|
Excision of benign lesion (scalp, neck, hands, feet, genitalia) 3.1-4.0cm 11424
|
Professional
|
Both
|
$967.00
|
|
|
Service Code
|
CPT 11424
|
| Hospital Charge Code |
3013545
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$159.57 |
| Max. Negotiated Rate |
$955.40 |
| Rate for Payer: Aetna Commercial |
$955.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$864.88
|
| Rate for Payer: Aetna Managed Medicare |
$159.57
|
| Rate for Payer: Anthem Medicare Advantage |
$159.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$159.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$159.57
|
| Rate for Payer: Cash Price |
$290.10
|
| Rate for Payer: Cash Price |
$290.10
|
| Rate for Payer: Cash Price |
$290.10
|
| Rate for Payer: Cigna Commercial |
$955.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$196.61
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$159.57
|
| Rate for Payer: Health EOS Commercial |
$915.17
|
| Rate for Payer: HFN Commercial |
$955.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$611.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$611.29
|
| Rate for Payer: Independent Care Health Plan Medicare |
$159.57
|
| Rate for Payer: Multiplan Commercial |
$804.54
|
| Rate for Payer: NAPHCARE Commercial |
$239.35
|
| Rate for Payer: Preferred Network Access Commercial |
$955.40
|
| Rate for Payer: Quartz Beloit One Network |
$442.50
|
| Rate for Payer: Quartz Commercial |
$573.24
|
| Rate for Payer: Quartz Medicare Advantage |
$159.57
|
| Rate for Payer: The Alliance Commercial |
$678.16
|
| Rate for Payer: United Healthcare Medicaid |
$196.61
|
| Rate for Payer: United Healthcare Medicare Advantage |
$159.57
|
| Rate for Payer: WEA Trust Commercial |
$553.12
|
| Rate for Payer: WPS Commercial |
$718.05
|
|
|
Excision of benign lesion (scalp, neck, hands, feet, genitalia) >4.0cm 11426
|
Professional
|
Both
|
$1,419.00
|
|
|
Service Code
|
CPT 11426
|
| Hospital Charge Code |
3013546
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$235.30 |
| Max. Negotiated Rate |
$1,401.97 |
| Rate for Payer: Aetna Commercial |
$1,401.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,269.15
|
| Rate for Payer: Aetna Managed Medicare |
$235.30
|
| Rate for Payer: Anthem Medicare Advantage |
$235.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$235.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$235.30
|
| Rate for Payer: Cash Price |
$425.70
|
| Rate for Payer: Cash Price |
$425.70
|
| Rate for Payer: Cash Price |
$425.70
|
| Rate for Payer: Cigna Commercial |
$1,401.97
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$282.31
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$235.30
|
| Rate for Payer: Health EOS Commercial |
$1,342.94
|
| Rate for Payer: HFN Commercial |
$1,401.97
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$941.12
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$941.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$235.30
|
| Rate for Payer: Multiplan Commercial |
$1,180.61
|
| Rate for Payer: NAPHCARE Commercial |
$352.95
|
| Rate for Payer: Preferred Network Access Commercial |
$1,401.97
|
| Rate for Payer: Quartz Beloit One Network |
$649.33
|
| Rate for Payer: Quartz Commercial |
$841.18
|
| Rate for Payer: Quartz Medicare Advantage |
$235.30
|
| Rate for Payer: The Alliance Commercial |
$1,000.02
|
| Rate for Payer: United Healthcare Medicaid |
$282.31
|
| Rate for Payer: United Healthcare Medicare Advantage |
$235.30
|
| Rate for Payer: WEA Trust Commercial |
$811.67
|
| Rate for Payer: WPS Commercial |
$1,058.85
|
|
|
Excision of benign lesion (trunk, arm, legs) <=0.5cm 11400
|
Professional
|
Both
|
$321.00
|
|
|
Service Code
|
CPT 11400
|
| Hospital Charge Code |
3013536
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$49.07 |
| Max. Negotiated Rate |
$337.52 |
| Rate for Payer: Aetna Commercial |
$317.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$287.10
|
| Rate for Payer: Aetna Managed Medicare |
$75.00
|
| Rate for Payer: Anthem Medicare Advantage |
$75.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$75.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$75.00
|
| Rate for Payer: Cash Price |
$96.30
|
| Rate for Payer: Cash Price |
$96.30
|
| Rate for Payer: Cash Price |
$96.30
|
| Rate for Payer: Cigna Commercial |
$317.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$49.07
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$75.00
|
| Rate for Payer: Health EOS Commercial |
$303.79
|
| Rate for Payer: HFN Commercial |
$317.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$289.62
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$289.62
|
| Rate for Payer: Independent Care Health Plan Medicare |
$75.00
|
