|
Sezary Diagnostic Flow Cytometry
|
Facility
|
IP
|
$240.00
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
5364855
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$122.30 |
| Max. Negotiated Rate |
$229.63 |
| Rate for Payer: Aetna Commercial |
$224.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$214.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$132.29
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cigna Commercial |
$229.63
|
| Rate for Payer: Health EOS Commercial |
$222.14
|
| Rate for Payer: HFN Commercial |
$229.63
|
| Rate for Payer: Multiplan Commercial |
$199.68
|
| Rate for Payer: Preferred Network Access Commercial |
$229.63
|
| Rate for Payer: Quartz Beloit One Network |
$122.30
|
| Rate for Payer: Quartz Commercial |
$149.76
|
| Rate for Payer: WEA Trust Commercial |
$137.28
|
| Rate for Payer: WPS Commercial |
$184.87
|
|
|
Sezary Monitoring Flow Cytometry, Blood
|
Facility
|
IP
|
$375.00
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
6166535
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$191.10 |
| Max. Negotiated Rate |
$358.80 |
| Rate for Payer: Aetna Commercial |
$351.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$335.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$206.70
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cigna Commercial |
$358.80
|
| Rate for Payer: Health EOS Commercial |
$347.10
|
| Rate for Payer: HFN Commercial |
$358.80
|
| Rate for Payer: Multiplan Commercial |
$312.00
|
| Rate for Payer: Preferred Network Access Commercial |
$358.80
|
| Rate for Payer: Quartz Beloit One Network |
$191.10
|
| Rate for Payer: Quartz Commercial |
$234.00
|
| Rate for Payer: WEA Trust Commercial |
$214.50
|
| Rate for Payer: WPS Commercial |
$288.86
|
|
|
Sezary Monitoring Flow Cytometry, Blood
|
Facility
|
OP
|
$375.00
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
6166535
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$191.10 |
| Max. Negotiated Rate |
$1,508.92 |
| Rate for Payer: Aetna Commercial |
$351.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$335.40
|
| Rate for Payer: Aetna Managed Medicare |
$377.23
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,385.59
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$646.61
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$613.36
|
| Rate for Payer: Anthem Medicare Advantage |
$377.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$206.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$377.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$377.23
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cigna Commercial |
$358.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$377.23
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$218.25
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$377.23
|
| Rate for Payer: Health EOS Commercial |
$347.10
|
| Rate for Payer: HFN Commercial |
$358.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,403.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$377.23
|
| Rate for Payer: Independent Care Health Plan Medicare |
$377.23
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$377.23
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$377.23
|
| Rate for Payer: Multiplan Commercial |
$312.00
|
| Rate for Payer: NAPHCARE Commercial |
$565.84
|
| Rate for Payer: Preferred Network Access Commercial |
$358.80
|
| Rate for Payer: Quartz Beloit One Network |
$191.10
|
| Rate for Payer: Quartz Commercial |
$253.50
|
| Rate for Payer: Quartz Medicare Advantage |
$377.23
|
| Rate for Payer: The Alliance Commercial |
$1,508.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$377.23
|
| Rate for Payer: United Healthcare PPO |
$292.50
|
| Rate for Payer: WEA Trust Commercial |
$214.50
|
| Rate for Payer: Wellcare Medicare |
$377.23
|
| Rate for Payer: WPS Commercial |
$288.86
|
|
|
Sezary Monitoring Flow Cytometry, Blood
|
Professional
|
Both
|
$375.00
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
6166535
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$80.41 |
| Max. Negotiated Rate |
$370.50 |
| Rate for Payer: Aetna Commercial |
