|
DESTROY NERVE TRIGEMINAL
|
Facility
|
IP
|
$379.00
|
|
| Hospital Charge Code |
5262690
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$193.14 |
| Max. Negotiated Rate |
$362.63 |
| Rate for Payer: Aetna Commercial |
$354.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$338.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$208.90
|
| Rate for Payer: Cash Price |
$113.70
|
| Rate for Payer: Cigna Commercial |
$362.63
|
| Rate for Payer: Health EOS Commercial |
$350.80
|
| Rate for Payer: HFN Commercial |
$362.63
|
| Rate for Payer: Multiplan Commercial |
$315.33
|
| Rate for Payer: Preferred Network Access Commercial |
$362.63
|
| Rate for Payer: Quartz Beloit One Network |
$193.14
|
| Rate for Payer: Quartz Commercial |
$236.50
|
| Rate for Payer: WEA Trust Commercial |
$216.79
|
| Rate for Payer: WPS Commercial |
$291.94
|
|
|
DESTROY VAG LESIONS, COMPLEX 57065
|
Professional
|
Both
|
$2,953.00
|
|
|
Service Code
|
CPT 57065
|
| Hospital Charge Code |
3015068
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$159.01 |
| Max. Negotiated Rate |
$2,917.56 |
| Rate for Payer: Aetna Commercial |
$2,917.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,641.16
|
| Rate for Payer: Aetna Managed Medicare |
$159.01
|
| Rate for Payer: Anthem Medicare Advantage |
$159.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$159.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$159.01
|
| Rate for Payer: Cash Price |
$885.90
|
| Rate for Payer: Cash Price |
$885.90
|
| Rate for Payer: Cash Price |
$885.90
|
| Rate for Payer: Cigna Commercial |
$2,917.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$312.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$159.01
|
| Rate for Payer: Health EOS Commercial |
$2,794.72
|
| Rate for Payer: HFN Commercial |
$2,917.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$640.63
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$640.63
|
| Rate for Payer: Independent Care Health Plan Medicare |
$159.01
|
| Rate for Payer: Multiplan Commercial |
$2,456.90
|
| Rate for Payer: NAPHCARE Commercial |
$238.51
|
| Rate for Payer: Preferred Network Access Commercial |
$2,917.56
|
| Rate for Payer: Quartz Beloit One Network |
$1,351.29
|
| Rate for Payer: Quartz Commercial |
$1,750.54
|
| Rate for Payer: Quartz Medicare Advantage |
$159.01
|
| Rate for Payer: The Alliance Commercial |
$675.77
|
| Rate for Payer: United Healthcare Medicaid |
$312.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$159.01
|
| Rate for Payer: WEA Trust Commercial |
$1,689.12
|
| Rate for Payer: WPS Commercial |
$715.53
|
|
|
DESTROY VAG LESIONS, SIMPLE 57061
|
Professional
|
Both
|
$375.00
|
|
|
Service Code
|
CPT 57061
|
| Hospital Charge Code |
3015067
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$44.80 |
| Max. Negotiated Rate |
$459.20 |
| Rate for Payer: Aetna Commercial |
$370.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$335.40
|
| Rate for Payer: Aetna Managed Medicare |
$102.04
|
| Rate for Payer: Anthem Medicare Advantage |
$102.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$102.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$102.04
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cigna Commercial |
$370.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$44.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$102.04
|
| Rate for Payer: Health EOS Commercial |
$354.90
|
| Rate for Payer: HFN Commercial |
$370.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$391.68
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$391.68
|
| Rate for Payer: Independent Care Health Plan Medicare |
$102.04
|
| Rate for Payer: Multiplan Commercial |
$312.00
|
| Rate for Payer: NAPHCARE Commercial |
$153.07
|
| 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 |
$102.04
|
| Rate for Payer: The Alliance Commercial |
$433.69
|
| Rate for Payer: United Healthcare Medicaid |
$44.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$102.04
|
| Rate for Payer: WEA Trust Commercial |
$214.50
|
| Rate for Payer: WPS Commercial |
$459.20
|
|
|
DESTRUCTION, ANAL LESION(S) 46900
|
Professional
|
Both
|
$495.00
|
|
|
Service Code
|
CPT 46900
|
| Hospital Charge Code |
3014846
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$28.05 |
| Max. Negotiated Rate |
$578.82 |
| Rate for Payer: Aetna Commercial |
$489.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$442.73
|
| Rate for Payer: Aetna Managed Medicare |
$128.63
|
| Rate for Payer: Anthem Medicare Advantage |
$128.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$128.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$128.63
|
| Rate for Payer: Cash Price |
$148.50
|
| Rate for Payer: Cash Price |
$148.50
|
| Rate for Payer: Cash Price |
$148.50
|
| Rate for Payer: Cigna Commercial |
$489.06
