|
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 |
$131.37 |
| Max. Negotiated Rate |
$3,743.53 |
| Rate for Payer: Aetna Commercial |
$3,743.53
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,388.88
|
| Rate for Payer: Aetna Managed Medicare |
$131.37
|
| Rate for Payer: Anthem Medicare Advantage |
$131.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$131.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$131.37
|
| Rate for Payer: Cash Price |
$1,136.70
|
| Rate for Payer: Cash Price |
$1,136.70
|
| Rate for Payer: Cash Price |
$1,136.70
|
| Rate for Payer: Cigna Commercial |
$3,743.53
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$328.31
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$131.37
|
| Rate for Payer: Health EOS Commercial |
$3,585.91
|
| Rate for Payer: HFN Commercial |
$3,743.53
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$515.55
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$515.55
|
| Rate for Payer: Independent Care Health Plan Medicare |
$131.37
|
| Rate for Payer: Multiplan Commercial |
$3,152.45
|
| Rate for Payer: NAPHCARE Commercial |
$197.06
|
| Rate for Payer: Preferred Network Access Commercial |
$3,743.53
|
| Rate for Payer: Quartz Beloit One Network |
$1,733.85
|
| Rate for Payer: Quartz Commercial |
$2,246.12
|
| Rate for Payer: Quartz Medicare Advantage |
$131.37
|
| Rate for Payer: The Alliance Commercial |
$558.33
|
| Rate for Payer: United Healthcare Medicaid |
$328.31
|
| Rate for Payer: United Healthcare Medicare Advantage |
$131.37
|
| Rate for Payer: WEA Trust Commercial |
$2,167.31
|
| Rate for Payer: WPS Commercial |
$591.18
|
|
|
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 |
$26.58 |
| Max. Negotiated Rate |
$277.38 |
| Rate for Payer: Aetna Commercial |
$142.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$128.79
|
| Rate for Payer: Aetna Managed Medicare |
$61.64
|
| Rate for Payer: Anthem Medicare Advantage |
$61.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$61.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$61.64
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cigna Commercial |
$142.27
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$26.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$61.64
|
| Rate for Payer: Health EOS Commercial |
$136.28
|
| Rate for Payer: HFN Commercial |
$142.27
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$230.70
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$230.70
|
| Rate for Payer: Independent Care Health Plan Medicare |
$61.64
|
| Rate for Payer: Multiplan Commercial |
$119.81
|
| Rate for Payer: NAPHCARE Commercial |
$92.46
|
| Rate for Payer: Preferred Network Access Commercial |
$142.27
|
| Rate for Payer: Quartz Beloit One Network |
$65.89
|
| Rate for Payer: Quartz Commercial |
$85.36
|
| Rate for Payer: Quartz Medicare Advantage |
$61.64
|
| Rate for Payer: The Alliance Commercial |
$261.97
|
| Rate for Payer: United Healthcare Medicaid |
$26.58
|
| Rate for Payer: United Healthcare Medicare Advantage |
$61.64
|
| Rate for Payer: WEA Trust Commercial |
$82.37
|
| Rate for Payer: WPS Commercial |
$277.38
|
|
|
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 |
$56.88 |
| Max. Negotiated Rate |
$329.05 |
| Rate for Payer: Aetna Commercial |
$151.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$136.84
|
| Rate for Payer: Aetna Managed Medicare |
$73.12
|
| Rate for Payer: Anthem Medicare Advantage |
$73.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$73.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$73.12
|
| Rate for Payer: Cash Price |
$45.90
|
| Rate for Payer: Cash Price |
$45.90
|
| Rate for Payer: Cash Price |
$45.90
|
| Rate for Payer: Cigna Commercial |
$151.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$56.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$73.12
|
| Rate for Payer: Health EOS Commercial |
$144.80
|
| Rate for Payer: HFN Commercial |
$151.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$283.35
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$283.35
|
| Rate for Payer: Independent Care Health Plan Medicare |
$73.12
|
| Rate for Payer: Multiplan Commercial |
$127.30
|
| Rate for Payer: NAPHCARE Commercial |
$109.68
|
| Rate for Payer: Preferred Network Access Commercial |
$151.16
|
| Rate for Payer: Quartz Beloit One Network |
$70.01
|
| Rate for Payer: Quartz Commercial |
$90.70
|
| Rate for Payer: Quartz Medicare Advantage |
$73.12
|
| Rate for Payer: The Alliance Commercial |
$310.77
|
| Rate for Payer: United Healthcare Medicaid |
$56.88
|
| Rate for Payer: United Healthcare Medicare Advantage |
$73.12
|
| Rate for Payer: WEA Trust Commercial |
$87.52
|
| Rate for Payer: WPS Commercial |
$329.05
|
|
|
