|
EXCISION, JAW CYST
|
Facility
|
OP
|
$1,006.00
|
|
| Hospital Charge Code |
2959986
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$281.68 |
| Max. Negotiated Rate |
$4,024.00 |
| Rate for Payer: Aetna Commercial |
$905.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$865.16
|
| Rate for Payer: Aetna Managed Medicare |
$281.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$653.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$503.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$482.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$533.18
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$925.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$562.96
|
| Rate for Payer: Health EOS Commercial |
$895.34
|
| Rate for Payer: HFN Commercial |
$925.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$754.50
|
| Rate for Payer: Multiplan Commercial |
$804.80
|
| Rate for Payer: NAPHCARE Commercial |
$603.60
|
| Rate for Payer: Preferred Network Access Commercial |
$925.52
|
| Rate for Payer: Quartz Beloit One Network |
$492.94
|
| Rate for Payer: Quartz Commercial |
$653.90
|
| Rate for Payer: Quartz Medicare Advantage |
$603.60
|
| Rate for Payer: The Alliance Commercial |
$4,024.00
|
| Rate for Payer: WEA Trust Commercial |
$553.30
|
| Rate for Payer: WPS Commercial |
$745.14
|
|
|
EXCISION, KIDNEY, CYST
|
Facility
|
OP
|
$4,460.00
|
|
| Hospital Charge Code |
2959976
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,248.80 |
| Max. Negotiated Rate |
$17,840.00 |
| Rate for Payer: Aetna Commercial |
$4,014.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,835.60
|
| Rate for Payer: Aetna Managed Medicare |
$1,248.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,899.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,230.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,140.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,363.80
|
| Rate for Payer: Cash Price |
$1,338.00
|
| Rate for Payer: Cigna Commercial |
$4,103.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,495.82
|
| Rate for Payer: Health EOS Commercial |
$3,969.40
|
| Rate for Payer: HFN Commercial |
$4,103.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,345.00
|
| Rate for Payer: Multiplan Commercial |
$3,568.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,676.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,103.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,185.40
|
| Rate for Payer: Quartz Commercial |
$2,899.00
|
| Rate for Payer: Quartz Medicare Advantage |
$2,676.00
|
| Rate for Payer: The Alliance Commercial |
$17,840.00
|
| Rate for Payer: WEA Trust Commercial |
$2,453.00
|
| Rate for Payer: WPS Commercial |
$3,303.52
|
|
|
EXCISION, KIDNEY, CYST
|
Facility
|
IP
|
$4,460.00
|
|
| Hospital Charge Code |
2959976
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,185.40 |
| Max. Negotiated Rate |
$4,103.20 |
| Rate for Payer: Aetna Commercial |
$4,014.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,835.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,363.80
|
| Rate for Payer: Cash Price |
$1,338.00
|
| Rate for Payer: Cigna Commercial |
$4,103.20
|
| Rate for Payer: Health EOS Commercial |
$3,969.40
|
| Rate for Payer: HFN Commercial |
$4,103.20
|
| Rate for Payer: Multiplan Commercial |
$3,568.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,676.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,103.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,185.40
|
| Rate for Payer: Quartz Commercial |
$2,676.00
|
| Rate for Payer: WEA Trust Commercial |
$2,453.00
|
| Rate for Payer: WPS Commercial |
$3,303.52
|
|
|
EXCISION LESION, MOUTH ROOF 42104
|
Professional
|
Both
|
$671.00
|
|
|
Service Code
|
CPT 42104
|
| Hospital Charge Code |
3014623
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$235.82 |
| Max. Negotiated Rate |
$637.45 |
| Rate for Payer: Aetna Commercial |
$637.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$577.06
|
| Rate for Payer: Cash Price |
$201.30
|
| Rate for Payer: Cash Price |
$201.30
|
| Rate for Payer: Cigna Commercial |
$637.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$235.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$402.60
|
| Rate for Payer: Health EOS Commercial |
$610.61
|
| Rate for Payer: HFN Commercial |
$637.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$451.35
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$451.35
|
| Rate for Payer: Multiplan Commercial |
