|
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: Aetna Gatekeeper/Not Gatekeeper |
$544.38
|
| 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 |
$4,218.22 |
| 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 |
$3,603.64
|
| 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
|
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: The Alliance Commercial |
$791.52
|
| 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 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: Aetna Gatekeeper/Not Gatekeeper |
$119.54
|
| 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 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: The Alliance Commercial |
$1,576.48
|
| 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 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: Aetna Gatekeeper/Not Gatekeeper |
$403.34
|
| 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 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 |
$4,665.56 |
| 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 |
$4,665.56
|
| 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: Aetna Gatekeeper/Not Gatekeeper |
$390.44
|
| 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
|
OP
|
$287.00
|
|
|
Service Code
|
CPT 54050
|
| Hospital Charge Code |
6174104
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$137.76 |
| Max. Negotiated Rate |
$4,218.22 |
| 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 |
$1,576.48
|
| 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 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: Aetna Gatekeeper/Not Gatekeeper |
$246.82
|
| 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 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: Aetna Gatekeeper/Not Gatekeeper |
$311.32
|
| 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 |
$4,218.22 |
| 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 |
$791.52
|
| 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
|
|
|
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: Aetna Gatekeeper/Not Gatekeeper |
$362.06
|
| 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 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 |
$7,209.92 |
| 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 |
$7,209.92
|
| 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 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: Aetna Gatekeeper/Not Gatekeeper |
$445.48
|
| 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 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 |
$7,209.92 |
| 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 |
$7,209.92
|
| 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 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 |
$791.52
|
| 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 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: Aetna Gatekeeper/Not Gatekeeper |
$378.40
|
| 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; 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 |
$7,209.92 |
| 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 |
$7,209.92
|
| 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: Aetna Gatekeeper/Not Gatekeeper |
$760.24
|
| 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: Aetna Gatekeeper/Not Gatekeeper |
$497.08
|
| 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 |
$7,209.92 |
| 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 |
$7,209.92
|
| 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: The Alliance Commercial |
$791.52
|
| 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: Aetna Gatekeeper/Not Gatekeeper |
$172.86
|
| 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: Aetna Gatekeeper/Not Gatekeeper |
$130.72
|
| 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
|
|
