|
ED Destruction of Lesion, Penis Electrodesiccation
|
Facility
OP
|
$421.00
|
|
|
Service Code
|
CPT 54055
|
| Hospital Charge Code |
6174106
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$202.08 |
| Max. Negotiated Rate |
$11,915.08 |
| Rate for Payer: Aetna Commercial |
$378.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$362.06
|
| Rate for Payer: Aetna Managed Medicare |
$1,802.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$273.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$210.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$202.08
|
| Rate for Payer: Anthem Medicare Advantage |
$1,802.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$223.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,802.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,802.48
|
| Rate for Payer: Cash Price |
$126.30
|
| Rate for Payer: Cash Price |
$126.30
|
| Rate for Payer: Cash Price |
$126.30
|
| Rate for Payer: Cigna Commercial |
$387.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,802.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,802.48
|
| Rate for Payer: Health EOS Commercial |
$374.69
|
| Rate for Payer: HFN Commercial |
$387.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,705.23
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,802.48
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,802.48
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,802.48
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,802.48
|
| Rate for Payer: Multiplan Commercial |
$336.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,703.72
|
| Rate for Payer: Preferred Network Access Commercial |
$387.32
|
| Rate for Payer: Quartz Beloit One Network |
$206.29
|
| Rate for Payer: Quartz Commercial |
$273.65
|
| Rate for Payer: Quartz Medicare Advantage |
$1,802.48
|
| Rate for Payer: The Alliance Commercial |
$11,915.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,802.48
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$231.55
|
| Rate for Payer: Wellcare Medicare |
$1,802.48
|
| Rate for Payer: WPS Commercial |
$311.83
|
|
|
ED Destruction of Lesion, Penis Electrodesiccation
|
Facility
IP
|
$421.00
|
|
|
Service Code
|
CPT 54055
|
| Hospital Charge Code |
6174106
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$206.29 |
| Max. Negotiated Rate |
$387.32 |
| Rate for Payer: Aetna Commercial |
$378.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$223.13
|
| Rate for Payer: Cash Price |
$126.30
|
| Rate for Payer: Cigna Commercial |
$387.32
|
| Rate for Payer: Health EOS Commercial |
$374.69
|
| Rate for Payer: HFN Commercial |
$387.32
|
| Rate for Payer: Multiplan Commercial |
$336.80
|
| Rate for Payer: NAPHCARE Commercial |
$252.60
|
| Rate for Payer: Preferred Network Access Commercial |
$387.32
|
| Rate for Payer: Quartz Beloit One Network |
$206.29
|
| Rate for Payer: Quartz Commercial |
$252.60
|
| Rate for Payer: WEA Trust Commercial |
$231.55
|
| Rate for Payer: WPS Commercial |
$311.83
|
|
|
ED Destruction of Lesion, Penis Surgical Excision
|
Facility
OP
|
$518.00
|
|
|
Service Code
|
CPT 54060
|
| Hospital Charge Code |
6174107
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$248.64 |
| Max. Negotiated Rate |
$11,915.08 |
| Rate for Payer: Aetna Commercial |
$466.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$445.48
|
| Rate for Payer: Aetna Managed Medicare |
$1,802.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$336.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$259.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$248.64
|
| Rate for Payer: Anthem Medicare Advantage |
$1,802.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$274.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,802.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,802.48
|
| Rate for Payer: Cash Price |
$155.40
|
| Rate for Payer: Cash Price |
$155.40
|
| Rate for Payer: Cash Price |
$155.40
|
| Rate for Payer: Cigna Commercial |
$476.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,802.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,802.48
|
| Rate for Payer: Health EOS Commercial |
$461.02
|
| Rate for Payer: HFN Commercial |
$476.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,705.23
