |
$54.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$78.36
|
| Rate for Payer: WEA Trust Commercial |
$84.15
|
| Rate for Payer: WPS Commercial |
$352.62
|
|
|
Destruction of Internal Hemorrhoid, Cautery
|
Professional
|
$367.00
|
|
|
Service Code
|
CPT 46930
|
| Hospital Charge Code |
2572830
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$140.97 |
| Max. Negotiated Rate |
$648.63 |
| Rate for Payer: Aetna Commercial |
$348.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$315.62
|
| Rate for Payer: Aetna Managed Medicare |
$144.14
|
| Rate for Payer: Anthem Medicare Advantage |
$144.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$144.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$144.14
|
| Rate for Payer: Cash Price |
$110.10
|
| Rate for Payer: Cash Price |
$110.10
|
| Rate for Payer: Cigna Commercial |
$348.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$183.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$144.14
|
| Rate for Payer: Health EOS Commercial |
$333.97
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$518.10
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$518.10
|
| Rate for Payer: Independent Care Health Plan Medicare |
$144.14
|
| Rate for Payer: Multiplan Commercial |
$293.60
|
| Rate for Payer: Preferred Network Access Commercial |
$348.65
|
| Rate for Payer: Quartz Beloit One Network |
$161.48
|
| Rate for Payer: Quartz Commercial |
$209.19
|
| Rate for Payer: Quartz Medicare Advantage |
$144.14
|
| Rate for Payer: The Alliance Commercial |
$612.60
|
| Rate for Payer: United Healthcare Medicaid |
$140.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$144.14
|
| Rate for Payer: WEA Trust Commercial |
$201.85
|
| Rate for Payer: WPS Commercial |
$648.63
|
|
|
Destruction Of Lesion On Penis Chemical 54050
|
Professional
|
$276.00
|
|
|
Service Code
|
CPT 54050
|
| Hospital Charge Code |
1188873
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$22.59 |
| Max. Negotiated Rate |
$455.49 |
| Rate for Payer: Aetna Commercial |
$262.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$237.36
|
| Rate for Payer: Aetna Managed Medicare |
$101.22
|
| Rate for Payer: Anthem Medicare Advantage |
$101.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$101.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$101.22
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cigna Commercial |
$262.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$138.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$101.22
|
| Rate for Payer: Health EOS Commercial |
$251.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$354.27
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$354.27
|
| Rate for Payer: Independent Care Health Plan Medicare |
$101.22
|
| Rate for Payer: Multiplan Commercial |
$220.80
|
| Rate for Payer: Preferred Network Access Commercial |
$262.20
|
| Rate for Payer: Quartz Beloit One Network |
$121.44
|
| Rate for Payer: Quartz Commercial |
$157.32
|
| Rate for Payer: Quartz Medicare Advantage |
$101.22
|
| Rate for Payer: The Alliance Commercial |
$430.18
|
| Rate for Payer: United Healthcare Medicaid |
$22.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$101.22
|
| Rate for Payer: WEA Trust Commercial |
$151.80
|
| Rate for Payer: WPS Commercial |
$455.49
|
|
|
Destruction Of Lesion On Penis Cryosurgery 54056
|
Professional
|
$266.00
|
|
|
Service Code
|
CPT 54056
|
| Hospital Charge Code |
1188874
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$45.18 |
| Max. Negotiated Rate |
$477.22 |
| Rate for Payer: Aetna Commercial |
$252.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$228.76
|
| Rate for Payer: Aetna Managed Medicare |
$106.05
|
| Rate for Payer: Anthem Medicare Advantage |
$106.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$106.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$106.05
|
| Rate for Payer: Cash Price |
$79.80
|
| Rate for Payer: Cash Price |
$79.80
|
| Rate for Payer: Cigna Commercial |
$252.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$133.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$106.05
|
| Rate for Payer: Health EOS Commercial |
$242.06
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$367.83
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$367.83
