|
ED Debridement, Masoidectomy Cavity, simple
|
Facility
IP
|
$153.00
|
|
|
Service Code
|
CPT 69220
|
| Hospital Charge Code |
6174444
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$74.97 |
| Max. Negotiated Rate |
$140.76 |
| Rate for Payer: Aetna Commercial |
$137.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$81.09
|
| Rate for Payer: Cash Price |
$45.90
|
| Rate for Payer: Cigna Commercial |
$140.76
|
| Rate for Payer: Health EOS Commercial |
$136.17
|
| Rate for Payer: HFN Commercial |
$140.76
|
| Rate for Payer: Multiplan Commercial |
$122.40
|
| Rate for Payer: NAPHCARE Commercial |
$91.80
|
| Rate for Payer: Preferred Network Access Commercial |
$140.76
|
| Rate for Payer: Quartz Beloit One Network |
$74.97
|
| Rate for Payer: Quartz Commercial |
$91.80
|
| Rate for Payer: WEA Trust Commercial |
$84.15
|
| Rate for Payer: WPS Commercial |
$113.33
|
|
|
ED Debridement of Nails, 1-5
|
Facility
IP
|
$66.00
|
|
|
Service Code
|
CPT 11720
|
| Hospital Charge Code |
6174787
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$32.34 |
| Max. Negotiated Rate |
$60.72 |
| Rate for Payer: Aetna Commercial |
$59.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$34.98
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cigna Commercial |
$60.72
|
| Rate for Payer: Health EOS Commercial |
$58.74
|
| Rate for Payer: HFN Commercial |
$60.72
|
| Rate for Payer: Multiplan Commercial |
$52.80
|
| Rate for Payer: NAPHCARE Commercial |
$39.60
|
| Rate for Payer: Preferred Network Access Commercial |
$60.72
|
| Rate for Payer: Quartz Beloit One Network |
$32.34
|
| Rate for Payer: Quartz Commercial |
$39.60
|
| Rate for Payer: WEA Trust Commercial |
$36.30
|
| Rate for Payer: WPS Commercial |
$48.89
|
|
|
ED Debridement of Nails, 1-5
|
Facility
OP
|
$66.00
|
|
|
Service Code
|
CPT 11720
|
| Hospital Charge Code |
6174787
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$31.68 |
| Max. Negotiated Rate |
$4,218.22 |
| Rate for Payer: Aetna Commercial |
$59.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$56.76
|
| Rate for Payer: Aetna Managed Medicare |
$60.46
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$42.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$33.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$31.68
|
| Rate for Payer: Anthem Medicare Advantage |
$60.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$34.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$60.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$60.46
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cigna Commercial |
$60.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$60.46
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$60.46
|
| Rate for Payer: Health EOS Commercial |
$58.74
|
| Rate for Payer: HFN Commercial |
$60.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$224.91
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$60.46
|
| Rate for Payer: Independent Care Health Plan Medicare |
$60.46
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$60.46
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$60.46
|
| Rate for Payer: Multiplan Commercial |
$52.80
|
| Rate for Payer: NAPHCARE Commercial |
$90.69
|
| Rate for Payer: Preferred Network Access Commercial |
$60.72
|
| Rate for Payer: Quartz Beloit One Network |
$32.34
|
| Rate for Payer: Quartz Commercial |
$42.90
|
| Rate for Payer: Quartz Medicare Advantage |
$60.46
|
| Rate for Payer: United Healthcare Medicare Advantage |
$60.46
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$36.30
|
| Rate for Payer: Wellcare Medicare |
$60.46
|
| Rate for Payer: WPS Commercial |
$48.89
|
|
|
ED Debridement of Nails, >5
|
Facility
IP
|
$110.00
|
|
|
Service Code
|
CPT 11721
|
| Hospital Charge Code |
6174788
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$53.90 |
| Max. Negotiated Rate |
$101.20 |
| Rate for Payer: Aetna Commercial |
$99.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$58.30
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cigna Commercial |
$101.20
|
| Rate for Payer: Health EOS Commercial |
$97.90
|
| Rate for Payer: HFN Commercial |
$101.20
|
| Rate for Payer: Multiplan Commercial |
$88.00
|
| Rate for Payer: NAPHCARE Commercial |
$66.00
|
| Rate for Payer: Preferred Network Access Commercial |
$101.20
|
| Rate for Payer: Quartz Beloit One Network |
$53.90
|
| Rate for Payer: Quartz Commercial |
$66.00
|