$370.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$335.40
|
| Rate for Payer: Aetna Managed Medicare |
$80.41
|
| Rate for Payer: Anthem Medicare Advantage |
$80.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$80.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$80.41
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cigna Commercial |
$370.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$195.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$80.41
|
| Rate for Payer: Health EOS Commercial |
$354.90
|
| Rate for Payer: HFN Commercial |
$370.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$239.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$239.69
|
| Rate for Payer: Independent Care Health Plan Medicare |
$80.41
|
| Rate for Payer: Multiplan Commercial |
$312.00
|
| Rate for Payer: NAPHCARE Commercial |
$120.62
|
| Rate for Payer: Preferred Network Access Commercial |
$370.50
|
| Rate for Payer: Quartz Beloit One Network |
$171.60
|
| Rate for Payer: Quartz Commercial |
$222.30
|
| Rate for Payer: Quartz Medicare Advantage |
$80.41
|
| Rate for Payer: The Alliance Commercial |
$317.63
|
| Rate for Payer: United Healthcare Medicare Advantage |
$80.41
|
| Rate for Payer: WEA Trust Commercial |
$214.50
|
| Rate for Payer: WPS Commercial |
$353.82
|
|
|
SHAVER BLADE 2.0 FULL RADIUS
|
Facility
|
IP
|
$832.00
|
|
| Hospital Charge Code |
3072521
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$423.99 |
| Max. Negotiated Rate |
$796.06 |
| Rate for Payer: Aetna Commercial |
$778.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$744.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$458.60
|
| Rate for Payer: Cash Price |
$249.60
|
| Rate for Payer: Cigna Commercial |
$796.06
|
| Rate for Payer: Health EOS Commercial |
$770.10
|
| Rate for Payer: HFN Commercial |
$796.06
|
| Rate for Payer: Multiplan Commercial |
$692.22
|
| Rate for Payer: Preferred Network Access Commercial |
$796.06
|
| Rate for Payer: Quartz Beloit One Network |
$423.99
|
| Rate for Payer: Quartz Commercial |
$519.17
|
| Rate for Payer: WEA Trust Commercial |
$475.90
|
| Rate for Payer: WPS Commercial |
$640.89
|
|
|
SHAVER BLADE 2.0 FULL RADIUS
|
Facility
|
OP
|
$832.00
|
|
| Hospital Charge Code |
3072521
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$242.28 |
| Max. Negotiated Rate |
$796.06 |
| Rate for Payer: Aetna Commercial |
$778.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$744.14
|
| Rate for Payer: Aetna Managed Medicare |
$242.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$562.43
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$432.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$415.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$458.60
|
| Rate for Payer: Cash Price |
$249.60
|
| Rate for Payer: Cigna Commercial |
$796.06
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$484.22
|
| Rate for Payer: Health EOS Commercial |
$770.10
|
| Rate for Payer: HFN Commercial |
$796.06
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$648.96
|
| Rate for Payer: Multiplan Commercial |
$692.22
|
| Rate for Payer: NAPHCARE Commercial |
$519.17
|
| Rate for Payer: Preferred Network Access Commercial |
$796.06
|
| Rate for Payer: Quartz Beloit One Network |
$423.99
|
| Rate for Payer: Quartz Commercial |
$562.43
|
| Rate for Payer: Quartz Medicare Advantage |
$519.17
|
| Rate for Payer: The Alliance Commercial |
$432.64
|
| Rate for Payer: WEA Trust Commercial |
$475.90
|
| Rate for Payer: WPS Commercial |
$640.89
|
|
|
SHAVER BONE CUTTER 4.0 STR AR-8400BC
|
Facility
|
IP
|
$925.00
|
|
| Hospital Charge Code |
5348952
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$471.38 |
| Max. Negotiated Rate |
$885.04 |
| Rate for Payer: Aetna Commercial |
$865.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$827.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$509.86
|
| Rate for Payer: Cash Price |
$277.50
|
| Rate for Payer: Cigna Commercial |
$885.04
|
| Rate for Payer: Health EOS Commercial |
$856.18
|
| Rate for Payer: HFN Commercial |
$885.04
|
| Rate for Payer: Multiplan Commercial |
$769.60
|
| Rate for Payer: Preferred Network Access Commercial |
