|
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 |
$189.05 |
| Max. Negotiated Rate |
$918.65 |
| Rate for Payer: Aetna Commercial |
$918.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$831.62
|
| Rate for Payer: Cash Price |
$290.10
|
| Rate for Payer: Cash Price |
$290.10
|
| Rate for Payer: Cigna Commercial |
$918.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$189.05
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$580.20
|
| Rate for Payer: Health EOS Commercial |
$879.97
|
| Rate for Payer: HFN Commercial |
$918.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$587.78
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$587.78
|
| Rate for Payer: Multiplan Commercial |
$773.60
|
| Rate for Payer: Preferred Network Access Commercial |
$918.65
|
| Rate for Payer: Quartz Beloit One Network |
$425.48
|
| Rate for Payer: Quartz Commercial |
$551.19
|
| Rate for Payer: The Alliance Commercial |
$483.50
|
| Rate for Payer: United Healthcare Medicaid |
$189.05
|
| Rate for Payer: WEA Trust Commercial |
$531.85
|
| Rate for Payer: WPS Commercial |
$716.26
|
|
|
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 |
$271.45 |
| Max. Negotiated Rate |
$1,348.05 |
| Rate for Payer: Aetna Commercial |
$1,348.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,220.34
|
| Rate for Payer: Cash Price |
$425.70
|
| Rate for Payer: Cash Price |
$425.70
|
| Rate for Payer: Cigna Commercial |
$1,348.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$271.45
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$851.40
|
| Rate for Payer: Health EOS Commercial |
$1,291.29
|
| Rate for Payer: HFN Commercial |
$1,348.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$904.92
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$904.92
|
| Rate for Payer: Multiplan Commercial |
$1,135.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,348.05
|
| Rate for Payer: Quartz Beloit One Network |
$624.36
|
| Rate for Payer: Quartz Commercial |
$808.83
|
| Rate for Payer: The Alliance Commercial |
$709.50
|
| Rate for Payer: United Healthcare Medicaid |
$271.45
|
| Rate for Payer: WEA Trust Commercial |
$780.45
|
| Rate for Payer: WPS Commercial |
$1,051.05
|
|
|
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 |
$47.18 |
| Max. Negotiated Rate |
$304.95 |
| Rate for Payer: Aetna Commercial |
$304.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$276.06
|
| Rate for Payer: Cash Price |
$96.30
|
| Rate for Payer: Cash Price |
$96.30
|
| Rate for Payer: Cigna Commercial |
$304.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$47.18
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$192.60
|
| Rate for Payer: Health EOS Commercial |
$292.11
|
| Rate for Payer: HFN Commercial |
$304.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$278.48
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$278.48
|
| Rate for Payer: Multiplan Commercial |
$256.80
|
| Rate for Payer: Preferred Network Access Commercial |
$304.95
|
| Rate for Payer: Quartz Beloit One Network |
$141.24
|
| Rate for Payer: Quartz Commercial |
$182.97
|
| Rate for Payer: The Alliance Commercial |
$160.50
|
| Rate for Payer: United Healthcare Medicaid |
$47.18
|
| Rate for Payer: WEA Trust Commercial |
$176.55
|
| Rate for Payer: WPS Commercial |
$237.76
|
|
|
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 |
$81.31 |
| Max. Negotiated Rate |
$401.85 |
| Rate for Payer: Aetna Commercial |
$401.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$363.78
|
| Rate for Payer: Cash Price |
$126.90
|
| Rate for Payer: Cash Price |
$126.90
|
| Rate for Payer: Cigna Commercial |
$401.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$81.31
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$253.80
|
| Rate for Payer: Health EOS Commercial |
$384.93
|
| Rate for Payer: HFN Commercial |
$401.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$351.09
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$351.09
|
| Rate for Payer: Multiplan Commercial |
$338.40
|
| Rate for Payer: Preferred Network Access Commercial |
$401.85
|
| Rate for Payer: Quartz Beloit One Network |
$186.12
|
| Rate for Payer: Quartz Commercial |
$241.11
|
| Rate for Payer: The Alliance Commercial |
$211.50
|
| Rate for Payer: United Healthcare Medicaid |
$81.31
|
| Rate for Payer: WEA Trust Commercial |
$232.65
|
| Rate for Payer: WPS Commercial |
$313.32
|
|
|
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 |
$131.53 |
| Max. Negotiated Rate |
$550.05 |
| Rate for Payer: Aetna Commercial |
$550.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$497.94
|
| Rate for Payer: Cash Price |
$173.70
|
| Rate for Payer: Cash Price |
$173.70
|
| Rate for Payer: Cigna Commercial |
$550.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$131.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$347.40
|
| Rate for Payer: Health EOS Commercial |
$526.89
|
| Rate for Payer: HFN Commercial |