| Rate for Payer: WEA Trust Commercial |
$60.50
|
| Rate for Payer: WPS Commercial |
$81.48
|
|
|
ED Debridement of Nails, >5
|
Facility
OP
|
$110.00
|
|
|
Service Code
|
CPT 11721
|
| Hospital Charge Code |
6174788
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$52.80 |
| Max. Negotiated Rate |
$4,218.22 |
| Rate for Payer: Aetna Commercial |
$99.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$94.60
|
| Rate for Payer: Aetna Managed Medicare |
$60.46
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$71.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$55.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$52.80
|
| Rate for Payer: Anthem Medicare Advantage |
$60.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$58.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$60.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$60.46
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cigna Commercial |
$101.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$60.46
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$60.46
|
| Rate for Payer: Health EOS Commercial |
$97.90
|
| Rate for Payer: HFN Commercial |
$101.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$224.91
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$60.46
|
| Rate for Payer: Independent Care Health Plan Medicare |
$60.46
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$60.46
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$60.46
|
| Rate for Payer: Multiplan Commercial |
$88.00
|
| Rate for Payer: NAPHCARE Commercial |
$90.69
|
| Rate for Payer: Preferred Network Access Commercial |
$101.20
|
| Rate for Payer: Quartz Beloit One Network |
$53.90
|
| Rate for Payer: Quartz Commercial |
$71.50
|
| Rate for Payer: Quartz Medicare Advantage |
$60.46
|
| Rate for Payer: United Healthcare Medicare Advantage |
$60.46
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$60.50
|
| Rate for Payer: Wellcare Medicare |
$60.46
|
| Rate for Payer: WPS Commercial |
$81.48
|
|
|
ED Debridement of Open Wound; 20 sq cm or less
|
Facility
OP
|
$305.00
|
|
|
Service Code
|
CPT 97597
|
| Hospital Charge Code |
6174451
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$146.40 |
| Max. Negotiated Rate |
$4,757.59 |
| Rate for Payer: Aetna Commercial |
$274.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$262.30
|
| Rate for Payer: Aetna Managed Medicare |
$197.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$198.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$152.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$146.40
|
| Rate for Payer: Anthem Medicare Advantage |
$197.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$161.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$197.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$197.88
|
| Rate for Payer: Cash Price |
$91.50
|
| Rate for Payer: Cash Price |
$91.50
|
| Rate for Payer: Cash Price |
$91.50
|
| Rate for Payer: Cigna Commercial |
$280.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$197.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,757.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$197.88
|
| Rate for Payer: Health EOS Commercial |
$271.45
|
| Rate for Payer: HFN Commercial |
$280.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$736.11
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$197.88
|
| Rate for Payer: Independent Care Health Plan Medicare |
$197.88
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$197.88
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$197.88
|
| Rate for Payer: Multiplan Commercial |
$244.00
|
| Rate for Payer: NAPHCARE Commercial |
$296.82
|
| Rate for Payer: Preferred Network Access Commercial |
$280.60
|
| Rate for Payer: Quartz Beloit One Network |
$149.45
|
| Rate for Payer: Quartz Commercial |
$198.25
|
| Rate for Payer: Quartz Medicare Advantage |
$197.88
|
| Rate for Payer: United Healthcare Medicare Advantage |
$197.88
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$167.75
|
| Rate for Payer: Wellcare Medicare |
$197.88
|
| Rate for Payer: WPS Commercial |
$225.91
|
|
|
ED Debridement of Open Wound; 20 sq cm or less
|
Facility
IP
|
$305.00
|
|
|
Service Code
|
CPT 97597
|
| Hospital Charge Code |
6174451
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$149.45 |
| Max. Negotiated Rate |
$280.60 |
| Rate for Payer: Aetna Commercial |
$274.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$161.65
