|
Sezary Diagnostic Flow Cytometry
|
Facility
|
OP
|
$240.00
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
5364855
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$117.60 |
| Max. Negotiated Rate |
$1,421.12 |
| Rate for Payer: Aetna Commercial |
$216.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$206.40
|
| Rate for Payer: Aetna Managed Medicare |
$355.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,332.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$621.74
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$589.76
|
| Rate for Payer: Anthem Medicare Advantage |
$355.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$127.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$355.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$355.28
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cigna Commercial |
$220.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$355.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$134.30
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$355.28
|
| Rate for Payer: Health EOS Commercial |
$213.60
|
| Rate for Payer: HFN Commercial |
$220.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,321.64
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$355.28
|
| Rate for Payer: Independent Care Health Plan Medicare |
$355.28
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$355.28
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$355.28
|
| Rate for Payer: Multiplan Commercial |
$192.00
|
| Rate for Payer: NAPHCARE Commercial |
$532.92
|
| Rate for Payer: Preferred Network Access Commercial |
$220.80
|
| Rate for Payer: Quartz Beloit One Network |
$117.60
|
| Rate for Payer: Quartz Commercial |
$156.00
|
| Rate for Payer: Quartz Medicare Advantage |
$355.28
|
| Rate for Payer: The Alliance Commercial |
$1,421.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$355.28
|
| Rate for Payer: United Healthcare PPO |
$180.00
|
| Rate for Payer: WEA Trust Commercial |
$132.00
|
| Rate for Payer: Wellcare Medicare |
$355.28
|
| Rate for Payer: WPS Commercial |
$177.77
|
|
|
Sezary Diagnostic Flow Cytometry
|
Facility
|
IP
|
$240.00
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
5364855
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$117.60 |
| Max. Negotiated Rate |
$220.80 |
| Rate for Payer: Aetna Commercial |
$216.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$206.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$127.20
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cigna Commercial |
$220.80
|
| Rate for Payer: Health EOS Commercial |
$213.60
|
| Rate for Payer: HFN Commercial |
$220.80
|
| Rate for Payer: Multiplan Commercial |
$192.00
|
| Rate for Payer: NAPHCARE Commercial |
$144.00
|
| Rate for Payer: Preferred Network Access Commercial |
$220.80
|
| Rate for Payer: Quartz Beloit One Network |
$117.60
|
| Rate for Payer: Quartz Commercial |
$144.00
|
| Rate for Payer: WEA Trust Commercial |
$132.00
|
| Rate for Payer: WPS Commercial |
$177.77
|
|
|
Sezary Monitoring Flow Cytometry, Blood
|
Facility
|
OP
|
$375.00
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
6166535
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$183.75 |
| Max. Negotiated Rate |
$1,421.12 |
| Rate for Payer: Aetna Commercial |
$337.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$322.50
|
| Rate for Payer: Aetna Managed Medicare |
$355.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,332.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$621.74
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$589.76
|
| Rate for Payer: Anthem Medicare Advantage |
$355.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$198.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$355.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$355.28
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cigna Commercial |
$345.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$355.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$209.85
