|
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 |
$155.43 |
| Max. Negotiated Rate |
$291.82 |
| Rate for Payer: Aetna Commercial |
$285.48
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$272.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$168.12
|
| Rate for Payer: Cash Price |
$91.50
|
| Rate for Payer: Cigna Commercial |
$291.82
|
| Rate for Payer: Health EOS Commercial |
$282.31
|
| Rate for Payer: HFN Commercial |
$291.82
|
| Rate for Payer: Multiplan Commercial |
$253.76
|
| Rate for Payer: Preferred Network Access Commercial |
$291.82
|
| Rate for Payer: Quartz Beloit One Network |
$155.43
|
| Rate for Payer: Quartz Commercial |
$190.32
|
| Rate for Payer: WEA Trust Commercial |
$174.46
|
| Rate for Payer: WPS Commercial |
$234.94
|
|
|
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 |
$64.21 |
| Max. Negotiated Rate |
$120.56 |
| Rate for Payer: Aetna Commercial |
$117.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$112.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$69.45
|
| Rate for Payer: Cash Price |
$37.80
|
| Rate for Payer: Cigna Commercial |
$120.56
|
| Rate for Payer: Health EOS Commercial |
$116.63
|
| Rate for Payer: HFN Commercial |
$120.56
|
| Rate for Payer: Multiplan Commercial |
$104.83
|
| Rate for Payer: Preferred Network Access Commercial |
$120.56
|
| Rate for Payer: Quartz Beloit One Network |
$64.21
|
| Rate for Payer: Quartz Commercial |
$78.62
|
| Rate for Payer: WEA Trust Commercial |
$72.07
|
| Rate for Payer: WPS Commercial |
$97.06
|
|
|
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 |
$62.90 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$117.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$112.69
|
| Rate for Payer: Aetna Managed Medicare |
$211.14
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$85.18
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$65.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$62.90
|
| Rate for Payer: Anthem Medicare Advantage |
$211.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$69.45
|
| 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: Cash Price |
$37.80
|
| Rate for Payer: Cash Price |
$37.80
|
| Rate for Payer: Cash Price |
$37.80
|
| Rate for Payer: Cigna Commercial |
$120.56
|
| 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: Health EOS Commercial |
$116.63
|
| Rate for Payer: HFN Commercial |
$120.56
|
| 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: Multiplan Commercial |
$104.83
|
| Rate for Payer: NAPHCARE Commercial |
$316.71
|
| Rate for Payer: Preferred Network Access Commercial |
$120.56
|
| Rate for Payer: Quartz Beloit One Network |
$64.21
|
| Rate for Payer: Quartz Commercial |
$85.18
|
| 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 |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$72.07
|
| Rate for Payer: Wellcare Medicare |
$211.14
|
| Rate for Payer: WPS Commercial |
$97.06
|
|
|
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 |
$83.95 |
| Max. Negotiated Rate |
$418.12 |
| Rate for Payer: Aetna Commercial |
$409.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$390.85
|
| Rate for Payer: Aetna Managed Medicare |
$127.25
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$295.41
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$227.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$218.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$240.87
|
| Rate for Payer: Cash Price |
$131.10
|
| Rate for Payer: Cash Price |
$131.10
|
| Rate for Payer: Cash Price |
$131.10
|
| Rate for Payer: Cigna Commercial |
$418.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$254.33
|
| Rate for Payer: Health EOS Commercial |
$404.49
|
| Rate for Payer: HFN Commercial |
$418.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$340.86
|
| Rate for Payer: Multiplan Commercial |
$363.58
|
| Rate for Payer: NAPHCARE Commercial |
$272.69
|
| Rate for Payer: Preferred Network Access Commercial |
$418.12
|
| Rate for Payer: Quartz Beloit One Network |
$222.70
|
| Rate for Payer: Quartz Commercial |
$295.41
|
| Rate for Payer: Quartz Medicare Advantage |
$272.69
|
| Rate for Payer: The Alliance Commercial |
$83.95
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$249.96
|
| Rate for Payer: WPS Commercial |
$336.62
|
|
|
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 |
$222.70 |
| Max. Negotiated Rate |
$418.12 |
| Rate for Payer: Aetna Commercial |
$409.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$390.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$240.87
|
| Rate for Payer: Cash Price |
$131.10
|
| Rate for Payer: Cigna Commercial |
$418.12
|
| Rate for Payer: Health EOS Commercial |
$404.49
|
| Rate for Payer: HFN Commercial |
$418.12
|
| Rate for Payer: Multiplan Commercial |
$363.58
|
| Rate for Payer: Preferred Network Access Commercial |