Destruction of Internal Hemorrhoid, Cautery
|
Professional
|
Both
|
$367.00
|
|
|
Service Code
|
CPT 46930
|
| Hospital Charge Code |
2572830
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$146.61 |
| Max. Negotiated Rate |
$694.79 |
| Rate for Payer: Aetna Commercial |
$362.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$328.24
|
| Rate for Payer: Aetna Managed Medicare |
$154.40
|
| Rate for Payer: Anthem Medicare Advantage |
$154.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$154.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$154.40
|
| Rate for Payer: Cash Price |
$110.10
|
| Rate for Payer: Cash Price |
$110.10
|
| Rate for Payer: Cash Price |
$110.10
|
| Rate for Payer: Cigna Commercial |
$362.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$146.61
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$154.40
|
| Rate for Payer: Health EOS Commercial |
$347.33
|
| Rate for Payer: HFN Commercial |
$362.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$538.82
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$538.82
|
| Rate for Payer: Independent Care Health Plan Medicare |
$154.40
|
| Rate for Payer: Multiplan Commercial |
$305.34
|
| Rate for Payer: NAPHCARE Commercial |
$231.60
|
| Rate for Payer: Preferred Network Access Commercial |
$362.60
|
| Rate for Payer: Quartz Beloit One Network |
$167.94
|
| Rate for Payer: Quartz Commercial |
$217.56
|
| Rate for Payer: Quartz Medicare Advantage |
$154.40
|
| Rate for Payer: The Alliance Commercial |
$656.19
|
| Rate for Payer: United Healthcare Medicaid |
$146.61
|
| Rate for Payer: United Healthcare Medicare Advantage |
$154.40
|
| Rate for Payer: WEA Trust Commercial |
$209.92
|
| Rate for Payer: WPS Commercial |
$694.79
|
|
|
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 |
$23.49 |
| Max. Negotiated Rate |
$428.31 |
| Rate for Payer: Aetna Commercial |
$272.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$246.85
|
| Rate for Payer: Aetna Managed Medicare |
$95.18
|
| Rate for Payer: Anthem Medicare Advantage |
$95.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$95.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$95.18
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cigna Commercial |
$272.69
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$23.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$95.18
|
| Rate for Payer: Health EOS Commercial |
$261.21
|
| Rate for Payer: HFN Commercial |
$272.69
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$368.44
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$368.44
|
| Rate for Payer: Independent Care Health Plan Medicare |
$95.18
|
| Rate for Payer: Multiplan Commercial |
$229.63
|
| Rate for Payer: NAPHCARE Commercial |
$142.77
|
| Rate for Payer: Preferred Network Access Commercial |
$272.69
|
| Rate for Payer: Quartz Beloit One Network |
$126.30
|
| Rate for Payer: Quartz Commercial |
$163.61
|
| Rate for Payer: Quartz Medicare Advantage |
$95.18
|
| Rate for Payer: The Alliance Commercial |
$404.52
|
| Rate for Payer: United Healthcare Medicaid |
$23.49
|
| Rate for Payer: United Healthcare Medicare Advantage |
$95.18
|
| Rate for Payer: WEA Trust Commercial |
$157.87
|
| Rate for Payer: WPS Commercial |
$428.31
|
|
|
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 |
$46.99 |
| Max. Negotiated Rate |
$439.83 |
| Rate for Payer: Aetna Commercial |
$262.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$237.91
|
| Rate for Payer: Aetna Managed Medicare |
$97.74
|
| Rate for Payer: Anthem Medicare Advantage |
$97.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$97.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$97.74
|
| Rate for Payer: Cash Price |
$79.80
|
| Rate for Payer: Cash Price |
$79.80
|
| Rate for Payer: Cash Price |
$79.80
|
| Rate for Payer: Cigna Commercial |
$262.81
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$46.99
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$97.74
|
| Rate for Payer: Health EOS Commercial |
$251.74
|
| Rate for Payer: HFN Commercial |
$262.81
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$382.54
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$382.54
|
| Rate for Payer: Independent Care Health Plan Medicare |
$97.74
|
| Rate for Payer: Multiplan Commercial |
$221.31
|
| Rate for Payer: NAPHCARE Commercial |
$146.61
|
| Rate for Payer: Preferred Network Access Commercial |
$262.81
|
| Rate for Payer: Quartz Beloit One Network |
$121.72
|
| Rate for Payer: Quartz Commercial |
$157.68
|
| Rate for Payer: Quartz Medicare Advantage |
$97.74
|
| Rate for Payer: The Alliance Commercial |
$415.39
|
| Rate for Payer: United Healthcare Medicaid |
$46.99
|
| Rate for Payer: United Healthcare Medicare Advantage |
$97.74
|