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$355.28
|
| Rate for Payer: Health EOS Commercial |
$333.75
|
| Rate for Payer: HFN Commercial |
$345.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,321.64
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$355.28
|
| Rate for Payer: Independent Care Health Plan Medicare |
$355.28
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$355.28
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$355.28
|
| Rate for Payer: Multiplan Commercial |
$300.00
|
| Rate for Payer: NAPHCARE Commercial |
$532.92
|
| Rate for Payer: Preferred Network Access Commercial |
$345.00
|
| Rate for Payer: Quartz Beloit One Network |
$183.75
|
| Rate for Payer: Quartz Commercial |
$243.75
|
| Rate for Payer: Quartz Medicare Advantage |
$355.28
|
| Rate for Payer: The Alliance Commercial |
$1,421.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$355.28
|
| Rate for Payer: United Healthcare PPO |
$281.25
|
| Rate for Payer: WEA Trust Commercial |
$206.25
|
| Rate for Payer: Wellcare Medicare |
$355.28
|
| Rate for Payer: WPS Commercial |
$277.76
|
|
|
Sezary Monitoring Flow Cytometry, Blood
|
Professional
|
Both
|
$375.00
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
6166535
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$356.25 |
| Rate for Payer: Aetna Commercial |
$356.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$322.50
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cigna Commercial |
$356.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$187.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$225.00
|
| Rate for Payer: Health EOS Commercial |
$341.25
|
| Rate for Payer: HFN Commercial |
$356.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$230.47
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$230.47
|
| Rate for Payer: Multiplan Commercial |
$300.00
|
| Rate for Payer: Preferred Network Access Commercial |
$356.25
|
| Rate for Payer: Quartz Beloit One Network |
$165.00
|
| Rate for Payer: Quartz Commercial |
$213.75
|
| Rate for Payer: The Alliance Commercial |
$187.50
|
| Rate for Payer: WEA Trust Commercial |
$206.25
|
| Rate for Payer: WPS Commercial |
$277.76
|
|
|
Sezary Monitoring Flow Cytometry, Blood
|
Facility
|
IP
|
$375.00
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
6166535
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$183.75 |
| Max. Negotiated Rate |
$345.00 |
| Rate for Payer: Aetna Commercial |
$337.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$322.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$198.75
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cigna Commercial |
$345.00
|
| Rate for Payer: Health EOS Commercial |
$333.75
|
| Rate for Payer: HFN Commercial |
$345.00
|
| Rate for Payer: Multiplan Commercial |
$300.00
|
| Rate for Payer: NAPHCARE Commercial |
$225.00
|
| Rate for Payer: Preferred Network Access Commercial |
$345.00
|
| Rate for Payer: Quartz Beloit One Network |
$183.75
|
| Rate for Payer: Quartz Commercial |
$225.00
|
| Rate for Payer: WEA Trust Commercial |
$206.25
|
| Rate for Payer: WPS Commercial |
$277.76
|
|
|
SHAVER BLADE 2.0 FULL RADIUS
|
Facility
|
OP
|
$832.00
|
|
| Hospital Charge Code |
3072521
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$232.96 |
| Max. Negotiated Rate |
$3,328.00 |
| Rate for Payer: Aetna Commercial |
$748.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$715.52
|
| Rate for Payer: Aetna Managed Medicare |
$232.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$540.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$416.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$399.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$440.96
|
| Rate for Payer: Cash Price |
$249.60
|
| Rate for Payer: Cigna Commercial |
$765.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$465.59
|
| Rate for Payer: Health EOS Commercial |
$740.48
|