$550.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$385.09
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$385.09
|
| Rate for Payer: Multiplan Commercial |
$463.20
|
| Rate for Payer: Preferred Network Access Commercial |
$550.05
|
| Rate for Payer: Quartz Beloit One Network |
$254.76
|
| Rate for Payer: Quartz Commercial |
$330.03
|
| Rate for Payer: The Alliance Commercial |
$289.50
|
| Rate for Payer: United Healthcare Medicaid |
$131.53
|
| Rate for Payer: WEA Trust Commercial |
$318.45
|
| Rate for Payer: WPS Commercial |
$428.87
|
|
|
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 |
$151.50 |
| Max. Negotiated Rate |
$726.75 |
| Rate for Payer: Aetna Commercial |
$726.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$657.90
|
| Rate for Payer: Cash Price |
$229.50
|
| Rate for Payer: Cash Price |
$229.50
|
| Rate for Payer: Cigna Commercial |
$726.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$151.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$459.00
|
| Rate for Payer: Health EOS Commercial |
$696.15
|
| Rate for Payer: HFN Commercial |
$726.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$492.54
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$492.54
|
| Rate for Payer: Multiplan Commercial |
$612.00
|
| Rate for Payer: Preferred Network Access Commercial |
$726.75
|
| Rate for Payer: Quartz Beloit One Network |
$336.60
|
| Rate for Payer: Quartz Commercial |
$436.05
|
| Rate for Payer: The Alliance Commercial |
$382.50
|
| Rate for Payer: United Healthcare Medicaid |
$151.50
|
| Rate for Payer: WEA Trust Commercial |
$420.75
|
| Rate for Payer: WPS Commercial |
$566.64
|
|
|
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 |
$172.45 |
| Max. Negotiated Rate |
$644.10 |
| Rate for Payer: Aetna Commercial |
$644.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$583.08
|
| Rate for Payer: Cash Price |
$203.40
|
| Rate for Payer: Cash Price |
$203.40
|
| Rate for Payer: Cigna Commercial |
$644.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$172.45
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$406.80
|
| Rate for Payer: Health EOS Commercial |
$616.98
|
| Rate for Payer: HFN Commercial |
$644.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$540.30
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$540.30
|
| Rate for Payer: Multiplan Commercial |
$542.40
|
| Rate for Payer: Preferred Network Access Commercial |
$644.10
|
| Rate for Payer: Quartz Beloit One Network |
$298.32
|
| Rate for Payer: Quartz Commercial |
$386.46
|
| Rate for Payer: The Alliance Commercial |
$339.00
|
| Rate for Payer: United Healthcare Medicaid |
$172.45
|
| Rate for Payer: WEA Trust Commercial |
$372.90
|
| Rate for Payer: WPS Commercial |
$502.19
|
|
|
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 |
$373.61 |
| Max. Negotiated Rate |
$1,179.90 |
| Rate for Payer: Aetna Commercial |
$1,179.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,068.12
|
| Rate for Payer: Cash Price |
$372.60
|
| Rate for Payer: Cash Price |
$372.60
|
| Rate for Payer: Cigna Commercial |
$1,179.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$373.61
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$745.20
|
| Rate for Payer: Health EOS Commercial |
$1,130.22
|
| Rate for Payer: HFN Commercial |
$1,179.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$813.49
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$813.49
|
| Rate for Payer: Multiplan Commercial |
$993.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,179.90
|
| Rate for Payer: Quartz Beloit One Network |
$546.48
|
| Rate for Payer: Quartz Commercial |
$707.94
|
| Rate for Payer: The Alliance Commercial |
$621.00
|
| Rate for Payer: United Healthcare Medicaid |
$373.61
|
| Rate for Payer: WEA Trust Commercial |
$683.10
|
| Rate for Payer: WPS Commercial |
$919.95
|
|
|
EXCISION OF BENIGN TUMOR OR CYST OF MAXILLA; REQUIRING INTRA-ORAL OSTEOTOMY (EG, LOCALLY AGGRESSIVE OR DESTRUCTIVE LESION[S])
|
Facility
|
OP
|
$23,153.12
|
|
|
Service Code
|
CPT 21048
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,240.00 |
| Max. Negotiated Rate |
$23,153.12 |
| Rate for Payer: Aetna Managed Medicare |
$5,788.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$12,238.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10,914.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10,367.00
|
| Rate for Payer: Anthem Medicare Advantage |
$5,788.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5,788.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5,788.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5,788.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,339.76
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5,788.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$21,532.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5,788.28
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5,788.28
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5,788.28