| Rate for Payer: Multiplan Commercial |
$267.07
|
| Rate for Payer: NAPHCARE Commercial |
$112.51
|
| Rate for Payer: Preferred Network Access Commercial |
$317.15
|
| Rate for Payer: Quartz Beloit One Network |
$146.89
|
| Rate for Payer: Quartz Commercial |
$190.29
|
| Rate for Payer: Quartz Medicare Advantage |
$75.00
|
| Rate for Payer: The Alliance Commercial |
$318.77
|
| Rate for Payer: United Healthcare Medicaid |
$49.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$75.00
|
| Rate for Payer: WEA Trust Commercial |
$183.61
|
| Rate for Payer: WPS Commercial |
$337.52
|
|
|
Excision of benign lesion (trunk, arm, legs) 0.6-1.0cm 11401
|
Professional
|
Both
|
$423.00
|
|
|
Service Code
|
CPT 11401
|
| Hospital Charge Code |
1152813
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$84.56 |
| Max. Negotiated Rate |
$417.92 |
| Rate for Payer: Aetna Commercial |
$417.92
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$378.33
|
| Rate for Payer: Aetna Managed Medicare |
$92.38
|
| Rate for Payer: Anthem Medicare Advantage |
$92.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$92.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$92.38
|
| Rate for Payer: Cash Price |
$126.90
|
| Rate for Payer: Cash Price |
$126.90
|
| Rate for Payer: Cash Price |
$126.90
|
| Rate for Payer: Cigna Commercial |
$417.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$84.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$92.38
|
| Rate for Payer: Health EOS Commercial |
$400.33
|
| Rate for Payer: HFN Commercial |
$417.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$365.13
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$365.13
|
| Rate for Payer: Independent Care Health Plan Medicare |
$92.38
|
| Rate for Payer: Multiplan Commercial |
$351.94
|
| Rate for Payer: NAPHCARE Commercial |
$138.57
|
| Rate for Payer: Preferred Network Access Commercial |
$417.92
|
| Rate for Payer: Quartz Beloit One Network |
$193.56
|
| Rate for Payer: Quartz Commercial |
$250.75
|
| Rate for Payer: Quartz Medicare Advantage |
$92.38
|
| Rate for Payer: The Alliance Commercial |
$392.63
|
| Rate for Payer: United Healthcare Medicaid |
$84.56
|
| Rate for Payer: United Healthcare Medicare Advantage |
$92.38
|
| Rate for Payer: WEA Trust Commercial |
$241.96
|
| Rate for Payer: WPS Commercial |
$415.72
|
|
|
Excision of benign lesion (trunk, arm, legs) 1.1-2.0cm 11402
|
Professional
|
Both
|
$579.00
|
|
|
Service Code
|
CPT 11402
|
| Hospital Charge Code |
3013537
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$100.15 |
| Max. Negotiated Rate |
$572.05 |
| Rate for Payer: Aetna Commercial |
$572.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$517.86
|
| Rate for Payer: Aetna Managed Medicare |
$100.15
|
| Rate for Payer: Anthem Medicare Advantage |
$100.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$100.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$100.15
|
| Rate for Payer: Cash Price |
$173.70
|
| Rate for Payer: Cash Price |
$173.70
|
| Rate for Payer: Cash Price |
$173.70
|
| Rate for Payer: Cigna Commercial |
$572.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$136.79
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$100.15
|
| Rate for Payer: Health EOS Commercial |
$547.97
|
| Rate for Payer: HFN Commercial |
$572.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$400.49
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$400.49
|
| Rate for Payer: Independent Care Health Plan Medicare |
$100.15
|
| Rate for Payer: Multiplan Commercial |
$481.73
|
| Rate for Payer: NAPHCARE Commercial |
$150.23
|
| Rate for Payer: Preferred Network Access Commercial |
$572.05
|
| Rate for Payer: Quartz Beloit One Network |
$264.95
|
| Rate for Payer: Quartz Commercial |
$343.23
|
| Rate for Payer: Quartz Medicare Advantage |
$100.15
|
| Rate for Payer: The Alliance Commercial |
$425.65
|
| Rate for Payer: United Healthcare Medicaid |
$136.79
|
| Rate for Payer: United Healthcare Medicare Advantage |
$100.15
|
| Rate for Payer: WEA Trust Commercial |
$331.19
|
| Rate for Payer: WPS Commercial |
$450.68
|
|
|
Excision of benign lesion (trunk, arm, legs) 2.1-3.0cm 11403
|
Professional
|
Both
|
$765.00
|
|
|
Service Code
|
CPT 11403
|
| Hospital Charge Code |
3013538
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$132.08 |
| Max. Negotiated Rate |
$755.82 |
| Rate for Payer: Aetna Commercial |
$755.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$684.22
|
| Rate for Payer: Aetna Managed Medicare |
$132.08
|
| Rate for Payer: Anthem Medicare Advantage |
$132.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$132.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$132.08
|
| Rate for Payer: Cash Price |
$229.50
|
