|
EXCALIBUR 4.0MM X 13CM ARTHROSCOPY ARTHREX AR-8400EX
|
Facility
|
IP
|
$959.00
|
|
| Hospital Charge Code |
5074914
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$488.71 |
| Max. Negotiated Rate |
$917.57 |
| Rate for Payer: Aetna Commercial |
$897.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$857.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$528.60
|
| Rate for Payer: Cash Price |
$287.70
|
| Rate for Payer: Cigna Commercial |
$917.57
|
| Rate for Payer: Health EOS Commercial |
$887.65
|
| Rate for Payer: HFN Commercial |
$917.57
|
| Rate for Payer: Multiplan Commercial |
$797.89
|
| Rate for Payer: Preferred Network Access Commercial |
$917.57
|
| Rate for Payer: Quartz Beloit One Network |
$488.71
|
| Rate for Payer: Quartz Commercial |
$598.42
|
| Rate for Payer: WEA Trust Commercial |
$548.55
|
| Rate for Payer: WPS Commercial |
$738.72
|
|
|
EXCALIBUR 4.0MM X 13CM ARTHROSCOPY ARTHREX AR-8400EX
|
Facility
|
OP
|
$959.00
|
|
| Hospital Charge Code |
5074914
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$279.26 |
| Max. Negotiated Rate |
$917.57 |
| Rate for Payer: Aetna Commercial |
$897.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$857.73
|
| Rate for Payer: Aetna Managed Medicare |
$279.26
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$648.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$498.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$478.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$528.60
|
| Rate for Payer: Cash Price |
$287.70
|
| Rate for Payer: Cigna Commercial |
$917.57
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$558.14
|
| Rate for Payer: Health EOS Commercial |
$887.65
|
| Rate for Payer: HFN Commercial |
$917.57
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$748.02
|
| Rate for Payer: Multiplan Commercial |
$797.89
|
| Rate for Payer: NAPHCARE Commercial |
$598.42
|
| Rate for Payer: Preferred Network Access Commercial |
$917.57
|
| Rate for Payer: Quartz Beloit One Network |
$488.71
|
| Rate for Payer: Quartz Commercial |
$648.28
|
| Rate for Payer: Quartz Medicare Advantage |
$598.42
|
| Rate for Payer: The Alliance Commercial |
$498.68
|
| Rate for Payer: WEA Trust Commercial |
$548.55
|
| Rate for Payer: WPS Commercial |
$738.72
|
|
|
EXCALIBUR 4.0MM X 13CM CURVED ARTHROSCOPY ARTHREX AR-8400CEX
|
Facility
|
IP
|
$959.00
|
|
| Hospital Charge Code |
5074915
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$488.71 |
| Max. Negotiated Rate |
$917.57 |
| Rate for Payer: Aetna Commercial |
$897.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$857.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$528.60
|
| Rate for Payer: Cash Price |
$287.70
|
| Rate for Payer: Cigna Commercial |
$917.57
|
| Rate for Payer: Health EOS Commercial |
$887.65
|
| Rate for Payer: HFN Commercial |
$917.57
|
| Rate for Payer: Multiplan Commercial |
$797.89
|
| Rate for Payer: Preferred Network Access Commercial |
$917.57
|
| Rate for Payer: Quartz Beloit One Network |
$488.71
|
| Rate for Payer: Quartz Commercial |
$598.42
|
| Rate for Payer: WEA Trust Commercial |
$548.55
|
| Rate for Payer: WPS Commercial |
$738.72
|
|
|
EXCALIBUR 4.0MM X 13CM CURVED ARTHROSCOPY ARTHREX AR-8400CEX
|
Facility
|
OP
|
$959.00
|
|
| Hospital Charge Code |
5074915
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$279.26 |
| Max. Negotiated Rate |
$917.57 |
| Rate for Payer: Aetna Commercial |
$897.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$857.73
|
| Rate for Payer: Aetna Managed Medicare |
$279.26
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$648.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$498.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$478.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$528.60
|
| Rate for Payer: Cash Price |
$287.70
|
| Rate for Payer: Cigna Commercial |
$917.57
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$558.14
|
| Rate for Payer: Health EOS Commercial |
$887.65
|
| Rate for Payer: HFN Commercial |
$917.57
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$748.02
|
| Rate for Payer: Multiplan Commercial |
$797.89
|
| Rate for Payer: NAPHCARE Commercial |
$598.42
|
| Rate for Payer: Preferred Network Access Commercial |
$917.57
|
| Rate for Payer: Quartz Beloit One Network |
$488.71
|