| Rate for Payer: WEA Trust Commercial |
$152.15
|
| Rate for Payer: WPS Commercial |
$439.83
|
|
|
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 |
$46.99 |
| Max. Negotiated Rate |
$469.30 |
| Rate for Payer: Aetna Commercial |
$469.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$424.84
|
| Rate for Payer: Aetna Managed Medicare |
$85.14
|
| Rate for Payer: Anthem Medicare Advantage |
$85.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$85.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$85.14
|
| Rate for Payer: Cash Price |
$142.50
|
| Rate for Payer: Cash Price |
$142.50
|
| Rate for Payer: Cash Price |
$142.50
|
| Rate for Payer: Cigna Commercial |
$469.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$46.99
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$85.14
|
| Rate for Payer: Health EOS Commercial |
$449.54
|
| Rate for Payer: HFN Commercial |
$469.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$330.74
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$330.74
|
| Rate for Payer: Independent Care Health Plan Medicare |
$85.14
|
| Rate for Payer: Multiplan Commercial |
$395.20
|
| Rate for Payer: NAPHCARE Commercial |
$127.72
|
| Rate for Payer: Preferred Network Access Commercial |
$469.30
|
| Rate for Payer: Quartz Beloit One Network |
$217.36
|
| Rate for Payer: Quartz Commercial |
$281.58
|
| Rate for Payer: Quartz Medicare Advantage |
$85.14
|
| Rate for Payer: The Alliance Commercial |
$361.87
|
| Rate for Payer: United Healthcare Medicaid |
$46.99
|
| Rate for Payer: United Healthcare Medicare Advantage |
$85.14
|
| Rate for Payer: WEA Trust Commercial |
$271.70
|
| Rate for Payer: WPS Commercial |
$383.15
|
|
|
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 |
$78.34 |
| Max. Negotiated Rate |
$689.62 |
| Rate for Payer: Aetna Commercial |
$689.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$624.29
|
| Rate for Payer: Aetna Managed Medicare |
$119.53
|
| Rate for Payer: Anthem Medicare Advantage |
$119.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$119.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$119.53
|
| Rate for Payer: Cash Price |
$209.40
|
| Rate for Payer: Cash Price |
$209.40
|
| Rate for Payer: Cash Price |
$209.40
|
| Rate for Payer: Cigna Commercial |
$689.62
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$78.34
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$119.53
|
| Rate for Payer: Health EOS Commercial |
$660.59
|
| Rate for Payer: HFN Commercial |
$689.62
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$454.24
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$454.24
|
| Rate for Payer: Independent Care Health Plan Medicare |
$119.53
|
| Rate for Payer: Multiplan Commercial |
$580.74
|
| Rate for Payer: NAPHCARE Commercial |
$179.29
|
| Rate for Payer: Preferred Network Access Commercial |
$689.62
|
| Rate for Payer: Quartz Beloit One Network |
$319.40
|
| Rate for Payer: Quartz Commercial |
$413.77
|
| Rate for Payer: Quartz Medicare Advantage |
$119.53
|
| Rate for Payer: The Alliance Commercial |
$507.99
|
| Rate for Payer: United Healthcare Medicaid |
$78.34
|
| Rate for Payer: United Healthcare Medicare Advantage |
$119.53
|
| Rate for Payer: WEA Trust Commercial |
$399.26
|
| Rate for Payer: WPS Commercial |
$537.87
|
|
|
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 |
$45.34 |
| Max. Negotiated Rate |
$539.98 |
| Rate for Payer: Aetna Commercial |
$515.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$466.88
|
| Rate for Payer: Aetna Managed Medicare |
$120.00
|
| Rate for Payer: Anthem Medicare Advantage |
$120.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$120.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$120.00
|
| Rate for Payer: Cash Price |
$156.60
|
| Rate for Payer: Cash Price |
$156.60
|
| Rate for Payer: Cash Price |
$156.60
|
| Rate for Payer: Cigna Commercial |
$515.74
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$45.34
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$120.00
|
| Rate for Payer: Health EOS Commercial |
$494.02
|
| Rate for Payer: HFN Commercial |
$515.74
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$494.44
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$494.44
|
| Rate for Payer: Independent Care Health Plan Medicare |
$120.00
|
| Rate for Payer: Multiplan Commercial |
$434.30
|
| Rate for Payer: NAPHCARE Commercial |
$179.99
|
| Rate for Payer: Preferred Network Access Commercial |
$515.74
|
| Rate for Payer: Quartz Beloit One Network |
$238.87
|
| Rate for Payer: Quartz Commercial |
$309.44
|
| Rate for Payer: Quartz Medicare Advantage |
$120.00
|
| Rate for Payer: The Alliance Commercial |
$509.98
|
| Rate for Payer: United Healthcare Medicaid |
$45.34
|