| Rate for Payer: Cash Price |
$229.50
|
| Rate for Payer: Cash Price |
$229.50
|
| Rate for Payer: Cigna Commercial |
$755.82
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$157.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$132.08
|
| Rate for Payer: Health EOS Commercial |
$724.00
|
| Rate for Payer: HFN Commercial |
$755.82
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$512.24
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$512.24
|
| Rate for Payer: Independent Care Health Plan Medicare |
$132.08
|
| Rate for Payer: Multiplan Commercial |
$636.48
|
| Rate for Payer: NAPHCARE Commercial |
$198.12
|
| Rate for Payer: Preferred Network Access Commercial |
$755.82
|
| Rate for Payer: Quartz Beloit One Network |
$350.06
|
| Rate for Payer: Quartz Commercial |
$453.49
|
| Rate for Payer: Quartz Medicare Advantage |
$132.08
|
| Rate for Payer: The Alliance Commercial |
$561.34
|
| Rate for Payer: United Healthcare Medicaid |
$157.56
|
| Rate for Payer: United Healthcare Medicare Advantage |
$132.08
|
| Rate for Payer: WEA Trust Commercial |
$437.58
|
| Rate for Payer: WPS Commercial |
$594.36
|
|
|
Excision of benign lesion (trunk, arm, legs) 3.1-4.0cm 11404
|
Professional
|
Both
|
$678.00
|
|
|
Service Code
|
CPT 11404
|
| Hospital Charge Code |
3013539
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$146.30 |
| Max. Negotiated Rate |
$669.86 |
| Rate for Payer: Aetna Commercial |
$669.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$606.40
|
| Rate for Payer: Aetna Managed Medicare |
$146.30
|
| Rate for Payer: Anthem Medicare Advantage |
$146.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$146.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$146.30
|
| Rate for Payer: Cash Price |
$203.40
|
| Rate for Payer: Cash Price |
$203.40
|
| Rate for Payer: Cash Price |
$203.40
|
| Rate for Payer: Cigna Commercial |
$669.86
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$179.35
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$146.30
|
| Rate for Payer: Health EOS Commercial |
$641.66
|
| Rate for Payer: HFN Commercial |
$669.86
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$561.91
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$561.91
|
| Rate for Payer: Independent Care Health Plan Medicare |
$146.30
|
| Rate for Payer: Multiplan Commercial |
$564.10
|
| Rate for Payer: NAPHCARE Commercial |
$219.45
|
| Rate for Payer: Preferred Network Access Commercial |
$669.86
|
| Rate for Payer: Quartz Beloit One Network |
$310.25
|
| Rate for Payer: Quartz Commercial |
$401.92
|
| Rate for Payer: Quartz Medicare Advantage |
$146.30
|
| Rate for Payer: The Alliance Commercial |
$621.76
|
| Rate for Payer: United Healthcare Medicaid |
$179.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$146.30
|
| Rate for Payer: WEA Trust Commercial |
$387.82
|
| Rate for Payer: WPS Commercial |
$658.34
|
|
|
Excision of benign lesion (trunk, arm, legs) > 4.0cm 11406
|
Professional
|
Both
|
$1,242.00
|
|
|
Service Code
|
CPT 11406
|
| Hospital Charge Code |
3013540
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$217.51 |
| Max. Negotiated Rate |
$1,227.10 |
| Rate for Payer: Aetna Commercial |
$1,227.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,110.84
|
| Rate for Payer: Aetna Managed Medicare |
$217.51
|
| Rate for Payer: Anthem Medicare Advantage |
$217.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$217.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$217.51
|
| Rate for Payer: Cash Price |
$372.60
|
| Rate for Payer: Cash Price |
$372.60
|
| Rate for Payer: Cash Price |
$372.60
|
| Rate for Payer: Cigna Commercial |
$1,227.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$388.55
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$217.51
|
| Rate for Payer: Health EOS Commercial |
$1,175.43
|
| Rate for Payer: HFN Commercial |
$1,227.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$846.03
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$846.03
|
| Rate for Payer: Independent Care Health Plan Medicare |
$217.51
|
| Rate for Payer: Multiplan Commercial |
$1,033.34
|
| Rate for Payer: NAPHCARE Commercial |
$326.26
|
| Rate for Payer: Preferred Network Access Commercial |
$1,227.10
|
| Rate for Payer: Quartz Beloit One Network |
$568.34
|
| Rate for Payer: Quartz Commercial |
$736.26
|
| Rate for Payer: Quartz Medicare Advantage |
$217.51
|
| Rate for Payer: The Alliance Commercial |
$924.40
|
| Rate for Payer: United Healthcare Medicaid |
$388.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$217.51
|
| Rate for Payer: WEA Trust Commercial |
$710.42
|
| Rate for Payer: WPS Commercial |
$978.78
|
|
|
EXCISION OF BENIGN TUMOR OR CYST OF MAXILLA; REQUIRING INTRA-ORAL OSTEOTOMY (EG, LOCALLY AGGRESSIVE OR DESTRUCTIVE LESION[S])