$885.04
|
| Rate for Payer: Quartz Beloit One Network |
$471.38
|
| Rate for Payer: Quartz Commercial |
$577.20
|
| Rate for Payer: WEA Trust Commercial |
$529.10
|
| Rate for Payer: WPS Commercial |
$712.53
|
|
|
SHAVER BONE CUTTER 4.0 STR AR-8400BC
|
Facility
|
OP
|
$925.00
|
|
| Hospital Charge Code |
5348952
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$269.36 |
| Max. Negotiated Rate |
$885.04 |
| Rate for Payer: Aetna Commercial |
$865.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$827.32
|
| Rate for Payer: Aetna Managed Medicare |
$269.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$625.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$481.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$461.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$509.86
|
| Rate for Payer: Cash Price |
$277.50
|
| Rate for Payer: Cigna Commercial |
$885.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$538.35
|
| Rate for Payer: Health EOS Commercial |
$856.18
|
| Rate for Payer: HFN Commercial |
$885.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$721.50
|
| Rate for Payer: Multiplan Commercial |
$769.60
|
| Rate for Payer: NAPHCARE Commercial |
$577.20
|
| Rate for Payer: Preferred Network Access Commercial |
$885.04
|
| Rate for Payer: Quartz Beloit One Network |
$471.38
|
| Rate for Payer: Quartz Commercial |
$625.30
|
| Rate for Payer: Quartz Medicare Advantage |
$577.20
|
| Rate for Payer: The Alliance Commercial |
$481.00
|
| Rate for Payer: WEA Trust Commercial |
$529.10
|
| Rate for Payer: WPS Commercial |
$712.53
|
|
|
SHAVERDRILL FIBER TAK 1.6MM AR-3600NDSR-1
|
Facility
|
IP
|
$2,862.00
|
|
| Hospital Charge Code |
5190725
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,458.48 |
| Max. Negotiated Rate |
$2,738.36 |
| Rate for Payer: Aetna Commercial |
$2,678.83
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,559.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,577.53
|
| Rate for Payer: Cash Price |
$858.60
|
| Rate for Payer: Cigna Commercial |
$2,738.36
|
| Rate for Payer: Health EOS Commercial |
$2,649.07
|
| Rate for Payer: HFN Commercial |
$2,738.36
|
| Rate for Payer: Multiplan Commercial |
$2,381.18
|
| Rate for Payer: Preferred Network Access Commercial |
$2,738.36
|
| Rate for Payer: Quartz Beloit One Network |
$1,458.48
|
| Rate for Payer: Quartz Commercial |
$1,785.89
|
| Rate for Payer: WEA Trust Commercial |
$1,637.06
|
| Rate for Payer: WPS Commercial |
$2,204.60
|
|
|
SHAVERDRILL FIBER TAK 1.6MM AR-3600NDSR-1
|
Facility
|
OP
|
$2,862.00
|
|
| Hospital Charge Code |
5190725
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$833.41 |
| Max. Negotiated Rate |
$2,738.36 |
| Rate for Payer: Aetna Commercial |
$2,678.83
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,559.77
|
| Rate for Payer: Aetna Managed Medicare |
$833.41
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,934.71
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,488.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,428.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,577.53
|
| Rate for Payer: Cash Price |
$858.60
|
| Rate for Payer: Cigna Commercial |
$2,738.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,665.68
|
| Rate for Payer: Health EOS Commercial |
$2,649.07
|
| Rate for Payer: HFN Commercial |
$2,738.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,232.36
|
| Rate for Payer: Multiplan Commercial |
$2,381.18
|
| Rate for Payer: NAPHCARE Commercial |
$1,785.89
|
| Rate for Payer: Preferred Network Access Commercial |
$2,738.36
|
| Rate for Payer: Quartz Beloit One Network |
$1,458.48
|
| Rate for Payer: Quartz Commercial |
$1,934.71
|
| Rate for Payer: Quartz Medicare Advantage |
$1,785.89
|
| Rate for Payer: The Alliance Commercial |
$1,488.24
|
| Rate for Payer: WEA Trust Commercial |
$1,637.06
|
| Rate for Payer: WPS Commercial |
$2,204.60
|
|
|
SHAVER SABRE 2.0MM SMALL JOINT AR-7200SR
|
Facility
|
OP
|
$925.00
|
|
| Hospital Charge Code |
5307155
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$269.36 |
| Max. Negotiated Rate |
$885.04 |
| Rate for Payer: Aetna Commercial |