| Rate for Payer: Quartz Commercial |
$648.28
|
| Rate for Payer: Quartz Medicare Advantage |
$598.42
|
| Rate for Payer: The Alliance Commercial |
$498.68
|
| Rate for Payer: WEA Trust Commercial |
$548.55
|
| Rate for Payer: WPS Commercial |
$738.72
|
|
|
EXCALIBUR 4.2MM X 19CM ARTHROSCOPY ARTHREX AR-6420EX
|
Facility
|
OP
|
$1,229.00
|
|
| Hospital Charge Code |
5074891
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$357.88 |
| Max. Negotiated Rate |
$1,175.91 |
| Rate for Payer: Aetna Commercial |
$1,150.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,099.22
|
| Rate for Payer: Aetna Managed Medicare |
$357.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$830.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$639.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$613.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$677.42
|
| Rate for Payer: Cash Price |
$368.70
|
| Rate for Payer: Cigna Commercial |
$1,175.91
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$715.28
|
| Rate for Payer: Health EOS Commercial |
$1,137.56
|
| Rate for Payer: HFN Commercial |
$1,175.91
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$958.62
|
| Rate for Payer: Multiplan Commercial |
$1,022.53
|
| Rate for Payer: NAPHCARE Commercial |
$766.90
|
| Rate for Payer: Preferred Network Access Commercial |
$1,175.91
|
| Rate for Payer: Quartz Beloit One Network |
$626.30
|
| Rate for Payer: Quartz Commercial |
$830.80
|
| Rate for Payer: Quartz Medicare Advantage |
$766.90
|
| Rate for Payer: The Alliance Commercial |
$639.08
|
| Rate for Payer: WEA Trust Commercial |
$702.99
|
| Rate for Payer: WPS Commercial |
$946.70
|
|
|
EXCALIBUR 4.2MM X 19CM ARTHROSCOPY ARTHREX AR-6420EX
|
Facility
|
IP
|
$1,229.00
|
|
| Hospital Charge Code |
5074891
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$626.30 |
| Max. Negotiated Rate |
$1,175.91 |
| Rate for Payer: Aetna Commercial |
$1,150.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,099.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$677.42
|
| Rate for Payer: Cash Price |
$368.70
|
| Rate for Payer: Cigna Commercial |
$1,175.91
|
| Rate for Payer: Health EOS Commercial |
$1,137.56
|
| Rate for Payer: HFN Commercial |
$1,175.91
|
| Rate for Payer: Multiplan Commercial |
$1,022.53
|
| Rate for Payer: Preferred Network Access Commercial |
$1,175.91
|
| Rate for Payer: Quartz Beloit One Network |
$626.30
|
| Rate for Payer: Quartz Commercial |
$766.90
|
| Rate for Payer: WEA Trust Commercial |
$702.99
|
| Rate for Payer: WPS Commercial |
$946.70
|
|
|
EXCALIBUR 5.0MM ARTHROSCOPY ARTHREX AR-8500EX
|
Facility
|
OP
|
$959.00
|
|
| Hospital Charge Code |
5206673
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$279.26 |
| Max. Negotiated Rate |
$917.57 |
| Rate for Payer: Aetna Commercial |
$897.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$857.73
|
| Rate for Payer: Aetna Managed Medicare |
$279.26
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$648.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$498.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$478.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$528.60
|
| Rate for Payer: Cash Price |
$287.70
|
| Rate for Payer: Cigna Commercial |
$917.57
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$558.14
|
| Rate for Payer: Health EOS Commercial |
$887.65
|
| Rate for Payer: HFN Commercial |
$917.57
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$748.02
|
| Rate for Payer: Multiplan Commercial |
$797.89
|
| Rate for Payer: NAPHCARE Commercial |
$598.42
|
| Rate for Payer: Preferred Network Access Commercial |
$917.57
|
| Rate for Payer: Quartz Beloit One Network |
$488.71
|
| Rate for Payer: Quartz Commercial |
$648.28
|
| Rate for Payer: Quartz Medicare Advantage |
$598.42
|
| Rate for Payer: The Alliance Commercial |
$498.68
|
| Rate for Payer: WEA Trust Commercial |
$548.55
|
| Rate for Payer: WPS Commercial |
$738.72
|
|
|
EXCALIBUR 5.0MM ARTHROSCOPY ARTHREX AR-8500EX
|
Facility
|
IP
|
$959.00
|
|
| Hospital Charge Code |
5206673
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$488.71 |
| Max. Negotiated Rate |
$917.57 |
| Rate for Payer: Aetna Commercial |
$897.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$857.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$528.60
