|
Repair, complex (eyelids, nose, ears, lips) 2.6-7.5cm 13152
|
Professional
|
Both
|
$2,232.00
|
|
|
Service Code
|
CPT 13152
|
| Hospital Charge Code |
3013617
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$271.37 |
| Max. Negotiated Rate |
$2,205.22 |
| Rate for Payer: Aetna Commercial |
$2,205.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,996.30
|
| Rate for Payer: Aetna Managed Medicare |
$271.37
|
| Rate for Payer: Anthem Medicare Advantage |
$271.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$271.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$271.37
|
| Rate for Payer: Cash Price |
$669.60
|
| Rate for Payer: Cash Price |
$669.60
|
| Rate for Payer: Cash Price |
$669.60
|
| Rate for Payer: Cigna Commercial |
$2,205.22
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$288.14
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$271.37
|
| Rate for Payer: Health EOS Commercial |
$2,112.36
|
| Rate for Payer: HFN Commercial |
$2,205.22
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,169.36
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,169.36
|
| Rate for Payer: Independent Care Health Plan Medicare |
$271.37
|
| Rate for Payer: Multiplan Commercial |
$1,857.02
|
| Rate for Payer: NAPHCARE Commercial |
$407.05
|
| Rate for Payer: Preferred Network Access Commercial |
$2,205.22
|
| Rate for Payer: Quartz Beloit One Network |
$1,021.36
|
| Rate for Payer: Quartz Commercial |
$1,323.13
|
| Rate for Payer: Quartz Medicare Advantage |
$271.37
|
| Rate for Payer: The Alliance Commercial |
$1,153.31
|
| Rate for Payer: United Healthcare Medicaid |
$288.14
|
| Rate for Payer: United Healthcare Medicare Advantage |
$271.37
|
| Rate for Payer: WEA Trust Commercial |
$1,276.70
|
| Rate for Payer: WPS Commercial |
$1,221.15
|
|
|
Repair, complex (eyelids, nose, ears, lips) each additional <= 5cm 13153
|
Professional
|
Both
|
$1,200.00
|
|
|
Service Code
|
CPT 13153
|
| Hospital Charge Code |
4017970
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$108.40 |
| Max. Negotiated Rate |
$1,185.60 |
| Rate for Payer: Aetna Commercial |
$1,185.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,073.28
|
| Rate for Payer: Aetna Managed Medicare |
$108.40
|
| Rate for Payer: Anthem Medicare Advantage |
$108.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$108.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$108.40
|
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: Cigna Commercial |
$1,185.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$146.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$108.40
|
| Rate for Payer: Health EOS Commercial |
$1,135.68
|
| Rate for Payer: HFN Commercial |
$1,185.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$472.22
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$472.22
|
| Rate for Payer: Independent Care Health Plan Medicare |
$108.40
|
| Rate for Payer: Multiplan Commercial |
$998.40
|
| Rate for Payer: NAPHCARE Commercial |
$162.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,185.60
|
| Rate for Payer: Quartz Beloit One Network |
$549.12
|
| Rate for Payer: Quartz Commercial |
$711.36
|
| Rate for Payer: Quartz Medicare Advantage |
$108.40
|
| Rate for Payer: The Alliance Commercial |
$460.70
|
| Rate for Payer: United Healthcare Medicaid |
$146.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$108.40
|
| Rate for Payer: WEA Trust Commercial |
$686.40
|
| Rate for Payer: WPS Commercial |
$487.80
|
|
|
Repair, complex (forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands, feet)†1.1-2.5cm 131
|
Professional
|
Both
|
$589.00
|
|
|
Service Code
|
CPT 13131
|
| Hospital Charge Code |
3013612
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$179.78 |
| Max. Negotiated Rate |
$895.19 |
| Rate for Payer: Aetna Commercial |
$581.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$526.80
|
| Rate for Payer: Aetna Managed Medicare |
$198.93
|
| Rate for Payer: Anthem Medicare Advantage |
$198.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$198.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$198.93
|
| Rate for Payer: Cash Price |
$176.70
|
| Rate for Payer: Cash Price |
$176.70
|
| Rate for Payer: Cash Price |
$176.70
|
| Rate for Payer: Cigna Commercial |
$581.93
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$179.78
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$198.93
|
| Rate for Payer: Health EOS Commercial |
$557.43
|
| Rate for Payer: HFN Commercial |
$581.93
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$844.04
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$844.04
|
| Rate for Payer: Independent Care Health Plan Medicare |
$198.93
|
| Rate for Payer: Multiplan Commercial |
$490.05
|
| Rate for Payer: NAPHCARE Commercial |
$298.40
|
| Rate for Payer: Preferred Network Access Commercial |
$581.93
|
| Rate for Payer: Quartz Beloit One Network |
$269.53
|
| Rate for Payer: Quartz Commercial |
$349.16
|
| Rate for Payer: Quartz Medicare Advantage |
$198.93
|
| Rate for Payer: The Alliance Commercial |
$845.46
|
| Rate for Payer: United Healthcare Medicaid |
$179.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$198.93
|
| Rate for Payer: WEA Trust Commercial |
$336.91
|
| Rate for Payer: WPS Commercial |
$895.19
|
|
|
Repair, complex (forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands, feet)†2.6-7.5cm 131
|
Professional
|
Both
|
$1,360.00
|
|
|
Service Code
|
CPT 13132
|
| Hospital Charge Code |
3013613
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$245.53 |
| Max. Negotiated Rate |
$1,343.68 |
| Rate for Payer: Aetna Commercial |
$1,343.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,216.38
|
| Rate for Payer: Aetna Managed Medicare |
$245.53
|
| Rate for Payer: Anthem Medicare Advantage |
$245.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$245.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$245.53