$865.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$827.32
|
| Rate for Payer: Aetna Managed Medicare |
$269.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$625.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$481.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$461.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$509.86
|
| Rate for Payer: Cash Price |
$277.50
|
| Rate for Payer: Cigna Commercial |
$885.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$538.35
|
| Rate for Payer: Health EOS Commercial |
$856.18
|
| Rate for Payer: HFN Commercial |
$885.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$721.50
|
| Rate for Payer: Multiplan Commercial |
$769.60
|
| Rate for Payer: NAPHCARE Commercial |
$577.20
|
| Rate for Payer: Preferred Network Access Commercial |
$885.04
|
| Rate for Payer: Quartz Beloit One Network |
$471.38
|
| Rate for Payer: Quartz Commercial |
$625.30
|
| Rate for Payer: Quartz Medicare Advantage |
$577.20
|
| Rate for Payer: The Alliance Commercial |
$481.00
|
| Rate for Payer: WEA Trust Commercial |
$529.10
|
| Rate for Payer: WPS Commercial |
$712.53
|
|
|
SHAVER SABRE 2.0MM SMALL JOINT AR-7200SR
|
Facility
|
IP
|
$925.00
|
|
| Hospital Charge Code |
5307155
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$471.38 |
| Max. Negotiated Rate |
$885.04 |
| Rate for Payer: Aetna Commercial |
$865.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$827.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$509.86
|
| Rate for Payer: Cash Price |
$277.50
|
| Rate for Payer: Cigna Commercial |
$885.04
|
| Rate for Payer: Health EOS Commercial |
$856.18
|
| Rate for Payer: HFN Commercial |
$885.04
|
| Rate for Payer: Multiplan Commercial |
$769.60
|
| Rate for Payer: Preferred Network Access Commercial |
$885.04
|
| Rate for Payer: Quartz Beloit One Network |
$471.38
|
| Rate for Payer: Quartz Commercial |
$577.20
|
| Rate for Payer: WEA Trust Commercial |
$529.10
|
| Rate for Payer: WPS Commercial |
$712.53
|
|
|
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 |
$75.43 |
| Max. Negotiated Rate |
$493.01 |
| Rate for Payer: Aetna Commercial |
$493.01
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$446.31
|
| Rate for Payer: Aetna Managed Medicare |
$75.43
|
| Rate for Payer: Anthem Medicare Advantage |
$75.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$75.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$75.43
|
| 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 |
$493.01
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$117.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$75.43
|
| Rate for Payer: Health EOS Commercial |
$472.25
|
| Rate for Payer: HFN Commercial |
$493.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$335.07
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$335.07
|
| Rate for Payer: Independent Care Health Plan Medicare |
$75.43
|
| Rate for Payer: Multiplan Commercial |
$415.17
|
| Rate for Payer: NAPHCARE Commercial |
$113.15
|
| Rate for Payer: Preferred Network Access Commercial |
$493.01
|
| Rate for Payer: Quartz Beloit One Network |
$228.34
|
| Rate for Payer: Quartz Commercial |
$295.81
|
| Rate for Payer: Quartz Medicare Advantage |
$75.43
|
| Rate for Payer: The Alliance Commercial |
$320.58
|
| Rate for Payer: United Healthcare Medicaid |
$117.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$75.43
|
| Rate for Payer: WEA Trust Commercial |
$285.43
|
| Rate for Payer: WPS Commercial |
$339.44
|
|
|
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 |
$35.83 |
| Max. Negotiated Rate |
$161.23 |
| Rate for Payer: Aetna Commercial |
$154.13
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$139.53
|
| Rate for Payer: Aetna Managed Medicare |
$35.83
|
| Rate for Payer: Anthem Medicare Advantage |
$35.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$35.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$35.83
|
| 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 |
$154.13
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$53.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$35.83
|
| Rate for Payer: Health EOS Commercial |
