|
EXCISION OF LESION, TENDON, TENDON SHEATH, OR CAPSULE (INCLUDING SYNOVECTOMY) (EG, CYST OR GANGLION); FOOT
|
Facility
|
OP
|
$6,546.14
|
|
|
Service Code
|
CPT 28090
|
|
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, TENDON, TENDON SHEATH, OR CAPSULE (INCLUDING SYNOVECTOMY) (EG, CYST OR GANGLION); TOE(S), EACH
|
Facility
|
OP
|
$6,546.14
|
|
|
Service Code
|
CPT 28092
|
|
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 LIP; FULL THICKNESS, RECONSTRUCTION WITH LOCAL FLAP (EG, ESTLANDER OR FAN)
|
Facility
|
OP
|
$12,729.16
|
|
|
Service Code
|
CPT 40525
|
|
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 Malignant Lesion (face, ears, eyelids, nose, lips, mucous membranes) <=0.5cm 11640
|
Professional
|
Both
|
$829.00
|
|
|
Service Code
|
CPT 11640
|
| Hospital Charge Code |
1152815
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$196.76 |
| Max. Negotiated Rate |
$787.55 |
| Rate for Payer: Aetna Commercial |
$787.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$712.94
|
| Rate for Payer: Cash Price |
$248.70
|
| Rate for Payer: Cash Price |
$248.70
|
| Rate for Payer: Cigna Commercial |
$787.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$196.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$497.40
|
| Rate for Payer: Health EOS Commercial |
$754.39
|
| Rate for Payer: HFN Commercial |
$787.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$421.06
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$421.06
|
| Rate for Payer: Multiplan Commercial |
$663.20
|
| Rate for Payer: Preferred Network Access Commercial |
$787.55
|
| Rate for Payer: Quartz Beloit One Network |
$364.76
|
| Rate for Payer: Quartz Commercial |
$472.53
|
| Rate for Payer: The Alliance Commercial |
$414.50
|
| Rate for Payer: United Healthcare Medicaid |
$196.76
|
| Rate for Payer: WEA Trust Commercial |
$455.95
|
| Rate for Payer: WPS Commercial |
$614.04
|
|
|
Excision of malignant lesion (face, ears, eyelids, nose, lips, mucous membranes) 0.6-1.0cm 11641
|
Professional
|
Both
|
$1,152.00
|
|
|
Service Code
|
CPT 11641
|
| Hospital Charge Code |
3013566
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$253.34 |
| Max. Negotiated Rate |
$1,094.40 |
| Rate for Payer: Aetna Commercial |
$1,094.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$990.72
|
| Rate for Payer: Cash Price |
$345.60
|
| Rate for Payer: Cash Price |
$345.60
|
| Rate for Payer: Cigna Commercial |
$1,094.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$253.34
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$691.20
|
| Rate for Payer: Health EOS Commercial |
$1,048.32
|
| Rate for Payer: HFN Commercial |
$1,094.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$516.93
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$516.93
|
| Rate for Payer: Multiplan Commercial |
$921.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,094.40
|
| Rate for Payer: Quartz Beloit One Network |
$506.88
|
| Rate for Payer: Quartz Commercial |
$656.64
|
| Rate for Payer: The Alliance Commercial |
$576.00
|
| Rate for Payer: United Healthcare Medicaid |
$253.34
|
| Rate for Payer: WEA Trust Commercial |
$633.60
|
| Rate for Payer: WPS Commercial |
$853.29
|
|
|
Excision of malignant lesion (face, ears, eyelids, nose, lips, mucous membranes) 1.1-2.0cm 11642
|
Professional
|
Both
|
$1,246.00
|
|
|
Service Code
|
CPT 11642
|
| Hospital Charge Code |
3013567
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$224.04 |
| Max. Negotiated Rate |
$1,183.70 |
| Rate for Payer: Aetna Commercial |
$1,183.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,071.56
|
| Rate for Payer: Cash Price |
$373.80
|
| Rate for Payer: Cash Price |
$373.80
|
| Rate for Payer: Cigna Commercial |
$1,183.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$224.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$747.60
|
| Rate for Payer: Health EOS Commercial |