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5,788.28
|
| Rate for Payer: NAPHCARE Commercial |
$8,682.42
|
| Rate for Payer: Quartz Medicare Advantage |
$5,788.28
|
| Rate for Payer: The Alliance Commercial |
$23,153.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,788.28
|
| Rate for Payer: United Healthcare PPO |
$4,240.00
|
| Rate for Payer: Wellcare Medicare |
$5,788.28
|
|
|
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
|
$15,070.20
|
|
|
Service Code
|
CPT 19120
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,767.55 |
| Max. Negotiated Rate |
$15,070.20 |
| Rate for Payer: Aetna Managed Medicare |
$3,767.55
|
| 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 |
$3,767.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,767.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,767.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,767.55
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,546.14
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,767.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$14,015.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,767.55
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,767.55
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,767.55
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,767.55
|
| Rate for Payer: NAPHCARE Commercial |
$5,651.32
|
| Rate for Payer: Quartz Medicare Advantage |
$3,767.55
|
| Rate for Payer: The Alliance Commercial |
$15,070.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,767.55
|
| Rate for Payer: United Healthcare PPO |
$4,103.00
|
| Rate for Payer: Wellcare Medicare |
$3,767.55
|
|
|
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 |
$78.52 |
| Max. Negotiated Rate |
$962.35 |
| Rate for Payer: Aetna Commercial |
$962.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$871.18
|
| Rate for Payer: Cash Price |
$303.90
|
| Rate for Payer: Cash Price |
$303.90
|
| Rate for Payer: Cigna Commercial |
$962.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$78.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$607.80
|
| Rate for Payer: Health EOS Commercial |
$921.83
|
| Rate for Payer: HFN Commercial |
$962.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$878.72
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$878.72
|
| Rate for Payer: Multiplan Commercial |
$810.40
|
| Rate for Payer: Preferred Network Access Commercial |
$962.35
|
| Rate for Payer: Quartz Beloit One Network |
$445.72
|
| Rate for Payer: Quartz Commercial |
$577.41
|
| Rate for Payer: The Alliance Commercial |
$506.50
|
| Rate for Payer: United Healthcare Medicaid |
$78.52
|
| Rate for Payer: WEA Trust Commercial |
$557.15
|
| Rate for Payer: WPS Commercial |
$750.33
|
|
|
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 |
$204.12 |
| Max. Negotiated Rate |
$2,024.45 |
| Rate for Payer: Aetna Commercial |
$2,024.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,832.66
|
| Rate for Payer: Cash Price |
$639.30
|
| Rate for Payer: Cash Price |
$639.30
|
| Rate for Payer: Cigna Commercial |
$2,024.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$204.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,278.60
|
| Rate for Payer: Health EOS Commercial |
$1,939.21
|
| Rate for Payer: HFN Commercial |
$2,024.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,171.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,171.40
|
| Rate for Payer: Multiplan Commercial |
$1,704.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,024.45
|
| Rate for Payer: Quartz Beloit One Network |
$937.64
|
| Rate for Payer: Quartz Commercial |
$1,214.67
|
| Rate for Payer: The Alliance Commercial |
$1,065.50
|
| Rate for Payer: United Healthcare Medicaid |
$204.12
|
| Rate for Payer: WEA Trust Commercial |
$1,172.05
|
| Rate for Payer: WPS Commercial |
$1,578.43
|
|
|
EXCISION OF GANGLION, WRIST (DORSAL OR VOLAR); PRIMARY
|
Facility
|
OP
|
$6,546.14
|
|
|
Service Code
|
CPT 25111
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,588.57 |
| Max. Negotiated Rate |
$6,546.14 |
| Rate for Payer: Aetna Managed Medicare |
$1,588.57
|
| 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 |
$1,588.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,588.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,588.57
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,588.57
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,546.14
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,588.57
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,909.48
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,588.57
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,588.57
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,588.57
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,588.57
|
| Rate for Payer: NAPHCARE Commercial |
$2,382.86
|
| Rate for Payer: Quartz Medicare Advantage |
$1,588.57
|
| Rate for Payer: The Alliance Commercial |