| Rate for Payer: HFN Commercial |
$765.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$624.00
|
| Rate for Payer: Multiplan Commercial |
$665.60
|
| Rate for Payer: NAPHCARE Commercial |
$499.20
|
| Rate for Payer: Preferred Network Access Commercial |
$765.44
|
| Rate for Payer: Quartz Beloit One Network |
$407.68
|
| Rate for Payer: Quartz Commercial |
$540.80
|
| Rate for Payer: Quartz Medicare Advantage |
$499.20
|
| Rate for Payer: The Alliance Commercial |
$3,328.00
|
| Rate for Payer: WEA Trust Commercial |
$457.60
|
| Rate for Payer: WPS Commercial |
$616.26
|
|
|
SHAVER BLADE 2.0 FULL RADIUS
|
Facility
|
IP
|
$832.00
|
|
| Hospital Charge Code |
3072521
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$407.68 |
| Max. Negotiated Rate |
$765.44 |
| Rate for Payer: Aetna Commercial |
$748.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$715.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$440.96
|
| Rate for Payer: Cash Price |
$249.60
|
| Rate for Payer: Cigna Commercial |
$765.44
|
| Rate for Payer: Health EOS Commercial |
$740.48
|
| Rate for Payer: HFN Commercial |
$765.44
|
| Rate for Payer: Multiplan Commercial |
$665.60
|
| Rate for Payer: NAPHCARE Commercial |
$499.20
|
| Rate for Payer: Preferred Network Access Commercial |
$765.44
|
| Rate for Payer: Quartz Beloit One Network |
$407.68
|
| Rate for Payer: Quartz Commercial |
$499.20
|
| Rate for Payer: WEA Trust Commercial |
$457.60
|
| Rate for Payer: WPS Commercial |
$616.26
|
|
|
SHAVER BONE CUTTER 4.0 STR AR-8400BC
|
Facility
|
OP
|
$925.00
|
|
| Hospital Charge Code |
5348952
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$259.00 |
| Max. Negotiated Rate |
$3,700.00 |
| Rate for Payer: Aetna Commercial |
$832.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$795.50
|
| Rate for Payer: Aetna Managed Medicare |
$259.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$601.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$462.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$444.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$490.25
|
| Rate for Payer: Cash Price |
$277.50
|
| Rate for Payer: Cigna Commercial |
$851.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$517.63
|
| Rate for Payer: Health EOS Commercial |
$823.25
|
| Rate for Payer: HFN Commercial |
$851.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$693.75
|
| Rate for Payer: Multiplan Commercial |
$740.00
|
| Rate for Payer: NAPHCARE Commercial |
$555.00
|
| Rate for Payer: Preferred Network Access Commercial |
$851.00
|
| Rate for Payer: Quartz Beloit One Network |
$453.25
|
| Rate for Payer: Quartz Commercial |
$601.25
|
| Rate for Payer: Quartz Medicare Advantage |
$555.00
|
| Rate for Payer: The Alliance Commercial |
$3,700.00
|
| Rate for Payer: WEA Trust Commercial |
$508.75
|
| Rate for Payer: WPS Commercial |
$685.15
|
|
|
SHAVER BONE CUTTER 4.0 STR AR-8400BC
|
Facility
|
IP
|
$925.00
|
|
| Hospital Charge Code |
5348952
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$453.25 |
| Max. Negotiated Rate |
$851.00 |
| Rate for Payer: Aetna Commercial |
$832.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$795.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$490.25
|
| Rate for Payer: Cash Price |
$277.50
|
| Rate for Payer: Cigna Commercial |
$851.00
|
| Rate for Payer: Health EOS Commercial |
$823.25
|
| Rate for Payer: HFN Commercial |
$851.00
|
| Rate for Payer: Multiplan Commercial |
$740.00
|
| Rate for Payer: NAPHCARE Commercial |
$555.00
|
| Rate for Payer: Preferred Network Access Commercial |
$851.00
|
| Rate for Payer: Quartz Beloit One Network |
$453.25
|
| Rate for Payer: Quartz Commercial |
$555.00
|
| Rate for Payer: WEA Trust Commercial |
$508.75
|
| Rate for Payer: WPS Commercial |
$685.15
|
|
|
SHAVERDRILL FIBER TAK 1.6MM AR-3600NDSR-1
|
Facility
|
OP
|
$2,862.00
|
|
| Hospital Charge Code |
5190725
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$801.36 |
| Max. Negotiated Rate |