$1,133.86
|
| Rate for Payer: HFN Commercial |
$1,183.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$605.54
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$605.54
|
| Rate for Payer: Multiplan Commercial |
$996.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,183.70
|
| Rate for Payer: Quartz Beloit One Network |
$548.24
|
| Rate for Payer: Quartz Commercial |
$710.22
|
| Rate for Payer: The Alliance Commercial |
$623.00
|
| Rate for Payer: United Healthcare Medicaid |
$224.04
|
| Rate for Payer: WEA Trust Commercial |
$685.30
|
| Rate for Payer: WPS Commercial |
$922.91
|
|
|
Excision of malignant lesion (face, ears, eyelids, nose, lips, mucous membranes) 2.1-3.0cm 11643
|
Professional
|
Both
|
$2,211.00
|
|
|
Service Code
|
CPT 11643
|
| Hospital Charge Code |
3013568
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$382.71 |
| Max. Negotiated Rate |
$2,100.45 |
| Rate for Payer: Aetna Commercial |
$2,100.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,901.46
|
| Rate for Payer: Cash Price |
$663.30
|
| Rate for Payer: Cash Price |
$663.30
|
| Rate for Payer: Cigna Commercial |
$2,100.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$382.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,326.60
|
| Rate for Payer: Health EOS Commercial |
$2,012.01
|
| Rate for Payer: HFN Commercial |
$2,100.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$756.37
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$756.37
|
| Rate for Payer: Multiplan Commercial |
$1,768.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,100.45
|
| Rate for Payer: Quartz Beloit One Network |
$972.84
|
| Rate for Payer: Quartz Commercial |
$1,260.27
|
| Rate for Payer: The Alliance Commercial |
$1,105.50
|
| Rate for Payer: United Healthcare Medicaid |
$382.71
|
| Rate for Payer: WEA Trust Commercial |
$1,216.05
|
| Rate for Payer: WPS Commercial |
$1,637.69
|
|
|
Excision of malignant lesion (face, ears, eyelids, nose, lips, mucous membranes) 3.1-4.0cm 11644
|
Professional
|
Both
|
$2,959.00
|
|
|
Service Code
|
CPT 11644
|
| Hospital Charge Code |
3013569
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$584.69 |
| Max. Negotiated Rate |
$2,811.05 |
| Rate for Payer: Aetna Commercial |
$2,811.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,544.74
|
| Rate for Payer: Cash Price |
$887.70
|
| Rate for Payer: Cash Price |
$887.70
|
| Rate for Payer: Cigna Commercial |
$2,811.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$584.69
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,775.40
|
| Rate for Payer: Health EOS Commercial |
$2,692.69
|
| Rate for Payer: HFN Commercial |
$2,811.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$936.23
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$936.23
|
| Rate for Payer: Multiplan Commercial |
$2,367.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,811.05
|
| Rate for Payer: Quartz Beloit One Network |
$1,301.96
|
| Rate for Payer: Quartz Commercial |
$1,686.63
|
| Rate for Payer: The Alliance Commercial |
$1,479.50
|
| Rate for Payer: United Healthcare Medicaid |
$584.69
|
| Rate for Payer: WEA Trust Commercial |
$1,627.45
|
| Rate for Payer: WPS Commercial |
$2,191.73
|
|
|
Excision of malignant lesion (face, ears, eyelids, nose, lips, mucous membranes) 4.1-5.0cm 11646
|
Professional
|
Both
|
$3,483.00
|
|
|
Service Code
|
CPT 11646
|
| Hospital Charge Code |
3013570
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$671.07 |
| Max. Negotiated Rate |
$3,308.85 |
| Rate for Payer: Aetna Commercial |
$3,308.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,995.38
|
| Rate for Payer: Cash Price |
$1,044.90
|
| Rate for Payer: Cash Price |
$1,044.90
|
| Rate for Payer: Cigna Commercial |
$3,308.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$671.07
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,089.80
|
| Rate for Payer: Health EOS Commercial |