|
| Rate for Payer: Cash Price |
$287.70
|
| Rate for Payer: Cigna Commercial |
$917.57
|
| Rate for Payer: Health EOS Commercial |
$887.65
|
| Rate for Payer: HFN Commercial |
$917.57
|
| Rate for Payer: Multiplan Commercial |
$797.89
|
| Rate for Payer: Preferred Network Access Commercial |
$917.57
|
| Rate for Payer: Quartz Beloit One Network |
$488.71
|
| Rate for Payer: Quartz Commercial |
$598.42
|
| Rate for Payer: WEA Trust Commercial |
$548.55
|
| Rate for Payer: WPS Commercial |
$738.72
|
|
|
EXCHANGE NEPHROSTOMY CATHETER, PERCUTANEOUS, INCLUDING DIAGNOSTIC NEPHROSTOGRAM AND/OR URETEROGRAM WHEN PERFORMED, IMAGING GUIDANCE (EG, ULTRASOUND AND/OR FLUOROSCOPY) AND ALL ASSOCIATED RADIOLOGICAL SUPERVISION AND INTERPRETATION
|
Facility
|
OP
|
$8,799.61
|
|
|
Service Code
|
CPT 50435
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,199.90 |
| Max. Negotiated Rate |
$8,799.61 |
| Rate for Payer: Aetna Managed Medicare |
$2,199.90
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,635.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,985.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,835.04
|
| Rate for Payer: Anthem Medicare Advantage |
$2,199.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$2,199.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$2,199.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$2,199.90
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$2,199.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,183.63
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2,199.90
|
| Rate for Payer: Independent Care Health Plan Medicare |
$2,199.90
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$2,199.90
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$2,199.90
|
| Rate for Payer: NAPHCARE Commercial |
$3,299.85
|
| Rate for Payer: Quartz Medicare Advantage |
$2,199.90
|
| Rate for Payer: The Alliance Commercial |
$8,799.61
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,199.90
|
| Rate for Payer: United Healthcare PPO |
$3,726.32
|
| Rate for Payer: Wellcare Medicare |
$2,199.90
|
|
|
EXCHANGE OF INTRAOCULAR LENS
|
Facility
|
OP
|
$11,234.62
|
|
|
Service Code
|
CPT 66986
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,428.73 |
| Max. Negotiated Rate |
$11,234.62 |
| Rate for Payer: Aetna Managed Medicare |
$2,428.73
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,635.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,985.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,835.04
|
| Rate for Payer: Anthem Medicare Advantage |
$2,428.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$2,428.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$2,428.73
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$2,428.73
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,234.62
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$2,428.73
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,034.89
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2,428.73
|
| Rate for Payer: Independent Care Health Plan Medicare |
$2,428.73
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$2,428.73
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$2,428.73
|
| Rate for Payer: NAPHCARE Commercial |
$3,643.10
|
| Rate for Payer: Quartz Medicare Advantage |
$2,428.73
|
| Rate for Payer: The Alliance Commercial |
$9,714.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,428.73
|
| Rate for Payer: United Healthcare PPO |
$3,726.32
|
| Rate for Payer: Wellcare Medicare |
$2,428.73
|
|
|
Exc hip pelvis les sc over 3 cm 27043
|
Professional
|
Both
|
$3,040.00
|
|
|
Service Code
|
CPT 27043
|
| Hospital Charge Code |
3014009
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$392.65 |
| Max. Negotiated Rate |
$3,003.52 |
| Rate for Payer: Aetna Commercial |
$3,003.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,718.98
|
| Rate for Payer: Aetna Managed Medicare |
$424.78
|
| Rate for Payer: Anthem Medicare Advantage |
$424.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$424.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$424.78
|
| Rate for Payer: Cash Price |
$912.00
|
| Rate for Payer: Cash Price |
$912.00
|
| Rate for Payer: Cash Price |
$912.00
|
| Rate for Payer: Cigna Commercial |
$3,003.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$392.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$424.78