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,802.48
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,802.48
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,802.48
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,802.48
|
| Rate for Payer: Multiplan Commercial |
$414.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,703.72
|
| Rate for Payer: Preferred Network Access Commercial |
$476.56
|
| Rate for Payer: Quartz Beloit One Network |
$253.82
|
| Rate for Payer: Quartz Commercial |
$336.70
|
| Rate for Payer: Quartz Medicare Advantage |
$1,802.48
|
| Rate for Payer: The Alliance Commercial |
$11,915.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,802.48
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$284.90
|
| Rate for Payer: Wellcare Medicare |
$1,802.48
|
| Rate for Payer: WPS Commercial |
$383.68
|
|
|
ED Destruction of Lesion, Penis Surgical Excision
|
Facility
IP
|
$518.00
|
|
|
Service Code
|
CPT 54060
|
| Hospital Charge Code |
6174107
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$253.82 |
| Max. Negotiated Rate |
$476.56 |
| Rate for Payer: Aetna Commercial |
$466.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$274.54
|
| Rate for Payer: Cash Price |
$155.40
|
| Rate for Payer: Cigna Commercial |
$476.56
|
| Rate for Payer: Health EOS Commercial |
$461.02
|
| Rate for Payer: HFN Commercial |
$476.56
|
| Rate for Payer: Multiplan Commercial |
$414.40
|
| Rate for Payer: NAPHCARE Commercial |
$310.80
|
| Rate for Payer: Preferred Network Access Commercial |
$476.56
|
| Rate for Payer: Quartz Beloit One Network |
$253.82
|
| Rate for Payer: Quartz Commercial |
$310.80
|
| Rate for Payer: WEA Trust Commercial |
$284.90
|
| Rate for Payer: WPS Commercial |
$383.68
|
|
|
ED Destruction Of Lesions On Anus; Cryosurgery
|
Facility
IP
|
$440.00
|
|
|
Service Code
|
CPT 46916
|
| Hospital Charge Code |
6174089
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$215.60 |
| Max. Negotiated Rate |
$404.80 |
| Rate for Payer: Aetna Commercial |
$396.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$233.20
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cigna Commercial |
$404.80
|
| Rate for Payer: Health EOS Commercial |
$391.60
|
| Rate for Payer: HFN Commercial |
$404.80
|
| Rate for Payer: Multiplan Commercial |
$352.00
|
| Rate for Payer: NAPHCARE Commercial |
$264.00
|
| Rate for Payer: Preferred Network Access Commercial |
$404.80
|
| Rate for Payer: Quartz Beloit One Network |
$215.60
|
| Rate for Payer: Quartz Commercial |
$264.00
|
| Rate for Payer: WEA Trust Commercial |
$242.00
|
| Rate for Payer: WPS Commercial |
$325.91
|
|
|
ED Destruction Of Lesions On Anus; Cryosurgery
|
Facility
OP
|
$440.00
|
|
|
Service Code
|
CPT 46916
|
| Hospital Charge Code |
6174089
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$197.88 |
| Max. Negotiated Rate |
$4,218.22 |
| Rate for Payer: Aetna Commercial |
$396.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$378.40
|
| Rate for Payer: Aetna Managed Medicare |
$197.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$286.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$220.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$211.20
|
| Rate for Payer: Anthem Medicare Advantage |
$197.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$233.20
|
| 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 |
$132.00
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cigna Commercial |
$404.80
|
| 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 |
$391.60
|
| Rate for Payer: HFN Commercial |
$404.80
|
| 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 |
$352.00
|
| Rate for Payer: NAPHCARE Commercial |
$296.82
|
| Rate for Payer: Preferred Network Access Commercial |
$404.80
|
| Rate for Payer: Quartz Beloit One Network |
$215.60
|
| Rate for Payer: Quartz Commercial |
$286.00
|
| Rate for Payer: Quartz Medicare Advantage |
$197.88
|
| Rate for Payer: The Alliance Commercial |
$2,603.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$197.88
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$242.00
|
| Rate for Payer: Wellcare Medicare |
$197.88
|
| Rate for Payer: WPS Commercial |
$325.91
|
|
|
ED Destruction Of Lesions; Vulva, Complex