$536.80
|
| Rate for Payer: Preferred Network Access Commercial |
$637.45
|
| Rate for Payer: Quartz Beloit One Network |
$295.24
|
| Rate for Payer: Quartz Commercial |
$382.47
|
| Rate for Payer: The Alliance Commercial |
$335.50
|
| Rate for Payer: United Healthcare Medicaid |
$235.82
|
| Rate for Payer: WEA Trust Commercial |
$369.05
|
| Rate for Payer: WPS Commercial |
$497.01
|
|
|
EXCISION LESION, MOUTH ROOF 42106
|
Professional
|
Both
|
$513.00
|
|
|
Service Code
|
CPT 42106
|
| Hospital Charge Code |
3014624
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$225.72 |
| Max. Negotiated Rate |
$560.60 |
| Rate for Payer: Aetna Commercial |
$487.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$441.18
|
| Rate for Payer: Cash Price |
$153.90
|
| Rate for Payer: Cash Price |
$153.90
|
| Rate for Payer: Cigna Commercial |
$487.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$235.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$307.80
|
| Rate for Payer: Health EOS Commercial |
$466.83
|
| Rate for Payer: HFN Commercial |
$487.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$560.60
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$560.60
|
| Rate for Payer: Multiplan Commercial |
$410.40
|
| Rate for Payer: Preferred Network Access Commercial |
$487.35
|
| Rate for Payer: Quartz Beloit One Network |
$225.72
|
| Rate for Payer: Quartz Commercial |
$292.41
|
| Rate for Payer: The Alliance Commercial |
$256.50
|
| Rate for Payer: United Healthcare Medicaid |
$235.82
|
| Rate for Payer: WEA Trust Commercial |
$282.15
|
| Rate for Payer: WPS Commercial |
$379.98
|
|
|
Excision Lesion, Mouth Roof 42107
|
Professional
|
Both
|
$1,823.00
|
|
|
Service Code
|
CPT 42107
|
| Hospital Charge Code |
3990002
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$802.12 |
| Max. Negotiated Rate |
$1,731.85 |
| Rate for Payer: Aetna Commercial |
$1,731.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,567.78
|
| Rate for Payer: Cash Price |
$546.90
|
| Rate for Payer: Cash Price |
$546.90
|
| Rate for Payer: Cigna Commercial |
$1,731.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$875.07
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,093.80
|
| Rate for Payer: Health EOS Commercial |
$1,658.93
|
| Rate for Payer: HFN Commercial |
$1,731.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,132.49
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,132.49
|
| Rate for Payer: Multiplan Commercial |
$1,458.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,731.85
|
| Rate for Payer: Quartz Beloit One Network |
$802.12
|
| Rate for Payer: Quartz Commercial |
$1,039.11
|
| Rate for Payer: The Alliance Commercial |
$911.50
|
| Rate for Payer: United Healthcare Medicaid |
$875.07
|
| Rate for Payer: WEA Trust Commercial |
$1,002.65
|
| Rate for Payer: WPS Commercial |
$1,350.30
|
|
|
EXCISION, LOOSE BODIES
|
Facility
|
OP
|
$1,006.00
|
|
| Hospital Charge Code |
2960029
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$281.68 |
| Max. Negotiated Rate |
$4,024.00 |
| Rate for Payer: Aetna Commercial |
$905.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$865.16
|
| Rate for Payer: Aetna Managed Medicare |
$281.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$653.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$503.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$482.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$533.18
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$925.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$562.96
|
| Rate for Payer: Health EOS Commercial |
$895.34
|
| Rate for Payer: HFN Commercial |
$925.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$754.50
|
| Rate for Payer: Multiplan Commercial |
$804.80
|
| Rate for Payer: NAPHCARE Commercial |
$603.60
|
| Rate for Payer: Preferred Network Access Commercial |
$925.52
|
| Rate for Payer: Quartz Beloit One Network |
$492.94
|
| Rate for Payer: Quartz Commercial |
$653.90
|
| Rate for Payer: Quartz Medicare Advantage |
$603.60
|
| Rate for Payer: The Alliance Commercial |
$4,024.00
|
| Rate for Payer: WEA Trust Commercial |
$553.30
|
| Rate for Payer: WPS Commercial |
$745.14
|
|
|
EXCISION, LOOSE BODIES
|
Facility
|
IP
|
$1,006.00
|
|
| Hospital Charge Code |
2960029
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$492.94 |
| Max. Negotiated Rate |
$925.52 |
| Rate for Payer: Aetna Commercial |