|
| Rate for Payer: Health EOS Commercial |
$2,877.06
|
| Rate for Payer: HFN Commercial |
$3,003.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,590.07
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,590.07
|
| Rate for Payer: Independent Care Health Plan Medicare |
$424.78
|
| Rate for Payer: Multiplan Commercial |
$2,529.28
|
| Rate for Payer: NAPHCARE Commercial |
$637.17
|
| Rate for Payer: Preferred Network Access Commercial |
$3,003.52
|
| Rate for Payer: Quartz Beloit One Network |
$1,391.10
|
| Rate for Payer: Quartz Commercial |
$1,802.11
|
| Rate for Payer: Quartz Medicare Advantage |
$424.78
|
| Rate for Payer: The Alliance Commercial |
$1,805.30
|
| Rate for Payer: United Healthcare Medicaid |
$392.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$424.78
|
| Rate for Payer: WEA Trust Commercial |
$1,738.88
|
| Rate for Payer: WPS Commercial |
$1,911.50
|
|
|
EXCHNG ABSC/CST DRG CATH RAD GID SPX 49423
|
Professional
|
Both
|
$465.00
|
|
|
Service Code
|
CPT 49423
|
| Hospital Charge Code |
6180166
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$59.02 |
| Max. Negotiated Rate |
$520.63 |
| Rate for Payer: Aetna Commercial |
$459.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$415.90
|
| Rate for Payer: Aetna Managed Medicare |
$59.02
|
| Rate for Payer: Anthem Medicare Advantage |
$59.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$59.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$59.02
|
| Rate for Payer: Cash Price |
$139.50
|
| Rate for Payer: Cash Price |
$139.50
|
| Rate for Payer: Cash Price |
$139.50
|
| Rate for Payer: Cigna Commercial |
$459.42
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$520.63
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$59.02
|
| Rate for Payer: Health EOS Commercial |
$440.08
|
| Rate for Payer: HFN Commercial |
$459.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$247.48
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$247.48
|
| Rate for Payer: Independent Care Health Plan Medicare |
$59.02
|
| Rate for Payer: Multiplan Commercial |
$386.88
|
| Rate for Payer: NAPHCARE Commercial |
$88.53
|
| Rate for Payer: Preferred Network Access Commercial |
$459.42
|
| Rate for Payer: Quartz Beloit One Network |
$212.78
|
| Rate for Payer: Quartz Commercial |
$275.65
|
| Rate for Payer: Quartz Medicare Advantage |
$59.02
|
| Rate for Payer: The Alliance Commercial |
$250.84
|
| Rate for Payer: United Healthcare Medicaid |
$520.63
|
| Rate for Payer: United Healthcare Medicare Advantage |
$59.02
|
| Rate for Payer: WEA Trust Commercial |
$265.98
|
| Rate for Payer: WPS Commercial |
$265.59
|
|
|
EXCISE FOOT TENDON SHEATH 28086
|
Professional
|
Both
|
$2,365.00
|
|
|
Service Code
|
CPT 28086
|
| Hospital Charge Code |
3014195
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$326.77 |
| Max. Negotiated Rate |
$2,336.62 |
| Rate for Payer: Aetna Commercial |
$2,336.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,115.26
|
| Rate for Payer: Aetna Managed Medicare |
$326.77
|
| Rate for Payer: Anthem Medicare Advantage |
$326.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$326.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$326.77
|
| Rate for Payer: Cash Price |
$709.50
|
| Rate for Payer: Cash Price |
$709.50
|
| Rate for Payer: Cash Price |
$709.50
|
| Rate for Payer: Cigna Commercial |
$2,336.62
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$438.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$326.77
|
| Rate for Payer: Health EOS Commercial |
$2,238.24
|
| Rate for Payer: HFN Commercial |
$2,336.62
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,243.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,243.40
|
| Rate for Payer: Independent Care Health Plan Medicare |
$326.77
|
| Rate for Payer: Multiplan Commercial |
$1,967.68
|
| Rate for Payer: NAPHCARE Commercial |
$490.15
|
| Rate for Payer: Preferred Network Access Commercial |
$2,336.62
|
| Rate for Payer: Quartz Beloit One Network |
$1,082.22
|
| Rate for Payer: Quartz Commercial |
$1,401.97
|
| Rate for Payer: Quartz Medicare Advantage |
$326.77
|
| Rate for Payer: The Alliance Commercial |
$1,388.76
|
| Rate for Payer: United Healthcare Medicaid |
$438.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$326.77