|
Facility
OP
|
$884.00
|
|
|
Service Code
|
CPT 56515
|
| Hospital Charge Code |
6174392
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$7,358.52 |
| Rate for Payer: Aetna Commercial |
$795.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$760.24
|
| Rate for Payer: Aetna Managed Medicare |
$1,802.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$574.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$442.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$424.32
|
| Rate for Payer: Anthem Medicare Advantage |
$1,802.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$468.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,802.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,802.48
|
| Rate for Payer: Cash Price |
$265.20
|
| Rate for Payer: Cash Price |
$265.20
|
| Rate for Payer: Cash Price |
$265.20
|
| Rate for Payer: Cigna Commercial |
$813.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,802.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,546.14
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,802.48
|
| Rate for Payer: Health EOS Commercial |
$786.76
|
| Rate for Payer: HFN Commercial |
$813.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,705.23
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,802.48
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,802.48
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,802.48
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,802.48
|
| Rate for Payer: Multiplan Commercial |
$707.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,703.72
|
| Rate for Payer: Preferred Network Access Commercial |
$813.28
|
| Rate for Payer: Quartz Beloit One Network |
$433.16
|
| Rate for Payer: Quartz Commercial |
$574.60
|
| Rate for Payer: Quartz Medicare Advantage |
$1,802.48
|
| Rate for Payer: The Alliance Commercial |
$7,358.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,802.48
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$486.20
|
| Rate for Payer: Wellcare Medicare |
$1,802.48
|
| Rate for Payer: WPS Commercial |
$654.78
|
|
|
ED Destruction Of Lesions; Vulva, Complex
|
Facility
IP
|
$884.00
|
|
|
Service Code
|
CPT 56515
|
| Hospital Charge Code |
6174392
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$433.16 |
| Max. Negotiated Rate |
$813.28 |
| Rate for Payer: Aetna Commercial |
$795.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$468.52
|
| Rate for Payer: Cash Price |
$265.20
|
| Rate for Payer: Cigna Commercial |
$813.28
|
| Rate for Payer: Health EOS Commercial |
$786.76
|
| Rate for Payer: HFN Commercial |
$813.28
|
| Rate for Payer: Multiplan Commercial |
$707.20
|
| Rate for Payer: NAPHCARE Commercial |
$530.40
|
| Rate for Payer: Preferred Network Access Commercial |
$813.28
|
| Rate for Payer: Quartz Beloit One Network |
$433.16
|
| Rate for Payer: Quartz Commercial |
$530.40
|
| Rate for Payer: WEA Trust Commercial |
$486.20
|
| Rate for Payer: WPS Commercial |
$654.78
|
|
|
ED Destruction Of Lesions; Vulva, Simple
|
Facility
IP
|
$578.00
|
|
|
Service Code
|
CPT 56501
|
| Hospital Charge Code |
6174391
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$283.22 |
| Max. Negotiated Rate |
$531.76 |
| Rate for Payer: Aetna Commercial |
$520.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$306.34
|
| Rate for Payer: Cash Price |
$173.40
|
| Rate for Payer: Cigna Commercial |
$531.76
|
| Rate for Payer: Health EOS Commercial |
$514.42
|
| Rate for Payer: HFN Commercial |
$531.76
|
| Rate for Payer: Multiplan Commercial |
$462.40
|
| Rate for Payer: NAPHCARE Commercial |
$346.80
|
| Rate for Payer: Preferred Network Access Commercial |
$531.76
|
| Rate for Payer: Quartz Beloit One Network |
$283.22
|
| Rate for Payer: Quartz Commercial |
$346.80
|
| Rate for Payer: WEA Trust Commercial |
$317.90
|
| Rate for Payer: WPS Commercial |
$428.12
|
|
|
ED Destruction Of Lesions; Vulva, Simple
|
Facility
OP
|
$578.00
|
|
|
Service Code
|
CPT 56501
|
| Hospital Charge Code |
6174391
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$277.44 |
| Max. Negotiated Rate |
$7,358.52 |
| Rate for Payer: Aetna Commercial |
$520.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$497.08
|
| Rate for Payer: Aetna Managed Medicare |