|
Facility
|
OP
|
$24,919.86
|
|
|
Service Code
|
CPT 21048
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,409.60 |
| Max. Negotiated Rate |
$24,919.86 |
| Rate for Payer: Aetna Managed Medicare |
$6,229.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$12,727.52
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$11,350.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10,781.68
|
| Rate for Payer: Anthem Medicare Advantage |
$6,229.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6,229.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6,229.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6,229.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,673.35
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6,229.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$23,175.47
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6,229.96
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6,229.96
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6,229.96
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6,229.96
|
| Rate for Payer: NAPHCARE Commercial |
$9,344.95
|
| Rate for Payer: Quartz Medicare Advantage |
$6,229.96
|
| Rate for Payer: The Alliance Commercial |
$24,919.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,229.96
|
| Rate for Payer: United Healthcare PPO |
$4,409.60
|
| Rate for Payer: Wellcare Medicare |
$6,229.96
|
|
|
EXCISION OF CHALAZION; MULTIPLE, SAME LID
|
Facility
|
OP
|
$4,386.95
|
|
|
Service Code
|
CPT 67801
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,049.10 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Managed Medicare |
$1,049.10
|
| 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 |
$1,049.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,049.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,049.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,049.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,049.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,902.65
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,049.10
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,049.10
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,049.10
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,049.10
|
| Rate for Payer: NAPHCARE Commercial |
$1,573.65
|
| Rate for Payer: Quartz Medicare Advantage |
$1,049.10
|
| Rate for Payer: The Alliance Commercial |
$4,196.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,049.10
|
| Rate for Payer: United Healthcare PPO |
$3,726.32
|
| Rate for Payer: Wellcare Medicare |
$1,049.10
|
|
|
EXCISION OF CHALAZION; SINGLE
|
Facility
|
OP
|
$4,386.95
|
|
|
Service Code
|
CPT 67800
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$334.04 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Managed Medicare |
$334.04
|
| 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 |
$334.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$334.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$334.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$334.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$334.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,242.62
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$334.04
|
| Rate for Payer: Independent Care Health Plan Medicare |
$334.04
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$334.04
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$334.04
|
| Rate for Payer: NAPHCARE Commercial |
$501.06
|
| Rate for Payer: Quartz Medicare Advantage |
$334.04
|
| Rate for Payer: The Alliance Commercial |
$1,336.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$334.04
|
| Rate for Payer: United Healthcare PPO |
$2,347.28
|
| Rate for Payer: Wellcare Medicare |
$334.04
|
|
|
EXCISION OF CHALAZION; UNDER GENERAL ANESTHESIA AND/OR REQUIRING HOSPITALIZATION, SINGLE OR MULTIPLE
|
Facility
|
OP
|
$10,008.17
|
|
|
Service Code
|
CPT 67808
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,502.04 |
| Max. Negotiated Rate |
$10,008.17 |
| Rate for Payer: Aetna Managed Medicare |
$2,502.04
|
| 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 |
$2,502.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$2,502.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$2,502.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$2,502.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,947.89
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$2,502.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,307.60
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2,502.04
|
| Rate for Payer: Independent Care Health Plan Medicare |
$2,502.04
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$2,502.04