$6,354.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,588.57
|
| Rate for Payer: United Healthcare PPO |
$3,583.00
|
| Rate for Payer: Wellcare Medicare |
$1,588.57
|
|
|
EXCISION OF GANGLION, WRIST (DORSAL OR VOLAR); RECURRENT
|
Facility
|
OP
|
$7,795.33
|
|
|
Service Code
|
CPT 25112
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,588.57 |
| Max. Negotiated Rate |
$7,795.33 |
| Rate for Payer: Aetna Managed Medicare |
$1,588.57
|
| 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 |
$1,588.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,588.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,588.57
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,588.57
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,795.33
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,588.57
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,909.48
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,588.57
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,588.57
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,588.57
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,588.57
|
| Rate for Payer: NAPHCARE Commercial |
$2,382.86
|
| Rate for Payer: Quartz Medicare Advantage |
$1,588.57
|
| Rate for Payer: The Alliance Commercial |
$6,354.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,588.57
|
| Rate for Payer: United Healthcare PPO |
$3,583.00
|
| Rate for Payer: Wellcare Medicare |
$1,588.57
|
|
|
EXCISION OF HYDROCELE; UNILATERAL
|
Facility
|
OP
|
$13,678.24
|
|
|
Service Code
|
CPT 55040
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,419.56 |
| Max. Negotiated Rate |
$13,678.24 |
| Rate for Payer: Aetna Managed Medicare |
$3,419.56
|
| 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 |
$3,419.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,419.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,419.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,419.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,546.14
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,419.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,720.76
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,419.56
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,419.56
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,419.56
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,419.56
|
| Rate for Payer: NAPHCARE Commercial |
$5,129.34
|
| Rate for Payer: Quartz Medicare Advantage |
$3,419.56
|
| Rate for Payer: The Alliance Commercial |
$13,678.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,419.56
|
| Rate for Payer: United Healthcare PPO |
$4,103.00
|
| Rate for Payer: Wellcare Medicare |
$3,419.56
|
|
|
EXCISION OF INFECTED GRAFT; EXTREMITY
|
Facility
|
OP
|
$12,602.12
|
|
|
Service Code
|
CPT 35903
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,150.53 |
| Max. Negotiated Rate |
$12,602.12 |
| Rate for Payer: Aetna Managed Medicare |
$3,150.53
|
| 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 |
$3,150.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,150.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,150.53
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,150.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,874.87
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,150.53
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,719.97
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,150.53
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,150.53
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,150.53
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,150.53
|
| Rate for Payer: NAPHCARE Commercial |
$4,725.80
|
| Rate for Payer: Quartz Medicare Advantage |
$3,150.53
|
| Rate for Payer: The Alliance Commercial |
$12,602.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,150.53
|
| Rate for Payer: United Healthcare PPO |
$4,103.00
|
| Rate for Payer: Wellcare Medicare |
$3,150.53
|
|
|
Excision Of Lesion; Eyelid Repair
|
Professional
|
Both
|
$967.00
|
|
|
Service Code
|
CPT 67840
|
| Hospital Charge Code |
1188900
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$77.21 |
| Max. Negotiated Rate |
$918.65 |
| Rate for Payer: Aetna Commercial |
$918.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$831.62
|
| Rate for Payer: Cash Price |
$290.10
|
| Rate for Payer: Cash Price |
$290.10
|
| Rate for Payer: Cigna Commercial |
$918.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$77.21
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$580.20
|
| Rate for Payer: Health EOS Commercial |
$879.97
|
| Rate for Payer: HFN Commercial |
$918.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$527.81
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$527.81
|
| Rate for Payer: Multiplan Commercial |
$773.60
|
| Rate for Payer: Preferred Network Access Commercial |
$918.65
|
| Rate for Payer: Quartz Beloit One Network |
$425.48
|
| Rate for Payer: Quartz Commercial |