|
| Rate for Payer: Independent Care Health Plan Medicare |
$106.05
|
| Rate for Payer: Multiplan Commercial |
$212.80
|
| Rate for Payer: Preferred Network Access Commercial |
$252.70
|
| Rate for Payer: Quartz Beloit One Network |
$117.04
|
| Rate for Payer: Quartz Commercial |
$151.62
|
| Rate for Payer: Quartz Medicare Advantage |
$106.05
|
| Rate for Payer: The Alliance Commercial |
$450.71
|
| Rate for Payer: United Healthcare Medicaid |
$45.18
|
| Rate for Payer: United Healthcare Medicare Advantage |
$106.05
|
| Rate for Payer: WEA Trust Commercial |
$146.30
|
| Rate for Payer: WPS Commercial |
$477.22
|
|
|
Destruction of Lesion, Penis Electrodesiccation 54055
|
Professional
|
$475.00
|
|
|
Service Code
|
CPT 54055
|
| Hospital Charge Code |
1188981
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$45.18 |
| Max. Negotiated Rate |
$451.25 |
| Rate for Payer: Aetna Commercial |
$451.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$408.50
|
| Rate for Payer: Aetna Managed Medicare |
$90.53
|
| Rate for Payer: Anthem Medicare Advantage |
$90.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$90.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$90.53
|
| Rate for Payer: Cash Price |
$142.50
|
| Rate for Payer: Cash Price |
$142.50
|
| Rate for Payer: Cigna Commercial |
$451.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$237.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$90.53
|
| Rate for Payer: Health EOS Commercial |
$432.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$318.02
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$318.02
|
| Rate for Payer: Independent Care Health Plan Medicare |
$90.53
|
| Rate for Payer: Multiplan Commercial |
$380.00
|
| Rate for Payer: Preferred Network Access Commercial |
$451.25
|
| Rate for Payer: Quartz Beloit One Network |
$209.00
|
| Rate for Payer: Quartz Commercial |
$270.75
|
| Rate for Payer: Quartz Medicare Advantage |
$90.53
|
| Rate for Payer: The Alliance Commercial |
$384.75
|
| Rate for Payer: United Healthcare Medicaid |
$45.18
|
| Rate for Payer: United Healthcare Medicare Advantage |
$90.53
|
| Rate for Payer: WEA Trust Commercial |
$261.25
|
| Rate for Payer: WPS Commercial |
$407.38
|
|
|
Destruction of Lesion, Penis Surgical Excision 54060
|
Professional
|
$698.00
|
|
|
Service Code
|
CPT 54060
|
| Hospital Charge Code |
1188982
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$75.33 |
| Max. Negotiated Rate |
$663.10 |
| Rate for Payer: Aetna Commercial |
$663.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$600.28
|
| Rate for Payer: Aetna Managed Medicare |
$123.63
|
| Rate for Payer: Anthem Medicare Advantage |
$123.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$123.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$123.63
|
| Rate for Payer: Cash Price |
$209.40
|
| Rate for Payer: Cash Price |
$209.40
|
| Rate for Payer: Cigna Commercial |
$663.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$349.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$123.63
|
| Rate for Payer: Health EOS Commercial |
$635.18
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$436.77
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$436.77
|
| Rate for Payer: Independent Care Health Plan Medicare |
$123.63
|
| Rate for Payer: Multiplan Commercial |
$558.40
|
| Rate for Payer: Preferred Network Access Commercial |
$663.10
|
| Rate for Payer: Quartz Beloit One Network |
$307.12
|
| Rate for Payer: Quartz Commercial |
$397.86
|
| Rate for Payer: Quartz Medicare Advantage |
$123.63
|
| Rate for Payer: The Alliance Commercial |
$525.43
|
| Rate for Payer: United Healthcare Medicaid |
$75.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$123.63
|
| Rate for Payer: WEA Trust Commercial |
$383.90
|
| Rate for Payer: WPS Commercial |
$556.34
|
|
|
Destruction Of Lesions On Anus; Cryosurgery
|
Professional
|
$522.00
|
|
|
Service Code
|
CPT 46916
|
| Hospital Charge Code |
1190851
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$43.60 |
| Max. Negotiated Rate |
$606.51 |
| Rate for Payer: Aetna Commercial |
$495.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$448.92
|
| Rate for Payer: Aetna Managed Medicare |
$134.78
|
| Rate for Payer: Anthem Medicare Advantage |