|
| Rate for Payer: Cash Price |
$91.50
|
| Rate for Payer: Cigna Commercial |
$280.60
|
| Rate for Payer: Health EOS Commercial |
$271.45
|
| Rate for Payer: HFN Commercial |
$280.60
|
| Rate for Payer: Multiplan Commercial |
$244.00
|
| Rate for Payer: NAPHCARE Commercial |
$183.00
|
| Rate for Payer: Preferred Network Access Commercial |
$280.60
|
| Rate for Payer: Quartz Beloit One Network |
$149.45
|
| Rate for Payer: Quartz Commercial |
$183.00
|
| Rate for Payer: WEA Trust Commercial |
$167.75
|
| Rate for Payer: WPS Commercial |
$225.91
|
|
|
ED Debridement of partial thickness burn; initial or subsequent, less than 5% BSA
|
Facility
OP
|
$126.00
|
|
|
Service Code
|
CPT 16020
|
| Hospital Charge Code |
6172914
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$60.48 |
| Max. Negotiated Rate |
$4,218.22 |
| Rate for Payer: Aetna Commercial |
$113.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$108.36
|
| Rate for Payer: Aetna Managed Medicare |
$197.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$81.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$63.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$60.48
|
| Rate for Payer: Anthem Medicare Advantage |
$197.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$66.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$197.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$197.88
|
| Rate for Payer: Cash Price |
$37.80
|
| Rate for Payer: Cash Price |
$37.80
|
| Rate for Payer: Cash Price |
$37.80
|
| Rate for Payer: Cigna Commercial |
$115.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$197.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$197.88
|
| Rate for Payer: Health EOS Commercial |
$112.14
|
| Rate for Payer: HFN Commercial |
$115.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$736.11
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$197.88
|
| Rate for Payer: Independent Care Health Plan Medicare |
$197.88
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$197.88
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$197.88
|
| Rate for Payer: Multiplan Commercial |
$100.80
|
| Rate for Payer: NAPHCARE Commercial |
$296.82
|
| Rate for Payer: Preferred Network Access Commercial |
$115.92
|
| Rate for Payer: Quartz Beloit One Network |
$61.74
|
| Rate for Payer: Quartz Commercial |
$81.90
|
| Rate for Payer: Quartz Medicare Advantage |
$197.88
|
| Rate for Payer: United Healthcare Medicare Advantage |
$197.88
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$69.30
|
| Rate for Payer: Wellcare Medicare |
$197.88
|
| Rate for Payer: WPS Commercial |
$93.33
|
|
|
ED Debridement of partial thickness burn; initial or subsequent, less than 5% BSA
|
Facility
IP
|
$126.00
|
|
|
Service Code
|
CPT 16020
|
| Hospital Charge Code |
6172914
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$61.74 |
| Max. Negotiated Rate |
$115.92 |
| Rate for Payer: Aetna Commercial |
$113.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$66.78
|
| Rate for Payer: Cash Price |
$37.80
|
| Rate for Payer: Cigna Commercial |
$115.92
|
| Rate for Payer: Health EOS Commercial |
$112.14
|
| Rate for Payer: HFN Commercial |
$115.92
|
| Rate for Payer: Multiplan Commercial |
$100.80
|
| Rate for Payer: NAPHCARE Commercial |
$75.60
|
| Rate for Payer: Preferred Network Access Commercial |
$115.92
|
| Rate for Payer: Quartz Beloit One Network |
$61.74
|
| Rate for Payer: Quartz Commercial |
$75.60
|
| Rate for Payer: WEA Trust Commercial |
$69.30
|
| Rate for Payer: WPS Commercial |
$93.33
|
|
|
ED Debridement Open Wound Each Additional 20 sq cm
|
Facility
IP
|
$437.00
|
|
|
Service Code
|
CPT 97598
|
| Hospital Charge Code |
6196740
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$214.13 |
| Max. Negotiated Rate |
$402.04 |
| Rate for Payer: Aetna Commercial |
$393.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$231.61
|
| Rate for Payer: Cash Price |
$131.10
|
| Rate for Payer: Cigna Commercial |
$402.04
|
| Rate for Payer: Health EOS Commercial |
$388.93
|
| Rate for Payer: HFN Commercial |
$402.04
|
| Rate for Payer: Multiplan Commercial |
$349.60
|
| Rate for Payer: NAPHCARE Commercial |
$262.20
|
| Rate for Payer: Preferred Network Access Commercial |
$402.04
|
| Rate for Payer: Quartz Beloit One Network |
$214.13
|
| Rate for Payer: Quartz Commercial |
$262.20
|
| Rate for Payer: WEA Trust Commercial |
$240.35
|
| Rate for Payer: WPS Commercial |