$147.64
|
| Rate for Payer: HFN Commercial |
$154.13
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$159.00
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$159.00
|
| Rate for Payer: Independent Care Health Plan Medicare |
$35.83
|
| Rate for Payer: Multiplan Commercial |
$129.79
|
| Rate for Payer: NAPHCARE Commercial |
$53.74
|
| Rate for Payer: Preferred Network Access Commercial |
$154.13
|
| Rate for Payer: Quartz Beloit One Network |
$71.39
|
| Rate for Payer: Quartz Commercial |
$92.48
|
| Rate for Payer: Quartz Medicare Advantage |
$35.83
|
| Rate for Payer: The Alliance Commercial |
$152.27
|
| Rate for Payer: United Healthcare Medicaid |
$53.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35.83
|
| Rate for Payer: WEA Trust Commercial |
$89.23
|
| Rate for Payer: WPS Commercial |
$161.23
|
|
|
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 |
$49.66 |
| Max. Negotiated Rate |
$223.47 |
| Rate for Payer: Aetna Commercial |
$188.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$170.83
|
| Rate for Payer: Aetna Managed Medicare |
$49.66
|
| Rate for Payer: Anthem Medicare Advantage |
$49.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$49.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$49.66
|
| 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 |
$188.71
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$76.27
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$49.66
|
| Rate for Payer: Health EOS Commercial |
$180.76
|
| Rate for Payer: HFN Commercial |
$188.71
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$219.46
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$219.46
|
| Rate for Payer: Independent Care Health Plan Medicare |
$49.66
|
| Rate for Payer: Multiplan Commercial |
$158.91
|
| Rate for Payer: NAPHCARE Commercial |
$74.49
|
| Rate for Payer: Preferred Network Access Commercial |
$188.71
|
| Rate for Payer: Quartz Beloit One Network |
$87.40
|
| Rate for Payer: Quartz Commercial |
$113.22
|
| Rate for Payer: Quartz Medicare Advantage |
$49.66
|
| Rate for Payer: The Alliance Commercial |
$211.06
|
| Rate for Payer: United Healthcare Medicaid |
$76.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$49.66
|
| Rate for Payer: WEA Trust Commercial |
$109.25
|
| Rate for Payer: WPS Commercial |
$223.47
|
|
|
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 |
$59.16 |
| Max. Negotiated Rate |
$312.21 |
| Rate for Payer: Aetna Commercial |
$312.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$282.63
|
| Rate for Payer: Aetna Managed Medicare |
$59.16
|
| Rate for Payer: Anthem Medicare Advantage |
$59.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$59.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$59.16
|
| 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 |
$312.21
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$87.99
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$59.16
|
| Rate for Payer: Health EOS Commercial |
$299.06
|
| Rate for Payer: HFN Commercial |
$312.21
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$259.92
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$259.92
|
| Rate for Payer: Independent Care Health Plan Medicare |
$59.16
|
| Rate for Payer: Multiplan Commercial |
$262.91
|
| Rate for Payer: NAPHCARE Commercial |
$88.73
|
| Rate for Payer: Preferred Network Access Commercial |
$312.21
|
| Rate for Payer: Quartz Beloit One Network |
$144.60
|
| Rate for Payer: Quartz Commercial |
$187.32
|
| Rate for Payer: Quartz Medicare Advantage |
$59.16
|
| Rate for Payer: The Alliance Commercial |
$251.41
|
| Rate for Payer: United Healthcare Medicaid |
$87.99
|
| Rate for Payer: United Healthcare Medicare Advantage |
$59.16
|
| Rate for Payer: WEA Trust Commercial |
$180.75
|
| Rate for Payer: WPS Commercial |
$266.20
|
|
|
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 |
$32.17 |
| Max. Negotiated Rate |
$229.22 |
| Rate for Payer: Aetna Commercial |
$229.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$207.50
|
| Rate for Payer: Aetna Managed Medicare |
$32.17
|
| Rate for Payer: Anthem Medicare Advantage |
