|
Destruction, malignant lesion (face, ears, eyelids, nose, lips, mucous membranes)†0.6-1.0cm 17281
|
Professional
|
Both
|
$829.00
|
|
|
Service Code
|
CPT 17281
|
| Hospital Charge Code |
3013669
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$188.32 |
| Max. Negotiated Rate |
$787.55 |
| Rate for Payer: Aetna Commercial |
$787.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$712.94
|
| 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 |
$188.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$497.40
|
| Rate for Payer: Health EOS Commercial |
$754.39
|
| Rate for Payer: HFN Commercial |
$787.55
|
| 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: 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: The Alliance Commercial |
$414.50
|
| Rate for Payer: United Healthcare Medicaid |
$188.32
|
| Rate for Payer: WEA Trust Commercial |
$455.95
|
| Rate for Payer: WPS Commercial |
$614.04
|
|
|
Destruction, malignant lesion (face, ears, eyelids, nose, lips, mucous membranes)†1.1-2.0cm 17282
|
Professional
|
Both
|
$1,025.00
|
|
|
Service Code
|
CPT 17282
|
| Hospital Charge Code |
3013670
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$257.75 |
| Max. Negotiated Rate |
$973.75 |
| Rate for Payer: Aetna Commercial |
$973.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$881.50
|
| 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 |
$257.75
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$615.00
|
| Rate for Payer: Health EOS Commercial |
$932.75
|
| Rate for Payer: HFN Commercial |
$973.75
|
| 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: 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: The Alliance Commercial |
$512.50
|
| Rate for Payer: United Healthcare Medicaid |
$257.75
|
| Rate for Payer: WEA Trust Commercial |
$563.75
|
| Rate for Payer: WPS Commercial |
$759.22
|
|
|
Destruction, malignant lesion (face, ears, eyelids, nose, lips, mucous membranes)†2.1-3.0cm 17283
|
Professional
|
Both
|
$1,336.00
|
|
|
Service Code
|
CPT 17283
|
| Hospital Charge Code |
3013671
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$268.71 |
| 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: 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 |
$268.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$801.60
|
| Rate for Payer: Health EOS Commercial |
$1,215.76
|
| Rate for Payer: HFN Commercial |
$1,269.20
|
| 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: 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: The Alliance Commercial |
$668.00
|
| Rate for Payer: United Healthcare Medicaid |
$268.71
|
| Rate for Payer: WEA Trust Commercial |
$734.80
|
| Rate for Payer: WPS Commercial |
$989.58
|
|
|
Destruction, malignant lesion (face, ears, eyelids, nose, lips, mucous membranes)†3.1-4.0cm 17284
|
Professional
|
Both
|
$1,042.00
|
|
|
Service Code
|
CPT 17284
|
| Hospital Charge Code |
3013672
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$423.22 |
| Max. Negotiated Rate |
$989.90 |
| Rate for Payer: Aetna Commercial |
$989.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$896.12
|
| 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 |
$423.22
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$625.20
|
| Rate for Payer: Health EOS Commercial |
$948.22
|
| Rate for Payer: HFN Commercial |
$989.90
|
| 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: 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: The Alliance Commercial |
$521.00
|
| Rate for Payer: United Healthcare Medicaid |
$423.22
|
| Rate for Payer: WEA Trust Commercial |
$573.10
|
| Rate for Payer: WPS Commercial |
$771.81
|
|
|
Destruction, malignant lesion (scalp, neck, hands, feet, genitalia)†<=0.5cm 17270
|
Professional
|
Both
|
$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: 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 |
$76.57
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$369.60
|
| Rate for Payer: Health EOS Commercial |
$560.56
|
| Rate for Payer: HFN Commercial |
$585.20
|
| 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: 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: The Alliance Commercial |
$308.00
|
| Rate for Payer: United Healthcare Medicaid |
$76.57
|
| Rate for Payer: WEA Trust Commercial |
$338.80
|
| Rate for Payer: WPS Commercial |