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$28.05
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$128.63
|
| Rate for Payer: Health EOS Commercial |
$468.47
|
| Rate for Payer: HFN Commercial |
$489.06
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$472.56
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$472.56
|
| Rate for Payer: Independent Care Health Plan Medicare |
$128.63
|
| Rate for Payer: Multiplan Commercial |
$411.84
|
| Rate for Payer: NAPHCARE Commercial |
$192.94
|
| Rate for Payer: Preferred Network Access Commercial |
$489.06
|
| Rate for Payer: Quartz Beloit One Network |
$226.51
|
| Rate for Payer: Quartz Commercial |
$293.44
|
| Rate for Payer: Quartz Medicare Advantage |
$128.63
|
| Rate for Payer: The Alliance Commercial |
$546.67
|
| Rate for Payer: United Healthcare Medicaid |
$28.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$128.63
|
| Rate for Payer: WEA Trust Commercial |
$283.14
|
| Rate for Payer: WPS Commercial |
$578.82
|
|
|
DESTRUCTION, ANAL LESION(S) 46924
|
Professional
|
Both
|
$2,273.00
|
|
|
Service Code
|
CPT 46924
|
| Hospital Charge Code |
3014849
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$165.67 |
| Max. Negotiated Rate |
$2,245.72 |
| Rate for Payer: Aetna Commercial |
$2,245.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,032.97
|
| Rate for Payer: Aetna Managed Medicare |
$165.67
|
| Rate for Payer: Anthem Medicare Advantage |
$165.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$165.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$165.67
|
| Rate for Payer: Cash Price |
$681.90
|
| Rate for Payer: Cash Price |
$681.90
|
| Rate for Payer: Cash Price |
$681.90
|
| Rate for Payer: Cigna Commercial |
$2,245.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$313.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$165.67
|
| Rate for Payer: Health EOS Commercial |
$2,151.17
|
| Rate for Payer: HFN Commercial |
$2,245.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$622.42
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$622.42
|
| Rate for Payer: Independent Care Health Plan Medicare |
$165.67
|
| Rate for Payer: Multiplan Commercial |
$1,891.14
|
| Rate for Payer: NAPHCARE Commercial |
$248.51
|
| Rate for Payer: Preferred Network Access Commercial |
$2,245.72
|
| Rate for Payer: Quartz Beloit One Network |
$1,040.12
|
| Rate for Payer: Quartz Commercial |
$1,347.43
|
| Rate for Payer: Quartz Medicare Advantage |
$165.67
|
| Rate for Payer: The Alliance Commercial |
$704.11
|
| Rate for Payer: United Healthcare Medicaid |
$313.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$165.67
|
| Rate for Payer: WEA Trust Commercial |
$1,300.16
|
| Rate for Payer: WPS Commercial |
$745.52
|
|
|
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
|
$4,386.95
|
|
|
Service Code
|
CPT 64636
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$198.97 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: The Alliance Commercial |
$198.97
|
|
|
DESTRUCTION BY NEUROLYTIC AGENT, PARAVERTEBRAL FACET JOINT NERVE(S), WITH IMAGING GUIDANCE (FLUOROSCOPY OR CT); LUMBAR OR SACRAL, SINGLE FACET JOINT
|
Facility
|
OP
|
$8,220.12
|
|
|
Service Code
|
CPT 64635
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,055.03 |
| Max. Negotiated Rate |
$8,220.12 |
| Rate for Payer: Aetna Managed Medicare |
$2,055.03
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,635.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,985.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,835.04
|
| Rate for Payer: Anthem Medicare Advantage |
$2,055.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$2,055.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$2,055.03
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$2,055.03
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$2,055.03
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,644.71
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2,055.03
|
| Rate for Payer: Independent Care Health Plan Medicare |
$2,055.03
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$2,055.03
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$2,055.03
|
| Rate for Payer: NAPHCARE Commercial |
$3,082.54
|
| Rate for Payer: Quartz Medicare Advantage |
$2,055.03
|
| Rate for Payer: The Alliance Commercial |
$8,220.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,055.03
|
| Rate for Payer: United Healthcare PPO |
$3,726.32
|
| Rate for Payer: Wellcare Medicare |
$2,055.03
|
|
|
Destruction By Neurolytic Agent, Peripheral Nerve Branch 64640
|
Professional
|
Both
|
$1,172.00
|
|
|
Service Code
|
CPT 64640
|
| Hospital Charge Code |
2572823
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$108.99 |
| Max. Negotiated Rate |
$1,157.94 |
| Rate for Payer: Aetna Commercial |