| Rate for Payer: United Healthcare Medicare Advantage |
$120.00
|
| Rate for Payer: WEA Trust Commercial |
$298.58
|
| Rate for Payer: WPS Commercial |
$539.98
|
|
|
DESTRUCTION OF LESION(S), PENIS (EG, CONDYLOMA, PAPILLOMA, MOLLUSCUM CONTAGIOSUM, HERPETIC VESICLE), EXTENSIVE (EG, LASER SURGERY, ELECTROSURGERY, CRYOSURGERY, CHEMOSURGERY)
|
Facility
|
OP
|
$8,685.50
|
|
|
Service Code
|
CPT 54065
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,171.37 |
| Max. Negotiated Rate |
$8,685.50 |
| Rate for Payer: Aetna Managed Medicare |
$2,171.37
|
| 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 |
$2,171.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$2,171.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$2,171.37
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$2,171.37
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$2,171.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,077.51
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2,171.37
|
| Rate for Payer: Independent Care Health Plan Medicare |
$2,171.37
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$2,171.37
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$2,171.37
|
| Rate for Payer: NAPHCARE Commercial |
$3,257.06
|
| Rate for Payer: Quartz Medicare Advantage |
$2,171.37
|
| Rate for Payer: The Alliance Commercial |
$8,685.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,171.37
|
| Rate for Payer: United Healthcare PPO |
$3,726.32
|
| Rate for Payer: Wellcare Medicare |
$2,171.37
|
|
|
DESTRUCTION OF LESION(S), PENIS (EG, CONDYLOMA, PAPILLOMA, MOLLUSCUM CONTAGIOSUM, HERPETIC VESICLE), SIMPLE; SURGICAL EXCISION
|
Facility
|
OP
|
$8,685.50
|
|
|
Service Code
|
CPT 54060
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,171.37 |
| Max. Negotiated Rate |
$8,685.50 |
| Rate for Payer: Aetna Managed Medicare |
$2,171.37
|
| 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 |
$2,171.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$2,171.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$2,171.37
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$2,171.37
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$2,171.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,077.51
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2,171.37
|
| Rate for Payer: Independent Care Health Plan Medicare |
$2,171.37
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$2,171.37
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$2,171.37
|
| Rate for Payer: NAPHCARE Commercial |
$3,257.06
|
| Rate for Payer: Quartz Medicare Advantage |
$2,171.37
|
| Rate for Payer: The Alliance Commercial |
$8,685.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,171.37
|
| Rate for Payer: United Healthcare PPO |
$3,726.32
|
| Rate for Payer: Wellcare Medicare |
$2,171.37
|
|
|
Destruction Of Lesions; Vulva, Complex 56515
|
Professional
|
Both
|
$1,431.00
|
|
|
Service Code
|
CPT 56515
|
| Hospital Charge Code |
1190843
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$182.22 |
| Max. Negotiated Rate |
$1,413.83 |
| Rate for Payer: Aetna Commercial |
$1,413.83
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,279.89
|
| Rate for Payer: Aetna Managed Medicare |
$182.22
|
| Rate for Payer: Anthem Medicare Advantage |
$182.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$182.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$182.22
|
| Rate for Payer: Cash Price |
$429.30
|
| Rate for Payer: Cash Price |
$429.30
|
| Rate for Payer: Cash Price |
$429.30
|
| Rate for Payer: Cigna Commercial |
$1,413.83
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$203.69
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$182.22
|
| Rate for Payer: Health EOS Commercial |
$1,354.30
|
| Rate for Payer: HFN Commercial |
$1,413.83
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$732.15
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$732.15
|
| Rate for Payer: Independent Care Health Plan Medicare |
$182.22
|
| Rate for Payer: Multiplan Commercial |
$1,190.59
|
| Rate for Payer: NAPHCARE Commercial |
$273.33
|
| Rate for Payer: Preferred Network Access Commercial |
$1,413.83
|
| Rate for Payer: Quartz Beloit One Network |
$654.83
|
| Rate for Payer: Quartz Commercial |
$848.30
|
| Rate for Payer: Quartz Medicare Advantage |
$182.22
|
| Rate for Payer: The Alliance Commercial |
$774.43
|
| Rate for Payer: United Healthcare Medicaid |
$203.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$182.22
|
| Rate for Payer: WEA Trust Commercial |
$818.53
|
| Rate for Payer: WPS Commercial |
$819.98
|
|
|
Destruction Of Lesions; Vulva, Simple 56501
|
Professional
|
Both
|
$438.00
|
|
|
Service Code
|
CPT 56501
|
| Hospital Charge Code |
1190842
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$116.07 |