$3,169.53
|
| Rate for Payer: HFN Commercial |
$3,308.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,293.46
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,293.46
|
| Rate for Payer: Multiplan Commercial |
$2,786.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,308.85
|
| Rate for Payer: Quartz Beloit One Network |
$1,532.52
|
| Rate for Payer: Quartz Commercial |
$1,985.31
|
| Rate for Payer: The Alliance Commercial |
$1,741.50
|
| Rate for Payer: United Healthcare Medicaid |
$671.07
|
| Rate for Payer: WEA Trust Commercial |
$1,915.65
|
| Rate for Payer: WPS Commercial |
$2,579.86
|
|
|
Excision of malignant lesion (scalp, neck, hands, feet, genitalia) <=0.5cm 11620
|
Professional
|
Both
|
$766.00
|
|
|
Service Code
|
CPT 11620
|
| Hospital Charge Code |
3013560
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$119.23 |
| 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 |
$119.23
|
| 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 |
$410.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$410.40
|
| 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 |
$119.23
|
| Rate for Payer: WEA Trust Commercial |
$421.30
|
| Rate for Payer: WPS Commercial |
$567.38
|
|
|
Excision of malignant lesion (scalp, neck, hands, feet, genitalia) 0.6-1.0cm 11621
|
Professional
|
Both
|
$848.00
|
|
|
Service Code
|
CPT 11621
|
| Hospital Charge Code |
3013561
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$201.40 |
| Max. Negotiated Rate |
$805.60 |
| Rate for Payer: Aetna Commercial |
$805.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$729.28
|
| Rate for Payer: Cash Price |
$254.40
|
| Rate for Payer: Cash Price |
$254.40
|
| Rate for Payer: Cigna Commercial |
$805.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$201.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$508.80
|
| Rate for Payer: Health EOS Commercial |
$771.68
|
| Rate for Payer: HFN Commercial |
$805.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$496.21
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$496.21
|
| Rate for Payer: Multiplan Commercial |
$678.40
|
| Rate for Payer: Preferred Network Access Commercial |
$805.60
|
| Rate for Payer: Quartz Beloit One Network |
$373.12
|
| Rate for Payer: Quartz Commercial |
$483.36
|
| Rate for Payer: The Alliance Commercial |
$424.00
|
| Rate for Payer: United Healthcare Medicaid |
$201.40
|
| Rate for Payer: WEA Trust Commercial |
$466.40
|
| Rate for Payer: WPS Commercial |
$628.11
|
|
|
Excision of malignant lesion (scalp, neck, hands, feet, genitalia) 1.1-2.0cm 11622
|
Professional
|
Both
|
$1,231.00
|
|
|
Service Code
|
CPT 11622
|
| Hospital Charge Code |
3013562
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$247.94 |
| Max. Negotiated Rate |
$1,169.45 |
| Rate for Payer: Aetna Commercial |
$1,169.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,058.66
|
| Rate for Payer: Cash Price |
$369.30
|
| Rate for Payer: Cash Price |
$369.30
|
| Rate for Payer: Cigna Commercial |
$1,169.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$247.94
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$738.60
|
| Rate for Payer: Health EOS Commercial |
$1,120.21
|
| Rate for Payer: HFN Commercial |
$1,169.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$563.92
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$563.92
|
| Rate for Payer: Multiplan Commercial |
$984.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,169.45
|
| Rate for Payer: Quartz Beloit One Network |
$541.64
|
| Rate for Payer: Quartz Commercial |
$701.67
|
| Rate for Payer: The Alliance Commercial |
$615.50
|
| Rate for Payer: United Healthcare Medicaid |
$247.94
|
| Rate for Payer: WEA Trust Commercial |
$677.05
|
| Rate for Payer: WPS Commercial |
$911.80
|
|
|
Excision of malignant lesion (scalp, neck, hands, feet, genitalia) 2.1-3.0cm 11623
|
Professional
|