$1,157.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,048.24
|
| Rate for Payer: Aetna Managed Medicare |
$108.99
|
| Rate for Payer: Anthem Medicare Advantage |
$108.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$108.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$108.99
|
| Rate for Payer: Cash Price |
$351.60
|
| Rate for Payer: Cash Price |
$351.60
|
| Rate for Payer: Cash Price |
$351.60
|
| Rate for Payer: Cigna Commercial |
$1,157.94
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$163.27
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$108.99
|
| Rate for Payer: Health EOS Commercial |
$1,109.18
|
| Rate for Payer: HFN Commercial |
$1,157.94
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$416.50
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$416.50
|
| Rate for Payer: Independent Care Health Plan Medicare |
$108.99
|
| Rate for Payer: Multiplan Commercial |
$975.10
|
| Rate for Payer: NAPHCARE Commercial |
$163.49
|
| Rate for Payer: Preferred Network Access Commercial |
$1,157.94
|
| Rate for Payer: Quartz Beloit One Network |
$536.31
|
| Rate for Payer: Quartz Commercial |
$694.76
|
| Rate for Payer: Quartz Medicare Advantage |
$108.99
|
| Rate for Payer: The Alliance Commercial |
$463.22
|
| Rate for Payer: United Healthcare Medicaid |
$163.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$108.99
|
| Rate for Payer: WEA Trust Commercial |
$670.38
|
| Rate for Payer: WPS Commercial |
$490.46
|
|
|
Destruction, malignant lesion (face, ears, eyelids, nose, lips, mucous membranes) <=0.5cm 17280
|
Professional
|
Both
|
$578.00
|
|
|
Service Code
|
CPT 17280
|
| Hospital Charge Code |
3013668
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$73.24 |
| Max. Negotiated Rate |
$571.06 |
| Rate for Payer: Aetna Commercial |
$571.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$516.96
|
| Rate for Payer: Aetna Managed Medicare |
$73.24
|
| Rate for Payer: Anthem Medicare Advantage |
$73.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$73.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$73.24
|
| Rate for Payer: Cash Price |
$173.40
|
| Rate for Payer: Cash Price |
$173.40
|
| Rate for Payer: Cash Price |
$173.40
|
| Rate for Payer: Cigna Commercial |
$571.06
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$91.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$73.24
|
| Rate for Payer: Health EOS Commercial |
$547.02
|
| Rate for Payer: HFN Commercial |
$571.06
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$301.18
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$301.18
|
| Rate for Payer: Independent Care Health Plan Medicare |
$73.24
|
| Rate for Payer: Multiplan Commercial |
$480.90
|
| Rate for Payer: NAPHCARE Commercial |
$109.86
|
| Rate for Payer: Preferred Network Access Commercial |
$571.06
|
| Rate for Payer: Quartz Beloit One Network |
$264.49
|
| Rate for Payer: Quartz Commercial |
$342.64
|
| Rate for Payer: Quartz Medicare Advantage |
$73.24
|
| Rate for Payer: The Alliance Commercial |
$311.26
|
| Rate for Payer: United Healthcare Medicaid |
$91.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$73.24
|
| Rate for Payer: WEA Trust Commercial |
$330.62
|
| Rate for Payer: WPS Commercial |
$329.57
|
|
|
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 |
$97.85 |
| Max. Negotiated Rate |
$819.05 |
| Rate for Payer: Aetna Commercial |
$819.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$741.46
|
| Rate for Payer: Aetna Managed Medicare |
$97.85
|
| Rate for Payer: Anthem Medicare Advantage |
$97.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$97.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$97.85
|
| Rate for Payer: Cash Price |
$248.70
|
| Rate for Payer: Cash Price |
$248.70
|
| Rate for Payer: Cash Price |
$248.70
|
| Rate for Payer: Cigna Commercial |
$819.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$195.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$97.85
|
| Rate for Payer: Health EOS Commercial |
$784.57
|
| Rate for Payer: HFN Commercial |
$819.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$411.39
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$411.39
|
| Rate for Payer: Independent Care Health Plan Medicare |
$97.85
|
| Rate for Payer: Multiplan Commercial |
$689.73
|
| Rate for Payer: NAPHCARE Commercial |
$146.78
|
| Rate for Payer: Preferred Network Access Commercial |
$819.05
|
| Rate for Payer: Quartz Beloit One Network |
$379.35
|
| Rate for Payer: Quartz Commercial |
$491.43
|
| Rate for Payer: Quartz Medicare Advantage |
$97.85
|
| Rate for Payer: The Alliance Commercial |
$415.88
|
| Rate for Payer: United Healthcare Medicaid |
$195.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$97.85
|
| Rate for Payer: WEA Trust Commercial |
$474.19
|
| Rate for Payer: WPS Commercial |