$1,802.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$375.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$289.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$277.44
|
| Rate for Payer: Anthem Medicare Advantage |
$1,802.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$306.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,802.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,802.48
|
| Rate for Payer: Cash Price |
$173.40
|
| Rate for Payer: Cash Price |
$173.40
|
| Rate for Payer: Cash Price |
$173.40
|
| Rate for Payer: Cigna Commercial |
$531.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,802.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,802.48
|
| Rate for Payer: Health EOS Commercial |
$514.42
|
| Rate for Payer: HFN Commercial |
$531.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,705.23
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,802.48
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,802.48
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,802.48
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,802.48
|
| Rate for Payer: Multiplan Commercial |
$462.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,703.72
|
| Rate for Payer: Preferred Network Access Commercial |
$531.76
|
| Rate for Payer: Quartz Beloit One Network |
$283.22
|
| Rate for Payer: Quartz Commercial |
$375.70
|
| Rate for Payer: Quartz Medicare Advantage |
$1,802.48
|
| Rate for Payer: The Alliance Commercial |
$7,358.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,802.48
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$317.90
|
| Rate for Payer: Wellcare Medicare |
$1,802.48
|
| Rate for Payer: WPS Commercial |
$428.12
|
|
|
ED Destruction Of Precancerous Lesion
|
Facility
OP
|
$201.00
|
|
|
Service Code
|
CPT 17000
|
| Hospital Charge Code |
6173179
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$96.48 |
| Max. Negotiated Rate |
$4,218.22 |
| Rate for Payer: Aetna Commercial |
$180.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$172.86
|
| Rate for Payer: Aetna Managed Medicare |
$197.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$130.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$100.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$96.48
|
| Rate for Payer: Anthem Medicare Advantage |
$197.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$106.53
|
| 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 |
$60.30
|
| Rate for Payer: Cash Price |
$60.30
|
| Rate for Payer: Cash Price |
$60.30
|
| Rate for Payer: Cigna Commercial |
$184.92
|
| 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 |
$178.89
|
| Rate for Payer: HFN Commercial |
$184.92
|
| 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 |
$160.80
|
| Rate for Payer: NAPHCARE Commercial |
$296.82
|
| Rate for Payer: Preferred Network Access Commercial |
$184.92
|
| Rate for Payer: Quartz Beloit One Network |
$98.49
|
| Rate for Payer: Quartz Commercial |
$130.65
|
| 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 |
$110.55
|
| Rate for Payer: Wellcare Medicare |
$197.88
|
| Rate for Payer: WPS Commercial |
$148.88
|
|
|
ED Destruction Of Precancerous Lesion
|
Facility
IP
|
$201.00
|
|
|
Service Code
|
CPT 17000
|
| Hospital Charge Code |
6173179
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$98.49 |
| Max. Negotiated Rate |
$184.92 |
| Rate for Payer: Aetna Commercial |
$180.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$106.53
|
| Rate for Payer: Cash Price |
$60.30
|
| Rate for Payer: Cigna Commercial |
$184.92
|
| Rate for Payer: Health EOS Commercial |
$178.89
|
| Rate for Payer: HFN Commercial |
$184.92
|
| Rate for Payer: Multiplan Commercial |
$160.80
|
| Rate for Payer: NAPHCARE Commercial |
$120.60
|
| Rate for Payer: Preferred Network Access Commercial |
$184.92
|
| Rate for Payer: Quartz Beloit One Network |
$98.49
|
| Rate for Payer: Quartz Commercial |
$120.60
|
| Rate for Payer: WEA Trust Commercial |
$110.55
|
| Rate for Payer: WPS Commercial |
$148.88
|
|
|
ED Destruction of precancerous lesions; 15 or more lesions
|
Facility
IP
|
$152.00
|
|
|
Service Code
|
CPT 17111
|
| Hospital Charge Code |
6173181
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$74.48 |
| Max. Negotiated Rate |