$323.69
|
|
|
ED Debridement Open Wound Each Additional 20 sq cm
|
Facility
OP
|
$437.00
|
|
|
Service Code
|
CPT 97598
|
| Hospital Charge Code |
6196740
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$122.36 |
| Max. Negotiated Rate |
$402.04 |
| Rate for Payer: Aetna Commercial |
$393.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$375.82
|
| Rate for Payer: Aetna Managed Medicare |
$122.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$284.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$218.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$209.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$231.61
|
| Rate for Payer: Cash Price |
$131.10
|
| Rate for Payer: Cash Price |
$131.10
|
| Rate for Payer: Cigna Commercial |
$402.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$244.55
|
| Rate for Payer: Health EOS Commercial |
$388.93
|
| Rate for Payer: HFN Commercial |
$402.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$327.75
|
| Rate for Payer: Multiplan Commercial |
$349.60
|
| Rate for Payer: NAPHCARE Commercial |
$262.20
|
| Rate for Payer: Preferred Network Access Commercial |
$402.04
|
| Rate for Payer: Quartz Beloit One Network |
$214.13
|
| Rate for Payer: Quartz Commercial |
$284.05
|
| Rate for Payer: Quartz Medicare Advantage |
$262.20
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$240.35
|
| Rate for Payer: WPS Commercial |
$323.69
|
|
|
ED Declotting or Thrombolytic Agent of Implnted Vascular Access Device or Catheter
|
Facility
OP
|
$48.00
|
|
|
Service Code
|
CPT 36593
|
| Hospital Charge Code |
6173892
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$23.04 |
| Max. Negotiated Rate |
$20,943.68 |
| Rate for Payer: Aetna Commercial |
$43.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$41.28
|
| Rate for Payer: Aetna Managed Medicare |
$334.74
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$31.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$24.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$23.04
|
| Rate for Payer: Anthem Medicare Advantage |
$334.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$25.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$334.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$334.74
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cigna Commercial |
$44.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$334.74
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$334.74
|
| Rate for Payer: Health EOS Commercial |
$42.72
|
| Rate for Payer: HFN Commercial |
$44.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,245.23
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$334.74
|
| Rate for Payer: Independent Care Health Plan Medicare |
$334.74
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$334.74
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$334.74
|
| Rate for Payer: Multiplan Commercial |
$38.40
|
| Rate for Payer: NAPHCARE Commercial |
$502.11
|
| Rate for Payer: Preferred Network Access Commercial |
$44.16
|
| Rate for Payer: Quartz Beloit One Network |
$23.52
|
| Rate for Payer: Quartz Commercial |
$31.20
|
| Rate for Payer: Quartz Medicare Advantage |
$334.74
|
| Rate for Payer: The Alliance Commercial |
$20,943.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$334.74
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$26.40
|
| Rate for Payer: Wellcare Medicare |
$334.74
|
| Rate for Payer: WPS Commercial |
$35.55
|
|
|
ED Declotting or Thrombolytic Agent of Implnted Vascular Access Device or Catheter
|
Facility
IP
|
$48.00
|
|
|
Service Code
|
CPT 36593
|
| Hospital Charge Code |
6173892
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$23.52 |
| Max. Negotiated Rate |
$44.16 |
| Rate for Payer: Aetna Commercial |
$43.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$25.44
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cigna Commercial |
$44.16
|
| Rate for Payer: Health EOS Commercial |
$42.72
|
| Rate for Payer: HFN Commercial |
$44.16
|
| Rate for Payer: Multiplan Commercial |
$38.40
|
| Rate for Payer: NAPHCARE Commercial |
$28.80
|
| Rate for Payer: Preferred Network Access Commercial |
$44.16
|
| Rate for Payer: Quartz Beloit One Network |
$23.52
|
| Rate for Payer: Quartz Commercial |
$28.80
|
| Rate for Payer: WEA Trust Commercial |
$26.40
|
| Rate for Payer: WPS Commercial |
$35.55
|
|
|
ED Destruction By Neurolytic Agent, Peripheral Nerve Branch
|
Facility