$440.34
|
|
|
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 |
$111.94 |
| Max. Negotiated Rate |
$1,012.70 |
| Rate for Payer: Aetna Commercial |
$1,012.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$916.76
|
| Rate for Payer: Aetna Managed Medicare |
$111.94
|
| Rate for Payer: Anthem Medicare Advantage |
$111.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$111.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$111.94
|
| Rate for Payer: Cash Price |
$307.50
|
| Rate for Payer: Cash Price |
$307.50
|
| Rate for Payer: Cash Price |
$307.50
|
| Rate for Payer: Cigna Commercial |
$1,012.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$268.06
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$111.94
|
| Rate for Payer: Health EOS Commercial |
$970.06
|
| Rate for Payer: HFN Commercial |
$1,012.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$476.01
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$476.01
|
| Rate for Payer: Independent Care Health Plan Medicare |
$111.94
|
| Rate for Payer: Multiplan Commercial |
$852.80
|
| Rate for Payer: NAPHCARE Commercial |
$167.90
|
| Rate for Payer: Preferred Network Access Commercial |
$1,012.70
|
| Rate for Payer: Quartz Beloit One Network |
$469.04
|
| Rate for Payer: Quartz Commercial |
$607.62
|
| Rate for Payer: Quartz Medicare Advantage |
$111.94
|
| Rate for Payer: The Alliance Commercial |
$475.72
|
| Rate for Payer: United Healthcare Medicaid |
$268.06
|
| Rate for Payer: United Healthcare Medicare Advantage |
$111.94
|
| Rate for Payer: WEA Trust Commercial |
$586.30
|
| Rate for Payer: WPS Commercial |
$503.71
|
|
|
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 |
$138.61 |
| Max. Negotiated Rate |
$1,319.97 |
| Rate for Payer: Aetna Commercial |
$1,319.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,194.92
|
| Rate for Payer: Aetna Managed Medicare |
$138.61
|
| Rate for Payer: Anthem Medicare Advantage |
$138.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$138.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$138.61
|
| Rate for Payer: Cash Price |
$400.80
|
| Rate for Payer: Cash Price |
$400.80
|
| Rate for Payer: Cash Price |
$400.80
|
| Rate for Payer: Cigna Commercial |
$1,319.97
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$279.46
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$138.61
|
| Rate for Payer: Health EOS Commercial |
$1,264.39
|
| Rate for Payer: HFN Commercial |
$1,319.97
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$594.59
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$594.59
|
| Rate for Payer: Independent Care Health Plan Medicare |
$138.61
|
| Rate for Payer: Multiplan Commercial |
$1,111.55
|
| Rate for Payer: NAPHCARE Commercial |
$207.92
|
| Rate for Payer: Preferred Network Access Commercial |
$1,319.97
|
| Rate for Payer: Quartz Beloit One Network |
$611.35
|
| Rate for Payer: Quartz Commercial |
$791.98
|
| Rate for Payer: Quartz Medicare Advantage |
$138.61
|
| Rate for Payer: The Alliance Commercial |
$589.10
|
| Rate for Payer: United Healthcare Medicaid |
$279.46
|
| Rate for Payer: United Healthcare Medicare Advantage |
$138.61
|
| Rate for Payer: WEA Trust Commercial |
$764.19
|
| Rate for Payer: WPS Commercial |
$623.75
|
|
|
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 |
$161.82 |
| Max. Negotiated Rate |
$1,029.50 |
| Rate for Payer: Aetna Commercial |
$1,029.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$931.96
|
| Rate for Payer: Aetna Managed Medicare |
$161.82
|
| Rate for Payer: Anthem Medicare Advantage |
$161.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$161.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$161.82
|
| Rate for Payer: Cash Price |
$312.60
|
| Rate for Payer: Cash Price |
$312.60
|
| Rate for Payer: Cash Price |
$312.60
|
| Rate for Payer: Cigna Commercial |
$1,029.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$440.15
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$161.82
|
| Rate for Payer: Health EOS Commercial |
$986.15
|
| Rate for Payer: HFN Commercial |
$1,029.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$694.37
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$694.37
|
| Rate for Payer: Independent Care Health Plan Medicare |
$161.82
|
| Rate for Payer: Multiplan Commercial |
$866.94
|
| Rate for Payer: NAPHCARE Commercial |
$242.74
|
| Rate for Payer: Preferred Network Access Commercial |
$1,029.50
|
| Rate for Payer: Quartz Beloit One Network |
$476.82
|
| Rate for Payer: Quartz Commercial |
$617.70
|
| Rate for Payer: Quartz Medicare Advantage |
$161.82
|
| Rate for Payer: The Alliance Commercial |
$687.75
|
| Rate for Payer: United Healthcare Medicaid |
$440.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$161.82
|
| Rate for Payer: WEA Trust Commercial |