$32.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$32.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$32.17
|
| 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 |
$229.22
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$47.30
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$32.17
|
| Rate for Payer: Health EOS Commercial |
$219.56
|
| Rate for Payer: HFN Commercial |
$229.22
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$133.70
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$133.70
|
| Rate for Payer: Independent Care Health Plan Medicare |
$32.17
|
| Rate for Payer: Multiplan Commercial |
$193.02
|
| Rate for Payer: NAPHCARE Commercial |
$48.25
|
| Rate for Payer: Preferred Network Access Commercial |
$229.22
|
| Rate for Payer: Quartz Beloit One Network |
$106.16
|
| Rate for Payer: Quartz Commercial |
$137.53
|
| Rate for Payer: Quartz Medicare Advantage |
$32.17
|
| Rate for Payer: The Alliance Commercial |
$136.71
|
| Rate for Payer: United Healthcare Medicaid |
$47.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$32.17
|
| Rate for Payer: WEA Trust Commercial |
$132.70
|
| Rate for Payer: WPS Commercial |
$144.75
|
|
|
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 |
$40.16 |
| Max. Negotiated Rate |
$270.71 |
| Rate for Payer: Aetna Commercial |
$270.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$245.07
|
| Rate for Payer: Aetna Managed Medicare |
$40.16
|
| Rate for Payer: Anthem Medicare Advantage |
$40.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$40.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$40.16
|
| 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 |
$270.71
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$59.25
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$40.16
|
| Rate for Payer: Health EOS Commercial |
$259.31
|
| Rate for Payer: HFN Commercial |
$270.71
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$173.46
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$173.46
|
| Rate for Payer: Independent Care Health Plan Medicare |
$40.16
|
| Rate for Payer: Multiplan Commercial |
$227.97
|
| Rate for Payer: NAPHCARE Commercial |
$60.25
|
| Rate for Payer: Preferred Network Access Commercial |
$270.71
|
| Rate for Payer: Quartz Beloit One Network |
$125.38
|
| Rate for Payer: Quartz Commercial |
$162.43
|
| Rate for Payer: Quartz Medicare Advantage |
$40.16
|
| Rate for Payer: The Alliance Commercial |
$170.70
|
| Rate for Payer: United Healthcare Medicaid |
$59.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$40.16
|
| Rate for Payer: WEA Trust Commercial |
$156.73
|
| Rate for Payer: WPS Commercial |
$180.74
|
|
|
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 |
$50.47 |
| Max. Negotiated Rate |
$239.10 |
| Rate for Payer: Aetna Commercial |
$239.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$216.44
|
| Rate for Payer: Aetna Managed Medicare |
$50.47
|
| Rate for Payer: Anthem Medicare Advantage |
$50.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$50.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$50.47
|
| 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 |
$239.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$59.25
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$50.47
|
| Rate for Payer: Health EOS Commercial |
$229.03
|
| Rate for Payer: HFN Commercial |
$239.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$223.06
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$223.06
|
| Rate for Payer: Independent Care Health Plan Medicare |
$50.47
|
| Rate for Payer: Multiplan Commercial |
$201.34
|
| Rate for Payer: NAPHCARE Commercial |
$75.71
|
| Rate for Payer: Preferred Network Access Commercial |
$239.10
|
| Rate for Payer: Quartz Beloit One Network |
$110.74
|
| Rate for Payer: Quartz Commercial |
$143.46
|
| Rate for Payer: Quartz Medicare Advantage |
$50.47
|
| Rate for Payer: The Alliance Commercial |
$214.50
|
| Rate for Payer: United Healthcare Medicaid |
$59.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$50.47
|
| Rate for Payer: WEA Trust Commercial |
$138.42
|
| Rate for Payer: WPS Commercial |
$227.12
|
|
|