$905.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$865.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$533.18
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$925.52
|
| Rate for Payer: Health EOS Commercial |
$895.34
|
| Rate for Payer: HFN Commercial |
$925.52
|
| Rate for Payer: Multiplan Commercial |
$804.80
|
| Rate for Payer: NAPHCARE Commercial |
$603.60
|
| Rate for Payer: Preferred Network Access Commercial |
$925.52
|
| Rate for Payer: Quartz Beloit One Network |
$492.94
|
| Rate for Payer: Quartz Commercial |
$603.60
|
| Rate for Payer: WEA Trust Commercial |
$553.30
|
| Rate for Payer: WPS Commercial |
$745.14
|
|
|
EXCISION, MALIGNANT LESION INCLUDING MARGINS, FACE, EARS, EYELIDS, NOSE, LIPS; EXCISED DIAMETER 1.1 TO 2.0 CM
|
Facility
|
OP
|
$4,218.22
|
|
|
Service Code
|
CPT 11642
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$695.42 |
| Max. Negotiated Rate |
$4,218.22 |
| Rate for Payer: Aetna Managed Medicare |
$695.42
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,914.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,297.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,183.00
|
| Rate for Payer: Anthem Medicare Advantage |
$695.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$695.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$695.42
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$695.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$695.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,586.96
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$695.42
|
| Rate for Payer: Independent Care Health Plan Medicare |
$695.42
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$695.42
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$695.42
|
| Rate for Payer: NAPHCARE Commercial |
$1,043.13
|
| Rate for Payer: Quartz Medicare Advantage |
$695.42
|
| Rate for Payer: The Alliance Commercial |
$2,781.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$695.42
|
| Rate for Payer: United Healthcare PPO |
$2,257.00
|
| Rate for Payer: Wellcare Medicare |
$695.42
|
|
|
EXCISION, MALIGNANT LESION INCLUDING MARGINS, SCALP, NECK, HANDS, FEET, GENITALIA; EXCISED DIAMETER OVER 4.0 CM
|
Facility
|
OP
|
$11,234.20
|
|
|
Service Code
|
CPT 11626
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,808.55 |
| Max. Negotiated Rate |
$11,234.20 |
| Rate for Payer: Aetna Managed Medicare |
$2,808.55
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,907.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,043.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,639.00
|
| Rate for Payer: Anthem Medicare Advantage |
$2,808.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$2,808.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$2,808.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$2,808.55
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,757.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$2,808.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$10,447.81
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2,808.55
|
| Rate for Payer: Independent Care Health Plan Medicare |
$2,808.55
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$2,808.55
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$2,808.55
|
| Rate for Payer: NAPHCARE Commercial |
$4,212.82
|
| Rate for Payer: Quartz Medicare Advantage |
$2,808.55
|
| Rate for Payer: The Alliance Commercial |
$11,234.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,808.55
|
| Rate for Payer: United Healthcare PPO |
$4,103.00
|
| Rate for Payer: Wellcare Medicare |
$2,808.55
|
|
|
EXCISION, MALIGNANT LESION INCLUDING MARGINS, TRUNK, ARMS, OR LEGS; EXCISED DIAMETER OVER 4.0 CM
|
Facility
|
OP
|
$6,409.96
|
|
|
Service Code
|
CPT 11606
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,602.49 |
| Max. Negotiated Rate |
$6,409.96 |
| Rate for Payer: Aetna Managed Medicare |
$1,602.49
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,496.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,871.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,726.00
|
| Rate for Payer: Anthem Medicare Advantage |
$1,602.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,602.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,602.49
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,602.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,757.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,602.49
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,961.26