$551.19
|
| Rate for Payer: The Alliance Commercial |
$483.50
|
| Rate for Payer: United Healthcare Medicaid |
$77.21
|
| Rate for Payer: WEA Trust Commercial |
$531.85
|
| Rate for Payer: WPS Commercial |
$716.26
|
|
|
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 |
$850.96 |
| Max. Negotiated Rate |
$1,837.30 |
| Rate for Payer: Aetna Commercial |
$1,837.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,663.24
|
| Rate for Payer: Cash Price |
$580.20
|
| Rate for Payer: Cash Price |
$580.20
|
| Rate for Payer: Cigna Commercial |
$1,837.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$967.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,160.40
|
| Rate for Payer: Health EOS Commercial |
$1,759.94
|
| Rate for Payer: HFN Commercial |
$1,837.30
|
| Rate for Payer: Multiplan Commercial |
$1,547.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,837.30
|
| Rate for Payer: Quartz Beloit One Network |
$850.96
|
| Rate for Payer: Quartz Commercial |
$1,102.38
|
| Rate for Payer: The Alliance Commercial |
$967.00
|
| Rate for Payer: WEA Trust Commercial |
$1,063.70
|
| Rate for Payer: WPS Commercial |
$1,432.51
|
|
|
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 |
$748.19 |
| Max. Negotiated Rate |
$3,090.35 |
| Rate for Payer: Aetna Commercial |
$3,090.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,797.58
|
| Rate for Payer: Cash Price |
$975.90
|
| Rate for Payer: Cash Price |
$975.90
|
| Rate for Payer: Cigna Commercial |
$3,090.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$748.19
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,951.80
|
| Rate for Payer: Health EOS Commercial |
$2,960.23
|
| Rate for Payer: HFN Commercial |
$3,090.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,524.08
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,524.08
|
| Rate for Payer: Multiplan Commercial |
$2,602.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,090.35
|
| Rate for Payer: Quartz Beloit One Network |
$1,431.32
|
| Rate for Payer: Quartz Commercial |
$1,854.21
|
| Rate for Payer: The Alliance Commercial |
$1,626.50
|
| Rate for Payer: United Healthcare Medicaid |
$748.19
|
| Rate for Payer: WEA Trust Commercial |
$1,789.15
|
| Rate for Payer: WPS Commercial |
$2,409.50
|
|
|
EXCISION OF LESION OF MUCOSA AND SUBMUCOSA, VESTIBULE OF MOUTH; WITH SIMPLE REPAIR
|
Facility
|
OP
|
$6,029.48
|
|
|
Service Code
|
CPT 40812
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,507.37 |
| Max. Negotiated Rate |
$6,029.48 |
| Rate for Payer: Aetna Managed Medicare |
$1,507.37
|
| 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 |
$1,507.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,507.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,507.37
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,507.37
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,507.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,607.42
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,507.37
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,507.37
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,507.37
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,507.37
|
| Rate for Payer: NAPHCARE Commercial |
$2,261.06
|
| Rate for Payer: Quartz Medicare Advantage |
$1,507.37
|
| Rate for Payer: The Alliance Commercial |
$6,029.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,507.37
|
| Rate for Payer: United Healthcare PPO |
$3,583.00
|
| Rate for Payer: Wellcare Medicare |
$1,507.37
|
|
|
EXCISION OF LESION OF TENDON SHEATH OR CAPSULE (EG, CYST OR GANGLION), LEG AND/OR ANKLE
|
Facility
|
OP
|
$12,797.24
|
|
|
Service Code
|
CPT 27630
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,199.31 |
| Max. Negotiated Rate |
$12,797.24 |
| Rate for Payer: Aetna Managed Medicare |
$3,199.31
|
| 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 |
$3,199.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,199.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,199.31
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,199.31
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,546.14
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,199.31
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,901.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,199.31
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,199.31
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,199.31
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,199.31
|
| Rate for Payer: NAPHCARE Commercial |
$4,798.96
|
| Rate for Payer: Quartz Medicare Advantage |
$3,199.31
|
| Rate for Payer: The Alliance Commercial |
$12,797.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,199.31
|
| Rate for Payer: United Healthcare PPO |
$4,103.00
|
| Rate for Payer: Wellcare Medicare |
$3,199.31
|
|
|
EXCISION OF LESION OF TENDON SHEATH OR JOINT CAPSULE (EG, CYST, MUCOUS CYST, OR GANGLION), HAND OR FINGER
|
Facility
|
OP
|
$6,546.14
|
|
|