$11,448.00 |
| Rate for Payer: Aetna Commercial |
$2,575.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,461.32
|
| Rate for Payer: Aetna Managed Medicare |
$801.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,860.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,431.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,373.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,516.86
|
| Rate for Payer: Cash Price |
$858.60
|
| Rate for Payer: Cigna Commercial |
$2,633.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,601.58
|
| Rate for Payer: Health EOS Commercial |
$2,547.18
|
| Rate for Payer: HFN Commercial |
$2,633.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,146.50
|
| Rate for Payer: Multiplan Commercial |
$2,289.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,717.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,633.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,402.38
|
| Rate for Payer: Quartz Commercial |
$1,860.30
|
| Rate for Payer: Quartz Medicare Advantage |
$1,717.20
|
| Rate for Payer: The Alliance Commercial |
$11,448.00
|
| Rate for Payer: WEA Trust Commercial |
$1,574.10
|
| Rate for Payer: WPS Commercial |
$2,119.88
|
|
|
SHAVERDRILL FIBER TAK 1.6MM AR-3600NDSR-1
|
Facility
|
IP
|
$2,862.00
|
|
| Hospital Charge Code |
5190725
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,402.38 |
| Max. Negotiated Rate |
$2,633.04 |
| Rate for Payer: Aetna Commercial |
$2,575.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,461.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,516.86
|
| Rate for Payer: Cash Price |
$858.60
|
| Rate for Payer: Cigna Commercial |
$2,633.04
|
| Rate for Payer: Health EOS Commercial |
$2,547.18
|
| Rate for Payer: HFN Commercial |
$2,633.04
|
| Rate for Payer: Multiplan Commercial |
$2,289.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,717.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,633.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,402.38
|
| Rate for Payer: Quartz Commercial |
$1,717.20
|
| Rate for Payer: WEA Trust Commercial |
$1,574.10
|
| Rate for Payer: WPS Commercial |
$2,119.88
|
|
|
SHAVER SABRE 2.0MM SMALL JOINT AR-7200SR
|
Facility
|
OP
|
$925.00
|
|
| Hospital Charge Code |
5307155
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$259.00 |
| Max. Negotiated Rate |
$3,700.00 |
| Rate for Payer: Aetna Commercial |
$832.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$795.50
|
| Rate for Payer: Aetna Managed Medicare |
$259.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$601.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$462.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$444.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$490.25
|
| Rate for Payer: Cash Price |
$277.50
|
| Rate for Payer: Cigna Commercial |
$851.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$517.63
|
| Rate for Payer: Health EOS Commercial |
$823.25
|
| Rate for Payer: HFN Commercial |
$851.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$693.75
|
| Rate for Payer: Multiplan Commercial |
$740.00
|
| Rate for Payer: NAPHCARE Commercial |
$555.00
|
| Rate for Payer: Preferred Network Access Commercial |
$851.00
|
| Rate for Payer: Quartz Beloit One Network |
$453.25
|
| Rate for Payer: Quartz Commercial |
$601.25
|
| Rate for Payer: Quartz Medicare Advantage |
$555.00
|
| Rate for Payer: The Alliance Commercial |
$3,700.00
|
| Rate for Payer: WEA Trust Commercial |
$508.75
|
| Rate for Payer: WPS Commercial |
$685.15
|
|
|
SHAVER SABRE 2.0MM SMALL JOINT AR-7200SR
|
Facility
|
IP
|
$925.00
|
|
| Hospital Charge Code |
5307155
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$453.25 |
| Max. Negotiated Rate |
$851.00 |
| Rate for Payer: Aetna Commercial |
$832.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$795.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$490.25
|
| Rate for Payer: Cash Price |
$277.50
|
| Rate for Payer: Cigna Commercial |