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 |
$58.71 |
| Max. Negotiated Rate |
$503.88 |
| Rate for Payer: Aetna Commercial |
$503.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$456.14
|
| Rate for Payer: Aetna Managed Medicare |
$58.71
|
| Rate for Payer: Anthem Medicare Advantage |
$58.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$58.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$58.71
|
| 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 |
$503.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$136.51
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$58.71
|
| Rate for Payer: Health EOS Commercial |
$482.66
|
| Rate for Payer: HFN Commercial |
$503.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$253.50
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$253.50
|
| Rate for Payer: Independent Care Health Plan Medicare |
$58.71
|
| Rate for Payer: Multiplan Commercial |
$424.32
|
| Rate for Payer: NAPHCARE Commercial |
$88.06
|
| Rate for Payer: Preferred Network Access Commercial |
$503.88
|
| Rate for Payer: Quartz Beloit One Network |
$233.38
|
| Rate for Payer: Quartz Commercial |
$302.33
|
| Rate for Payer: Quartz Medicare Advantage |
$58.71
|
| Rate for Payer: The Alliance Commercial |
$249.51
|
| Rate for Payer: United Healthcare Medicaid |
$136.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$58.71
|
| Rate for Payer: WEA Trust Commercial |
$291.72
|
| Rate for Payer: WPS Commercial |
$264.19
|
|
|
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 |
$27.12 |
| Max. Negotiated Rate |
$152.15 |
| Rate for Payer: Aetna Commercial |
$152.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$137.74
|
| Rate for Payer: Aetna Managed Medicare |
$27.12
|
| Rate for Payer: Anthem Medicare Advantage |
$27.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$27.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$27.12
|
| 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 |
$152.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$51.39
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$27.12
|
| Rate for Payer: Health EOS Commercial |
$145.75
|
| Rate for Payer: HFN Commercial |
$152.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$118.58
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$118.58
|
| Rate for Payer: Independent Care Health Plan Medicare |
$27.12
|
| Rate for Payer: Multiplan Commercial |
$128.13
|
| Rate for Payer: NAPHCARE Commercial |
$40.68
|
| Rate for Payer: Preferred Network Access Commercial |
$152.15
|
| Rate for Payer: Quartz Beloit One Network |
$70.47
|
| Rate for Payer: Quartz Commercial |
$91.29
|
| Rate for Payer: Quartz Medicare Advantage |
$27.12
|
| Rate for Payer: The Alliance Commercial |
$115.27
|
| Rate for Payer: United Healthcare Medicaid |
$51.39
|
| Rate for Payer: United Healthcare Medicare Advantage |
$27.12
|
| Rate for Payer: WEA Trust Commercial |
$88.09
|
| Rate for Payer: WPS Commercial |
$122.05
|
|
|
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 |
$41.08 |
| Max. Negotiated Rate |
$184.86 |
| Rate for Payer: Aetna Commercial |
$163.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$147.58
|
| Rate for Payer: Aetna Managed Medicare |
$41.08
|
| Rate for Payer: Anthem Medicare Advantage |
$41.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$41.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$41.08
|
| 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 |
$163.02
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$63.35
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$41.08
|
| Rate for Payer: Health EOS Commercial |
$156.16
|
| Rate for Payer: HFN Commercial |
$163.02
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$179.05
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$179.05
|
| Rate for Payer: Independent Care Health Plan Medicare |
$41.08
|
| Rate for Payer: Multiplan Commercial |
$137.28
|
| Rate for Payer: NAPHCARE Commercial |
$61.62
|
| Rate for Payer: Preferred Network Access Commercial |
$163.02
|
| Rate for Payer: Quartz Beloit One Network |
$75.50
|
| Rate for Payer: Quartz Commercial |
$97.81
|
| Rate for Payer: Quartz Medicare Advantage |