| Max. Negotiated Rate |
$522.33 |
| Rate for Payer: Aetna Commercial |
$432.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$391.75
|
| Rate for Payer: Aetna Managed Medicare |
$116.07
|
| Rate for Payer: Anthem Medicare Advantage |
$116.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$116.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$116.07
|
| Rate for Payer: Cash Price |
$131.40
|
| Rate for Payer: Cash Price |
$131.40
|
| Rate for Payer: Cash Price |
$131.40
|
| Rate for Payer: Cigna Commercial |
$432.74
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$118.93
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$116.07
|
| Rate for Payer: Health EOS Commercial |
$414.52
|
| Rate for Payer: HFN Commercial |
$432.74
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$453.65
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$453.65
|
| Rate for Payer: Independent Care Health Plan Medicare |
$116.07
|
| Rate for Payer: Multiplan Commercial |
$364.42
|
| Rate for Payer: NAPHCARE Commercial |
$174.11
|
| Rate for Payer: Preferred Network Access Commercial |
$432.74
|
| Rate for Payer: Quartz Beloit One Network |
$200.43
|
| Rate for Payer: Quartz Commercial |
$259.65
|
| Rate for Payer: Quartz Medicare Advantage |
$116.07
|
| Rate for Payer: The Alliance Commercial |
$493.32
|
| Rate for Payer: United Healthcare Medicaid |
$118.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$116.07
|
| Rate for Payer: WEA Trust Commercial |
$250.54
|
| Rate for Payer: WPS Commercial |
$522.33
|
|
|
Destruction of Localized Lesion of Retina, Photocoagulation
|
Professional
|
Both
|
$2,778.00
|
|
|
Service Code
|
CPT 67210
|
| Hospital Charge Code |
1188905
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$424.60 |
| Max. Negotiated Rate |
$2,744.66 |
| Rate for Payer: Aetna Commercial |
$2,744.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,484.64
|
| Rate for Payer: Aetna Managed Medicare |
$424.60
|
| Rate for Payer: Anthem Medicare Advantage |
$424.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$424.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$424.60
|
| Rate for Payer: Cash Price |
$833.40
|
| Rate for Payer: Cash Price |
$833.40
|
| Rate for Payer: Cash Price |
$833.40
|
| Rate for Payer: Cigna Commercial |
$2,744.66
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$575.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$424.60
|
| Rate for Payer: Health EOS Commercial |
$2,629.10
|
| Rate for Payer: HFN Commercial |
$2,744.66
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,742.38
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,742.38
|
| Rate for Payer: Independent Care Health Plan Medicare |
$424.60
|
| Rate for Payer: Multiplan Commercial |
$2,311.30
|
| Rate for Payer: NAPHCARE Commercial |
$636.90
|
| Rate for Payer: Preferred Network Access Commercial |
$2,744.66
|
| Rate for Payer: Quartz Beloit One Network |
$1,271.21
|
| Rate for Payer: Quartz Commercial |
$1,646.80
|
| Rate for Payer: Quartz Medicare Advantage |
$424.60
|
| Rate for Payer: The Alliance Commercial |
$1,804.55
|
| Rate for Payer: United Healthcare Medicaid |
$575.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$424.60
|
| Rate for Payer: WEA Trust Commercial |
$1,589.02
|
| Rate for Payer: WPS Commercial |
$1,910.70
|
|
|
Destruction of Localized Lesion of Retina, Photocoagulation 6721050
|
Professional
|
Both
|
$5,556.00
|
|
|
Service Code
|
CPT 67210 50
|
| Hospital Charge Code |
5492810
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$575.44 |
| Max. Negotiated Rate |
$5,489.33 |
| Rate for Payer: Aetna Commercial |
$5,489.33
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,969.29
|
| Rate for Payer: Cash Price |
$1,666.80
|
| Rate for Payer: Cash Price |
$1,666.80
|
| Rate for Payer: Cash Price |
$1,666.80
|
| Rate for Payer: Cigna Commercial |
$5,489.33
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$575.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,466.94
|
| Rate for Payer: Health EOS Commercial |
$5,258.20
|
| Rate for Payer: HFN Commercial |
$5,489.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,742.38
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,742.38
|
| Rate for Payer: Multiplan Commercial |
$4,622.59
|
| Rate for Payer: Preferred Network Access Commercial |
$5,489.33
|
| Rate for Payer: Quartz Beloit One Network |
$2,542.43
|
| Rate for Payer: Quartz Commercial |
$3,293.60
|
| Rate for Payer: The Alliance Commercial |
$2,889.12
|
| Rate for Payer: United Healthcare Medicaid |
$575.44
|
| Rate for Payer: WEA Trust Commercial |
$3,178.03
|
| Rate for Payer: WPS Commercial |
$4,279.79
|
|
|
Destruction Of Precancerous Lesion 17000
|
Professional
|
Both
|