$456.27
|
|
|
Destruction, malignant lesion (scalp, neck, hands, feet, genitalia)†0.6-1.0cm 17271
|
Professional
|
Both
|
$390.00
|
|
|
Service Code
|
CPT 17271
|
| Hospital Charge Code |
3013664
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$116.60 |
| Max. Negotiated Rate |
$370.50 |
| Rate for Payer: Aetna Commercial |
$370.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$335.40
|
| 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 |
$116.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$234.00
|
| Rate for Payer: Health EOS Commercial |
$354.90
|
| Rate for Payer: HFN Commercial |
$370.50
|
| 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: 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: The Alliance Commercial |
$195.00
|
| Rate for Payer: United Healthcare Medicaid |
$116.60
|
| Rate for Payer: WEA Trust Commercial |
$214.50
|
| Rate for Payer: WPS Commercial |
$288.87
|
|
|
Destruction, malignant lesion (scalp, neck, hands, feet, genitalia)†1.1-2.0cm 17272
|
Professional
|
Both
|
$866.00
|
|
|
Service Code
|
CPT 17272
|
| Hospital Charge Code |
3013665
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$119.71 |
| Max. Negotiated Rate |
$822.70 |
| Rate for Payer: Aetna Commercial |
$822.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$744.76
|
| 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 |
$119.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$519.60
|
| Rate for Payer: Health EOS Commercial |
$788.06
|
| Rate for Payer: HFN Commercial |
$822.70
|
| 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: 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: The Alliance Commercial |
$433.00
|
| Rate for Payer: United Healthcare Medicaid |
$119.71
|
| Rate for Payer: WEA Trust Commercial |
$476.30
|
| Rate for Payer: WPS Commercial |
$641.45
|
|
|
Destruction, malignant lesion (scalp, neck, hands, feet, genitalia)†2.1-3.0cm 17273
|
Professional
|
Both
|
$995.00
|
|
|
Service Code
|
CPT 17273
|
| Hospital Charge Code |
3013666
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$164.07 |
| Max. Negotiated Rate |
$945.25 |
| Rate for Payer: Aetna Commercial |
$945.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$855.70
|
| 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 |
$164.07
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$597.00
|
| Rate for Payer: Health EOS Commercial |
$905.45
|
| Rate for Payer: HFN Commercial |
$945.25
|
| 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: 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: The Alliance Commercial |
$497.50
|
| Rate for Payer: United Healthcare Medicaid |
$164.07
|
| Rate for Payer: WEA Trust Commercial |
$547.25
|
| Rate for Payer: WPS Commercial |
$737.00
|
|
|
Destruction, malignant lesion (scalp, neck, hands, feet, genitalia)†>4.0cm 17276
|
Professional
|
Both
|
$972.00
|
|
|
Service Code
|
CPT 17276
|
| Hospital Charge Code |
3013667
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$251.59 |
| Max. Negotiated Rate |
$923.40 |
| Rate for Payer: Aetna Commercial |
$923.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$835.92
|
| 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 |
$251.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$583.20
|
| Rate for Payer: Health EOS Commercial |
$884.52
|
| Rate for Payer: HFN Commercial |
$923.40
|
| 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: 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: The Alliance Commercial |
$486.00
|
| Rate for Payer: United Healthcare Medicaid |
$251.59
|
| Rate for Payer: WEA Trust Commercial |
$534.60
|
| Rate for Payer: WPS Commercial |
$719.96
|
|
|
Destruction Malignant Lesion S/N/H/F/G 3.1-4.0cm 17274
|
Professional
|
Both
|
$997.00
|
|
|
Service Code
|
CPT 17274
|
| Hospital Charge Code |
4558611
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$202.36 |
| Max. Negotiated Rate |
$947.15 |
| Rate for Payer: Aetna Commercial |
$947.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$857.42
|
| 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 |
$202.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$598.20
|
| Rate for Payer: Health EOS Commercial |
$907.27
|
| Rate for Payer: HFN Commercial |
$947.15
|