$41.08
|
| Rate for Payer: The Alliance Commercial |
$174.59
|
| Rate for Payer: United Healthcare Medicaid |
$63.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$41.08
|
| Rate for Payer: WEA Trust Commercial |
$94.38
|
| Rate for Payer: WPS Commercial |
$184.86
|
|
|
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 |
$47.70 |
| Max. Negotiated Rate |
$214.67 |
| Rate for Payer: Aetna Commercial |
$197.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$178.88
|
| Rate for Payer: Aetna Managed Medicare |
$47.70
|
| Rate for Payer: Anthem Medicare Advantage |
$47.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$47.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$47.70
|
| 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 |
$197.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$63.35
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$47.70
|
| Rate for Payer: Health EOS Commercial |
$189.28
|
| Rate for Payer: HFN Commercial |
$197.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$209.88
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$209.88
|
| Rate for Payer: Independent Care Health Plan Medicare |
$47.70
|
| Rate for Payer: Multiplan Commercial |
$166.40
|
| Rate for Payer: NAPHCARE Commercial |
$71.56
|
| Rate for Payer: Preferred Network Access Commercial |
$197.60
|
| Rate for Payer: Quartz Beloit One Network |
$91.52
|
| Rate for Payer: Quartz Commercial |
$118.56
|
| Rate for Payer: Quartz Medicare Advantage |
$47.70
|
| Rate for Payer: The Alliance Commercial |
$202.75
|
| Rate for Payer: United Healthcare Medicaid |
$63.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$47.70
|
| Rate for Payer: WEA Trust Commercial |
$114.40
|
| Rate for Payer: WPS Commercial |
$214.67
|
|
|
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 |
$56.42 |
| Max. Negotiated Rate |
$472.26 |
| Rate for Payer: Aetna Commercial |
$472.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$427.52
|
| Rate for Payer: Aetna Managed Medicare |
$56.42
|
| Rate for Payer: Anthem Medicare Advantage |
$56.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$56.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$56.42
|
| 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 |
$472.26
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$118.05
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$56.42
|
| Rate for Payer: Health EOS Commercial |
$452.38
|
| Rate for Payer: HFN Commercial |
$472.26
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$248.32
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$248.32
|
| Rate for Payer: Independent Care Health Plan Medicare |
$56.42
|
| Rate for Payer: Multiplan Commercial |
$397.70
|
| Rate for Payer: NAPHCARE Commercial |
$84.63
|
| Rate for Payer: Preferred Network Access Commercial |
$472.26
|
| Rate for Payer: Quartz Beloit One Network |
$218.73
|
| Rate for Payer: Quartz Commercial |
$283.36
|
| Rate for Payer: Quartz Medicare Advantage |
$56.42
|
| Rate for Payer: The Alliance Commercial |
$239.78
|
| Rate for Payer: United Healthcare Medicaid |
$118.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$56.42
|
| Rate for Payer: WEA Trust Commercial |
$273.42
|
| Rate for Payer: WPS Commercial |
$253.89
|
|
|
SHEAR HARMONIC FOCUS FCS9
|
Facility
|
IP
|
$5,601.00
|
|
| Hospital Charge Code |
2965114
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,854.27 |
| Max. Negotiated Rate |
$5,359.04 |
| Rate for Payer: Aetna Commercial |
$5,242.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,009.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,087.27
|
| Rate for Payer: Cash Price |
$1,680.30
|
| Rate for Payer: Cigna Commercial |
$5,359.04
|
| Rate for Payer: Health EOS Commercial |
$5,184.29
|
| Rate for Payer: HFN Commercial |
$5,359.04
|
| Rate for Payer: Multiplan Commercial |
$4,660.03
|
| Rate for Payer: Preferred Network Access Commercial |
$5,359.04
|
| Rate for Payer: Quartz Beloit One Network |
$2,854.27
|
| Rate for Payer: Quartz Commercial |
$3,495.02
|
| Rate for Payer: WEA Trust Commercial |
$3,203.77
|
| Rate for Payer: WPS Commercial |
$4,314.45
|
|