IP
|
$633.00
|
|
|
Service Code
|
CPT 64640
|
| Hospital Charge Code |
6174411
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$310.17 |
| Max. Negotiated Rate |
$582.36 |
| Rate for Payer: Aetna Commercial |
$569.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$335.49
|
| Rate for Payer: Cash Price |
$189.90
|
| Rate for Payer: Cigna Commercial |
$582.36
|
| Rate for Payer: Health EOS Commercial |
$563.37
|
| Rate for Payer: HFN Commercial |
$582.36
|
| Rate for Payer: Multiplan Commercial |
$506.40
|
| Rate for Payer: NAPHCARE Commercial |
$379.80
|
| Rate for Payer: Preferred Network Access Commercial |
$582.36
|
| Rate for Payer: Quartz Beloit One Network |
$310.17
|
| Rate for Payer: Quartz Commercial |
$379.80
|
| Rate for Payer: WEA Trust Commercial |
$348.15
|
| Rate for Payer: WPS Commercial |
$468.86
|
|
|
ED Destruction By Neurolytic Agent, Peripheral Nerve Branch
|
Facility
OP
|
$633.00
|
|
|
Service Code
|
CPT 64640
|
| Hospital Charge Code |
6174411
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$50,159.28 |
| Rate for Payer: Aetna Commercial |
$569.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$544.38
|
| Rate for Payer: Aetna Managed Medicare |
$900.91
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$411.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$316.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$303.84
|
| Rate for Payer: Anthem Medicare Advantage |
$900.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$335.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$900.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$900.91
|
| Rate for Payer: Cash Price |
$189.90
|
| Rate for Payer: Cash Price |
$189.90
|
| Rate for Payer: Cash Price |
$189.90
|
| Rate for Payer: Cigna Commercial |
$582.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$900.91
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$900.91
|
| Rate for Payer: Health EOS Commercial |
$563.37
|
| Rate for Payer: HFN Commercial |
$582.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,351.39
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$900.91
|
| Rate for Payer: Independent Care Health Plan Medicare |
$900.91
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$900.91
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$900.91
|
| Rate for Payer: Multiplan Commercial |
$506.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,351.36
|
| Rate for Payer: Preferred Network Access Commercial |
$582.36
|
| Rate for Payer: Quartz Beloit One Network |
$310.17
|
| Rate for Payer: Quartz Commercial |
$411.45
|
| Rate for Payer: Quartz Medicare Advantage |
$900.91
|
| Rate for Payer: The Alliance Commercial |
$50,159.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$900.91
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$348.15
|
| Rate for Payer: Wellcare Medicare |
$900.91
|
| Rate for Payer: WPS Commercial |
$468.86
|
|
|
ED Destruction of benign lesion; 1-14 lesions
|
Facility
IP
|
$139.00
|
|
|
Service Code
|
CPT 17110
|
| Hospital Charge Code |
6173182
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$68.11 |
| Max. Negotiated Rate |
$127.88 |
| Rate for Payer: Aetna Commercial |
$125.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$73.67
|
| Rate for Payer: Cash Price |
$41.70
|
| Rate for Payer: Cigna Commercial |
$127.88
|
| Rate for Payer: Health EOS Commercial |
$123.71
|
| Rate for Payer: HFN Commercial |
$127.88
|
| Rate for Payer: Multiplan Commercial |
$111.20
|
| Rate for Payer: NAPHCARE Commercial |
$83.40
|
| Rate for Payer: Preferred Network Access Commercial |
$127.88
|
| Rate for Payer: Quartz Beloit One Network |
$68.11
|
| Rate for Payer: Quartz Commercial |
$83.40
|
| Rate for Payer: WEA Trust Commercial |
$76.45
|
| Rate for Payer: WPS Commercial |
$102.96
|
|
|
ED Destruction of benign lesion; 1-14 lesions
|
Facility
OP
|
$139.00
|
|
|
Service Code
|
CPT 17110
|
| Hospital Charge Code |
6173182
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$66.72 |
| Max. Negotiated Rate |
$4,218.22 |
| Rate for Payer: Aetna Commercial |
$125.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$119.54
|
| Rate for Payer: Aetna Managed Medicare |
$197.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$90.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$69.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$66.72
|
| Rate for Payer: Anthem Medicare Advantage |