$134.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$134.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$134.78
|
| Rate for Payer: Cash Price |
$156.60
|
| Rate for Payer: Cash Price |
$156.60
|
| Rate for Payer: Cigna Commercial |
$495.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$261.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$134.78
|
| Rate for Payer: Health EOS Commercial |
$475.02
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$475.42
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$475.42
|
| Rate for Payer: Independent Care Health Plan Medicare |
$134.78
|
| Rate for Payer: Multiplan Commercial |
$417.60
|
| Rate for Payer: Preferred Network Access Commercial |
$495.90
|
| Rate for Payer: Quartz Beloit One Network |
$229.68
|
| Rate for Payer: Quartz Commercial |
$297.54
|
| Rate for Payer: Quartz Medicare Advantage |
$134.78
|
| Rate for Payer: The Alliance Commercial |
$572.82
|
| Rate for Payer: United Healthcare Medicaid |
$43.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$134.78
|
| Rate for Payer: WEA Trust Commercial |
$287.10
|
| Rate for Payer: WPS Commercial |
$606.51
|
|
|
DESTRUCTION OF LESION(S), PENIS (EG, CONDYLOMA, PAPILLOMA, MOLLUSCUM CONTAGIOSUM, HERPETIC VESICLE), EXTENSIVE (EG, LASER SURGERY, ELECTROSURGERY, CRYOSURGERY, CHEMOSURGERY)
|
Facility
OP
|
$11,915.08
|
|
|
Service Code
|
CPT 54065
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,802.48 |
| Max. Negotiated Rate |
$11,915.08 |
| Rate for Payer: Aetna Managed Medicare |
$1,802.48
|
| 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 |
$1,802.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,802.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,802.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,802.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,802.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,705.23
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,802.48
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,802.48
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,802.48
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,802.48
|
| Rate for Payer: NAPHCARE Commercial |
$2,703.72
|
| Rate for Payer: Quartz Medicare Advantage |
$1,802.48
|
| Rate for Payer: The Alliance Commercial |
$11,915.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,802.48
|
| Rate for Payer: United Healthcare PPO |
$3,583.00
|
| Rate for Payer: Wellcare Medicare |
$1,802.48
|
|
|
DESTRUCTION OF LESION(S), PENIS (EG, CONDYLOMA, PAPILLOMA, MOLLUSCUM CONTAGIOSUM, HERPETIC VESICLE), SIMPLE; SURGICAL EXCISION
|
Facility
OP
|
$11,915.08
|
|
|
Service Code
|
CPT 54060
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,802.48 |
| Max. Negotiated Rate |
$11,915.08 |
| Rate for Payer: Aetna Managed Medicare |
$1,802.48
|
| 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 |
$1,802.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,802.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,802.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,802.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,802.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,705.23
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,802.48
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,802.48
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,802.48
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,802.48
|
| Rate for Payer: NAPHCARE Commercial |
$2,703.72
|
| Rate for Payer: Quartz Medicare Advantage |
$1,802.48
|
| Rate for Payer: The Alliance Commercial |
$11,915.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,802.48
|
| Rate for Payer: United Healthcare PPO |
$3,583.00
|
| Rate for Payer: Wellcare Medicare |
$1,802.48
|
|
|
Destruction Of Lesions; Vulva, Complex 56515
|
Professional
|
$1,431.00
|
|
|
Service Code
|
CPT 56515
|
| Hospital Charge Code |
1190843
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$195.86 |
| Max. Negotiated Rate |
$1,359.45 |
| Rate for Payer: Aetna Commercial |
$1,359.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,230.66
|
| Rate for Payer: Aetna Managed Medicare |
$200.48
|
| Rate for Payer: Anthem Medicare Advantage |
$200.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$200.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$200.48