|
| Rate for Payer: WEA Trust Commercial |
$1,352.78
|
| Rate for Payer: WPS Commercial |
$1,470.46
|
|
|
EXCISE LIP OR CHEEK FOLD 40819
|
Professional
|
Both
|
$562.00
|
|
|
Service Code
|
CPT 40819
|
| Hospital Charge Code |
3014609
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$140.16 |
| Max. Negotiated Rate |
$834.72 |
| Rate for Payer: Aetna Commercial |
$555.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$502.65
|
| Rate for Payer: Aetna Managed Medicare |
$185.49
|
| Rate for Payer: Anthem Medicare Advantage |
$185.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$185.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$185.49
|
| Rate for Payer: Cash Price |
$168.60
|
| Rate for Payer: Cash Price |
$168.60
|
| Rate for Payer: Cash Price |
$168.60
|
| Rate for Payer: Cigna Commercial |
$555.26
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$140.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$185.49
|
| Rate for Payer: Health EOS Commercial |
$531.88
|
| Rate for Payer: HFN Commercial |
$555.26
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$714.42
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$714.42
|
| Rate for Payer: Independent Care Health Plan Medicare |
$185.49
|
| Rate for Payer: Multiplan Commercial |
$467.58
|
| Rate for Payer: NAPHCARE Commercial |
$278.24
|
| Rate for Payer: Preferred Network Access Commercial |
$555.26
|
| Rate for Payer: Quartz Beloit One Network |
$257.17
|
| Rate for Payer: Quartz Commercial |
$333.15
|
| Rate for Payer: Quartz Medicare Advantage |
$185.49
|
| Rate for Payer: The Alliance Commercial |
$788.35
|
| Rate for Payer: United Healthcare Medicaid |
$140.16
|
| Rate for Payer: United Healthcare Medicare Advantage |
$185.49
|
| Rate for Payer: WEA Trust Commercial |
$321.46
|
| Rate for Payer: WPS Commercial |
$834.72
|
|
|
Excise Mandible Lesion 21040
|
Professional
|
Both
|
$2,016.00
|
|
|
Service Code
|
CPT 21040
|
| Hospital Charge Code |
4157351
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$330.11 |
| Max. Negotiated Rate |
$1,991.81 |
| Rate for Payer: Aetna Commercial |
$1,991.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,803.11
|
| Rate for Payer: Aetna Managed Medicare |
$330.11
|
| Rate for Payer: Anthem Medicare Advantage |
$330.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$330.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$330.11
|
| Rate for Payer: Cash Price |
$604.80
|
| Rate for Payer: Cash Price |
$604.80
|
| Rate for Payer: Cash Price |
$604.80
|
| Rate for Payer: Cigna Commercial |
$1,991.81
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$391.73
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$330.11
|
| Rate for Payer: Health EOS Commercial |
$1,907.94
|
| Rate for Payer: HFN Commercial |
$1,991.81
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,321.78
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,321.78
|
| Rate for Payer: Independent Care Health Plan Medicare |
$330.11
|
| Rate for Payer: Multiplan Commercial |
$1,677.31
|
| Rate for Payer: NAPHCARE Commercial |
$495.16
|
| Rate for Payer: Preferred Network Access Commercial |
$1,991.81
|
| Rate for Payer: Quartz Beloit One Network |
$922.52
|
| Rate for Payer: Quartz Commercial |
$1,195.08
|
| Rate for Payer: Quartz Medicare Advantage |
$330.11
|
| Rate for Payer: The Alliance Commercial |
$1,402.95
|
| Rate for Payer: United Healthcare Medicaid |
$391.73
|
| Rate for Payer: United Healthcare Medicare Advantage |
$330.11
|
| Rate for Payer: WEA Trust Commercial |
$1,153.15
|
| Rate for Payer: WPS Commercial |
$1,485.48
|
|
|
EXCISE/REPAIR MOUTH LESION 40814
|
Professional
|
Both
|
$1,400.00
|
|
|
Service Code
|
CPT 40814
|
| Hospital Charge Code |
3014607
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$113.76 |
| Max. Negotiated Rate |
$1,383.20 |
| Rate for Payer: Aetna Commercial |
$1,383.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,252.16
|
| Rate for Payer: Aetna Managed Medicare |
$258.63
|
| Rate for Payer: Anthem Medicare Advantage |
$258.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$258.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$258.63
|
| Rate for Payer: Cash Price |
$420.00
|
| Rate for Payer: Cash Price |
$420.00
|
| Rate for Payer: Cash Price |