$418.12
|
| Rate for Payer: Quartz Beloit One Network |
$222.70
|
| Rate for Payer: Quartz Commercial |
$272.69
|
| Rate for Payer: WEA Trust Commercial |
$249.96
|
| Rate for Payer: WPS Commercial |
$336.62
|
|
|
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 |
$23.96 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$44.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$42.93
|
| Rate for Payer: Aetna Managed Medicare |
$347.61
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$32.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$24.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$23.96
|
| Rate for Payer: Anthem Medicare Advantage |
$347.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$26.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$347.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$347.61
|
| 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 |
$45.93
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$347.61
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$347.61
|
| Rate for Payer: Health EOS Commercial |
$44.43
|
| Rate for Payer: HFN Commercial |
$45.93
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,293.11
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$347.61
|
| Rate for Payer: Independent Care Health Plan Medicare |
$347.61
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$347.61
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$347.61
|
| Rate for Payer: Multiplan Commercial |
$39.94
|
| Rate for Payer: NAPHCARE Commercial |
$521.41
|
| Rate for Payer: Preferred Network Access Commercial |
$45.93
|
| Rate for Payer: Quartz Beloit One Network |
$24.46
|
| Rate for Payer: Quartz Commercial |
$32.45
|
| Rate for Payer: Quartz Medicare Advantage |
$347.61
|
| Rate for Payer: The Alliance Commercial |
$1,390.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$347.61
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$27.46
|
| Rate for Payer: Wellcare Medicare |
$347.61
|
| Rate for Payer: WPS Commercial |
$36.97
|
|
|
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 |
$24.46 |
| Max. Negotiated Rate |
$45.93 |
| Rate for Payer: Aetna Commercial |
$44.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$42.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$26.46
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cigna Commercial |
$45.93
|
| Rate for Payer: Health EOS Commercial |
$44.43
|
| Rate for Payer: HFN Commercial |
$45.93
|
| Rate for Payer: Multiplan Commercial |
$39.94
|
| Rate for Payer: Preferred Network Access Commercial |
$45.93
|
| Rate for Payer: Quartz Beloit One Network |
$24.46
|
| Rate for Payer: Quartz Commercial |
$29.95
|
| Rate for Payer: WEA Trust Commercial |
$27.46
|
| Rate for Payer: WPS Commercial |
$36.97
|
|
|
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 |
$322.58 |
| Max. Negotiated Rate |
$605.65 |
| Rate for Payer: Aetna Commercial |
$592.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$566.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$348.91
|
| Rate for Payer: Cash Price |
$189.90
|
| Rate for Payer: Cigna Commercial |
$605.65
|
| Rate for Payer: Health EOS Commercial |
$585.90
|
| Rate for Payer: HFN Commercial |
$605.65
|
| Rate for Payer: Multiplan Commercial |
$526.66
|
| Rate for Payer: Preferred Network Access Commercial |
$605.65
|
| Rate for Payer: Quartz Beloit One Network |
$322.58
|
| Rate for Payer: Quartz Commercial |
$394.99
|
| Rate for Payer: WEA Trust Commercial |
$362.08
|
| Rate for Payer: WPS Commercial |
$487.60
|
|
|
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 |
$313.04 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$592.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$566.16
|
| Rate for Payer: Aetna Managed Medicare |
$930.81
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$427.91
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$329.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$315.99
|
| Rate for Payer: Anthem Medicare Advantage |
$930.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$348.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$930.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$930.81
|
| 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 |
$605.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$930.81
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$930.81
|
| Rate for Payer: Health EOS Commercial |
$585.90
|
| Rate for Payer: HFN Commercial |
$605.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,462.61
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$930.81
|
| Rate for Payer: Independent Care Health Plan Medicare |
$930.81
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$930.81
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$930.81
|