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$2,502.04
|
| Rate for Payer: NAPHCARE Commercial |
$3,753.06
|
| Rate for Payer: Quartz Medicare Advantage |
$2,502.04
|
| Rate for Payer: The Alliance Commercial |
$10,008.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,502.04
|
| Rate for Payer: United Healthcare PPO |
$3,726.32
|
| Rate for Payer: Wellcare Medicare |
$2,502.04
|
|
|
Excision of cyst, fibroadenoma, or other benign or malignant tumor, aberrant breast tissue, duct lesion, nipple or areolar lesion (except 19300), open, male or female, 1 or more lesions
|
Facility
|
OP
|
$16,482.25
|
|
|
Service Code
|
CPT 19120
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,120.56 |
| Max. Negotiated Rate |
$16,482.25 |
| Rate for Payer: Aetna Managed Medicare |
$4,120.56
|
| 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 |
$4,120.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$4,120.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$4,120.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$4,120.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,807.99
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$4,120.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15,328.50
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$4,120.56
|
| Rate for Payer: Independent Care Health Plan Medicare |
$4,120.56
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$4,120.56
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$4,120.56
|
| Rate for Payer: NAPHCARE Commercial |
$6,180.84
|
| Rate for Payer: Quartz Medicare Advantage |
$4,120.56
|
| Rate for Payer: The Alliance Commercial |
$16,482.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4,120.56
|
| Rate for Payer: United Healthcare PPO |
$4,267.12
|
| Rate for Payer: Wellcare Medicare |
$4,120.56
|
|
|
EXCISION OF FOOT LESION 28043
|
Professional
|
Both
|
$1,013.00
|
|
|
Service Code
|
CPT 28043
|
| Hospital Charge Code |
3014185
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$81.66 |
| Max. Negotiated Rate |
$1,094.37 |
| Rate for Payer: Aetna Commercial |
$1,000.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$906.03
|
| Rate for Payer: Aetna Managed Medicare |
$243.19
|
| Rate for Payer: Anthem Medicare Advantage |
$243.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$243.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$243.19
|
| Rate for Payer: Cash Price |
$303.90
|
| Rate for Payer: Cash Price |
$303.90
|
| Rate for Payer: Cash Price |
$303.90
|
| Rate for Payer: Cigna Commercial |
$1,000.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$81.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$243.19
|
| Rate for Payer: Health EOS Commercial |
$958.70
|
| Rate for Payer: HFN Commercial |
$1,000.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$913.87
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$913.87
|
| Rate for Payer: Independent Care Health Plan Medicare |
$243.19
|
| Rate for Payer: Multiplan Commercial |
$842.82
|
| Rate for Payer: NAPHCARE Commercial |
$364.79
|
| Rate for Payer: Preferred Network Access Commercial |
$1,000.84
|
| Rate for Payer: Quartz Beloit One Network |
$463.55
|
| Rate for Payer: Quartz Commercial |
$600.51
|
| Rate for Payer: Quartz Medicare Advantage |
$243.19
|
| Rate for Payer: The Alliance Commercial |
$1,033.57
|
| Rate for Payer: United Healthcare Medicaid |
$81.66
|
| Rate for Payer: United Healthcare Medicare Advantage |
$243.19
|
| Rate for Payer: WEA Trust Commercial |
$579.44
|
| Rate for Payer: WPS Commercial |
$1,094.37
|
|
|
EXCISION OF FOOT LESION 28045
|
Professional
|
Both
|
$2,131.00
|
|
|
Service Code
|
CPT 28045
|
| Hospital Charge Code |
3014186
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$212.28 |
| Max. Negotiated Rate |
$2,105.43 |
| Rate for Payer: Aetna Commercial |
$2,105.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,905.97
|
| Rate for Payer: Aetna Managed Medicare |
$323.68
|
| Rate for Payer: Anthem Medicare Advantage |
$323.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$323.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$323.68
|
| Rate for Payer: Cash Price |
$639.30
|
| Rate for Payer: Cash Price |
$639.30
|
| Rate for Payer: Cash Price |
$639.30
|
| Rate for Payer: Cigna Commercial |
$2,105.43
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$212.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$323.68
|
| Rate for Payer: Health EOS Commercial |
$2,016.78
|
| Rate for Payer: HFN Commercial |
$2,105.43
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,218.26
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,218.26
|
| Rate for Payer: Independent Care Health Plan Medicare |
$323.68
|