Both
|
$1,870.00
|
|
|
Service Code
|
CPT 11623
|
| Hospital Charge Code |
3013563
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$283.02 |
| Max. Negotiated Rate |
$1,776.50 |
| Rate for Payer: Aetna Commercial |
$1,776.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,608.20
|
| Rate for Payer: Cash Price |
$561.00
|
| Rate for Payer: Cash Price |
$561.00
|
| Rate for Payer: Cigna Commercial |
$1,776.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$283.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,122.00
|
| Rate for Payer: Health EOS Commercial |
$1,701.70
|
| Rate for Payer: HFN Commercial |
$1,776.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$697.42
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$697.42
|
| Rate for Payer: Multiplan Commercial |
$1,496.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,776.50
|
| Rate for Payer: Quartz Beloit One Network |
$822.80
|
| Rate for Payer: Quartz Commercial |
$1,065.90
|
| Rate for Payer: The Alliance Commercial |
$935.00
|
| Rate for Payer: United Healthcare Medicaid |
$283.02
|
| Rate for Payer: WEA Trust Commercial |
$1,028.50
|
| Rate for Payer: WPS Commercial |
$1,385.11
|
|
|
Excision of malignant lesion (scalp, neck, hands, feet, genitalia) 3.1-4.0cm 11624
|
Professional
|
Both
|
$1,722.00
|
|
|
Service Code
|
CPT 11624
|
| Hospital Charge Code |
3013564
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$382.71 |
| Max. Negotiated Rate |
$1,635.90 |
| Rate for Payer: Aetna Commercial |
$1,635.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,480.92
|
| Rate for Payer: Cash Price |
$516.60
|
| Rate for Payer: Cash Price |
$516.60
|
| Rate for Payer: Cigna Commercial |
$1,635.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$382.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,033.20
|
| Rate for Payer: Health EOS Commercial |
$1,567.02
|
| Rate for Payer: HFN Commercial |
$1,635.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$788.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$788.25
|
| Rate for Payer: Multiplan Commercial |
$1,377.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,635.90
|
| Rate for Payer: Quartz Beloit One Network |
$757.68
|
| Rate for Payer: Quartz Commercial |
$981.54
|
| Rate for Payer: The Alliance Commercial |
$861.00
|
| Rate for Payer: United Healthcare Medicaid |
$382.71
|
| Rate for Payer: WEA Trust Commercial |
$947.10
|
| Rate for Payer: WPS Commercial |
$1,275.49
|
|
|
Excision of malignant lesion (scalp, neck, hands, feet, genitalia) > 4.0cm 11626
|
Professional
|
Both
|
$2,614.00
|
|
|
Service Code
|
CPT 11626
|
| Hospital Charge Code |
3013565
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$448.16 |
| Max. Negotiated Rate |
$2,483.30 |
| Rate for Payer: Aetna Commercial |
$2,483.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,248.04
|
| Rate for Payer: Cash Price |
$784.20
|
| Rate for Payer: Cash Price |
$784.20
|
| Rate for Payer: Cigna Commercial |
$2,483.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$448.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,568.40
|
| Rate for Payer: Health EOS Commercial |
$2,378.74
|
| Rate for Payer: HFN Commercial |
$2,483.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$962.63
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$962.63
|
| Rate for Payer: Multiplan Commercial |
$2,091.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,483.30
|
| Rate for Payer: Quartz Beloit One Network |
$1,150.16
|
| Rate for Payer: Quartz Commercial |
$1,489.98
|
| Rate for Payer: The Alliance Commercial |
$1,307.00
|
| Rate for Payer: United Healthcare Medicaid |
$448.16
|
| Rate for Payer: WEA Trust Commercial |
$1,437.70
|
| Rate for Payer: WPS Commercial |
$1,936.19
|
|
|
Excision of malignant lesion (trunk, arms, legs) <=0.5cm 11600
|
Professional
|
Both
|
$518.00
|
|
|
Service Code
|
CPT 11600
|