$596.02
|
| Rate for Payer: WPS Commercial |
$728.21
|
|
|
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 |
$79.63 |
| Max. Negotiated Rate |
$608.61 |
| Rate for Payer: Aetna Commercial |
$608.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$550.95
|
| Rate for Payer: Aetna Managed Medicare |
$79.88
|
| Rate for Payer: Anthem Medicare Advantage |
$79.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$79.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$79.88
|
| Rate for Payer: Cash Price |
$184.80
|
| Rate for Payer: Cash Price |
$184.80
|
| Rate for Payer: Cash Price |
$184.80
|
| Rate for Payer: Cigna Commercial |
$608.61
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$79.63
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$79.88
|
| Rate for Payer: Health EOS Commercial |
$582.98
|
| Rate for Payer: HFN Commercial |
$608.61
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$330.45
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$330.45
|
| Rate for Payer: Independent Care Health Plan Medicare |
$79.88
|
| Rate for Payer: Multiplan Commercial |
$512.51
|
| Rate for Payer: NAPHCARE Commercial |
$119.82
|
| Rate for Payer: Preferred Network Access Commercial |
$608.61
|
| Rate for Payer: Quartz Beloit One Network |
$281.88
|
| Rate for Payer: Quartz Commercial |
$365.16
|
| Rate for Payer: Quartz Medicare Advantage |
$79.88
|
| Rate for Payer: The Alliance Commercial |
$339.50
|
| Rate for Payer: United Healthcare Medicaid |
$79.63
|
| Rate for Payer: United Healthcare Medicare Advantage |
$79.88
|
| Rate for Payer: WEA Trust Commercial |
$352.35
|
| Rate for Payer: WPS Commercial |
$359.47
|
|
|
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 |
$87.65 |
| Max. Negotiated Rate |
$394.43 |
| Rate for Payer: Aetna Commercial |
$385.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$348.82
|
| Rate for Payer: Aetna Managed Medicare |
$87.65
|
| Rate for Payer: Anthem Medicare Advantage |
$87.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$87.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$87.65
|
| Rate for Payer: Cash Price |
$117.00
|
| Rate for Payer: Cash Price |
$117.00
|
| Rate for Payer: Cash Price |
$117.00
|
| Rate for Payer: Cigna Commercial |
$385.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$121.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$87.65
|
| Rate for Payer: Health EOS Commercial |
$369.10
|
| Rate for Payer: HFN Commercial |
$385.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$365.87
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$365.87
|
| Rate for Payer: Independent Care Health Plan Medicare |
$87.65
|
| Rate for Payer: Multiplan Commercial |
$324.48
|
| Rate for Payer: NAPHCARE Commercial |
$131.48
|
| Rate for Payer: Preferred Network Access Commercial |
$385.32
|
| Rate for Payer: Quartz Beloit One Network |
$178.46
|
| Rate for Payer: Quartz Commercial |
$231.19
|
| Rate for Payer: Quartz Medicare Advantage |
$87.65
|
| Rate for Payer: The Alliance Commercial |
$372.52
|
| Rate for Payer: United Healthcare Medicaid |
$121.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$87.65
|
| Rate for Payer: WEA Trust Commercial |
$223.08
|
| Rate for Payer: WPS Commercial |
$394.43
|
|
|
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 |
$99.68 |
| Max. Negotiated Rate |
$855.61 |
| Rate for Payer: Aetna Commercial |
$855.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$774.55
|
| Rate for Payer: Aetna Managed Medicare |
$99.68
|
| Rate for Payer: Anthem Medicare Advantage |
$99.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$99.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$99.68
|
| Rate for Payer: Cash Price |
$259.80
|
| Rate for Payer: Cash Price |
$259.80
|
| Rate for Payer: Cash Price |
$259.80
|
| Rate for Payer: Cigna Commercial |
$855.61
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$124.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$99.68
|
| Rate for Payer: Health EOS Commercial |
$819.58
|
| Rate for Payer: HFN Commercial |
$855.61
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$421.78
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$421.78
|
| Rate for Payer: Independent Care Health Plan Medicare |
$99.68
|
| Rate for Payer: Multiplan Commercial |
$720.51
|
| Rate for Payer: NAPHCARE Commercial |
$149.53
|
| Rate for Payer: Preferred Network Access Commercial |
$855.61
|
| Rate for Payer: Quartz Beloit One Network |
$396.28
|
| Rate for Payer: Quartz Commercial |
$513.36
|
| Rate for Payer: Quartz Medicare Advantage |
$99.68
|
| Rate for Payer: The Alliance Commercial |
$423.66
|
| Rate for Payer: United Healthcare Medicaid |
$124.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$99.68
|
| Rate for Payer: WEA Trust Commercial |
$495.35
|