$139.84 |
| Rate for Payer: Aetna Commercial |
$136.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$80.56
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Cigna Commercial |
$139.84
|
| Rate for Payer: Health EOS Commercial |
$135.28
|
| Rate for Payer: HFN Commercial |
$139.84
|
| Rate for Payer: Multiplan Commercial |
$121.60
|
| Rate for Payer: NAPHCARE Commercial |
$91.20
|
| Rate for Payer: Preferred Network Access Commercial |
$139.84
|
| Rate for Payer: Quartz Beloit One Network |
$74.48
|
| Rate for Payer: Quartz Commercial |
$91.20
|
| Rate for Payer: WEA Trust Commercial |
$83.60
|
| Rate for Payer: WPS Commercial |
$112.59
|
|
|
ED Destruction of precancerous lesions; 15 or more lesions
|
Facility
OP
|
$152.00
|
|
|
Service Code
|
CPT 17111
|
| Hospital Charge Code |
6173181
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$72.96 |
| Max. Negotiated Rate |
$4,218.22 |
| Rate for Payer: Aetna Commercial |
$136.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$130.72
|
| Rate for Payer: Aetna Managed Medicare |
$197.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$98.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$76.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$72.96
|
| Rate for Payer: Anthem Medicare Advantage |
$197.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$80.56
|
| 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 |
$45.60
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Cigna Commercial |
$139.84
|
| 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 |
$135.28
|
| Rate for Payer: HFN Commercial |
$139.84
|
| 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 |
$121.60
|
| Rate for Payer: NAPHCARE Commercial |
$296.82
|
| Rate for Payer: Preferred Network Access Commercial |
$139.84
|
| Rate for Payer: Quartz Beloit One Network |
$74.48
|
| Rate for Payer: Quartz Commercial |
$98.80
|
| 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 |
$83.60
|
| Rate for Payer: Wellcare Medicare |
$197.88
|
| Rate for Payer: WPS Commercial |
$112.59
|
|
|
ED Destruction of precancerous lesions; 2-14 lesions
|
Facility
OP
|
$36.00
|
|
|
Service Code
|
CPT 17003
|
| Hospital Charge Code |
6173180
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$10.08 |
| Max. Negotiated Rate |
$4,218.22 |
| Rate for Payer: Aetna Commercial |
$32.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$30.96
|
| Rate for Payer: Aetna Managed Medicare |
$10.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$23.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$18.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$17.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$19.08
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cigna Commercial |
$33.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Health EOS Commercial |
$32.04
|
| Rate for Payer: HFN Commercial |
$33.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$27.00
|
| Rate for Payer: Multiplan Commercial |
$28.80
|
| Rate for Payer: NAPHCARE Commercial |
$21.60
|
| Rate for Payer: Preferred Network Access Commercial |
$33.12
|
| Rate for Payer: Quartz Beloit One Network |
$17.64
|
| Rate for Payer: Quartz Commercial |
$23.40
|
| Rate for Payer: Quartz Medicare Advantage |
$21.60
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$19.80
|
| Rate for Payer: WPS Commercial |
$26.67
|
|
|
ED Destruction of precancerous lesions; 2-14 lesions
|
Facility
IP
|
$36.00
|
|
|
Service Code
|
CPT 17003
|
| Hospital Charge Code |
6173180
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$17.64 |
| Max. Negotiated Rate |
$33.12 |
| Rate for Payer: Aetna Commercial |
$32.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$19.08
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cigna Commercial |
$33.12
|
| Rate for Payer: Health EOS Commercial |
$32.04
|
| Rate for Payer: HFN Commercial |
$33.12
|
| Rate for Payer: Multiplan Commercial |
$28.80
|
| Rate for Payer: NAPHCARE Commercial |
$21.60
|
| Rate for Payer: Preferred Network Access Commercial |
$33.12
|
| Rate for Payer: Quartz Beloit One Network |
$17.64
|
| Rate for Payer: Quartz Commercial |
$21.60
|
| Rate for Payer: WEA Trust Commercial |
$19.80
|
| Rate for Payer: WPS Commercial |
$26.67