| Hospital Charge Code |
1152814
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$90.38 |
| Max. Negotiated Rate |
$492.10 |
| Rate for Payer: Aetna Commercial |
$492.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$445.48
|
| Rate for Payer: Cash Price |
$155.40
|
| Rate for Payer: Cash Price |
$155.40
|
| Rate for Payer: Cigna Commercial |
$492.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$90.38
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$310.80
|
| Rate for Payer: Health EOS Commercial |
$471.38
|
| Rate for Payer: HFN Commercial |
$492.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$408.00
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$408.00
|
| Rate for Payer: Multiplan Commercial |
$414.40
|
| Rate for Payer: Preferred Network Access Commercial |
$492.10
|
| Rate for Payer: Quartz Beloit One Network |
$227.92
|
| Rate for Payer: Quartz Commercial |
$295.26
|
| Rate for Payer: The Alliance Commercial |
$259.00
|
| Rate for Payer: United Healthcare Medicaid |
$90.38
|
| Rate for Payer: WEA Trust Commercial |
$284.90
|
| Rate for Payer: WPS Commercial |
$383.68
|
|
|
Excision of malignant lesion (trunk, arms, legs) 0.6-1.0cm 11601
|
Professional
|
Both
|
$612.00
|
|
|
Service Code
|
CPT 11601
|
| Hospital Charge Code |
3013555
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$120.52 |
| Max. Negotiated Rate |
$581.40 |
| Rate for Payer: Aetna Commercial |
$581.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$526.32
|
| Rate for Payer: Cash Price |
$183.60
|
| Rate for Payer: Cash Price |
$183.60
|
| Rate for Payer: Cigna Commercial |
$581.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$120.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$367.20
|
| Rate for Payer: Health EOS Commercial |
$556.92
|
| Rate for Payer: HFN Commercial |
$581.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$494.98
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$494.98
|
| Rate for Payer: Multiplan Commercial |
$489.60
|
| Rate for Payer: Preferred Network Access Commercial |
$581.40
|
| Rate for Payer: Quartz Beloit One Network |
$269.28
|
| Rate for Payer: Quartz Commercial |
$348.84
|
| Rate for Payer: The Alliance Commercial |
$306.00
|
| Rate for Payer: United Healthcare Medicaid |
$120.52
|
| Rate for Payer: WEA Trust Commercial |
$336.60
|
| Rate for Payer: WPS Commercial |
$453.31
|
|
|
Excision of malignant lesion (trunk, arms, legs) 1.1-2.0cm 11602
|
Professional
|
Both
|
$758.00
|
|
|
Service Code
|
CPT 11602
|
| Hospital Charge Code |
3013556
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$184.72 |
| Max. Negotiated Rate |
$720.10 |
| Rate for Payer: Aetna Commercial |
$720.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$651.88
|
| Rate for Payer: Cash Price |
$227.40
|
| Rate for Payer: Cash Price |
$227.40
|
| Rate for Payer: Cigna Commercial |
$720.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$184.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$454.80
|
| Rate for Payer: Health EOS Commercial |
$689.78
|
| Rate for Payer: HFN Commercial |
$720.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$539.35
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$539.35
|
| Rate for Payer: Multiplan Commercial |
$606.40
|
| Rate for Payer: Preferred Network Access Commercial |
$720.10
|
| Rate for Payer: Quartz Beloit One Network |
$333.52
|
| Rate for Payer: Quartz Commercial |
$432.06
|
| Rate for Payer: The Alliance Commercial |
$379.00
|
| Rate for Payer: United Healthcare Medicaid |
$184.72
|
| Rate for Payer: WEA Trust Commercial |
$416.90
|
| Rate for Payer: WPS Commercial |
$561.45
|
|
|
Excision of malignant lesion (trunk, arms, legs) 2.1-3.0cm 11603
|
Professional
|
Both
|
$1,113.00
|
|
|
Service Code
|
CPT 11603
|
| Hospital Charge Code |
3013557
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$245.99 |
| Max. Negotiated Rate |
$1,057.35 |