| Rate for Payer: WPS Commercial |
$448.58
|
|
|
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 |
$112.62 |
| Max. Negotiated Rate |
$983.06 |
| Rate for Payer: Aetna Commercial |
$983.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$889.93
|
| Rate for Payer: Aetna Managed Medicare |
$112.62
|
| Rate for Payer: Anthem Medicare Advantage |
$112.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$112.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$112.62
|
| Rate for Payer: Cash Price |
$298.50
|
| Rate for Payer: Cash Price |
$298.50
|
| Rate for Payer: Cash Price |
$298.50
|
| Rate for Payer: Cigna Commercial |
$983.06
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$170.63
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$112.62
|
| Rate for Payer: Health EOS Commercial |
$941.67
|
| Rate for Payer: HFN Commercial |
$983.06
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$478.50
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$478.50
|
| Rate for Payer: Independent Care Health Plan Medicare |
$112.62
|
| Rate for Payer: Multiplan Commercial |
$827.84
|
| Rate for Payer: NAPHCARE Commercial |
$168.93
|
| Rate for Payer: Preferred Network Access Commercial |
$983.06
|
| Rate for Payer: Quartz Beloit One Network |
$455.31
|
| Rate for Payer: Quartz Commercial |
$589.84
|
| Rate for Payer: Quartz Medicare Advantage |
$112.62
|
| Rate for Payer: The Alliance Commercial |
$478.64
|
| Rate for Payer: United Healthcare Medicaid |
$170.63
|
| Rate for Payer: United Healthcare Medicare Advantage |
$112.62
|
| Rate for Payer: WEA Trust Commercial |
$569.14
|
| Rate for Payer: WPS Commercial |
$506.80
|
|
|
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 |
$164.01 |
| Max. Negotiated Rate |
$960.34 |
| Rate for Payer: Aetna Commercial |
$960.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$869.36
|
| Rate for Payer: Aetna Managed Medicare |
$164.01
|
| Rate for Payer: Anthem Medicare Advantage |
$164.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$164.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$164.01
|
| Rate for Payer: Cash Price |
$291.60
|
| Rate for Payer: Cash Price |
$291.60
|
| Rate for Payer: Cash Price |
$291.60
|
| Rate for Payer: Cigna Commercial |
$960.34
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$261.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$164.01
|
| Rate for Payer: Health EOS Commercial |
$919.90
|
| Rate for Payer: HFN Commercial |
$960.34
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$703.22
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$703.22
|
| Rate for Payer: Independent Care Health Plan Medicare |
$164.01
|
| Rate for Payer: Multiplan Commercial |
$808.70
|
| Rate for Payer: NAPHCARE Commercial |
$246.01
|
| Rate for Payer: Preferred Network Access Commercial |
$960.34
|
| Rate for Payer: Quartz Beloit One Network |
$444.79
|
| Rate for Payer: Quartz Commercial |
$576.20
|
| Rate for Payer: Quartz Medicare Advantage |
$164.01
|
| Rate for Payer: The Alliance Commercial |
$697.03
|
| Rate for Payer: United Healthcare Medicaid |
$261.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$164.01
|
| Rate for Payer: WEA Trust Commercial |
$555.98
|
| Rate for Payer: WPS Commercial |
$738.04
|
|
|
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 |
$136.54 |
| Max. Negotiated Rate |
$985.04 |
| Rate for Payer: Aetna Commercial |
$985.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$891.72
|
| Rate for Payer: Aetna Managed Medicare |
$136.54
|
| Rate for Payer: Anthem Medicare Advantage |
$136.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$136.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$136.54
|
| Rate for Payer: Cash Price |
$299.10
|
| Rate for Payer: Cash Price |
$299.10
|
| Rate for Payer: Cash Price |
$299.10
|
| Rate for Payer: Cigna Commercial |
$985.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$210.45
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$136.54
|
| Rate for Payer: Health EOS Commercial |
$943.56
|
| Rate for Payer: HFN Commercial |
$985.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$584.16
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$584.16
|
| Rate for Payer: Independent Care Health Plan Medicare |
$136.54
|
| Rate for Payer: Multiplan Commercial |
$829.50
|
| Rate for Payer: NAPHCARE Commercial |
$204.81
|
| Rate for Payer: Preferred Network Access Commercial |
$985.04
|
| Rate for Payer: Quartz Beloit One Network |
$456.23
|
| Rate for Payer: Quartz Commercial |
$591.02
|
| Rate for Payer: Quartz Medicare Advantage |
$136.54
|
| Rate for Payer: The Alliance Commercial |
$580.30
|
| Rate for Payer: United Healthcare Medicaid |
$210.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$136.54
|
| Rate for Payer: WEA Trust Commercial |
$570.28
|