| 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: 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: The Alliance Commercial |
$498.50
|
| Rate for Payer: United Healthcare Medicaid |
$202.36
|
| Rate for Payer: WEA Trust Commercial |
$548.35
|
| Rate for Payer: WPS Commercial |
$738.48
|
|
|
Destruction, malignant lesion (trunk, arms, legs)†<=0.5cm 17260
|
Professional
|
Both
|
$359.00
|
|
|
Service Code
|
CPT 17260
|
| Hospital Charge Code |
3013657
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$72.43 |
| Max. Negotiated Rate |
$341.05 |
| Rate for Payer: Aetna Commercial |
$341.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$308.74
|
| 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 |
$72.43
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$215.40
|
| Rate for Payer: Health EOS Commercial |
$326.69
|
| Rate for Payer: HFN Commercial |
$341.05
|
| 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: 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: The Alliance Commercial |
$179.50
|
| Rate for Payer: United Healthcare Medicaid |
$72.43
|
| Rate for Payer: WEA Trust Commercial |
$197.45
|
| Rate for Payer: WPS Commercial |
$265.91
|
|
|
Destruction, malignant lesion (trunk, arms, legs)†0.6-1.0cm 17261
|
Professional
|
Both
|
$269.00
|
|
|
Service Code
|
CPT 17261
|
| Hospital Charge Code |
3013658
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$91.04 |
| Max. Negotiated Rate |
$290.77 |
| Rate for Payer: Aetna Commercial |
$255.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$231.34
|
| 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 |
$91.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$161.40
|
| Rate for Payer: Health EOS Commercial |
$244.79
|
| Rate for Payer: HFN Commercial |
$255.55
|
| 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: 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: The Alliance Commercial |
$134.50
|
| Rate for Payer: United Healthcare Medicaid |
$91.04
|
| Rate for Payer: WEA Trust Commercial |
$147.95
|
| Rate for Payer: WPS Commercial |
$199.25
|
|
|
Destruction, malignant lesion (trunk, arms, legs)†1.1-2.0cm 17262
|
Professional
|
Both
|
$348.00
|
|
|
Service Code
|
CPT 17262
|
| Hospital Charge Code |
3013659
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$121.50 |
| Max. Negotiated Rate |
$368.67 |
| Rate for Payer: Aetna Commercial |
$330.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$299.28
|
| 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 |
$121.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$208.80
|
| Rate for Payer: Health EOS Commercial |
$316.68
|
| Rate for Payer: HFN Commercial |
$330.60
|
| 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: 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: The Alliance Commercial |
$174.00
|
| Rate for Payer: United Healthcare Medicaid |
$121.50
|
| Rate for Payer: WEA Trust Commercial |
$191.40
|
| Rate for Payer: WPS Commercial |
$257.76
|
|
|
Destruction, malignant lesion (trunk, arms, legs)†2.1-3.0cm 17263
|
Professional
|
Both
|
$457.00
|
|
|
Service Code
|
CPT 17263
|
| Hospital Charge Code |
3013660
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$145.53 |
| Max. Negotiated Rate |
$434.15 |
| Rate for Payer: Aetna Commercial |
$434.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$393.02
|
| 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 |
$145.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$274.20
|
| Rate for Payer: Health EOS Commercial |
$415.87
|
| Rate for Payer: HFN Commercial |
$434.15
|
| 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: 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: The Alliance Commercial |
$228.50
|
| Rate for Payer: United Healthcare Medicaid |
$145.53
|
| Rate for Payer: WEA Trust Commercial |
$251.35
|
| Rate for Payer: WPS Commercial |
$338.50
|
|
|
Destruction, malignant lesion (trunk, arms, legs)†3.1-4.0cm 17264
|
Professional
|
Both
|
$804.00
|
|
|
Service Code
|
CPT 17264
|
| Hospital Charge Code |
3013661
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$164.16 |
| Max. Negotiated Rate |
$763.80 |
| Rate for Payer: Aetna Commercial |
$763.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$691.44
|
| 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 |
$164.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$482.40