$420.00
|
| Rate for Payer: Cigna Commercial |
$1,383.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$113.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$258.63
|
| Rate for Payer: Health EOS Commercial |
$1,324.96
|
| Rate for Payer: HFN Commercial |
$1,383.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,012.41
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,012.41
|
| Rate for Payer: Independent Care Health Plan Medicare |
$258.63
|
| Rate for Payer: Multiplan Commercial |
$1,164.80
|
| Rate for Payer: NAPHCARE Commercial |
$387.94
|
| Rate for Payer: Preferred Network Access Commercial |
$1,383.20
|
| Rate for Payer: Quartz Beloit One Network |
$640.64
|
| Rate for Payer: Quartz Commercial |
$829.92
|
| Rate for Payer: Quartz Medicare Advantage |
$258.63
|
| Rate for Payer: The Alliance Commercial |
$1,099.17
|
| Rate for Payer: United Healthcare Medicaid |
$113.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$258.63
|
| Rate for Payer: WEA Trust Commercial |
$800.80
|
| Rate for Payer: WPS Commercial |
$1,163.82
|
|
|
Excise/Repair Mouth Lesion 4081450
|
Professional
|
Both
|
$2,801.00
|
|
|
Service Code
|
CPT 40814 50
|
| Hospital Charge Code |
4605682
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$113.76 |
| Max. Negotiated Rate |
$2,767.39 |
| Rate for Payer: Aetna Commercial |
$2,767.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,505.21
|
| Rate for Payer: Cash Price |
$840.30
|
| Rate for Payer: Cash Price |
$840.30
|
| Rate for Payer: Cash Price |
$840.30
|
| Rate for Payer: Cigna Commercial |
$2,767.39
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$113.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,747.82
|
| Rate for Payer: Health EOS Commercial |
$2,650.87
|
| Rate for Payer: HFN Commercial |
$2,767.39
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,012.41
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,012.41
|
| Rate for Payer: Multiplan Commercial |
$2,330.43
|
| Rate for Payer: Preferred Network Access Commercial |
$2,767.39
|
| Rate for Payer: Quartz Beloit One Network |
$1,281.74
|
| Rate for Payer: Quartz Commercial |
$1,660.43
|
| Rate for Payer: The Alliance Commercial |
$1,456.52
|
| Rate for Payer: United Healthcare Medicaid |
$113.76
|
| Rate for Payer: WEA Trust Commercial |
$1,602.17
|
| Rate for Payer: WPS Commercial |
$2,157.61
|
|
|
EXCISION, AXILLA HYDRADENITIS
|
Facility
|
OP
|
$1,084.00
|
|
| Hospital Charge Code |
2960026
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$315.66 |
| Max. Negotiated Rate |
$1,037.17 |
| Rate for Payer: Aetna Commercial |
$1,014.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$969.53
|
| Rate for Payer: Aetna Managed Medicare |
$315.66
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$732.78
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$563.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$541.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$597.50
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$1,037.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$630.89
|
| Rate for Payer: Health EOS Commercial |
$1,003.35
|
| Rate for Payer: HFN Commercial |
$1,037.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$845.52
|
| Rate for Payer: Multiplan Commercial |
$901.89
|
| Rate for Payer: NAPHCARE Commercial |
$676.42
|
| Rate for Payer: Preferred Network Access Commercial |
$1,037.17
|
| Rate for Payer: Quartz Beloit One Network |
$552.41
|
| Rate for Payer: Quartz Commercial |
$732.78
|
| Rate for Payer: Quartz Medicare Advantage |
$676.42
|
| Rate for Payer: The Alliance Commercial |
$563.68
|
| Rate for Payer: WEA Trust Commercial |
$620.05
|
| Rate for Payer: WPS Commercial |
$835.01
|
|
|
EXCISION, AXILLA HYDRADENITIS
|
Facility
|
IP
|
$1,084.00
|
|
| Hospital Charge Code |
2960026
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$552.41 |
| Max. Negotiated Rate |
$1,037.17 |
| Rate for Payer: Aetna Commercial |
$1,014.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$969.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$597.50
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$1,037.17
|
| Rate for Payer: Health EOS Commercial |
$1,003.35
|
| Rate for Payer: HFN Commercial |
$1,037.17
|
| Rate for Payer: Multiplan Commercial |
$901.89
|