| Rate for Payer: Aetna Commercial |
$1,057.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$957.18
|
| Rate for Payer: Cash Price |
$333.90
|
| Rate for Payer: Cash Price |
$333.90
|
| Rate for Payer: Cigna Commercial |
$1,057.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$245.99
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$667.80
|
| Rate for Payer: Health EOS Commercial |
$1,012.83
|
| Rate for Payer: HFN Commercial |
$1,057.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$643.27
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$643.27
|
| Rate for Payer: Multiplan Commercial |
$890.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,057.35
|
| Rate for Payer: Quartz Beloit One Network |
$489.72
|
| Rate for Payer: Quartz Commercial |
$634.41
|
| Rate for Payer: The Alliance Commercial |
$556.50
|
| Rate for Payer: United Healthcare Medicaid |
$245.99
|
| Rate for Payer: WEA Trust Commercial |
$612.15
|
| Rate for Payer: WPS Commercial |
$824.40
|
|
|
Excision of malignant lesion (trunk, arms, legs) 3.1-4.0cm 11604
|
Professional
|
Both
|
$1,206.00
|
|
|
Service Code
|
CPT 11604
|
| Hospital Charge Code |
3013558
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$362.15 |
| 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 |
$362.15
|
| 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 |
$707.45
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$707.45
|
| 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 |
$362.15
|
| Rate for Payer: WEA Trust Commercial |
$663.30
|
| Rate for Payer: WPS Commercial |
$893.28
|
|
|
Excision of malignant lesion (trunk, arms, legs) >4.0cm 11606
|
Professional
|
Both
|
$1,817.00
|
|
|
Service Code
|
CPT 11606
|
| Hospital Charge Code |
3013559
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$430.96 |
| Max. Negotiated Rate |
$1,726.15 |
| Rate for Payer: Aetna Commercial |
$1,726.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,562.62
|
| Rate for Payer: Cash Price |
$545.10
|
| Rate for Payer: Cash Price |
$545.10
|
| Rate for Payer: Cigna Commercial |
$1,726.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$430.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,090.20
|
| Rate for Payer: Health EOS Commercial |
$1,653.47
|
| Rate for Payer: HFN Commercial |
$1,726.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,044.74
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,044.74
|
| Rate for Payer: Multiplan Commercial |
$1,453.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,726.15
|
| Rate for Payer: Quartz Beloit One Network |
$799.48
|
| Rate for Payer: Quartz Commercial |
$1,035.69
|
| Rate for Payer: The Alliance Commercial |
$908.50
|
| Rate for Payer: United Healthcare Medicaid |
$430.96
|
| Rate for Payer: WEA Trust Commercial |
$999.35
|
| Rate for Payer: WPS Commercial |
$1,345.85
|
|
|
Excision of Mouth Lesion 40810
|
Professional
|
Both
|
$243.00
|
|
|
Service Code
|
CPT 40810
|
| Hospital Charge Code |
3190222
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$45.18 |
| Max. Negotiated Rate |
$411.99 |
| Rate for Payer: Aetna Commercial |
$230.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$208.98
|
| Rate for Payer: Cash Price |
$72.90
|
| Rate for Payer: Cash Price |
$72.90
|
| Rate for Payer: Cigna Commercial |
$230.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$45.18
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$145.80
|
| Rate for Payer: Health EOS Commercial |
$221.13
|
| Rate for Payer: HFN Commercial |
$230.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$411.99
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$411.99
|
| Rate for Payer: Multiplan Commercial |
$194.40
|
| Rate for Payer: Preferred Network Access Commercial |
$230.85
|
| Rate for Payer: Quartz Beloit One Network |
$106.92
|
| Rate for Payer: Quartz Commercial |
$138.51
|