| Rate for Payer: Multiplan Commercial |
$526.66
|
| Rate for Payer: NAPHCARE Commercial |
$1,396.22
|
| Rate for Payer: Preferred Network Access Commercial |
$605.65
|
| Rate for Payer: Quartz Beloit One Network |
$322.58
|
| Rate for Payer: Quartz Commercial |
$427.91
|
| Rate for Payer: Quartz Medicare Advantage |
$930.81
|
| Rate for Payer: The Alliance Commercial |
$3,723.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$930.81
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$362.08
|
| Rate for Payer: Wellcare Medicare |
$930.81
|
| Rate for Payer: WPS Commercial |
$487.60
|
|
|
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 |
$69.39 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$130.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$124.32
|
| Rate for Payer: Aetna Managed Medicare |
$211.14
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$93.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$72.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$69.39
|
| Rate for Payer: Anthem Medicare Advantage |
$211.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$76.62
|
| 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: Cash Price |
$41.70
|
| Rate for Payer: Cash Price |
$41.70
|
| Rate for Payer: Cash Price |
$41.70
|
| Rate for Payer: Cigna Commercial |
$133.00
|
| 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: Health EOS Commercial |
$128.66
|
| Rate for Payer: HFN Commercial |
$133.00
|
| 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: Multiplan Commercial |
$115.65
|
| Rate for Payer: NAPHCARE Commercial |
$316.71
|
| Rate for Payer: Preferred Network Access Commercial |
$133.00
|
| Rate for Payer: Quartz Beloit One Network |
$70.83
|
| Rate for Payer: Quartz Commercial |
$93.96
|
| 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 |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$79.51
|
| Rate for Payer: Wellcare Medicare |
$211.14
|
| Rate for Payer: WPS Commercial |
$107.07
|
|
|
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 |
$70.83 |
| Max. Negotiated Rate |
$133.00 |
| Rate for Payer: Aetna Commercial |
$130.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$124.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$76.62
|
| Rate for Payer: Cash Price |
$41.70
|
| Rate for Payer: Cigna Commercial |
$133.00
|
| Rate for Payer: Health EOS Commercial |
$128.66
|
| Rate for Payer: HFN Commercial |
$133.00
|
| Rate for Payer: Multiplan Commercial |
$115.65
|
| Rate for Payer: Preferred Network Access Commercial |
$133.00
|
| Rate for Payer: Quartz Beloit One Network |
$70.83
|
| Rate for Payer: Quartz Commercial |
$86.74
|
| Rate for Payer: WEA Trust Commercial |
$79.51
|
| Rate for Payer: WPS Commercial |
$107.07
|
|
|
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 |
$239.00 |
| Max. Negotiated Rate |
$448.74 |
| Rate for Payer: Aetna Commercial |
$438.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$419.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$258.51
|
| Rate for Payer: Cash Price |
$140.70
|
| Rate for Payer: Cigna Commercial |
$448.74
|
| Rate for Payer: Health EOS Commercial |
$434.11
|
| Rate for Payer: HFN Commercial |
$448.74
|
| Rate for Payer: Multiplan Commercial |
$390.21
|
| Rate for Payer: Preferred Network Access Commercial |
$448.74
|
| Rate for Payer: Quartz Beloit One Network |
$239.00
|
| Rate for Payer: Quartz Commercial |
$292.66
|
| Rate for Payer: WEA Trust Commercial |
$268.27
|
| Rate for Payer: WPS Commercial |
$361.27
|
|
|
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 |
$234.12 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$438.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$419.47
|
| Rate for Payer: Aetna Managed Medicare |
$427.81
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$317.04
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$243.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$234.12
|
| Rate for Payer: Anthem Medicare Advantage |
$427.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$258.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$427.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$427.81
|
| 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 |
$448.74
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$427.81
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$427.81
|
| Rate for Payer: Health EOS Commercial |
$434.11
|
| Rate for Payer: HFN Commercial |
$448.74
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,591.47
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$427.81
|
| Rate for Payer: Independent Care Health Plan Medicare |
$427.81
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$427.81
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$427.81
|
| Rate for Payer: Multiplan Commercial |
$390.21
|