| Rate for Payer: WPS Commercial |
$614.44
|
|
|
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 |
$58.47 |
| Max. Negotiated Rate |
$354.69 |
| Rate for Payer: Aetna Commercial |
$354.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$321.09
|
| Rate for Payer: Aetna Managed Medicare |
$58.47
|
| Rate for Payer: Anthem Medicare Advantage |
$58.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$58.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$58.47
|
| Rate for Payer: Cash Price |
$107.70
|
| Rate for Payer: Cash Price |
$107.70
|
| Rate for Payer: Cash Price |
$107.70
|
| Rate for Payer: Cigna Commercial |
$354.69
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$75.33
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$58.47
|
| Rate for Payer: Health EOS Commercial |
$339.76
|
| Rate for Payer: HFN Commercial |
$354.69
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$245.86
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$245.86
|
| Rate for Payer: Independent Care Health Plan Medicare |
$58.47
|
| Rate for Payer: Multiplan Commercial |
$298.69
|
| Rate for Payer: NAPHCARE Commercial |
$87.70
|
| Rate for Payer: Preferred Network Access Commercial |
$354.69
|
| Rate for Payer: Quartz Beloit One Network |
$164.28
|
| Rate for Payer: Quartz Commercial |
$212.82
|
| Rate for Payer: Quartz Medicare Advantage |
$58.47
|
| Rate for Payer: The Alliance Commercial |
$248.49
|
| Rate for Payer: United Healthcare Medicaid |
$75.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$58.47
|
| Rate for Payer: WEA Trust Commercial |
$205.35
|
| Rate for Payer: WPS Commercial |
$263.11
|
|
|
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 |
$73.24 |
| Max. Negotiated Rate |
$329.57 |
| Rate for Payer: Aetna Commercial |
$265.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$240.59
|
| Rate for Payer: Aetna Managed Medicare |
$73.24
|
| Rate for Payer: Anthem Medicare Advantage |
$73.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$73.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$73.24
|
| Rate for Payer: Cash Price |
$80.70
|
| Rate for Payer: Cash Price |
$80.70
|
| Rate for Payer: Cash Price |
$80.70
|
| Rate for Payer: Cigna Commercial |
$265.77
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$94.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$73.24
|
| Rate for Payer: Health EOS Commercial |
$254.58
|
| Rate for Payer: HFN Commercial |
$265.77
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$302.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$302.40
|
| Rate for Payer: Independent Care Health Plan Medicare |
$73.24
|
| Rate for Payer: Multiplan Commercial |
$223.81
|
| Rate for Payer: NAPHCARE Commercial |
$109.86
|
| Rate for Payer: Preferred Network Access Commercial |
$265.77
|
| Rate for Payer: Quartz Beloit One Network |
$123.09
|
| Rate for Payer: Quartz Commercial |
$159.46
|
| Rate for Payer: Quartz Medicare Advantage |
$73.24
|
| Rate for Payer: The Alliance Commercial |
$311.26
|
| Rate for Payer: United Healthcare Medicaid |
$94.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$73.24
|
| Rate for Payer: WEA Trust Commercial |
$153.87
|
| Rate for Payer: WPS Commercial |
$329.57
|
|
|
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 |
$91.55 |
| Max. Negotiated Rate |
$411.98 |
| Rate for Payer: Aetna Commercial |
$343.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$311.25
|
| Rate for Payer: Aetna Managed Medicare |
$91.55
|
| Rate for Payer: Anthem Medicare Advantage |
$91.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$91.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$91.55
|
| Rate for Payer: Cash Price |
$104.40
|
| Rate for Payer: Cash Price |
$104.40
|
| Rate for Payer: Cash Price |
$104.40
|
| Rate for Payer: Cigna Commercial |
$343.82
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$126.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$91.55
|
| Rate for Payer: Health EOS Commercial |
$329.35
|
| Rate for Payer: HFN Commercial |
$343.82
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$383.42
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$383.42
|
| Rate for Payer: Independent Care Health Plan Medicare |
$91.55
|
| Rate for Payer: Multiplan Commercial |
$289.54
|
| Rate for Payer: NAPHCARE Commercial |
$137.33
|
| Rate for Payer: Preferred Network Access Commercial |
$343.82
|
| Rate for Payer: Quartz Beloit One Network |
$159.24
|
| Rate for Payer: Quartz Commercial |
$206.29
|
| Rate for Payer: Quartz Medicare Advantage |
$91.55
|
| Rate for Payer: The Alliance Commercial |
$389.09
|
| Rate for Payer: United Healthcare Medicaid |
$126.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$91.55
|
| Rate for Payer: WEA Trust Commercial |
$199.06
|
| Rate for Payer: WPS Commercial |
$411.98
|
|