Service Code
|
CPT 26160
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,588.57 |
| Max. Negotiated Rate |
$6,546.14 |
| Rate for Payer: Aetna Managed Medicare |
$1,588.57
|
| 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 |
$1,588.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,588.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,588.57
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,588.57
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,546.14
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,588.57
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,909.48
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,588.57
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,588.57
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,588.57
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,588.57
|
| Rate for Payer: NAPHCARE Commercial |
$2,382.86
|
| Rate for Payer: Quartz Medicare Advantage |
$1,588.57
|
| Rate for Payer: The Alliance Commercial |
$6,354.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,588.57
|
| Rate for Payer: United Healthcare PPO |
$3,583.00
|
| Rate for Payer: Wellcare Medicare |
$1,588.57
|
|
|
Excision Of Lesion Of Tongue With Closure; Anterior Two-Thirds
|
Professional
|
Both
|
$647.00
|
|
|
Service Code
|
CPT 41112
|
| Hospital Charge Code |
1190857
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$139.23 |
| Max. Negotiated Rate |
$820.87 |
| Rate for Payer: Aetna Commercial |
$614.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$556.42
|
| Rate for Payer: Cash Price |
$194.10
|
| Rate for Payer: Cash Price |
$194.10
|
| Rate for Payer: Cigna Commercial |
$614.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$139.23
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$388.20
|
| Rate for Payer: Health EOS Commercial |
$588.77
|
| Rate for Payer: HFN Commercial |
$614.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$820.87
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$820.87
|
| Rate for Payer: Multiplan Commercial |
$517.60
|
| Rate for Payer: Preferred Network Access Commercial |
$614.65
|
| Rate for Payer: Quartz Beloit One Network |
$284.68
|
| Rate for Payer: Quartz Commercial |
$368.79
|
| Rate for Payer: The Alliance Commercial |
$323.50
|
| Rate for Payer: United Healthcare Medicaid |
$139.23
|
| Rate for Payer: WEA Trust Commercial |
$355.85
|
| Rate for Payer: WPS Commercial |
$479.23
|
|
|
EXCISION OF LESION OF TONGUE WITH CLOSURE; ANTERIOR TWO-THIRDS
|
Facility
|
OP
|
$12,729.16
|
|
|
Service Code
|
CPT 41112
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,726.00 |
| Max. Negotiated Rate |
$12,729.16 |
| Rate for Payer: Aetna Managed Medicare |
$3,182.29
|
| 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 |
$3,182.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,182.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,182.29
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,182.29
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,757.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,182.29
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,838.12
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,182.29
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,182.29
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,182.29
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,182.29
|
| Rate for Payer: NAPHCARE Commercial |
$4,773.44
|
| Rate for Payer: Quartz Medicare Advantage |
$3,182.29
|
| Rate for Payer: The Alliance Commercial |
$12,729.16
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,182.29
|
| Rate for Payer: United Healthcare PPO |
$3,583.00
|
| Rate for Payer: Wellcare Medicare |
$3,182.29
|
|
|
Excision of Lesion of Tongue Without Closure
|
Professional
|
Both
|
$508.00
|
|
|
Service Code
|
CPT 41010
|
| Hospital Charge Code |
1190859
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$95.26 |
| Max. Negotiated Rate |
$482.60 |
| Rate for Payer: Aetna Commercial |
$482.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$436.88
|
| Rate for Payer: Cash Price |
$152.40
|
| Rate for Payer: Cash Price |
$152.40
|
| Rate for Payer: Cigna Commercial |
$482.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$95.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$304.80
|
| Rate for Payer: Health EOS Commercial |
$462.28
|
| Rate for Payer: HFN Commercial |
$482.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$366.13
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$366.13
|
| Rate for Payer: Multiplan Commercial |
$406.40
|
| Rate for Payer: Preferred Network Access Commercial |
$482.60
|
| Rate for Payer: Quartz Beloit One Network |
$223.52
|
| Rate for Payer: Quartz Commercial |
$289.56
|
| Rate for Payer: The Alliance Commercial |
$254.00
|
| Rate for Payer: United Healthcare Medicaid |
$95.26
|
| Rate for Payer: WEA Trust Commercial |
$279.40
|
| Rate for Payer: WPS Commercial |
$376.28
|
|