| Rate for Payer: NAPHCARE Commercial |
$641.72
|
| Rate for Payer: Preferred Network Access Commercial |
$448.74
|
| Rate for Payer: Quartz Beloit One Network |
$239.00
|
| Rate for Payer: Quartz Commercial |
$317.04
|
| Rate for Payer: Quartz Medicare Advantage |
$427.81
|
| Rate for Payer: The Alliance Commercial |
$1,711.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$427.81
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$268.27
|
| Rate for Payer: Wellcare Medicare |
$427.81
|
| Rate for Payer: WPS Commercial |
$361.27
|
|
|
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 |
$226.64 |
| Max. Negotiated Rate |
$5,037.34 |
| Rate for Payer: Aetna Commercial |
$424.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$406.06
|
| Rate for Payer: Aetna Managed Medicare |
$1,259.34
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$306.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$236.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$226.64
|
| Rate for Payer: Anthem Medicare Advantage |
$1,259.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$250.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,259.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,259.34
|
| 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 |
$434.39
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,259.34
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,259.34
|
| Rate for Payer: Health EOS Commercial |
$420.22
|
| Rate for Payer: HFN Commercial |
$434.39
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,684.73
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,259.34
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,259.34
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,259.34
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,259.34
|
| Rate for Payer: Multiplan Commercial |
$377.73
|
| Rate for Payer: NAPHCARE Commercial |
$1,889.00
|
| Rate for Payer: Preferred Network Access Commercial |
$434.39
|
| Rate for Payer: Quartz Beloit One Network |
$231.36
|
| Rate for Payer: Quartz Commercial |
$306.90
|
| Rate for Payer: Quartz Medicare Advantage |
$1,259.34
|
| Rate for Payer: The Alliance Commercial |
$5,037.34
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,259.34
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$259.69
|
| Rate for Payer: Wellcare Medicare |
$1,259.34
|
| Rate for Payer: WPS Commercial |
$349.72
|
|
|
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 |
$231.36 |
| Max. Negotiated Rate |
$434.39 |
| Rate for Payer: Aetna Commercial |
$424.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$406.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$250.24
|
| Rate for Payer: Cash Price |
$136.20
|
| Rate for Payer: Cigna Commercial |
$434.39
|
| Rate for Payer: Health EOS Commercial |
$420.22
|
| Rate for Payer: HFN Commercial |
$434.39
|
| Rate for Payer: Multiplan Commercial |
$377.73
|
| Rate for Payer: Preferred Network Access Commercial |
$434.39
|
| Rate for Payer: Quartz Beloit One Network |
$231.36
|
| Rate for Payer: Quartz Commercial |
$283.30
|
| Rate for Payer: WEA Trust Commercial |
$259.69
|
| Rate for Payer: WPS Commercial |
$349.72
|
|
|
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 |
$143.27 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$268.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$256.69
|
| Rate for Payer: Aetna Managed Medicare |
$427.81
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$194.01
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$149.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$143.27
|
| Rate for Payer: Anthem Medicare Advantage |
$427.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$158.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$427.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$427.81
|
| 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 |
$274.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$427.81
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$427.81
|
| Rate for Payer: Health EOS Commercial |
$265.65
|
| Rate for Payer: HFN Commercial |
$274.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,591.47
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$427.81
|
| Rate for Payer: Independent Care Health Plan Medicare |
$427.81
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$427.81
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$427.81
|
| Rate for Payer: Multiplan Commercial |
$238.78
|
| Rate for Payer: NAPHCARE Commercial |
$641.72
|
| Rate for Payer: Preferred Network Access Commercial |
$274.60
|
| Rate for Payer: Quartz Beloit One Network |
$146.26
|
| Rate for Payer: Quartz Commercial |
$194.01
|
| Rate for Payer: Quartz Medicare Advantage |
$427.81
|
| Rate for Payer: The Alliance Commercial |