| Rate for Payer: Multiplan Commercial |
$1,772.99
|
| Rate for Payer: NAPHCARE Commercial |
$485.52
|
| Rate for Payer: Preferred Network Access Commercial |
$2,105.43
|
| Rate for Payer: Quartz Beloit One Network |
$975.15
|
| Rate for Payer: Quartz Commercial |
$1,263.26
|
| Rate for Payer: Quartz Medicare Advantage |
$323.68
|
| Rate for Payer: The Alliance Commercial |
$1,375.64
|
| Rate for Payer: United Healthcare Medicaid |
$212.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$323.68
|
| Rate for Payer: WEA Trust Commercial |
$1,218.93
|
| Rate for Payer: WPS Commercial |
$1,456.56
|
|
|
EXCISION OF FRENUM, LABIAL OR BUCCAL (FRENUMECTOMY, FRENULECTOMY, FRENECTOMY)
|
Facility
|
OP
|
$6,531.49
|
|
|
Service Code
|
CPT 40819
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,632.87 |
| Max. Negotiated Rate |
$6,531.49 |
| Rate for Payer: Aetna Managed Medicare |
$1,632.87
|
| 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 |
$1,632.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,632.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,632.87
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,632.87
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,632.87
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,074.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,632.87
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,632.87
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,632.87
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,632.87
|
| Rate for Payer: NAPHCARE Commercial |
$2,449.31
|
| Rate for Payer: Quartz Medicare Advantage |
$1,632.87
|
| Rate for Payer: The Alliance Commercial |
$6,531.49
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,632.87
|
| Rate for Payer: United Healthcare PPO |
$3,726.32
|
| Rate for Payer: Wellcare Medicare |
$1,632.87
|
|
|
Excision of ganglion, wrist (dorsal or volar); primary
|
Facility
|
OP
|
$6,807.99
|
|
|
Service Code
|
CPT 25111
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,692.24 |
| Max. Negotiated Rate |
$6,807.99 |
| Rate for Payer: Aetna Managed Medicare |
$1,692.24
|
| 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 |
$1,692.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,692.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,692.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,692.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,807.99
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,692.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,295.12
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,692.24
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,692.24
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,692.24
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,692.24
|
| Rate for Payer: NAPHCARE Commercial |
$2,538.35
|
| Rate for Payer: Quartz Medicare Advantage |
$1,692.24
|
| Rate for Payer: The Alliance Commercial |
$6,768.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,692.24
|
| Rate for Payer: United Healthcare PPO |
$3,726.32
|
| Rate for Payer: Wellcare Medicare |
$1,692.24
|
|
|
EXCISION OF GANGLION, WRIST (DORSAL OR VOLAR); RECURRENT
|
Facility
|
OP
|
$8,107.14
|
|
|
Service Code
|
CPT 25112
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,692.24 |
| Max. Negotiated Rate |
$8,107.14 |
| Rate for Payer: Aetna Managed Medicare |
$1,692.24
|
| 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 |
$1,692.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,692.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,692.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,692.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,107.14
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,692.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,295.12
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,692.24
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,692.24
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,692.24
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,692.24
|
| Rate for Payer: NAPHCARE Commercial |
$2,538.35
|
| Rate for Payer: Quartz Medicare Advantage |
$1,692.24
|
| Rate for Payer: The Alliance Commercial |
$6,768.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,692.24
|
| Rate for Payer: United Healthcare PPO |
$3,726.32
|
| Rate for Payer: Wellcare Medicare |
$1,692.24
|
|
|
Excision of hydrocele; bilateral
|
Facility
|
OP
|
$15,071.89
|
|
|
Service Code
|
CPT 55041
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,767.97 |
| Max. Negotiated Rate |
$15,071.89 |
| Rate for Payer: Aetna Managed Medicare |
$3,767.97
|
| 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 |
$3,767.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,767.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,767.97