|
|
|
ED Dilation Of Cervical Canal
|
Facility
OP
|
$113.00
|
|
|
Service Code
|
CPT 57800
|
| Hospital Charge Code |
6174406
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$54.24 |
| Max. Negotiated Rate |
$15,495.60 |
| Rate for Payer: Aetna Commercial |
$101.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$97.18
|
| Rate for Payer: Aetna Managed Medicare |
$3,090.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$73.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$56.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$54.24
|
| Rate for Payer: Anthem Medicare Advantage |
$3,090.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$59.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,090.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,090.12
|
| Rate for Payer: Cash Price |
$33.90
|
| Rate for Payer: Cash Price |
$33.90
|
| Rate for Payer: Cash Price |
$33.90
|
| Rate for Payer: Cigna Commercial |
$103.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,090.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,090.12
|
| Rate for Payer: Health EOS Commercial |
$100.57
|
| Rate for Payer: HFN Commercial |
$103.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,495.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,090.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,090.12
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,090.12
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,090.12
|
| Rate for Payer: Multiplan Commercial |
$90.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,635.18
|
| Rate for Payer: Preferred Network Access Commercial |
$103.96
|
| Rate for Payer: Quartz Beloit One Network |
$55.37
|
| Rate for Payer: Quartz Commercial |
$73.45
|
| Rate for Payer: Quartz Medicare Advantage |
$3,090.12
|
| Rate for Payer: The Alliance Commercial |
$15,495.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,090.12
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$62.15
|
| Rate for Payer: Wellcare Medicare |
$3,090.12
|
| Rate for Payer: WPS Commercial |
$83.70
|
|
|
ED Dilation Of Cervical Canal
|
Facility
IP
|
$113.00
|
|
|
Service Code
|
CPT 57800
|
| Hospital Charge Code |
6174406
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$55.37 |
| Max. Negotiated Rate |
$103.96 |
| Rate for Payer: Aetna Commercial |
$101.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$59.89
|
| Rate for Payer: Cash Price |
$33.90
|
| Rate for Payer: Cigna Commercial |
$103.96
|
| Rate for Payer: Health EOS Commercial |
$100.57
|
| Rate for Payer: HFN Commercial |
$103.96
|
| Rate for Payer: Multiplan Commercial |
$90.40
|
| Rate for Payer: NAPHCARE Commercial |
$67.80
|
| Rate for Payer: Preferred Network Access Commercial |
$103.96
|
| Rate for Payer: Quartz Beloit One Network |
$55.37
|
| Rate for Payer: Quartz Commercial |
$67.80
|
| Rate for Payer: WEA Trust Commercial |
$62.15
|
| Rate for Payer: WPS Commercial |
$83.70
|
|
|
ED Dilation of Female Urethra, Initial
|
Facility
IP
|
$163.00
|
|
|
Service Code
|
CPT 53660
|
| Hospital Charge Code |
6174102
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$79.87 |
| Max. Negotiated Rate |
$149.96 |
| Rate for Payer: Aetna Commercial |
$146.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$86.39
|
| Rate for Payer: Cash Price |
$48.90
|
| Rate for Payer: Cigna Commercial |
$149.96
|
| Rate for Payer: Health EOS Commercial |
$145.07
|
| Rate for Payer: HFN Commercial |
$149.96
|
| Rate for Payer: Multiplan Commercial |
$130.40
|
| Rate for Payer: NAPHCARE Commercial |
$97.80
|
| Rate for Payer: Preferred Network Access Commercial |
$149.96
|
| Rate for Payer: Quartz Beloit One Network |
$79.87
|
| Rate for Payer: Quartz Commercial |
$97.80
|
| Rate for Payer: WEA Trust Commercial |
$89.65
|
| Rate for Payer: WPS Commercial |
$120.73
|
|
|
ED Dilation of Female Urethra, Initial
|
Facility
OP
|
$163.00
|
|
|
Service Code
|
CPT 53660
|
| Hospital Charge Code |
6174102
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$78.24 |
| Max. Negotiated Rate |
$21,990.36 |
| Rate for Payer: Aetna Commercial |
$146.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$140.18
|
| Rate for Payer: Aetna Managed Medicare |
$154.39