$1,711.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$427.81
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$164.16
|
| Rate for Payer: Wellcare Medicare |
$427.81
|
| Rate for Payer: WPS Commercial |
$221.08
|
|
|
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 |
$146.26 |
| Max. Negotiated Rate |
$274.60 |
| Rate for Payer: Aetna Commercial |
$268.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$256.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$158.19
|
| Rate for Payer: Cash Price |
$86.10
|
| Rate for Payer: Cigna Commercial |
$274.60
|
| Rate for Payer: Health EOS Commercial |
$265.65
|
| Rate for Payer: HFN Commercial |
$274.60
|
| Rate for Payer: Multiplan Commercial |
$238.78
|
| Rate for Payer: Preferred Network Access Commercial |
$274.60
|
| Rate for Payer: Quartz Beloit One Network |
$146.26
|
| Rate for Payer: Quartz Commercial |
$179.09
|
| Rate for Payer: WEA Trust Commercial |
$164.16
|
| Rate for Payer: WPS Commercial |
$221.08
|
|
|
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 |
$184.48 |
| Max. Negotiated Rate |
$346.36 |
| Rate for Payer: Aetna Commercial |
$338.83
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$323.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$199.53
|
| Rate for Payer: Cash Price |
$108.60
|
| Rate for Payer: Cigna Commercial |
$346.36
|
| Rate for Payer: Health EOS Commercial |
$335.07
|
| Rate for Payer: HFN Commercial |
$346.36
|
| Rate for Payer: Multiplan Commercial |
$301.18
|
| Rate for Payer: Preferred Network Access Commercial |
$346.36
|
| Rate for Payer: Quartz Beloit One Network |
$184.48
|
| Rate for Payer: Quartz Commercial |
$225.89
|
| Rate for Payer: WEA Trust Commercial |
$207.06
|
| Rate for Payer: WPS Commercial |
$278.85
|
|
|
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 |
$180.71 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$338.83
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$323.77
|
| Rate for Payer: Aetna Managed Medicare |
$211.14
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$244.71
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$188.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$180.71
|
| Rate for Payer: Anthem Medicare Advantage |
$211.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$199.53
|
| 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: Cash Price |
$108.60
|
| Rate for Payer: Cash Price |
$108.60
|
| Rate for Payer: Cash Price |
$108.60
|
| Rate for Payer: Cigna Commercial |
$346.36
|
| 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: Health EOS Commercial |
$335.07
|
| Rate for Payer: HFN Commercial |
$346.36
|
| 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: Multiplan Commercial |
$301.18
|
| Rate for Payer: NAPHCARE Commercial |
$316.71
|
| Rate for Payer: Preferred Network Access Commercial |
$346.36
|
| Rate for Payer: Quartz Beloit One Network |
$184.48
|
| Rate for Payer: Quartz Commercial |
$244.71
|
| 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 |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$207.06
|
| Rate for Payer: Wellcare Medicare |
$211.14
|
| Rate for Payer: WPS Commercial |
$278.85
|
|
|
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 |
$214.54 |
| Max. Negotiated Rate |
$402.81 |
| Rate for Payer: Aetna Commercial |
$394.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$376.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$232.06
|
| Rate for Payer: Cash Price |
$126.30
|
| Rate for Payer: Cigna Commercial |
$402.81
|
| Rate for Payer: Health EOS Commercial |
$389.68
|
| Rate for Payer: HFN Commercial |
$402.81
|
| Rate for Payer: Multiplan Commercial |
$350.27
|
| Rate for Payer: Preferred Network Access Commercial |
$402.81
|
| Rate for Payer: Quartz Beloit One Network |
$214.54
|
| Rate for Payer: Quartz Commercial |
$262.70
|
| Rate for Payer: WEA Trust Commercial |
$240.81
|
| Rate for Payer: WPS Commercial |
$324.30
|
|
|
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 |
$210.16 |
| Max. Negotiated Rate |
$8,685.50 |
| Rate for Payer: Aetna Commercial |
$394.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$376.54
|
| Rate for Payer: Aetna Managed Medicare |
$2,171.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$284.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$218.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$210.16
|
| Rate for Payer: Anthem Medicare Advantage |
$2,171.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$232.06
|
| 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: Cash Price |
$126.30
|
| Rate for Payer: Cash Price |
$126.30
|
| Rate for Payer: Cash Price |
$126.30
|
| Rate for Payer: Cigna Commercial |
$402.81
|
| 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: Health EOS Commercial |
$389.68
|
| Rate for Payer: HFN Commercial |
$402.81
|