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,602.49
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,602.49
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,602.49
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,602.49
|
| Rate for Payer: NAPHCARE Commercial |
$2,403.74
|
| Rate for Payer: Quartz Medicare Advantage |
$1,602.49
|
| Rate for Payer: The Alliance Commercial |
$6,409.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,602.49
|
| Rate for Payer: United Healthcare PPO |
$3,583.00
|
| Rate for Payer: Wellcare Medicare |
$1,602.49
|
|
|
EXCISION, MANDIBLE TUMOR
|
Facility
|
IP
|
$3,935.00
|
|
| Hospital Charge Code |
2960455
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,928.15 |
| Max. Negotiated Rate |
$3,620.20 |
| Rate for Payer: Aetna Commercial |
$3,541.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,384.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,085.55
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,620.20
|
| Rate for Payer: Health EOS Commercial |
$3,502.15
|
| Rate for Payer: HFN Commercial |
$3,620.20
|
| Rate for Payer: Multiplan Commercial |
$3,148.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,361.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,620.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,928.15
|
| Rate for Payer: Quartz Commercial |
$2,361.00
|
| Rate for Payer: WEA Trust Commercial |
$2,164.25
|
| Rate for Payer: WPS Commercial |
$2,914.65
|
|
|
EXCISION, MANDIBLE TUMOR
|
Facility
|
OP
|
$3,935.00
|
|
| Hospital Charge Code |
2960455
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,101.80 |
| Max. Negotiated Rate |
$15,740.00 |
| Rate for Payer: Aetna Commercial |
$3,541.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,384.10
|
| Rate for Payer: Aetna Managed Medicare |
$1,101.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,557.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,967.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,888.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,085.55
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,620.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,202.03
|
| Rate for Payer: Health EOS Commercial |
$3,502.15
|
| Rate for Payer: HFN Commercial |
$3,620.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,951.25
|
| Rate for Payer: Multiplan Commercial |
$3,148.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,361.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,620.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,928.15
|
| Rate for Payer: Quartz Commercial |
$2,557.75
|
| Rate for Payer: Quartz Medicare Advantage |
$2,361.00
|
| Rate for Payer: The Alliance Commercial |
$15,740.00
|
| Rate for Payer: WEA Trust Commercial |
$2,164.25
|
| Rate for Payer: WPS Commercial |
$2,914.65
|
|
|
EXCISION OF ANAL LESION(S) 46922
|
Professional
|
Both
|
$971.00
|
|
|
Service Code
|
CPT 46922
|
| Hospital Charge Code |
3014848
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$75.33 |
| Max. Negotiated Rate |
$922.45 |
| Rate for Payer: Aetna Commercial |
$922.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$835.06
|
| Rate for Payer: Cash Price |
$291.30
|
| Rate for Payer: Cash Price |
$291.30
|
| Rate for Payer: Cigna Commercial |
$922.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$75.33
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$582.60
|
| Rate for Payer: Health EOS Commercial |
$883.61
|
| Rate for Payer: HFN Commercial |
$922.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$451.88
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$451.88
|
| Rate for Payer: Multiplan Commercial |
$776.80
|
| Rate for Payer: Preferred Network Access Commercial |
$922.45
|
| Rate for Payer: Quartz Beloit One Network |
$427.24
|
| Rate for Payer: Quartz Commercial |
$553.47
|
| Rate for Payer: The Alliance Commercial |
$485.50
|
| Rate for Payer: United Healthcare Medicaid |
$75.33
|
| Rate for Payer: WEA Trust Commercial |
$534.05
|
| Rate for Payer: WPS Commercial |
$719.22
|
|
|
Excision of benign lesion 0.6-1.0cm 41899 -11441
|
Professional
|
Both
|
$650.00
|
|
|
Service Code
|
CPT 41899
|
| Hospital Charge Code |
5313634
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$286.00 |
| Max. Negotiated Rate |
$617.50 |
| Rate for Payer: Aetna Commercial |
$617.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$559.00
|
| Rate for Payer: Cash Price |
$195.00
|
| Rate for Payer: Cash Price |
$195.00
|