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$105.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$81.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$78.24
|
| Rate for Payer: Anthem Medicare Advantage |
$154.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$86.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$154.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$154.39
|
| Rate for Payer: Cash Price |
$48.90
|
| Rate for Payer: Cash Price |
$48.90
|
| Rate for Payer: Cash Price |
$48.90
|
| Rate for Payer: Cigna Commercial |
$149.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$154.39
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$154.39
|
| Rate for Payer: Health EOS Commercial |
$145.07
|
| Rate for Payer: HFN Commercial |
$149.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$574.33
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$154.39
|
| Rate for Payer: Independent Care Health Plan Medicare |
$154.39
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$154.39
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$154.39
|
| Rate for Payer: Multiplan Commercial |
$130.40
|
| Rate for Payer: NAPHCARE Commercial |
$231.58
|
| Rate for Payer: Preferred Network Access Commercial |
$149.96
|
| Rate for Payer: Quartz Beloit One Network |
$79.87
|
| Rate for Payer: Quartz Commercial |
$105.95
|
| Rate for Payer: Quartz Medicare Advantage |
$154.39
|
| Rate for Payer: The Alliance Commercial |
$21,990.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$154.39
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$89.65
|
| Rate for Payer: Wellcare Medicare |
$154.39
|
| Rate for Payer: WPS Commercial |
$120.73
|
|
|
ED Dilation of Female Urethra, Subsequent
|
Facility
IP
|
$154.00
|
|
|
Service Code
|
CPT 53661
|
| Hospital Charge Code |
6174103
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$75.46 |
| Max. Negotiated Rate |
$141.68 |
| Rate for Payer: Aetna Commercial |
$138.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$81.62
|
| Rate for Payer: Cash Price |
$46.20
|
| Rate for Payer: Cigna Commercial |
$141.68
|
| Rate for Payer: Health EOS Commercial |
$137.06
|
| Rate for Payer: HFN Commercial |
$141.68
|
| Rate for Payer: Multiplan Commercial |
$123.20
|
| Rate for Payer: NAPHCARE Commercial |
$92.40
|
| Rate for Payer: Preferred Network Access Commercial |
$141.68
|
| Rate for Payer: Quartz Beloit One Network |
$75.46
|
| Rate for Payer: Quartz Commercial |
$92.40
|
| Rate for Payer: WEA Trust Commercial |
$84.70
|
| Rate for Payer: WPS Commercial |
$114.07
|
|
|
ED Dilation of Female Urethra, Subsequent
|
Facility
OP
|
$154.00
|
|
|
Service Code
|
CPT 53661
|
| Hospital Charge Code |
6174103
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$73.92 |
| Max. Negotiated Rate |
$28,799.20 |
| Rate for Payer: Aetna Commercial |
$138.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$132.44
|
| Rate for Payer: Aetna Managed Medicare |
$126.26
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$100.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$77.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$73.92
|
| Rate for Payer: Anthem Medicare Advantage |
$126.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$81.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$126.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$126.26
|
| Rate for Payer: Cash Price |
$46.20
|
| Rate for Payer: Cash Price |
$46.20
|
| Rate for Payer: Cash Price |
$46.20
|
| Rate for Payer: Cigna Commercial |
$141.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$126.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$126.26
|
| Rate for Payer: Health EOS Commercial |
$137.06
|
| Rate for Payer: HFN Commercial |
$141.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$469.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$126.26
|
| Rate for Payer: Independent Care Health Plan Medicare |
$126.26
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$126.26
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$126.26
|
| Rate for Payer: Multiplan Commercial |
$123.20
|
| Rate for Payer: NAPHCARE Commercial |
$189.39
|
| Rate for Payer: Preferred Network Access Commercial |
$141.68
|
| Rate for Payer: Quartz Beloit One Network |
$75.46
|