| Rate for Payer: Preferred Network Access Commercial |
$1,037.17
|
| Rate for Payer: Quartz Beloit One Network |
$552.41
|
| Rate for Payer: Quartz Commercial |
$676.42
|
| Rate for Payer: WEA Trust Commercial |
$620.05
|
| Rate for Payer: WPS Commercial |
$835.01
|
|
|
Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 0.5 cm or less
|
Facility
|
OP
|
$6,952.48
|
|
|
Service Code
|
CPT 11420
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,738.12 |
| Max. Negotiated Rate |
$6,952.48 |
| Rate for Payer: Aetna Managed Medicare |
$1,738.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,635.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,985.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,835.04
|
| Rate for Payer: Anthem Medicare Advantage |
$1,738.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,738.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,738.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,738.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,738.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,465.81
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,738.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,738.12
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,738.12
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,738.12
|
| Rate for Payer: NAPHCARE Commercial |
$2,607.18
|
| Rate for Payer: Quartz Medicare Advantage |
$1,738.12
|
| Rate for Payer: The Alliance Commercial |
$6,952.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,738.12
|
| Rate for Payer: United Healthcare PPO |
$3,726.32
|
| Rate for Payer: Wellcare Medicare |
$1,738.12
|
|
|
Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 0.6 to 1.0 cm
|
Facility
|
OP
|
$4,386.95
|
|
|
Service Code
|
CPT 11421
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$745.23 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Managed Medicare |
$745.23
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,030.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,388.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,270.32
|
| Rate for Payer: Anthem Medicare Advantage |
$745.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$745.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$745.23
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$745.23
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$745.23
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,772.27
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$745.23
|
| Rate for Payer: Independent Care Health Plan Medicare |
$745.23
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$745.23
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$745.23
|
| Rate for Payer: NAPHCARE Commercial |
$1,117.85
|
| Rate for Payer: Quartz Medicare Advantage |
$745.23
|
| Rate for Payer: The Alliance Commercial |
$2,980.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$745.23
|
| Rate for Payer: United Healthcare PPO |
$2,347.28
|
| Rate for Payer: Wellcare Medicare |
$745.23
|
|
|
Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 1.1 to 2.0 cm
|
Facility
|
OP
|
$6,952.48
|
|
|
Service Code
|
CPT 11422
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,738.12 |
| Max. Negotiated Rate |
$6,952.48 |
| Rate for Payer: Aetna Managed Medicare |
$1,738.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,635.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,985.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,835.04
|
| Rate for Payer: Anthem Medicare Advantage |
$1,738.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,738.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,738.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,738.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,738.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,465.81
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,738.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,738.12
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,738.12
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,738.12
|
| Rate for Payer: NAPHCARE Commercial |
$2,607.18
|
| Rate for Payer: Quartz Medicare Advantage |
$1,738.12
|
| Rate for Payer: The Alliance Commercial |
$6,952.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,738.12
|
| Rate for Payer: United Healthcare PPO |