$851.00
|
| Rate for Payer: Health EOS Commercial |
$823.25
|
| Rate for Payer: HFN Commercial |
$851.00
|
| Rate for Payer: Multiplan Commercial |
$740.00
|
| Rate for Payer: NAPHCARE Commercial |
$555.00
|
| Rate for Payer: Preferred Network Access Commercial |
$851.00
|
| Rate for Payer: Quartz Beloit One Network |
$453.25
|
| Rate for Payer: Quartz Commercial |
$555.00
|
| Rate for Payer: WEA Trust Commercial |
$508.75
|
| Rate for Payer: WPS Commercial |
$685.15
|
|
|
Shaving of single lesion (face, ears, eyes, nose, lower lips, mucous membrane) >2.0cm 11313
|
Professional
|
Both
|
$499.00
|
|
|
Service Code
|
CPT 11313
|
| Hospital Charge Code |
3013535
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$112.81 |
| Max. Negotiated Rate |
$474.05 |
| Rate for Payer: Aetna Commercial |
$474.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$429.14
|
| Rate for Payer: Cash Price |
$149.70
|
| Rate for Payer: Cash Price |
$149.70
|
| Rate for Payer: Cash Price |
$149.70
|
| Rate for Payer: Cigna Commercial |
$474.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$112.81
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$299.40
|
| Rate for Payer: Health EOS Commercial |
$454.09
|
| Rate for Payer: HFN Commercial |
$474.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$322.18
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$322.18
|
| Rate for Payer: Multiplan Commercial |
$399.20
|
| Rate for Payer: Preferred Network Access Commercial |
$474.05
|
| Rate for Payer: Quartz Beloit One Network |
$219.56
|
| Rate for Payer: Quartz Commercial |
$284.43
|
| Rate for Payer: The Alliance Commercial |
$249.50
|
| Rate for Payer: United Healthcare Medicaid |
$112.81
|
| Rate for Payer: WEA Trust Commercial |
$274.45
|
| Rate for Payer: WPS Commercial |
$369.61
|
|
|
Shaving of single lesion (face, ears, eyes, nose, lower lips, mucous membranes) <=0.5cm 11310
|
Professional
|
Both
|
$156.00
|
|
|
Service Code
|
CPT 11310
|
| Hospital Charge Code |
3013532
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$51.44 |
| Max. Negotiated Rate |
$152.88 |
| Rate for Payer: Aetna Commercial |
$148.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$134.16
|
| Rate for Payer: Cash Price |
$46.80
|
| Rate for Payer: Cash Price |
$46.80
|
| Rate for Payer: Cash Price |
$46.80
|
| Rate for Payer: Cigna Commercial |
$148.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$51.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$93.60
|
| Rate for Payer: Health EOS Commercial |
$141.96
|
| Rate for Payer: HFN Commercial |
$148.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$152.88
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$152.88
|
| Rate for Payer: Multiplan Commercial |
$124.80
|
| Rate for Payer: Preferred Network Access Commercial |
$148.20
|
| Rate for Payer: Quartz Beloit One Network |
$68.64
|
| Rate for Payer: Quartz Commercial |
$88.92
|
| Rate for Payer: The Alliance Commercial |
$78.00
|
| Rate for Payer: United Healthcare Medicaid |
$51.44
|
| Rate for Payer: WEA Trust Commercial |
$85.80
|
| Rate for Payer: WPS Commercial |
$115.55
|
|
|
Shaving of single lesion (face, ears, eyes, nose, lower lips, mucous membranes) 0.6-1.0cm 11311
|
Professional
|
Both
|
$191.00
|
|
|
Service Code
|
CPT 11311
|
| Hospital Charge Code |
3013533
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$73.34 |
| Max. Negotiated Rate |
$211.02 |
| Rate for Payer: Aetna Commercial |
$181.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$164.26
|
| Rate for Payer: Cash Price |
$57.30
|
| Rate for Payer: Cash Price |
$57.30
|
| Rate for Payer: Cash Price |
$57.30
|
| Rate for Payer: Cigna Commercial |
$181.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$73.34
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$114.60
|
| Rate for Payer: Health EOS Commercial |
$173.81
|
| Rate for Payer: HFN Commercial |
$181.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$211.02