| Rate for Payer: The Alliance Commercial |
$121.50
|
| Rate for Payer: United Healthcare Medicaid |
$45.18
|
| Rate for Payer: WEA Trust Commercial |
$133.65
|
| Rate for Payer: WPS Commercial |
$179.99
|
|
|
EXCISION OF MOUTH LESION 40816
|
Professional
|
Both
|
$1,522.00
|
|
|
Service Code
|
CPT 40816
|
| Hospital Charge Code |
3014608
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$209.35 |
| Max. Negotiated Rate |
$1,445.90 |
| Rate for Payer: Aetna Commercial |
$1,445.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,308.92
|
| Rate for Payer: Cash Price |
$456.60
|
| Rate for Payer: Cash Price |
$456.60
|
| Rate for Payer: Cigna Commercial |
$1,445.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$209.35
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$913.20
|
| Rate for Payer: Health EOS Commercial |
$1,385.02
|
| Rate for Payer: HFN Commercial |
$1,445.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,021.90
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,021.90
|
| Rate for Payer: Multiplan Commercial |
$1,217.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,445.90
|
| Rate for Payer: Quartz Beloit One Network |
$669.68
|
| Rate for Payer: Quartz Commercial |
$867.54
|
| Rate for Payer: The Alliance Commercial |
$761.00
|
| Rate for Payer: United Healthcare Medicaid |
$209.35
|
| Rate for Payer: WEA Trust Commercial |
$837.10
|
| Rate for Payer: WPS Commercial |
$1,127.35
|
|
|
EXCISION OF MOUTH LESION 41116
|
Professional
|
Both
|
$617.00
|
|
|
Service Code
|
CPT 41116
|
| Hospital Charge Code |
3014616
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$209.35 |
| Max. Negotiated Rate |
$723.16 |
| Rate for Payer: Aetna Commercial |
$586.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$530.62
|
| Rate for Payer: Cash Price |
$185.10
|
| Rate for Payer: Cash Price |
$185.10
|
| Rate for Payer: Cigna Commercial |
$586.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$209.35
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$370.20
|
| Rate for Payer: Health EOS Commercial |
$561.47
|
| Rate for Payer: HFN Commercial |
$586.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$723.16
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$723.16
|
| Rate for Payer: Multiplan Commercial |
$493.60
|
| Rate for Payer: Preferred Network Access Commercial |
$586.15
|
| Rate for Payer: Quartz Beloit One Network |
$271.48
|
| Rate for Payer: Quartz Commercial |
$351.69
|
| Rate for Payer: The Alliance Commercial |
$308.50
|
| Rate for Payer: United Healthcare Medicaid |
$209.35
|
| Rate for Payer: WEA Trust Commercial |
$339.35
|
| Rate for Payer: WPS Commercial |
$457.01
|
|
|
Excision of Multiple External Papillae or tags, anus
|
Professional
|
Both
|
$709.00
|
|
|
Service Code
|
CPT 46230
|
| Hospital Charge Code |
1190849
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$75.33 |
| Max. Negotiated Rate |
$673.55 |
| Rate for Payer: Aetna Commercial |
$673.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$609.74
|
| Rate for Payer: Cash Price |
$212.70
|
| Rate for Payer: Cash Price |
$212.70
|
| Rate for Payer: Cigna Commercial |
$673.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$75.33
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$425.40
|
| Rate for Payer: Health EOS Commercial |
$645.19
|
| Rate for Payer: HFN Commercial |
$673.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$573.13
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$573.13
|
| Rate for Payer: Multiplan Commercial |
$567.20
|
| Rate for Payer: Preferred Network Access Commercial |
$673.55
|
| Rate for Payer: Quartz Beloit One Network |
$311.96
|
| Rate for Payer: Quartz Commercial |
$404.13
|
| Rate for Payer: The Alliance Commercial |
$354.50
|
| Rate for Payer: United Healthcare Medicaid |
$75.33
|
| Rate for Payer: WEA Trust Commercial |
$389.95
|
| Rate for Payer: WPS Commercial |
$525.16
|
|
