|
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
|
|
|
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 LESION(S), ANUS (EG, CONDYLOMA, PAPILLOMA, MOLLUSCUM CONTAGIOSUM, HERPETIC VESICLE), EXTENSIVE (EG, LASER SURGERY, ELECTROSURGERY, CRYOSURGERY, CHEMOSURGERY)
|
Facility
|
OP
|
$11,684.32
|
|
|
Service Code
|
CPT 46924
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,835.04 |
| Max. Negotiated Rate |
$11,684.32 |
| Rate for Payer: Aetna Managed Medicare |
$2,921.08
|
| 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 |
$2,921.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$2,921.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$2,921.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$2,921.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$2,921.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$10,866.41
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2,921.08
|
| Rate for Payer: Independent Care Health Plan Medicare |
$2,921.08
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$2,921.08
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$2,921.08
|
| Rate for Payer: NAPHCARE Commercial |
$4,381.62
|
| Rate for Payer: Quartz Medicare Advantage |
$2,921.08
|
| Rate for Payer: The Alliance Commercial |
$11,684.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,921.08
|
| Rate for Payer: United Healthcare PPO |
$3,726.32
|
| Rate for Payer: Wellcare Medicare |
$2,921.08
|
|
|
DESTRUCTION OF LESION(S), ANUS (EG, CONDYLOMA, PAPILLOMA, MOLLUSCUM CONTAGIOSUM, HERPETIC VESICLE), SIMPLE; ELECTRODESICCATION
|
Facility
|
OP
|
$8,685.50
|
|
|
Service Code
|
CPT 46910
|
|
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), ANUS (EG, CONDYLOMA, PAPILLOMA, MOLLUSCUM CONTAGIOSUM, HERPETIC VESICLE), SIMPLE; SURGICAL EXCISION
|
Facility
|
OP
|
$11,684.32
|
|
|
Service Code
|
CPT 46922
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,835.04 |
| Max. Negotiated Rate |
$11,684.32 |
| Rate for Payer: Aetna Managed Medicare |
$2,921.08
|
| 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 |
$2,921.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$2,921.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$2,921.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$2,921.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$2,921.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$10,866.41
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2,921.08
|
| Rate for Payer: Independent Care Health Plan Medicare |
$2,921.08
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$2,921.08
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$2,921.08
|
| Rate for Payer: NAPHCARE Commercial |
$4,381.62
|
| Rate for Payer: Quartz Medicare Advantage |
$2,921.08
|
| Rate for Payer: The Alliance Commercial |
$11,684.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,921.08
|
| Rate for Payer: United Healthcare PPO |
$3,726.32
|
| Rate for Payer: Wellcare Medicare |
$2,921.08
|
|
|
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; CRYOSURGERY
|
Facility
|
OP
|
$4,386.95
|
|
|
Service Code
|
CPT 54056
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$211.14 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Managed Medicare |
$211.14
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,030.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,388.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,270.32
|
| Rate for Payer: Anthem Medicare Advantage |
$211.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$211.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$211.14
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$211.14
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$211.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$785.44
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$211.14
|
| Rate for Payer: Independent Care Health Plan Medicare |
$211.14
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$211.14
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$211.14
|
| Rate for Payer: NAPHCARE Commercial |
$316.71
|
| Rate for Payer: Quartz Medicare Advantage |
$211.14
|
| Rate for Payer: The Alliance Commercial |
$844.56
|
| Rate for Payer: United Healthcare Medicare Advantage |
$211.14
|
| Rate for Payer: United Healthcare PPO |
$2,347.28
|
| Rate for Payer: Wellcare Medicare |
$211.14
|
|
|
DESTRUCTION OF LESION(S), PENIS (EG, CONDYLOMA, PAPILLOMA, MOLLUSCUM CONTAGIOSUM, HERPETIC VESICLE), SIMPLE; ELECTRODESICCATION
|
Facility
|
OP
|
$8,685.50
|
|
|
Service Code
|
CPT 54055
|
|
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
|
|