$197.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$73.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$197.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$197.88
|
| Rate for Payer: Cash Price |
$41.70
|
| Rate for Payer: Cash Price |
$41.70
|
| Rate for Payer: Cash Price |
$41.70
|
| Rate for Payer: Cigna Commercial |
$127.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$197.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$197.88
|
| Rate for Payer: Health EOS Commercial |
$123.71
|
| Rate for Payer: HFN Commercial |
$127.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$736.11
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$197.88
|
| Rate for Payer: Independent Care Health Plan Medicare |
$197.88
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$197.88
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$197.88
|
| Rate for Payer: Multiplan Commercial |
$111.20
|
| Rate for Payer: NAPHCARE Commercial |
$296.82
|
| Rate for Payer: Preferred Network Access Commercial |
$127.88
|
| Rate for Payer: Quartz Beloit One Network |
$68.11
|
| Rate for Payer: Quartz Commercial |
$90.35
|
| Rate for Payer: Quartz Medicare Advantage |
$197.88
|
| Rate for Payer: United Healthcare Medicare Advantage |
$197.88
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$76.45
|
| Rate for Payer: Wellcare Medicare |
$197.88
|
| Rate for Payer: WPS Commercial |
$102.96
|
|
|
ED Destruction of benign lesions; 15 or more lesions
|
Facility
IP
|
$469.00
|
|
|
Service Code
|
CPT 17004
|
| Hospital Charge Code |
6173183
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$229.81 |
| Max. Negotiated Rate |
$431.48 |
| Rate for Payer: Aetna Commercial |
$422.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$248.57
|
| Rate for Payer: Cash Price |
$140.70
|
| Rate for Payer: Cigna Commercial |
$431.48
|
| Rate for Payer: Health EOS Commercial |
$417.41
|
| Rate for Payer: HFN Commercial |
$431.48
|
| Rate for Payer: Multiplan Commercial |
$375.20
|
| Rate for Payer: NAPHCARE Commercial |
$281.40
|
| Rate for Payer: Preferred Network Access Commercial |
$431.48
|
| Rate for Payer: Quartz Beloit One Network |
$229.81
|
| Rate for Payer: Quartz Commercial |
$281.40
|
| Rate for Payer: WEA Trust Commercial |
$257.95
|
| Rate for Payer: WPS Commercial |
$347.39
|
|
|
ED Destruction of benign lesions; 15 or more lesions
|
Facility
OP
|
$469.00
|
|
|
Service Code
|
CPT 17004
|
| Hospital Charge Code |
6173183
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$225.12 |
| Max. Negotiated Rate |
$4,218.22 |
| Rate for Payer: Aetna Commercial |
$422.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$403.34
|
| Rate for Payer: Aetna Managed Medicare |
$394.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$304.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$234.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$225.12
|
| Rate for Payer: Anthem Medicare Advantage |
$394.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$248.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$394.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$394.12
|
| Rate for Payer: Cash Price |
$140.70
|
| Rate for Payer: Cash Price |
$140.70
|
| Rate for Payer: Cash Price |
$140.70
|
| Rate for Payer: Cigna Commercial |
$431.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$394.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$394.12
|
| Rate for Payer: Health EOS Commercial |
$417.41
|
| Rate for Payer: HFN Commercial |
$431.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,466.13
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$394.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$394.12
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$394.12
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$394.12
|
| Rate for Payer: Multiplan Commercial |
$375.20
|
| Rate for Payer: NAPHCARE Commercial |
$591.18
|
| Rate for Payer: Preferred Network Access Commercial |
$431.48
|
| Rate for Payer: Quartz Beloit One Network |
$229.81
|
| Rate for Payer: Quartz Commercial |
$304.85
|
| Rate for Payer: Quartz Medicare Advantage |
$394.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$394.12
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$257.95
|
| Rate for Payer: Wellcare Medicare |
$394.12
|
| Rate for Payer: WPS Commercial |
$347.39
|
|
|
ED Destruction of Internal Hemorrhoid, Cautery
|
Facility
OP
|
$454.00
|
|
|
Service Code