| Rate for Payer: Cigna Commercial |
$617.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$325.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$390.00
|
| Rate for Payer: Health EOS Commercial |
$591.50
|
| Rate for Payer: HFN Commercial |
$617.50
|
| Rate for Payer: Multiplan Commercial |
$520.00
|
| Rate for Payer: Preferred Network Access Commercial |
$617.50
|
| Rate for Payer: Quartz Beloit One Network |
$286.00
|
| Rate for Payer: Quartz Commercial |
$370.50
|
| Rate for Payer: The Alliance Commercial |
$325.00
|
| Rate for Payer: WEA Trust Commercial |
$357.50
|
| Rate for Payer: WPS Commercial |
$481.46
|
|
|
Excision of benign lesion (face, ears, eyelids, nose, lips, mucous membrane) <=0.5cm 11440
|
Professional
|
Both
|
$442.00
|
|
|
Service Code
|
CPT 11440
|
| Hospital Charge Code |
1188921
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$81.26 |
| Max. Negotiated Rate |
$419.90 |
| Rate for Payer: Aetna Commercial |
$419.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$380.12
|
| Rate for Payer: Cash Price |
$132.60
|
| Rate for Payer: Cash Price |
$132.60
|
| Rate for Payer: Cigna Commercial |
$419.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$81.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$265.20
|
| Rate for Payer: Health EOS Commercial |
$402.22
|
| Rate for Payer: HFN Commercial |
$419.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$350.32
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$350.32
|
| Rate for Payer: Multiplan Commercial |
$353.60
|
| Rate for Payer: Preferred Network Access Commercial |
$419.90
|
| Rate for Payer: Quartz Beloit One Network |
$194.48
|
| Rate for Payer: Quartz Commercial |
$251.94
|
| Rate for Payer: The Alliance Commercial |
$221.00
|
| Rate for Payer: United Healthcare Medicaid |
$81.26
|
| Rate for Payer: WEA Trust Commercial |
$243.10
|
| Rate for Payer: WPS Commercial |
$327.39
|
|
|
Excision of benign lesion (face, ears, eyelids, nose, lips, mucous membrane) 0.6-1.0cm 11441
|
Professional
|
Both
|
$651.00
|
|
|
Service Code
|
CPT 11441
|
| Hospital Charge Code |
1188922
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$114.53 |
| Max. Negotiated Rate |
$618.45 |
| Rate for Payer: Aetna Commercial |
$618.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$559.86
|
| Rate for Payer: Cash Price |
$195.30
|
| Rate for Payer: Cash Price |
$195.30
|
| Rate for Payer: Cigna Commercial |
$618.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$114.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$390.60
|
| Rate for Payer: Health EOS Commercial |
$592.41
|
| Rate for Payer: HFN Commercial |
$618.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$439.03
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$439.03
|
| Rate for Payer: Multiplan Commercial |
$520.80
|
| Rate for Payer: Preferred Network Access Commercial |
$618.45
|
| Rate for Payer: Quartz Beloit One Network |
$286.44
|
| Rate for Payer: Quartz Commercial |
$371.07
|
| Rate for Payer: The Alliance Commercial |
$325.50
|
| Rate for Payer: United Healthcare Medicaid |
$114.53
|
| Rate for Payer: WEA Trust Commercial |
$358.05
|
| Rate for Payer: WPS Commercial |
$482.20
|
|
|
Excision of benign lesion (face, ears, eyelids, nose, lips, mucous membranes) 1.1-2.0cm 11442
|
Professional
|
Both
|
$551.00
|
|
|
Service Code
|
CPT 11442
|
| Hospital Charge Code |
3013547
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$151.81 |
| Max. Negotiated Rate |
$523.45 |
| Rate for Payer: Aetna Commercial |
$523.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$473.86
|
| Rate for Payer: Cash Price |
$165.30
|
| Rate for Payer: Cash Price |
$165.30
|
| Rate for Payer: Cigna Commercial |
$523.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$151.81
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$330.60
|
| Rate for Payer: Health EOS Commercial |
$501.41
|
| Rate for Payer: HFN Commercial |
$523.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$484.00
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$484.00
|
| Rate for Payer: Multiplan Commercial |
$440.80
|
| Rate for Payer: Preferred Network Access Commercial |
$523.45
|
| Rate for Payer: Quartz Beloit One Network |
$242.44
|
| Rate for Payer: Quartz Commercial |
$314.07
|
| Rate for Payer: The Alliance Commercial |
$275.50
|
| Rate for Payer: United Healthcare Medicaid |
$151.81
|
| Rate for Payer: WEA Trust Commercial |
$303.05
|
| Rate for Payer: WPS Commercial |