|
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 |
$100.71 |
| Max. Negotiated Rate |
$453.21 |
| Rate for Payer: Aetna Commercial |
$451.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$408.74
|
| Rate for Payer: Aetna Managed Medicare |
$100.71
|
| Rate for Payer: Anthem Medicare Advantage |
$100.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$100.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$100.71
|
| Rate for Payer: Cash Price |
$137.10
|
| Rate for Payer: Cash Price |
$137.10
|
| Rate for Payer: Cash Price |
$137.10
|
| Rate for Payer: Cigna Commercial |
$451.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$151.35
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$100.71
|
| Rate for Payer: Health EOS Commercial |
$432.50
|
| Rate for Payer: HFN Commercial |
$451.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$425.57
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$425.57
|
| Rate for Payer: Independent Care Health Plan Medicare |
$100.71
|
| Rate for Payer: Multiplan Commercial |
$380.22
|
| Rate for Payer: NAPHCARE Commercial |
$151.07
|
| Rate for Payer: Preferred Network Access Commercial |
$451.52
|
| Rate for Payer: Quartz Beloit One Network |
$209.12
|
| Rate for Payer: Quartz Commercial |
$270.91
|
| Rate for Payer: Quartz Medicare Advantage |
$100.71
|
| Rate for Payer: The Alliance Commercial |
$428.03
|
| Rate for Payer: United Healthcare Medicaid |
$151.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$100.71
|
| Rate for Payer: WEA Trust Commercial |
$261.40
|
| Rate for Payer: WPS Commercial |
$453.21
|
|
|
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 |
$107.36 |
| Max. Negotiated Rate |
$794.35 |
| Rate for Payer: Aetna Commercial |
$794.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$719.10
|
| Rate for Payer: Aetna Managed Medicare |
$107.36
|
| Rate for Payer: Anthem Medicare Advantage |
$107.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$107.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$107.36
|
| Rate for Payer: Cash Price |
$241.20
|
| Rate for Payer: Cash Price |
$241.20
|
| Rate for Payer: Cash Price |
$241.20
|
| Rate for Payer: Cigna Commercial |
$794.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$170.73
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$107.36
|
| Rate for Payer: Health EOS Commercial |
$760.91
|
| Rate for Payer: HFN Commercial |
$794.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$455.19
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$455.19
|
| Rate for Payer: Independent Care Health Plan Medicare |
$107.36
|
| Rate for Payer: Multiplan Commercial |
$668.93
|
| Rate for Payer: NAPHCARE Commercial |
$161.04
|
| Rate for Payer: Preferred Network Access Commercial |
$794.35
|
| Rate for Payer: Quartz Beloit One Network |
$367.91
|
| Rate for Payer: Quartz Commercial |
$476.61
|
| Rate for Payer: Quartz Medicare Advantage |
$107.36
|
| Rate for Payer: The Alliance Commercial |
$456.28
|
| Rate for Payer: United Healthcare Medicaid |
$170.73
|
| Rate for Payer: United Healthcare Medicare Advantage |
$107.36
|
| Rate for Payer: WEA Trust Commercial |
$459.89
|
| Rate for Payer: WPS Commercial |
$483.12
|
|
|
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 |
$125.33 |
| Max. Negotiated Rate |
$1,167.82 |
| Rate for Payer: Aetna Commercial |
$1,167.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,057.18
|
| Rate for Payer: Aetna Managed Medicare |
$125.33
|
| Rate for Payer: Anthem Medicare Advantage |
$125.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$125.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$125.33
|
| Rate for Payer: Cash Price |
$354.60
|
| Rate for Payer: Cash Price |
$354.60
|
| Rate for Payer: Cash Price |
$354.60
|
| Rate for Payer: Cigna Commercial |
$1,167.82
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$212.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$125.33
|
| Rate for Payer: Health EOS Commercial |
$1,118.64
|
| Rate for Payer: HFN Commercial |
$1,167.82
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$534.49
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$534.49
|
| Rate for Payer: Independent Care Health Plan Medicare |
$125.33
|
| Rate for Payer: Multiplan Commercial |
$983.42
|
| Rate for Payer: NAPHCARE Commercial |
$188.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,167.82
|
| Rate for Payer: Quartz Beloit One Network |
$540.88
|
| Rate for Payer: Quartz Commercial |
$700.69
|
| Rate for Payer: Quartz Medicare Advantage |
$125.33
|
| Rate for Payer: The Alliance Commercial |
$532.65
|
| Rate for Payer: United Healthcare Medicaid |
$212.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$125.33
|
| Rate for Payer: WEA Trust Commercial |
$676.10
|
| Rate for Payer: WPS Commercial |
$563.99
|
|