| Rate for Payer: Quartz Commercial |
$100.10
|
| Rate for Payer: Quartz Medicare Advantage |
$126.26
|
| Rate for Payer: The Alliance Commercial |
$28,799.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$126.26
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$84.70
|
| Rate for Payer: Wellcare Medicare |
$126.26
|
| Rate for Payer: WPS Commercial |
$114.07
|
|
|
ED Dilation Of Lacrimal Punctum
|
Facility
IP
|
$523.00
|
|
|
Service Code
|
CPT 68801
|
| Hospital Charge Code |
6174438
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$256.27 |
| Max. Negotiated Rate |
$481.16 |
| Rate for Payer: Aetna Commercial |
$470.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$277.19
|
| Rate for Payer: Cash Price |
$156.90
|
| Rate for Payer: Cigna Commercial |
$481.16
|
| Rate for Payer: Health EOS Commercial |
$465.47
|
| Rate for Payer: HFN Commercial |
$481.16
|
| Rate for Payer: Multiplan Commercial |
$418.40
|
| Rate for Payer: NAPHCARE Commercial |
$313.80
|
| Rate for Payer: Preferred Network Access Commercial |
$481.16
|
| Rate for Payer: Quartz Beloit One Network |
$256.27
|
| Rate for Payer: Quartz Commercial |
$313.80
|
| Rate for Payer: WEA Trust Commercial |
$287.65
|
| Rate for Payer: WPS Commercial |
$387.39
|
|
|
ED Dilation Of Lacrimal Punctum
|
Facility
OP
|
$523.00
|
|
|
Service Code
|
CPT 68801
|
| Hospital Charge Code |
6174438
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$251.04 |
| Max. Negotiated Rate |
$4,218.22 |
| Rate for Payer: Aetna Commercial |
$470.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$449.78
|
| Rate for Payer: Aetna Managed Medicare |
$393.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$339.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$261.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$251.04
|
| Rate for Payer: Anthem Medicare Advantage |
$393.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$277.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$393.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$393.82
|
| Rate for Payer: Cash Price |
$156.90
|
| Rate for Payer: Cash Price |
$156.90
|
| Rate for Payer: Cash Price |
$156.90
|
| Rate for Payer: Cigna Commercial |
$481.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$393.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$393.82
|
| Rate for Payer: Health EOS Commercial |
$465.47
|
| Rate for Payer: HFN Commercial |
$481.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,465.01
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$393.82
|
| Rate for Payer: Independent Care Health Plan Medicare |
$393.82
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$393.82
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$393.82
|
| Rate for Payer: Multiplan Commercial |
$418.40
|
| Rate for Payer: NAPHCARE Commercial |
$590.73
|
| Rate for Payer: Preferred Network Access Commercial |
$481.16
|
| Rate for Payer: Quartz Beloit One Network |
$256.27
|
| Rate for Payer: Quartz Commercial |
$339.95
|
| Rate for Payer: Quartz Medicare Advantage |
$393.82
|
| Rate for Payer: The Alliance Commercial |
$1,867.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$393.82
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$287.65
|
| Rate for Payer: Wellcare Medicare |
$393.82
|
| Rate for Payer: WPS Commercial |
$387.39
|
|
|
ED Dilation of Urethral Stricture by Passage of Sound or Urethral Dilator, Male Initial
|
Facility
IP
|
$164.00
|
|
|
Service Code
|
CPT 53600
|
| Hospital Charge Code |
6174100
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$80.36 |
| Max. Negotiated Rate |
$150.88 |
| Rate for Payer: Aetna Commercial |
$147.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$86.92
|
| Rate for Payer: Cash Price |
$49.20
|
| Rate for Payer: Cigna Commercial |
$150.88
|
| Rate for Payer: Health EOS Commercial |
$145.96
|
| Rate for Payer: HFN Commercial |
$150.88
|
| Rate for Payer: Multiplan Commercial |
$131.20
|
| Rate for Payer: NAPHCARE Commercial |
$98.40
|
| Rate for Payer: Preferred Network Access Commercial |
$150.88
|
| Rate for Payer: Quartz Beloit One Network |
$80.36
|
| Rate for Payer: Quartz Commercial |
$98.40
|
| Rate for Payer: WEA Trust Commercial |
$90.20
|
| Rate for Payer: WPS Commercial |
$121.47
|
|