$215.00
|
|
|
Service Code
|
CPT 17000
|
| Hospital Charge Code |
1188865
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$47.09 |
| Max. Negotiated Rate |
$212.42 |
| Rate for Payer: Aetna Commercial |
$212.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$192.30
|
| Rate for Payer: Aetna Managed Medicare |
$47.09
|
| Rate for Payer: Anthem Medicare Advantage |
$47.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$47.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$47.09
|
| Rate for Payer: Cash Price |
$64.50
|
| Rate for Payer: Cash Price |
$64.50
|
| Rate for Payer: Cash Price |
$64.50
|
| Rate for Payer: Cigna Commercial |
$212.42
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$49.30
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$47.09
|
| Rate for Payer: Health EOS Commercial |
$203.48
|
| Rate for Payer: HFN Commercial |
$212.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$188.62
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$188.62
|
| Rate for Payer: Independent Care Health Plan Medicare |
$47.09
|
| Rate for Payer: Multiplan Commercial |
$178.88
|
| Rate for Payer: NAPHCARE Commercial |
$70.64
|
| Rate for Payer: Preferred Network Access Commercial |
$212.42
|
| Rate for Payer: Quartz Beloit One Network |
$98.38
|
| Rate for Payer: Quartz Commercial |
$127.45
|
| Rate for Payer: Quartz Medicare Advantage |
$47.09
|
| Rate for Payer: The Alliance Commercial |
$200.14
|
| Rate for Payer: United Healthcare Medicaid |
$49.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$47.09
|
| Rate for Payer: WEA Trust Commercial |
$122.98
|
| Rate for Payer: WPS Commercial |
$211.91
|
|
|
Destruction of precancerous lesions; 15 or more lesions 17004
|
Professional
|
Both
|
$585.00
|
|
|
Service Code
|
CPT 17004
|
| Hospital Charge Code |
1188867
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$81.55 |
| Max. Negotiated Rate |
$577.98 |
| Rate for Payer: Aetna Commercial |
$577.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$523.22
|
| Rate for Payer: Aetna Managed Medicare |
$81.55
|
| Rate for Payer: Anthem Medicare Advantage |
$81.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$81.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$81.55
|
| Rate for Payer: Cash Price |
$175.50
|
| Rate for Payer: Cash Price |
$175.50
|
| Rate for Payer: Cash Price |
$175.50
|
| Rate for Payer: Cigna Commercial |
$577.98
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$182.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$81.55
|
| Rate for Payer: Health EOS Commercial |
$553.64
|
| Rate for Payer: HFN Commercial |
$577.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$342.12
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$342.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$81.55
|
| Rate for Payer: Multiplan Commercial |
$486.72
|
| Rate for Payer: NAPHCARE Commercial |
$122.32
|
| Rate for Payer: Preferred Network Access Commercial |
$577.98
|
| Rate for Payer: Quartz Beloit One Network |
$267.70
|
| Rate for Payer: Quartz Commercial |
$346.79
|
| Rate for Payer: Quartz Medicare Advantage |
$81.55
|
| Rate for Payer: The Alliance Commercial |
$346.57
|
| Rate for Payer: United Healthcare Medicaid |
$182.02
|
| Rate for Payer: United Healthcare Medicare Advantage |
$81.55
|
| Rate for Payer: WEA Trust Commercial |
$334.62
|
| Rate for Payer: WPS Commercial |
$366.96
|
|
|
Destruction of precancerous lesions; 2-14 lesions 17003
|
Professional
|
Both
|
$64.00
|
|
|
Service Code
|
CPT 17003
|
| Hospital Charge Code |
1188866
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$1.73 |
| Max. Negotiated Rate |
$63.23 |
| Rate for Payer: Aetna Commercial |
$63.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$57.24
|
| Rate for Payer: Aetna Managed Medicare |
$1.73
|
| Rate for Payer: Anthem Medicare Advantage |
$1.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1.73
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Cigna Commercial |
$63.23
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$6.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1.73
|
| Rate for Payer: Health EOS Commercial |
$60.57
|
| Rate for Payer: HFN Commercial |
$63.23
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7.53
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$7.53
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1.73
|
| Rate for Payer: Multiplan Commercial |
$53.25
|
| Rate for Payer: NAPHCARE Commercial |
$2.59
|
| Rate for Payer: Preferred Network Access Commercial |
$63.23
|
| Rate for Payer: Quartz Beloit One Network |
$29.29
|
| Rate for Payer: Quartz Commercial |
$37.94
|
| Rate for Payer: Quartz Medicare Advantage |
$1.73
|
| Rate for Payer: The Alliance Commercial |
$7.34
|