|
| Rate for Payer: Cash Price |
$429.30
|
| Rate for Payer: Cash Price |
$429.30
|
| Rate for Payer: Cigna Commercial |
$1,359.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$715.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$200.48
|
| Rate for Payer: Health EOS Commercial |
$1,302.21
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$703.99
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$703.99
|
| Rate for Payer: Independent Care Health Plan Medicare |
$200.48
|
| Rate for Payer: Multiplan Commercial |
$1,144.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,359.45
|
| Rate for Payer: Quartz Beloit One Network |
$629.64
|
| Rate for Payer: Quartz Commercial |
$815.67
|
| Rate for Payer: Quartz Medicare Advantage |
$200.48
|
| Rate for Payer: The Alliance Commercial |
$852.04
|
| Rate for Payer: United Healthcare Medicaid |
$195.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$200.48
|
| Rate for Payer: WEA Trust Commercial |
$787.05
|
| Rate for Payer: WPS Commercial |
$902.16
|
|
|
Destruction Of Lesions; Vulva, Simple 56501
|
Professional
|
$438.00
|
|
|
Service Code
|
CPT 56501
|
| Hospital Charge Code |
1190842
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$114.36 |
| Max. Negotiated Rate |
$571.64 |
| Rate for Payer: Aetna Commercial |
$416.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$376.68
|
| Rate for Payer: Aetna Managed Medicare |
$127.03
|
| Rate for Payer: Anthem Medicare Advantage |
$127.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$127.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$127.03
|
| Rate for Payer: Cash Price |
$131.40
|
| Rate for Payer: Cash Price |
$131.40
|
| Rate for Payer: Cigna Commercial |
$416.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$219.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$127.03
|
| Rate for Payer: Health EOS Commercial |
$398.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$436.20
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$436.20
|
| Rate for Payer: Independent Care Health Plan Medicare |
$127.03
|
| Rate for Payer: Multiplan Commercial |
$350.40
|
| Rate for Payer: Preferred Network Access Commercial |
$416.10
|
| Rate for Payer: Quartz Beloit One Network |
$192.72
|
| Rate for Payer: Quartz Commercial |
$249.66
|
| Rate for Payer: Quartz Medicare Advantage |
$127.03
|
| Rate for Payer: The Alliance Commercial |
$539.88
|
| Rate for Payer: United Healthcare Medicaid |
$114.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$127.03
|
| Rate for Payer: WEA Trust Commercial |
$240.90
|
| Rate for Payer: WPS Commercial |
$571.64
|
|
|
Destruction of Localized Lesion of Retina, Photocoagulation
|
Professional
|
$2,778.00
|
|
|
Service Code
|
CPT 67210
|
| Hospital Charge Code |
1188905
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$471.95 |
| Max. Negotiated Rate |
$2,639.10 |
| Rate for Payer: Aetna Commercial |
$2,639.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,389.08
|
| Rate for Payer: Aetna Managed Medicare |
$471.95
|
| Rate for Payer: Anthem Medicare Advantage |
$471.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$471.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$471.95
|
| Rate for Payer: Cash Price |
$833.40
|
| Rate for Payer: Cash Price |
$833.40
|
| Rate for Payer: Cigna Commercial |
$2,639.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,389.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$471.95
|
| Rate for Payer: Health EOS Commercial |
$2,527.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,675.37
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,675.37
|
| Rate for Payer: Independent Care Health Plan Medicare |
$471.95
|
| Rate for Payer: Multiplan Commercial |
$2,222.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,639.10
|
| Rate for Payer: Quartz Beloit One Network |
$1,222.32
|
| Rate for Payer: Quartz Commercial |
$1,583.46
|
| Rate for Payer: Quartz Medicare Advantage |
$471.95
|
| Rate for Payer: The Alliance Commercial |
$2,005.79
|
| Rate for Payer: United Healthcare Medicaid |
$553.31
|
| Rate for Payer: United Healthcare Medicare Advantage |
$471.95
|
| Rate for Payer: WEA Trust Commercial |
$1,527.90
|
| Rate for Payer: WPS Commercial |