|
| Rate for Payer: Health EOS Commercial |
$731.64
|
| Rate for Payer: HFN Commercial |
$763.80
|
| 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: 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: The Alliance Commercial |
$402.00
|
| Rate for Payer: United Healthcare Medicaid |
$164.16
|
| Rate for Payer: WEA Trust Commercial |
$442.20
|
| Rate for Payer: WPS Commercial |
$595.52
|
|
|
Destruction, malignant lesion (trunk, arms, legs)†> 4.0cm 17266
|
Professional
|
Both
|
$1,182.00
|
|
|
Service Code
|
CPT 17266
|
| Hospital Charge Code |
3013662
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$204.42 |
| 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: 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 |
$204.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$709.20
|
| Rate for Payer: Health EOS Commercial |
$1,075.62
|
| Rate for Payer: HFN Commercial |
$1,122.90
|
| 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: 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: The Alliance Commercial |
$591.00
|
| Rate for Payer: United Healthcare Medicaid |
$204.42
|
| Rate for Payer: WEA Trust Commercial |
$650.10
|
| Rate for Payer: WPS Commercial |
$875.51
|
|
|
DESTRUCTION NEURLTC AGENT GENIC NERV W/IMAG 64624
|
Professional
|
Both
|
$3,789.00
|
|
|
Service Code
|
CPT 64624
|
| Hospital Charge Code |
5608019
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$315.68 |
| 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: 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 |
$315.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,273.40
|
| Rate for Payer: Health EOS Commercial |
$3,447.99
|
| Rate for Payer: HFN Commercial |
$3,599.55
|
| 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: 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: The Alliance Commercial |
$1,894.50
|
| Rate for Payer: United Healthcare Medicaid |
$315.68
|
| Rate for Payer: WEA Trust Commercial |
$2,083.95
|
| Rate for Payer: WPS Commercial |
$2,806.51
|
|
|
Destruction of benign lesion; 1-14 lesions 17110
|
Professional
|
Both
|
$144.00
|
|
|
Service Code
|
CPT 17110
|
| Hospital Charge Code |
1188868
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$25.56 |
| Max. Negotiated Rate |
$221.83 |
| Rate for Payer: Aetna Commercial |
$136.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$123.84
|
| 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 |
$25.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$86.40
|
| Rate for Payer: Health EOS Commercial |
$131.04
|
| Rate for Payer: HFN Commercial |
$136.80
|
| 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: 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: The Alliance Commercial |
$72.00
|
| Rate for Payer: United Healthcare Medicaid |
$25.56
|
| Rate for Payer: WEA Trust Commercial |
$79.20
|
| Rate for Payer: WPS Commercial |
$106.66
|
|
|
Destruction of benign lesions; 15 or more lesions 17111
|
Professional
|
Both
|
$153.00
|
|
|
Service Code
|
CPT 17111
|
| Hospital Charge Code |
1188869
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$54.69 |
| Max. Negotiated Rate |
$272.45 |
| Rate for Payer: Aetna Commercial |
$145.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$131.58
|
| 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 |
$54.69
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$91.80
|
| Rate for Payer: Health EOS Commercial |
$139.23
|
| Rate for Payer: HFN Commercial |
$145.35
|
| 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: 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: The Alliance Commercial |
$76.50
|
| Rate for Payer: United Healthcare Medicaid |
$54.69
|
| Rate for Payer: WEA Trust Commercial |
$84.15
|
| Rate for Payer: WPS Commercial |
$113.33
|
|
|
Destruction of Internal Hemorrhoid, Cautery
|
Professional
|
Both
|
$367.00
|
|
|
Service Code
|
CPT 46930
|
| Hospital Charge Code |
2572830
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$140.97 |
| Max. Negotiated Rate |
$518.10 |
| Rate for Payer: Aetna Commercial |
$348.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$315.62
|
| 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 |
$140.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$220.20
|
| Rate for Payer: Health EOS Commercial |