$408.13
|
|
|
Excision of benign lesion (face, ears, eyelids, nose, lips, mucous membranes) 2.1-3.0cm 11443
|
Professional
|
Both
|
$1,206.00
|
|
|
Service Code
|
CPT 11443
|
| Hospital Charge Code |
3013548
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$226.00 |
| Max. Negotiated Rate |
$1,145.70 |
| Rate for Payer: Aetna Commercial |
$1,145.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,037.16
|
| Rate for Payer: Cash Price |
$361.80
|
| Rate for Payer: Cash Price |
$361.80
|
| Rate for Payer: Cigna Commercial |
$1,145.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$226.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$723.60
|
| Rate for Payer: Health EOS Commercial |
$1,097.46
|
| Rate for Payer: HFN Commercial |
$1,145.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$592.30
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$592.30
|
| Rate for Payer: Multiplan Commercial |
$964.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,145.70
|
| Rate for Payer: Quartz Beloit One Network |
$530.64
|
| Rate for Payer: Quartz Commercial |
$687.42
|
| Rate for Payer: The Alliance Commercial |
$603.00
|
| Rate for Payer: United Healthcare Medicaid |
$226.00
|
| Rate for Payer: WEA Trust Commercial |
$663.30
|
| Rate for Payer: WPS Commercial |
$893.28
|
|
|
Excision of benign lesion (face, ears, eyelids, nose, lips, mucous membranes) 3.1-4.0cm 11444
|
Professional
|
Both
|
$1,585.00
|
|
|
Service Code
|
CPT 11444
|
| Hospital Charge Code |
3013549
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$331.44 |
| Max. Negotiated Rate |
$1,505.75 |
| Rate for Payer: Aetna Commercial |
$1,505.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,363.10
|
| Rate for Payer: Cash Price |
$475.50
|
| Rate for Payer: Cash Price |
$475.50
|
| Rate for Payer: Cigna Commercial |
$1,505.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$331.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$951.00
|
| Rate for Payer: Health EOS Commercial |
$1,442.35
|
| Rate for Payer: HFN Commercial |
$1,505.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$750.44
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$750.44
|
| Rate for Payer: Multiplan Commercial |
$1,268.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,505.75
|
| Rate for Payer: Quartz Beloit One Network |
$697.40
|
| Rate for Payer: Quartz Commercial |
$903.45
|
| Rate for Payer: The Alliance Commercial |
$792.50
|
| Rate for Payer: United Healthcare Medicaid |
$331.44
|
| Rate for Payer: WEA Trust Commercial |
$871.75
|
| Rate for Payer: WPS Commercial |
$1,174.01
|
|
|
Excision of benign lesion (face, ears, eyelids, nose, lips, mucous membranes) >4.0cm 11446
|
Professional
|
Both
|
$2,269.00
|
|
|
Service Code
|
CPT 11446
|
| Hospital Charge Code |
3013550
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$314.85 |
| Max. Negotiated Rate |
$2,155.55 |
| Rate for Payer: Aetna Commercial |
$2,155.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,951.34
|
| Rate for Payer: Cash Price |
$680.70
|
| Rate for Payer: Cash Price |
$680.70
|
| Rate for Payer: Cigna Commercial |
$2,155.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$314.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,361.40
|
| Rate for Payer: Health EOS Commercial |
$2,064.79
|
| Rate for Payer: HFN Commercial |
$2,155.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,068.95
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,068.95
|
| Rate for Payer: Multiplan Commercial |
$1,815.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,155.55
|
| Rate for Payer: Quartz Beloit One Network |
$998.36
|
| Rate for Payer: Quartz Commercial |
$1,293.33
|
| Rate for Payer: The Alliance Commercial |
$1,134.50
|
| Rate for Payer: United Healthcare Medicaid |
$314.85
|
| Rate for Payer: WEA Trust Commercial |
$1,247.95
|
| Rate for Payer: WPS Commercial |
$1,680.65
|
|
|
Excision of benign lesion (scalp, neck, hands, feet, genitalia) <=0.5cm 11420
|
Professional
|
Both
|
$400.00
|
|
|
Service Code
|
CPT 11420
|
| Hospital Charge Code |
3013541
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$68.95 |
| Max. Negotiated Rate |
$380.00 |
| Rate for Payer: Aetna Commercial |
$380.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$344.00
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cigna Commercial |
$380.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$68.95
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$240.00