$3,726.32
|
| Rate for Payer: Wellcare Medicare |
$1,738.12
|
|
|
Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 2.1 to 3.0 cm
|
Facility
|
OP
|
$6,952.48
|
|
|
Service Code
|
CPT 11423
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,738.12 |
| Max. Negotiated Rate |
$6,952.48 |
| Rate for Payer: Aetna Managed Medicare |
$1,738.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,635.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,985.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,835.04
|
| Rate for Payer: Anthem Medicare Advantage |
$1,738.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,738.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,738.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,738.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,738.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,465.81
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,738.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,738.12
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,738.12
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,738.12
|
| Rate for Payer: NAPHCARE Commercial |
$2,607.18
|
| Rate for Payer: Quartz Medicare Advantage |
$1,738.12
|
| Rate for Payer: The Alliance Commercial |
$6,952.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,738.12
|
| Rate for Payer: United Healthcare PPO |
$3,726.32
|
| Rate for Payer: Wellcare Medicare |
$1,738.12
|
|
|
Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm
|
Facility
|
OP
|
$6,952.48
|
|
|
Service Code
|
CPT 11424
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,738.12 |
| Max. Negotiated Rate |
$6,952.48 |
| Rate for Payer: Aetna Managed Medicare |
$1,738.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,635.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,985.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,835.04
|
| Rate for Payer: Anthem Medicare Advantage |
$1,738.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,738.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,738.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,738.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,947.89
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,738.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,465.81
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,738.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,738.12
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,738.12
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,738.12
|
| Rate for Payer: NAPHCARE Commercial |
$2,607.18
|
| Rate for Payer: Quartz Medicare Advantage |
$1,738.12
|
| Rate for Payer: The Alliance Commercial |
$6,952.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,738.12
|
| Rate for Payer: United Healthcare PPO |
$3,726.32
|
| Rate for Payer: Wellcare Medicare |
$1,738.12
|
|
|
Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm
|
Facility
|
OP
|
$12,227.57
|
|
|
Service Code
|
CPT 11426
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,056.89 |
| Max. Negotiated Rate |
$12,227.57 |
| Rate for Payer: Aetna Managed Medicare |
$3,056.89
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$10,303.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,364.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,944.56
|
| Rate for Payer: Anthem Medicare Advantage |
$3,056.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,056.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,056.89
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,056.89
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,947.89
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,056.89
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,371.64
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,056.89
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,056.89
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,056.89
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,056.89
|
| Rate for Payer: NAPHCARE Commercial |
$4,585.34
|
| Rate for Payer: Quartz Medicare Advantage |
$3,056.89
|
| Rate for Payer: The Alliance Commercial |
$12,227.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,056.89
|
| Rate for Payer: United Healthcare PPO |
$4,267.12
|
| Rate for Payer: Wellcare Medicare |
$3,056.89
|
|