$333.97
|
| Rate for Payer: HFN Commercial |
$348.65
|
| 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: 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: The Alliance Commercial |
$183.50
|
| Rate for Payer: United Healthcare Medicaid |
$140.97
|
| Rate for Payer: WEA Trust Commercial |
$201.85
|
| Rate for Payer: WPS Commercial |
$271.84
|
|
|
Destruction Of Lesion On Penis Chemical 54050
|
Professional
|
Both
|
$276.00
|
|
|
Service Code
|
CPT 54050
|
| Hospital Charge Code |
1188873
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$22.59 |
| Max. Negotiated Rate |
$354.27 |
| Rate for Payer: Aetna Commercial |
$262.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$237.36
|
| 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 |
$22.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$165.60
|
| Rate for Payer: Health EOS Commercial |
$251.16
|
| Rate for Payer: HFN Commercial |
$262.20
|
| 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: 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: The Alliance Commercial |
$138.00
|
| Rate for Payer: United Healthcare Medicaid |
$22.59
|
| Rate for Payer: WEA Trust Commercial |
$151.80
|
| Rate for Payer: WPS Commercial |
$204.43
|
|
|
Destruction Of Lesion On Penis Cryosurgery 54056
|
Professional
|
Both
|
$266.00
|
|
|
Service Code
|
CPT 54056
|
| Hospital Charge Code |
1188874
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$45.18 |
| Max. Negotiated Rate |
$367.83 |
| Rate for Payer: Aetna Commercial |
$252.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$228.76
|
| 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 |
$45.18
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$159.60
|
| Rate for Payer: Health EOS Commercial |
$242.06
|
| Rate for Payer: HFN Commercial |
$252.70
|
| 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: 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: The Alliance Commercial |
$133.00
|
| Rate for Payer: United Healthcare Medicaid |
$45.18
|
| Rate for Payer: WEA Trust Commercial |
$146.30
|
| Rate for Payer: WPS Commercial |
$197.03
|
|
|
Destruction of Lesion, Penis Electrodesiccation 54055
|
Professional
|
Both
|
$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: 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 |
$45.18
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$285.00
|
| Rate for Payer: Health EOS Commercial |
$432.25
|
| Rate for Payer: HFN Commercial |
$451.25
|
| 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: 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: The Alliance Commercial |
$237.50
|
| Rate for Payer: United Healthcare Medicaid |
$45.18
|
| Rate for Payer: WEA Trust Commercial |
$261.25
|
| Rate for Payer: WPS Commercial |
$351.83
|
|
|
Destruction of Lesion, Penis Surgical Excision 54060
|
Professional
|
Both
|
$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: 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 |
$75.33
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$418.80
|
| Rate for Payer: Health EOS Commercial |
$635.18
|
| Rate for Payer: HFN Commercial |
$663.10
|
| 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: 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: The Alliance Commercial |
$349.00
|
| Rate for Payer: United Healthcare Medicaid |
$75.33
|
| Rate for Payer: WEA Trust Commercial |
$383.90
|
| Rate for Payer: WPS Commercial |
$517.01
|
|
|
Destruction Of Lesions On Anus; Cryosurgery
|
Professional
|
Both
|
$522.00
|
|
|
Service Code
|
CPT 46916
|
| Hospital Charge Code |
1190851
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$43.60 |
| Max. Negotiated Rate |
$495.90 |
| Rate for Payer: Aetna Commercial |
$495.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$448.92
|
| 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 |
$43.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$313.20
|
| Rate for Payer: Health EOS Commercial |
$475.02
|
| Rate for Payer: HFN Commercial |
$495.90
|
| 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: 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: The Alliance Commercial |
$261.00
|
| Rate for Payer: United Healthcare Medicaid |
$43.60
|
| Rate for Payer: WEA Trust Commercial |
$287.10
|
| Rate for Payer: WPS Commercial |
$386.65
|
|