| Rate for Payer: United Healthcare Medicaid |
$6.58
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1.73
|
| Rate for Payer: WEA Trust Commercial |
$36.61
|
| Rate for Payer: WPS Commercial |
$7.77
|
|
|
Destruction of Skin Lesions 17107
|
Professional
|
Both
|
$2,666.00
|
|
|
Service Code
|
CPT 17107
|
| Hospital Charge Code |
4422915
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$303.58 |
| Max. Negotiated Rate |
$2,634.01 |
| Rate for Payer: Aetna Commercial |
$2,634.01
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,384.47
|
| Rate for Payer: Aetna Managed Medicare |
$303.58
|
| Rate for Payer: Anthem Medicare Advantage |
$303.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$303.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$303.58
|
| Rate for Payer: Cash Price |
$799.80
|
| Rate for Payer: Cash Price |
$799.80
|
| Rate for Payer: Cash Price |
$799.80
|
| Rate for Payer: Cigna Commercial |
$2,634.01
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$396.98
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$303.58
|
| Rate for Payer: Health EOS Commercial |
$2,523.10
|
| Rate for Payer: HFN Commercial |
$2,634.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,238.18
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,238.18
|
| Rate for Payer: Independent Care Health Plan Medicare |
$303.58
|
| Rate for Payer: Multiplan Commercial |
$2,218.11
|
| Rate for Payer: NAPHCARE Commercial |
$455.36
|
| Rate for Payer: Preferred Network Access Commercial |
$2,634.01
|
| Rate for Payer: Quartz Beloit One Network |
$1,219.96
|
| Rate for Payer: Quartz Commercial |
$1,580.40
|
| Rate for Payer: Quartz Medicare Advantage |
$303.58
|
| Rate for Payer: The Alliance Commercial |
$1,290.20
|
| Rate for Payer: United Healthcare Medicaid |
$396.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$303.58
|
| Rate for Payer: WEA Trust Commercial |
$1,524.95
|
| Rate for Payer: WPS Commercial |
$1,366.09
|
|
|
DESTRUCTION, PENIS LESION(S) 54065
|
Professional
|
Both
|
$893.00
|
|
|
Service Code
|
CPT 54065
|
| Hospital Charge Code |
3015020
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$108.86 |
| Max. Negotiated Rate |
$882.28 |
| Rate for Payer: Aetna Commercial |
$882.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$798.70
|
| Rate for Payer: Aetna Managed Medicare |
$147.95
|
| Rate for Payer: Anthem Medicare Advantage |
$147.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$147.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$147.95
|
| Rate for Payer: Cash Price |
$267.90
|
| Rate for Payer: Cash Price |
$267.90
|
| Rate for Payer: Cash Price |
$267.90
|
| Rate for Payer: Cigna Commercial |
$882.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$108.86
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$147.95
|
| Rate for Payer: Health EOS Commercial |
$845.14
|
| Rate for Payer: HFN Commercial |
$882.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$594.99
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$594.99
|
| Rate for Payer: Independent Care Health Plan Medicare |
$147.95
|
| Rate for Payer: Multiplan Commercial |
$742.98
|
| Rate for Payer: NAPHCARE Commercial |
$221.93
|
| Rate for Payer: Preferred Network Access Commercial |
$882.28
|
| Rate for Payer: Quartz Beloit One Network |
$408.64
|
| Rate for Payer: Quartz Commercial |
$529.37
|
| Rate for Payer: Quartz Medicare Advantage |
$147.95
|
| Rate for Payer: The Alliance Commercial |
$628.79
|
| Rate for Payer: United Healthcare Medicaid |
$108.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$147.95
|
| Rate for Payer: WEA Trust Commercial |
$510.80
|
| Rate for Payer: WPS Commercial |
$665.78
|
|
|
DETECTOR CO2 FEF END TIDAL PED
|
Facility
|
IP
|
$271.00
|
|
| Hospital Charge Code |
2963448
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$138.10 |
| Max. Negotiated Rate |
$259.29 |
| Rate for Payer: Aetna Commercial |
$253.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$242.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$149.38
|
| Rate for Payer: Cash Price |
$81.30
|
| Rate for Payer: Cigna Commercial |
$259.29
|
| Rate for Payer: Health EOS Commercial |
$250.84
|
| Rate for Payer: HFN Commercial |
$259.29
|
| Rate for Payer: Multiplan Commercial |
$225.47
|
| Rate for Payer: Preferred Network Access Commercial |
$259.29
|
| Rate for Payer: Quartz Beloit One Network |
$138.10
|
| Rate for Payer: Quartz Commercial |
$169.10
|
| Rate for Payer: WEA Trust Commercial |
$155.01
|
| Rate for Payer: WPS Commercial |
$208.75
|
|
|
DETECTOR CO2 FEF END TIDAL PED
|
Facility
|
OP
|
$271.00
|
|
| Hospital Charge Code |
2963448
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$78.92 |
| Max. Negotiated Rate |
$259.29 |