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$211.02
|
| Rate for Payer: Multiplan Commercial |
$152.80
|
| Rate for Payer: Preferred Network Access Commercial |
$181.45
|
| Rate for Payer: Quartz Beloit One Network |
$84.04
|
| Rate for Payer: Quartz Commercial |
$108.87
|
| Rate for Payer: The Alliance Commercial |
$95.50
|
| Rate for Payer: United Healthcare Medicaid |
$73.34
|
| Rate for Payer: WEA Trust Commercial |
$105.05
|
| Rate for Payer: WPS Commercial |
$141.47
|
|
|
Shaving of single lesion (face, ears, eyes, nose, lower lips, mucous membranes) 1.1-2.0cm 11312
|
Professional
|
Both
|
$316.00
|
|
|
Service Code
|
CPT 11312
|
| Hospital Charge Code |
3013534
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$84.61 |
| Max. Negotiated Rate |
$300.20 |
| Rate for Payer: Aetna Commercial |
$300.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$271.76
|
| Rate for Payer: Cash Price |
$94.80
|
| Rate for Payer: Cash Price |
$94.80
|
| Rate for Payer: Cash Price |
$94.80
|
| Rate for Payer: Cigna Commercial |
$300.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$84.61
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$189.60
|
| Rate for Payer: Health EOS Commercial |
$287.56
|
| Rate for Payer: HFN Commercial |
$300.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$249.92
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$249.92
|
| Rate for Payer: Multiplan Commercial |
$252.80
|
| Rate for Payer: Preferred Network Access Commercial |
$300.20
|
| Rate for Payer: Quartz Beloit One Network |
$139.04
|
| Rate for Payer: Quartz Commercial |
$180.12
|
| Rate for Payer: The Alliance Commercial |
$158.00
|
| Rate for Payer: United Healthcare Medicaid |
$84.61
|
| Rate for Payer: WEA Trust Commercial |
$173.80
|
| Rate for Payer: WPS Commercial |
$234.06
|
|
|
Shaving of single lesion (scalp, hands, feet, genitalia) <=0.5cm 11305
|
Professional
|
Both
|
$232.00
|
|
|
Service Code
|
CPT 11305
|
| Hospital Charge Code |
3013528
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$45.48 |
| Max. Negotiated Rate |
$220.40 |
| Rate for Payer: Aetna Commercial |
$220.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$199.52
|
| Rate for Payer: Cash Price |
$69.60
|
| Rate for Payer: Cash Price |
$69.60
|
| Rate for Payer: Cash Price |
$69.60
|
| Rate for Payer: Cigna Commercial |
$220.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$45.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$139.20
|
| Rate for Payer: Health EOS Commercial |
$211.12
|
| Rate for Payer: HFN Commercial |
$220.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$128.56
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$128.56
|
| Rate for Payer: Multiplan Commercial |
$185.60
|
| Rate for Payer: Preferred Network Access Commercial |
$220.40
|
| Rate for Payer: Quartz Beloit One Network |
$102.08
|
| Rate for Payer: Quartz Commercial |
$132.24
|
| Rate for Payer: The Alliance Commercial |
$116.00
|
| Rate for Payer: United Healthcare Medicaid |
$45.48
|
| Rate for Payer: WEA Trust Commercial |
$127.60
|
| Rate for Payer: WPS Commercial |
$171.84
|
|
|
Shaving of single lesion (scalp, hands, feet, genitalia) 0.6-1.0cm 11306
|
Professional
|
Both
|
$274.00
|
|
|
Service Code
|
CPT 11306
|
| Hospital Charge Code |
3013529
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$56.97 |
| Max. Negotiated Rate |
$260.30 |
| Rate for Payer: Aetna Commercial |
$260.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$235.64
|
| Rate for Payer: Cash Price |
$82.20
|
| Rate for Payer: Cash Price |
$82.20
|
| Rate for Payer: Cash Price |
$82.20
|
| Rate for Payer: Cigna Commercial |
$260.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$56.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$164.40
|
| Rate for Payer: Health EOS Commercial |
$249.34
|
| Rate for Payer: HFN Commercial |
$260.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$166.79
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$166.79