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,767.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,673.35
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,767.97
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$14,016.86
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,767.97
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,767.97
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,767.97
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,767.97
|
| Rate for Payer: NAPHCARE Commercial |
$5,651.96
|
| Rate for Payer: Quartz Medicare Advantage |
$3,767.97
|
| Rate for Payer: The Alliance Commercial |
$15,071.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,767.97
|
| Rate for Payer: United Healthcare PPO |
$4,267.12
|
| Rate for Payer: Wellcare Medicare |
$3,767.97
|
|
|
Excision of hydrocele; unilateral
|
Facility
|
OP
|
$15,071.89
|
|
|
Service Code
|
CPT 55040
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,767.97 |
| Max. Negotiated Rate |
$15,071.89 |
| Rate for Payer: Aetna Managed Medicare |
$3,767.97
|
| 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 |
$3,767.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,767.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,767.97
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,767.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,807.99
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,767.97
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$14,016.86
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,767.97
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,767.97
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,767.97
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,767.97
|
| Rate for Payer: NAPHCARE Commercial |
$5,651.96
|
| Rate for Payer: Quartz Medicare Advantage |
$3,767.97
|
| Rate for Payer: The Alliance Commercial |
$15,071.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,767.97
|
| Rate for Payer: United Healthcare PPO |
$4,267.12
|
| Rate for Payer: Wellcare Medicare |
$3,767.97
|
|
|
EXCISION OF INFECTED GRAFT; EXTREMITY
|
Facility
|
OP
|
$13,291.62
|
|
|
Service Code
|
CPT 35903
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,322.90 |
| Max. Negotiated Rate |
$13,291.62 |
| Rate for Payer: Aetna Managed Medicare |
$3,322.90
|
| 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 |
$3,322.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,322.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,322.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,322.90
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,349.86
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,322.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,361.20
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,322.90
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,322.90
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,322.90
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,322.90
|
| Rate for Payer: NAPHCARE Commercial |
$4,984.36
|
| Rate for Payer: Quartz Medicare Advantage |
$3,322.90
|
| Rate for Payer: The Alliance Commercial |
$13,291.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,322.90
|
| Rate for Payer: United Healthcare PPO |
$4,267.12
|
| Rate for Payer: Wellcare Medicare |
$3,322.90
|
|
|
Excision Of Lesion; Eyelid Repair
|
Professional
|
Both
|
$967.00
|
|
|
Service Code
|
CPT 67840
|
| Hospital Charge Code |
1188900
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$80.30 |
| Max. Negotiated Rate |
$955.40 |
| Rate for Payer: Aetna Commercial |
$955.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$864.88
|
| Rate for Payer: Aetna Managed Medicare |
$132.91
|
| Rate for Payer: Anthem Medicare Advantage |
$132.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$132.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$132.91
|
| Rate for Payer: Cash Price |
$290.10
|
| Rate for Payer: Cash Price |
$290.10
|
| Rate for Payer: Cash Price |
$290.10
|
| Rate for Payer: Cigna Commercial |
$955.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$80.30
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$132.91
|
| Rate for Payer: Health EOS Commercial |
$915.17
|
| Rate for Payer: HFN Commercial |
$955.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$548.92
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$548.92
|
| Rate for Payer: Independent Care Health Plan Medicare |
$132.91
|
| Rate for Payer: Multiplan Commercial |
$804.54
|
| Rate for Payer: NAPHCARE Commercial |
$199.37
|
| Rate for Payer: Preferred Network Access Commercial |
$955.40
|
| Rate for Payer: Quartz Beloit One Network |