|
CPT 46930
|
| Hospital Charge Code |
6174090
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$217.92 |
| Max. Negotiated Rate |
$4,338.97 |
| Rate for Payer: Aetna Commercial |
$408.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$390.44
|
| Rate for Payer: Aetna Managed Medicare |
$1,166.39
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$295.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$227.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$217.92
|
| Rate for Payer: Anthem Medicare Advantage |
$1,166.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$240.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,166.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,166.39
|
| Rate for Payer: Cash Price |
$136.20
|
| Rate for Payer: Cash Price |
$136.20
|
| Rate for Payer: Cash Price |
$136.20
|
| Rate for Payer: Cigna Commercial |
$417.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,166.39
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,166.39
|
| Rate for Payer: Health EOS Commercial |
$404.06
|
| Rate for Payer: HFN Commercial |
$417.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,338.97
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,166.39
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,166.39
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,166.39
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,166.39
|
| Rate for Payer: Multiplan Commercial |
$363.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,749.58
|
| Rate for Payer: Preferred Network Access Commercial |
$417.68
|
| Rate for Payer: Quartz Beloit One Network |
$222.46
|
| Rate for Payer: Quartz Commercial |
$295.10
|
| Rate for Payer: Quartz Medicare Advantage |
$1,166.39
|
| Rate for Payer: The Alliance Commercial |
$2,603.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,166.39
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$249.70
|
| Rate for Payer: Wellcare Medicare |
$1,166.39
|
| Rate for Payer: WPS Commercial |
$336.28
|
|
|
ED Destruction of Internal Hemorrhoid, Cautery
|
Facility
IP
|
$454.00
|
|
|
Service Code
|
CPT 46930
|
| Hospital Charge Code |
6174090
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$222.46 |
| Max. Negotiated Rate |
$417.68 |
| Rate for Payer: Aetna Commercial |
$408.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$240.62
|
| Rate for Payer: Cash Price |
$136.20
|
| Rate for Payer: Cigna Commercial |
$417.68
|
| Rate for Payer: Health EOS Commercial |
$404.06
|
| Rate for Payer: HFN Commercial |
$417.68
|
| Rate for Payer: Multiplan Commercial |
$363.20
|
| Rate for Payer: NAPHCARE Commercial |
$272.40
|
| Rate for Payer: Preferred Network Access Commercial |
$417.68
|
| Rate for Payer: Quartz Beloit One Network |
$222.46
|
| Rate for Payer: Quartz Commercial |
$272.40
|
| Rate for Payer: WEA Trust Commercial |
$249.70
|
| Rate for Payer: WPS Commercial |
$336.28
|
|
|
ED Destruction Of Lesion On Penis Chemical
|
Facility
IP
|
$287.00
|
|
|
Service Code
|
CPT 54050
|
| Hospital Charge Code |
6174104
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$140.63 |
| Max. Negotiated Rate |
$264.04 |
| Rate for Payer: Aetna Commercial |
$258.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$152.11
|
| Rate for Payer: Cash Price |
$86.10
|
| Rate for Payer: Cigna Commercial |
$264.04
|
| Rate for Payer: Health EOS Commercial |
$255.43
|
| Rate for Payer: HFN Commercial |
$264.04
|
| Rate for Payer: Multiplan Commercial |
$229.60
|
| Rate for Payer: NAPHCARE Commercial |
$172.20
|
| Rate for Payer: Preferred Network Access Commercial |
$264.04
|
| Rate for Payer: Quartz Beloit One Network |
$140.63
|
| Rate for Payer: Quartz Commercial |
$172.20
|
| Rate for Payer: WEA Trust Commercial |
$157.85
|
| Rate for Payer: WPS Commercial |
$212.58
|
|
|
ED Destruction Of Lesion On Penis Chemical
|
Facility
OP
|
$287.00
|
|
|
Service Code
|
CPT 54050
|
| Hospital Charge Code |
6174104
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$137.76 |
| Max. Negotiated Rate |
$21,990.36 |
| Rate for Payer: Aetna Commercial |
$258.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$246.82
|
| Rate for Payer: Aetna Managed Medicare |
$394.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$186.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$143.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$137.76
|
| Rate for Payer: Anthem Medicare Advantage |