|
| Rate for Payer: Health EOS Commercial |
$364.00
|
| Rate for Payer: HFN Commercial |
$380.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$275.90
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$275.90
|
| Rate for Payer: Multiplan Commercial |
$320.00
|
| Rate for Payer: Preferred Network Access Commercial |
$380.00
|
| Rate for Payer: Quartz Beloit One Network |
$176.00
|
| Rate for Payer: Quartz Commercial |
$228.00
|
| Rate for Payer: The Alliance Commercial |
$200.00
|
| Rate for Payer: United Healthcare Medicaid |
$68.95
|
| Rate for Payer: WEA Trust Commercial |
$220.00
|
| Rate for Payer: WPS Commercial |
$296.28
|
|
|
Excision of benign lesion (scalp, neck, hands, feet, genitalia) 0.6-1.0cm 11421
|
Professional
|
Both
|
$566.00
|
|
|
Service Code
|
CPT 11421
|
| Hospital Charge Code |
3013542
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$91.47 |
| Max. Negotiated Rate |
$537.70 |
| Rate for Payer: Aetna Commercial |
$537.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$486.76
|
| Rate for Payer: Cash Price |
$169.80
|
| Rate for Payer: Cash Price |
$169.80
|
| Rate for Payer: Cigna Commercial |
$537.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$91.47
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$339.60
|
| Rate for Payer: Health EOS Commercial |
$515.06
|
| Rate for Payer: HFN Commercial |
$537.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$365.57
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$365.57
|
| Rate for Payer: Multiplan Commercial |
$452.80
|
| Rate for Payer: Preferred Network Access Commercial |
$537.70
|
| Rate for Payer: Quartz Beloit One Network |
$249.04
|
| Rate for Payer: Quartz Commercial |
$322.62
|
| Rate for Payer: The Alliance Commercial |
$283.00
|
| Rate for Payer: United Healthcare Medicaid |
$91.47
|
| Rate for Payer: WEA Trust Commercial |
$311.30
|
| Rate for Payer: WPS Commercial |
$419.24
|
|
|
Excision of benign lesion (scalp, neck, hands, feet, genitalia) 1.1-2.0cm 11422
|
Professional
|
Both
|
$641.00
|
|
|
Service Code
|
CPT 11422
|
| Hospital Charge Code |
3013543
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$140.60 |
| Max. Negotiated Rate |
$608.95 |
| Rate for Payer: Aetna Commercial |
$608.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$551.26
|
| Rate for Payer: Cash Price |
$192.30
|
| Rate for Payer: Cash Price |
$192.30
|
| Rate for Payer: Cigna Commercial |
$608.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$140.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$384.60
|
| Rate for Payer: Health EOS Commercial |
$583.31
|
| Rate for Payer: HFN Commercial |
$608.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$451.28
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$451.28
|
| Rate for Payer: Multiplan Commercial |
$512.80
|
| Rate for Payer: Preferred Network Access Commercial |
$608.95
|
| Rate for Payer: Quartz Beloit One Network |
$282.04
|
| Rate for Payer: Quartz Commercial |
$365.37
|
| Rate for Payer: The Alliance Commercial |
$320.50
|
| Rate for Payer: United Healthcare Medicaid |
$140.60
|
| Rate for Payer: WEA Trust Commercial |
$352.55
|
| Rate for Payer: WPS Commercial |
$474.79
|
|
|
Excision of benign lesion (scalp, neck, hands, feet, genitalia) 2.1-3.0cm 11423
|
Professional
|
Both
|
$766.00
|
|
|
Service Code
|
CPT 11423
|
| Hospital Charge Code |
3013544
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$163.86 |
| Max. Negotiated Rate |
$727.70 |
| Rate for Payer: Aetna Commercial |
$727.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$658.76
|
| Rate for Payer: Cash Price |
$229.80
|
| Rate for Payer: Cash Price |
$229.80
|
| Rate for Payer: Cigna Commercial |
$727.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$163.86
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$459.60
|
| Rate for Payer: Health EOS Commercial |
$697.06
|
| Rate for Payer: HFN Commercial |
$727.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$517.67
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$517.67
|
| Rate for Payer: Multiplan Commercial |
$612.80
|
| Rate for Payer: Preferred Network Access Commercial |
$727.70
|
| Rate for Payer: Quartz Beloit One Network |
$337.04
|
| Rate for Payer: Quartz Commercial |
$436.62
|
| Rate for Payer: The Alliance Commercial |
$383.00
|
| Rate for Payer: United Healthcare Medicaid |
$163.86
|
| Rate for Payer: WEA Trust Commercial |
$421.30
|
| Rate for Payer: WPS Commercial |
$567.38
|
|