$442.50
|
| Rate for Payer: Quartz Commercial |
$573.24
|
| Rate for Payer: Quartz Medicare Advantage |
$132.91
|
| Rate for Payer: The Alliance Commercial |
$564.88
|
| Rate for Payer: United Healthcare Medicaid |
$80.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$132.91
|
| Rate for Payer: WEA Trust Commercial |
$553.12
|
| Rate for Payer: WPS Commercial |
$598.10
|
|
|
Excision of Lesion, Eyelid Repair 6784050
|
Professional
|
Both
|
$1,934.00
|
|
|
Service Code
|
CPT 67840 50
|
| Hospital Charge Code |
4628615
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$80.30 |
| Max. Negotiated Rate |
$1,910.79 |
| Rate for Payer: Aetna Commercial |
$1,910.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,729.77
|
| Rate for Payer: Cash Price |
$580.20
|
| Rate for Payer: Cash Price |
$580.20
|
| Rate for Payer: Cash Price |
$580.20
|
| Rate for Payer: Cigna Commercial |
$1,910.79
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$80.30
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,206.82
|
| Rate for Payer: Health EOS Commercial |
$1,830.34
|
| Rate for Payer: HFN Commercial |
$1,910.79
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$548.92
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$548.92
|
| Rate for Payer: Multiplan Commercial |
$1,609.09
|
| Rate for Payer: Preferred Network Access Commercial |
$1,910.79
|
| Rate for Payer: Quartz Beloit One Network |
$885.00
|
| Rate for Payer: Quartz Commercial |
$1,146.48
|
| Rate for Payer: The Alliance Commercial |
$1,005.68
|
| Rate for Payer: United Healthcare Medicaid |
$80.30
|
| Rate for Payer: WEA Trust Commercial |
$1,106.25
|
| Rate for Payer: WPS Commercial |
$1,489.76
|
|
|
Excision Of Lesion; Eyelid Repair Margin
|
Professional
|
Both
|
$3,253.00
|
|
|
Service Code
|
CPT 67961
|
| Hospital Charge Code |
1188901
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$386.73 |
| Max. Negotiated Rate |
$3,213.96 |
| Rate for Payer: Aetna Commercial |
$3,213.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,909.48
|
| Rate for Payer: Aetna Managed Medicare |
$386.73
|
| Rate for Payer: Anthem Medicare Advantage |
$386.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$386.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$386.73
|
| Rate for Payer: Cash Price |
$975.90
|
| Rate for Payer: Cash Price |
$975.90
|
| Rate for Payer: Cash Price |
$975.90
|
| Rate for Payer: Cigna Commercial |
$3,213.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$778.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$386.73
|
| Rate for Payer: Health EOS Commercial |
$3,078.64
|
| Rate for Payer: HFN Commercial |
$3,213.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,585.04
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,585.04
|
| Rate for Payer: Independent Care Health Plan Medicare |
$386.73
|
| Rate for Payer: Multiplan Commercial |
$2,706.50
|
| Rate for Payer: NAPHCARE Commercial |
$580.10
|
| Rate for Payer: Preferred Network Access Commercial |
$3,213.96
|
| Rate for Payer: Quartz Beloit One Network |
$1,488.57
|
| Rate for Payer: Quartz Commercial |
$1,928.38
|
| Rate for Payer: Quartz Medicare Advantage |
$386.73
|
| Rate for Payer: The Alliance Commercial |
$1,643.62
|
| Rate for Payer: United Healthcare Medicaid |
$778.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$386.73
|
| Rate for Payer: WEA Trust Commercial |
$1,860.72
|
| Rate for Payer: WPS Commercial |
$1,740.30
|
|
|
EXCISION OF LESION OF MENISCUS OR CAPSULE (EG, CYST, GANGLION), KNEE
|
Facility
|
OP
|
$13,773.68
|
|
|
Service Code
|
CPT 27347
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,443.42 |
| Max. Negotiated Rate |
$13,773.68 |
| Rate for Payer: Aetna Managed Medicare |
$3,443.42
|
| 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 |
$3,443.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,443.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,443.42
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,443.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,107.14
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,443.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,809.52
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,443.42
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,443.42
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,443.42
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,443.42
|
| Rate for Payer: NAPHCARE Commercial |
$5,165.13
|
| Rate for Payer: Quartz Medicare Advantage |
$3,443.42
|
| Rate for Payer: The Alliance Commercial |
$13,773.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,443.42
|
| Rate for Payer: United Healthcare PPO |
$4,267.12
|
| Rate for Payer: Wellcare Medicare |
$3,443.42
|
|