$394.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$152.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$394.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$394.12
|
| Rate for Payer: Cash Price |
$86.10
|
| Rate for Payer: Cash Price |
$86.10
|
| Rate for Payer: Cash Price |
$86.10
|
| Rate for Payer: Cigna Commercial |
$264.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$394.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$394.12
|
| Rate for Payer: Health EOS Commercial |
$255.43
|
| Rate for Payer: HFN Commercial |
$264.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,466.13
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$394.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$394.12
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$394.12
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$394.12
|
| Rate for Payer: Multiplan Commercial |
$229.60
|
| Rate for Payer: NAPHCARE Commercial |
$591.18
|
| Rate for Payer: Preferred Network Access Commercial |
$264.04
|
| Rate for Payer: Quartz Beloit One Network |
$140.63
|
| Rate for Payer: Quartz Commercial |
$186.55
|
| Rate for Payer: Quartz Medicare Advantage |
$394.12
|
| Rate for Payer: The Alliance Commercial |
$21,990.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$394.12
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$157.85
|
| Rate for Payer: Wellcare Medicare |
$394.12
|
| Rate for Payer: WPS Commercial |
$212.58
|
|
|
ED Destruction Of Lesion On Penis Cryosurgery
|
Facility
IP
|
$362.00
|
|
|
Service Code
|
CPT 54056
|
| Hospital Charge Code |
6174105
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$177.38 |
| Max. Negotiated Rate |
$333.04 |
| Rate for Payer: Aetna Commercial |
$325.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$191.86
|
| Rate for Payer: Cash Price |
$108.60
|
| Rate for Payer: Cigna Commercial |
$333.04
|
| Rate for Payer: Health EOS Commercial |
$322.18
|
| Rate for Payer: HFN Commercial |
$333.04
|
| Rate for Payer: Multiplan Commercial |
$289.60
|
| Rate for Payer: NAPHCARE Commercial |
$217.20
|
| Rate for Payer: Preferred Network Access Commercial |
$333.04
|
| Rate for Payer: Quartz Beloit One Network |
$177.38
|
| Rate for Payer: Quartz Commercial |
$217.20
|
| Rate for Payer: WEA Trust Commercial |
$199.10
|
| Rate for Payer: WPS Commercial |
$268.13
|
|
|
ED Destruction Of Lesion On Penis Cryosurgery
|
Facility
OP
|
$362.00
|
|
|
Service Code
|
CPT 54056
|
| Hospital Charge Code |
6174105
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$173.76 |
| Max. Negotiated Rate |
$11,915.08 |
| Rate for Payer: Aetna Commercial |
$325.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$311.32
|
| Rate for Payer: Aetna Managed Medicare |
$197.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$235.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$181.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$173.76
|
| Rate for Payer: Anthem Medicare Advantage |
$197.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$191.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$197.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$197.88
|
| Rate for Payer: Cash Price |
$108.60
|
| Rate for Payer: Cash Price |
$108.60
|
| Rate for Payer: Cash Price |
$108.60
|
| Rate for Payer: Cigna Commercial |
$333.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$197.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$197.88
|
| Rate for Payer: Health EOS Commercial |
$322.18
|
| Rate for Payer: HFN Commercial |
$333.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$736.11
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$197.88
|
| Rate for Payer: Independent Care Health Plan Medicare |
$197.88
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$197.88
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$197.88
|
| Rate for Payer: Multiplan Commercial |
$289.60
|
| Rate for Payer: NAPHCARE Commercial |
$296.82
|
| Rate for Payer: Preferred Network Access Commercial |
$333.04
|
| Rate for Payer: Quartz Beloit One Network |
$177.38
|
| Rate for Payer: Quartz Commercial |
$235.30
|
| Rate for Payer: Quartz Medicare Advantage |
$197.88
|
| Rate for Payer: The Alliance Commercial |
$11,915.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$197.88
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$199.10
|
| Rate for Payer: Wellcare Medicare |
$197.88
|
| Rate for Payer: WPS Commercial |
$268.13
|
|