|
| Rate for Payer: Multiplan Commercial |
$219.20
|
| Rate for Payer: Preferred Network Access Commercial |
$260.30
|
| Rate for Payer: Quartz Beloit One Network |
$120.56
|
| Rate for Payer: Quartz Commercial |
$156.18
|
| Rate for Payer: The Alliance Commercial |
$137.00
|
| Rate for Payer: United Healthcare Medicaid |
$56.97
|
| Rate for Payer: WEA Trust Commercial |
$150.70
|
| Rate for Payer: WPS Commercial |
$202.95
|
|
|
Shaving of single lesion (scalp, hands, feet, genitalia) 1.1-2.0cm 11307
|
Professional
|
Both
|
$242.00
|
|
|
Service Code
|
CPT 11307
|
| Hospital Charge Code |
3013530
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$56.97 |
| Max. Negotiated Rate |
$229.90 |
| Rate for Payer: Aetna Commercial |
$229.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$208.12
|
| Rate for Payer: Cash Price |
$72.60
|
| Rate for Payer: Cash Price |
$72.60
|
| Rate for Payer: Cash Price |
$72.60
|
| Rate for Payer: Cigna Commercial |
$229.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$56.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$145.20
|
| Rate for Payer: Health EOS Commercial |
$220.22
|
| Rate for Payer: HFN Commercial |
$229.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$214.48
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$214.48
|
| Rate for Payer: Multiplan Commercial |
$193.60
|
| Rate for Payer: Preferred Network Access Commercial |
$229.90
|
| Rate for Payer: Quartz Beloit One Network |
$106.48
|
| Rate for Payer: Quartz Commercial |
$137.94
|
| Rate for Payer: The Alliance Commercial |
$121.00
|
| Rate for Payer: United Healthcare Medicaid |
$56.97
|
| Rate for Payer: WEA Trust Commercial |
$133.10
|
| Rate for Payer: WPS Commercial |
$179.25
|
|
|
Shaving of single lesion (scalp, hands, feet, genitalia) >2.0cm 11308
|
Professional
|
Both
|
$510.00
|
|
|
Service Code
|
CPT 11308
|
| Hospital Charge Code |
3013531
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$131.26 |
| Max. Negotiated Rate |
$484.50 |
| Rate for Payer: Aetna Commercial |
$484.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$438.60
|
| Rate for Payer: Cash Price |
$153.00
|
| Rate for Payer: Cash Price |
$153.00
|
| Rate for Payer: Cash Price |
$153.00
|
| Rate for Payer: Cigna Commercial |
$484.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$131.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$306.00
|
| Rate for Payer: Health EOS Commercial |
$464.10
|
| Rate for Payer: HFN Commercial |
$484.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$243.75
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$243.75
|
| Rate for Payer: Multiplan Commercial |
$408.00
|
| Rate for Payer: Preferred Network Access Commercial |
$484.50
|
| Rate for Payer: Quartz Beloit One Network |
$224.40
|
| Rate for Payer: Quartz Commercial |
$290.70
|
| Rate for Payer: The Alliance Commercial |
$255.00
|
| Rate for Payer: United Healthcare Medicaid |
$131.26
|
| Rate for Payer: WEA Trust Commercial |
$280.50
|
| Rate for Payer: WPS Commercial |
$377.76
|
|
|
Shaving of single lesion (trunk, arm, legs) <=0.5cm 11300
|
Professional
|
Both
|
$154.00
|
|
|
Service Code
|
CPT 11300
|
| Hospital Charge Code |
3013524
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$49.41 |
| Max. Negotiated Rate |
$146.30 |
| Rate for Payer: Aetna Commercial |
$146.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$132.44
|
| 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 |
$146.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$49.41
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$92.40
|
| Rate for Payer: Health EOS Commercial |
$140.14
|
| Rate for Payer: HFN Commercial |
$146.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$114.02
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$114.02
|
| Rate for Payer: Multiplan Commercial |
$123.20
|
| Rate for Payer: Preferred Network Access Commercial |
$146.30
|
| Rate for Payer: Quartz Beloit One Network |