| 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: Multiplan Commercial |
$350.27
|
| Rate for Payer: NAPHCARE Commercial |
$3,257.06
|
| Rate for Payer: Preferred Network Access Commercial |
$402.81
|
| Rate for Payer: Quartz Beloit One Network |
$214.54
|
| Rate for Payer: Quartz Commercial |
$284.60
|
| 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 |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$240.81
|
| Rate for Payer: Wellcare Medicare |
$2,171.37
|
| Rate for Payer: WPS Commercial |
$324.30
|
|
|
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 |
$263.97 |
| Max. Negotiated Rate |
$495.62 |
| Rate for Payer: Cigna Commercial |
$495.62
|
| Rate for Payer: Aetna Commercial |
$484.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$463.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$285.52
|
| Rate for Payer: Cash Price |
$155.40
|
| Rate for Payer: Health EOS Commercial |
$479.46
|
| Rate for Payer: HFN Commercial |
$495.62
|
| Rate for Payer: Multiplan Commercial |
$430.98
|
| Rate for Payer: Preferred Network Access Commercial |
$495.62
|
| Rate for Payer: Quartz Beloit One Network |
$263.97
|
| Rate for Payer: Quartz Commercial |
$323.23
|
| Rate for Payer: WEA Trust Commercial |
$296.30
|
| Rate for Payer: WPS Commercial |
$399.02
|
|
|
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 |
$258.59 |
| Max. Negotiated Rate |
$8,685.50 |
| Rate for Payer: Aetna Commercial |
$484.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$463.30
|
| Rate for Payer: Aetna Managed Medicare |
$2,171.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$350.17
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$269.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$258.59
|
| Rate for Payer: Anthem Medicare Advantage |
$2,171.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$285.52
|
| 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: Cash Price |
$155.40
|
| Rate for Payer: Cash Price |
$155.40
|
| Rate for Payer: Cash Price |
$155.40
|
| Rate for Payer: Cigna Commercial |
$495.62
|
| 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: Health EOS Commercial |
$479.46
|
| Rate for Payer: HFN Commercial |
$495.62
|
| 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: Multiplan Commercial |
$430.98
|
| Rate for Payer: NAPHCARE Commercial |
$3,257.06
|
| Rate for Payer: Preferred Network Access Commercial |
$495.62
|
| Rate for Payer: Quartz Beloit One Network |
$263.97
|
| Rate for Payer: Quartz Commercial |
$350.17
|
| 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 |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$296.30
|
| Rate for Payer: Wellcare Medicare |
$2,171.37
|
| Rate for Payer: WPS Commercial |
$399.02
|
|
|
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 |
$211.14 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$411.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$393.54
|
| Rate for Payer: Aetna Managed Medicare |
$211.14
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$297.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$228.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$219.65
|
| Rate for Payer: Anthem Medicare Advantage |
$211.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$242.53
|
| 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: Cash Price |
$132.00
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cigna Commercial |
$420.99
|
| 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: Health EOS Commercial |
$407.26
|
| Rate for Payer: HFN Commercial |
$420.99
|
| 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: Multiplan Commercial |
$366.08
|
| Rate for Payer: NAPHCARE Commercial |
$316.71
|
| Rate for Payer: Preferred Network Access Commercial |
$420.99
|
| Rate for Payer: Quartz Beloit One Network |
$224.22
|
| Rate for Payer: Quartz Commercial |
$297.44
|
| 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 |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$251.68
|
| Rate for Payer: Wellcare Medicare |
$211.14
|
| Rate for Payer: WPS Commercial |
$338.93
|
|
|
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 |
$224.22 |
| Max. Negotiated Rate |
$420.99 |
| Rate for Payer: Aetna Commercial |
$411.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$393.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$242.53
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cigna Commercial |
$420.99
|
| Rate for Payer: Health EOS Commercial |
$407.26
|
| Rate for Payer: HFN Commercial |
$420.99
|
| Rate for Payer: Multiplan Commercial |
$366.08
|
| Rate for Payer: Preferred Network Access Commercial |
$420.99
|
| Rate for Payer: Quartz Beloit One Network |
$224.22
|
| Rate for Payer: Quartz Commercial |
$274.56
|
| Rate for Payer: WEA Trust Commercial |
$251.68
|
| Rate for Payer: WPS Commercial |
$338.93
|
|