| Rate for Payer: Aetna Commercial |
$253.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$242.38
|
| Rate for Payer: Aetna Managed Medicare |
$78.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$183.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$140.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$135.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$149.38
|
| Rate for Payer: Cash Price |
$81.30
|
| Rate for Payer: Cigna Commercial |
$259.29
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$157.72
|
| Rate for Payer: Health EOS Commercial |
$250.84
|
| Rate for Payer: HFN Commercial |
$259.29
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$211.38
|
| Rate for Payer: Multiplan Commercial |
$225.47
|
| Rate for Payer: NAPHCARE Commercial |
$169.10
|
| Rate for Payer: Preferred Network Access Commercial |
$259.29
|
| Rate for Payer: Quartz Beloit One Network |
$138.10
|
| Rate for Payer: Quartz Commercial |
$183.20
|
| Rate for Payer: Quartz Medicare Advantage |
$169.10
|
| Rate for Payer: The Alliance Commercial |
$140.92
|
| Rate for Payer: WEA Trust Commercial |
$155.01
|
| Rate for Payer: WPS Commercial |
$208.75
|
|
|
DETECTOR LEAK POINT EP3 DISP #LPD-3D
|
Facility
|
OP
|
$220.00
|
|
| Hospital Charge Code |
2972292
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$64.06 |
| Max. Negotiated Rate |
$210.50 |
| Rate for Payer: Aetna Commercial |
$205.92
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$196.77
|
| Rate for Payer: Aetna Managed Medicare |
$64.06
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$148.72
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$114.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$109.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$121.26
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cigna Commercial |
$210.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$128.04
|
| Rate for Payer: Health EOS Commercial |
$203.63
|
| Rate for Payer: HFN Commercial |
$210.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$171.60
|
| Rate for Payer: Multiplan Commercial |
$183.04
|
| Rate for Payer: NAPHCARE Commercial |
$137.28
|
| Rate for Payer: Preferred Network Access Commercial |
$210.50
|
| Rate for Payer: Quartz Beloit One Network |
$112.11
|
| Rate for Payer: Quartz Commercial |
$148.72
|
| Rate for Payer: Quartz Medicare Advantage |
$137.28
|
| Rate for Payer: The Alliance Commercial |
$114.40
|
| Rate for Payer: WEA Trust Commercial |
$125.84
|
| Rate for Payer: WPS Commercial |
$169.47
|
|
|
DETECTOR LEAK POINT EP3 DISP #LPD-3D
|
Facility
|
IP
|
$220.00
|
|
| Hospital Charge Code |
2972292
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$112.11 |
| Max. Negotiated Rate |
$210.50 |
| Rate for Payer: Aetna Commercial |
$205.92
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$196.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$121.26
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cigna Commercial |
$210.50
|
| Rate for Payer: Health EOS Commercial |
$203.63
|
| Rate for Payer: HFN Commercial |
$210.50
|
| Rate for Payer: Multiplan Commercial |
$183.04
|
| Rate for Payer: Preferred Network Access Commercial |
$210.50
|
| Rate for Payer: Quartz Beloit One Network |
$112.11
|
| Rate for Payer: Quartz Commercial |
$137.28
|
| Rate for Payer: WEA Trust Commercial |
$125.84
|
| Rate for Payer: WPS Commercial |
$169.47
|
|
|
DETECTORS CO2 FEF END-TIDAL
|
Facility
|
OP
|
$274.00
|
|
| Hospital Charge Code |
2963009
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$79.79 |
| Max. Negotiated Rate |
$262.16 |
| Rate for Payer: Aetna Commercial |
$256.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$245.07
|
| Rate for Payer: Aetna Managed Medicare |
$79.79
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$185.22
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$142.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$136.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$151.03
|
| Rate for Payer: Cash Price |
$82.20
|
| Rate for Payer: Cigna Commercial |
$262.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$159.47
|
| Rate for Payer: Health EOS Commercial |
$253.61
|
| Rate for Payer: HFN Commercial |
$262.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$213.72
|
| Rate for Payer: Multiplan Commercial |
$227.97
|
| Rate for Payer: NAPHCARE Commercial |
$170.98
|
| Rate for Payer: Preferred Network Access Commercial |
$262.16
|
| Rate for Payer: Quartz Beloit One Network |
$139.63
|
| Rate for Payer: Quartz Commercial |
$185.22
|
| Rate for Payer: Quartz Medicare Advantage |
$170.98
|
| Rate for Payer: The Alliance Commercial |
$142.48
|
| Rate for Payer: WEA Trust Commercial |
$156.73
|
| Rate for Payer: WPS Commercial |
$211.06
|
|