$67.76
|
| Rate for Payer: Quartz Commercial |
$87.78
|
| Rate for Payer: The Alliance Commercial |
$77.00
|
| Rate for Payer: United Healthcare Medicaid |
$49.41
|
| Rate for Payer: WEA Trust Commercial |
$84.70
|
| Rate for Payer: WPS Commercial |
$114.07
|
|
|
Shaving of single lesion (trunk, arm, legs) 0.6-1.0cm 11301
|
Professional
|
Both
|
$165.00
|
|
|
Service Code
|
CPT 11301
|
| Hospital Charge Code |
3013525
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$60.91 |
| Max. Negotiated Rate |
$172.16 |
| Rate for Payer: Aetna Commercial |
$156.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$141.90
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cigna Commercial |
$156.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$60.91
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$99.00
|
| Rate for Payer: Health EOS Commercial |
$150.15
|
| Rate for Payer: HFN Commercial |
$156.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$172.16
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$172.16
|
| Rate for Payer: Multiplan Commercial |
$132.00
|
| Rate for Payer: Preferred Network Access Commercial |
$156.75
|
| Rate for Payer: Quartz Beloit One Network |
$72.60
|
| Rate for Payer: Quartz Commercial |
$94.05
|
| Rate for Payer: The Alliance Commercial |
$82.50
|
| Rate for Payer: United Healthcare Medicaid |
$60.91
|
| Rate for Payer: WEA Trust Commercial |
$90.75
|
| Rate for Payer: WPS Commercial |
$122.22
|
|
|
Shaving of single lesion (trunk, arm, legs) 1.1-2.0cm 11302
|
Professional
|
Both
|
$200.00
|
|
|
Service Code
|
CPT 11302
|
| Hospital Charge Code |
3013526
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$60.91 |
| Max. Negotiated Rate |
$201.81 |
| Rate for Payer: Aetna Commercial |
$190.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$172.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cigna Commercial |
$190.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$60.91
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$120.00
|
| Rate for Payer: Health EOS Commercial |
$182.00
|
| Rate for Payer: HFN Commercial |
$190.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$201.81
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$201.81
|
| Rate for Payer: Multiplan Commercial |
$160.00
|
| Rate for Payer: Preferred Network Access Commercial |
$190.00
|
| Rate for Payer: Quartz Beloit One Network |
$88.00
|
| Rate for Payer: Quartz Commercial |
$114.00
|
| Rate for Payer: The Alliance Commercial |
$100.00
|
| Rate for Payer: United Healthcare Medicaid |
$60.91
|
| Rate for Payer: WEA Trust Commercial |
$110.00
|
| Rate for Payer: WPS Commercial |
$148.14
|
|
|
Shaving of single lesion (trunk, arm, legs) >2.0cm 11303
|
Professional
|
Both
|
$478.00
|
|
|
Service Code
|
CPT 11303
|
| Hospital Charge Code |
3013527
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$113.51 |
| Max. Negotiated Rate |
$454.10 |
| Rate for Payer: Aetna Commercial |
$454.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$411.08
|
| Rate for Payer: Cash Price |
$143.40
|
| Rate for Payer: Cash Price |
$143.40
|
| Rate for Payer: Cash Price |
$143.40
|
| Rate for Payer: Cigna Commercial |
$454.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$113.51
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$286.80
|
| Rate for Payer: Health EOS Commercial |
$434.98
|
| Rate for Payer: HFN Commercial |
$454.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$238.77
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$238.77
|
| Rate for Payer: Multiplan Commercial |
$382.40
|
| Rate for Payer: Preferred Network Access Commercial |
$454.10
|
| Rate for Payer: Quartz Beloit One Network |
$210.32
|
| Rate for Payer: Quartz Commercial |
$272.46
|
| Rate for Payer: The Alliance Commercial |
$239.00
|
| Rate for Payer: United Healthcare Medicaid |
$113.51
|
| Rate for Payer: WEA Trust Commercial |
$262.90
|
| Rate for Payer: WPS Commercial |
$354.05
|
|