$2,123.78
|
|
|
Destruction of Localized Lesion of Retina, Photocoagulation 6721050
|
Professional
|
$5,556.00
|
|
|
Service Code
|
CPT 67210 50
|
| Hospital Charge Code |
5492810
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$2,444.64 |
| Max. Negotiated Rate |
$5,278.20 |
| Rate for Payer: Aetna Commercial |
$5,278.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,778.16
|
| Rate for Payer: Cash Price |
$1,666.80
|
| Rate for Payer: Cash Price |
$1,666.80
|
| Rate for Payer: Cigna Commercial |
$5,278.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,778.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,333.60
|
| Rate for Payer: Health EOS Commercial |
$5,055.96
|
| Rate for Payer: Multiplan Commercial |
$4,444.80
|
| Rate for Payer: Preferred Network Access Commercial |
$5,278.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,444.64
|
| Rate for Payer: Quartz Commercial |
$3,166.92
|
| Rate for Payer: The Alliance Commercial |
$2,778.00
|
| Rate for Payer: WEA Trust Commercial |
$3,055.80
|
| Rate for Payer: WPS Commercial |
$4,115.33
|
|
|
Destruction Of Precancerous Lesion 17000
|
Professional
|
$215.00
|
|
|
Service Code
|
CPT 17000
|
| Hospital Charge Code |
1188865
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$47.40 |
| Max. Negotiated Rate |
$234.94 |
| Rate for Payer: Aetna Commercial |
$204.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$184.90
|
| Rate for Payer: Aetna Managed Medicare |
$52.21
|
| Rate for Payer: Anthem Medicare Advantage |
$52.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$52.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$52.21
|
| Rate for Payer: Cash Price |
$64.50
|
| Rate for Payer: Cash Price |
$64.50
|
| Rate for Payer: Cigna Commercial |
$204.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$107.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$52.21
|
| Rate for Payer: Health EOS Commercial |
$195.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$181.37
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$181.37
|
| Rate for Payer: Independent Care Health Plan Medicare |
$52.21
|
| Rate for Payer: Multiplan Commercial |
$172.00
|
| Rate for Payer: Preferred Network Access Commercial |
$204.25
|
| Rate for Payer: Quartz Beloit One Network |
$94.60
|
| Rate for Payer: Quartz Commercial |
$122.55
|
| Rate for Payer: Quartz Medicare Advantage |
$52.21
|
| Rate for Payer: The Alliance Commercial |
$221.89
|
| Rate for Payer: United Healthcare Medicaid |
$47.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$52.21
|
| Rate for Payer: WEA Trust Commercial |
$118.25
|
| Rate for Payer: WPS Commercial |
$234.94
|
|
|
Destruction of precancerous lesions; 15 or more lesions 17004
|
Professional
|
$585.00
|
|
|
Service Code
|
CPT 17004
|
| Hospital Charge Code |
1188867
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$93.63 |
| Max. Negotiated Rate |
$555.75 |
| Rate for Payer: Aetna Commercial |
$555.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$503.10
|
| Rate for Payer: Aetna Managed Medicare |
$93.63
|
| Rate for Payer: Anthem Medicare Advantage |
$93.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$93.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$93.63
|
| Rate for Payer: Cash Price |
$175.50
|
| Rate for Payer: Cash Price |
$175.50
|
| Rate for Payer: Cigna Commercial |
$555.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$292.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$93.63
|
| Rate for Payer: Health EOS Commercial |
$532.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$328.96
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$328.96
|
| Rate for Payer: Independent Care Health Plan Medicare |
$93.63
|
| Rate for Payer: Multiplan Commercial |
$468.00
|
| Rate for Payer: Preferred Network Access Commercial |
$555.75
|
| Rate for Payer: Quartz Beloit One Network |
$257.40
|
| Rate for Payer: Quartz Commercial |
$333.45
|
| Rate for Payer: Quartz Medicare Advantage |
$93.63
|
| Rate for Payer: The Alliance Commercial |
$397.93
|
| Rate for Payer: United Healthcare Medicaid |
$175.02
|
| Rate for Payer: United Healthcare Medicare Advantage |
$93.63
|
| Rate for Payer: WEA Trust Commercial |
$321.75
|
| Rate for Payer: WPS Commercial |
$421.34
|
|