|
| Rate for Payer: Cash Price |
$408.00
|
| Rate for Payer: Cash Price |
$408.00
|
| Rate for Payer: Cash Price |
$408.00
|
| Rate for Payer: Cigna Commercial |
$1,343.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$273.90
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$245.53
|
| Rate for Payer: Health EOS Commercial |
$1,287.10
|
| Rate for Payer: HFN Commercial |
$1,343.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,055.65
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,055.65
|
| Rate for Payer: Independent Care Health Plan Medicare |
$245.53
|
| Rate for Payer: Multiplan Commercial |
$1,131.52
|
| Rate for Payer: NAPHCARE Commercial |
$368.30
|
| Rate for Payer: Preferred Network Access Commercial |
$1,343.68
|
| Rate for Payer: Quartz Beloit One Network |
$622.34
|
| Rate for Payer: Quartz Commercial |
$806.21
|
| Rate for Payer: Quartz Medicare Advantage |
$245.53
|
| Rate for Payer: The Alliance Commercial |
$1,043.52
|
| Rate for Payer: United Healthcare Medicaid |
$273.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$245.53
|
| Rate for Payer: WEA Trust Commercial |
$777.92
|
| Rate for Payer: WPS Commercial |
$1,104.90
|
|
|
Repair, complex (forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands, feet) each addition
|
Professional
|
Both
|
$662.00
|
|
|
Service Code
|
CPT 13133
|
| Hospital Charge Code |
3013614
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$98.85 |
| Max. Negotiated Rate |
$654.06 |
| Rate for Payer: Aetna Commercial |
$654.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$592.09
|
| Rate for Payer: Aetna Managed Medicare |
$98.85
|
| Rate for Payer: Anthem Medicare Advantage |
$98.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$98.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$98.85
|
| Rate for Payer: Cash Price |
$198.60
|
| Rate for Payer: Cash Price |
$198.60
|
| Rate for Payer: Cash Price |
$198.60
|
| Rate for Payer: Cigna Commercial |
$654.06
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$132.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$98.85
|
| Rate for Payer: Health EOS Commercial |
$626.52
|
| Rate for Payer: HFN Commercial |
$654.06
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$437.61
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$437.61
|
| Rate for Payer: Independent Care Health Plan Medicare |
$98.85
|
| Rate for Payer: Multiplan Commercial |
$550.78
|
| Rate for Payer: NAPHCARE Commercial |
$148.28
|
| Rate for Payer: Preferred Network Access Commercial |
$654.06
|
| Rate for Payer: Quartz Beloit One Network |
$302.93
|
| Rate for Payer: Quartz Commercial |
$392.43
|
| Rate for Payer: Quartz Medicare Advantage |
$98.85
|
| Rate for Payer: The Alliance Commercial |
$420.12
|
| Rate for Payer: United Healthcare Medicaid |
$132.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$98.85
|
| Rate for Payer: WEA Trust Commercial |
$378.66
|
| Rate for Payer: WPS Commercial |
$444.83
|
|
|
REPAIR, COMPLEX, SCALP, ARMS, AND/OR LEGS; 1.1 CM TO 2.5 CM
|
Facility
|
OP
|
$4,947.89
|
|
|
Service Code
|
CPT 13120
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$427.81 |
| Max. Negotiated Rate |
$4,947.89 |
| Rate for Payer: Aetna Managed Medicare |
$427.81
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,030.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,388.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,270.32
|
| Rate for Payer: Anthem Medicare Advantage |
$427.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$427.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$427.81
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$427.81
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,947.89
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$427.81
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,591.47
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$427.81
|
| Rate for Payer: Independent Care Health Plan Medicare |
$427.81
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$427.81
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$427.81
|
| Rate for Payer: NAPHCARE Commercial |
$641.72
|
| Rate for Payer: Quartz Medicare Advantage |
$427.81
|
| Rate for Payer: The Alliance Commercial |
$1,711.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$427.81
|
| Rate for Payer: United Healthcare PPO |
$2,347.28
|
| Rate for Payer: Wellcare Medicare |
$427.81
|
|
|
Repair, complex (scalp, arms, legs) 1.1-2.5cm 13120
|
Professional
|
Both
|
$809.00
|
|
|
Service Code
|
CPT 13120
|
| Hospital Charge Code |
3013609
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$134.45 |
| Max. Negotiated Rate |
$871.60 |
| Rate for Payer: Aetna Commercial |
$799.29
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$723.57
|
| Rate for Payer: Aetna Managed Medicare |
$193.69
|
| Rate for Payer: Anthem Medicare Advantage |
$193.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$193.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$193.69
|
| Rate for Payer: Cash Price |
$242.70
|
| Rate for Payer: Cash Price |
$242.70
|
| Rate for Payer: Cash Price |
$242.70
|
| Rate for Payer: Cigna Commercial |
$799.29
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$134.45
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$193.69
|
| Rate for Payer: Health EOS Commercial |
$765.64
|
| Rate for Payer: HFN Commercial |
$799.29
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$816.37
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$816.37
|
| Rate for Payer: Independent Care Health Plan Medicare |
$193.69
|
| Rate for Payer: Multiplan Commercial |
$673.09
|
| Rate for Payer: NAPHCARE Commercial |
$290.53
|
| Rate for Payer: Preferred Network Access Commercial |
$799.29
|
| Rate for Payer: Quartz Beloit One Network |
$370.20
|
| Rate for Payer: Quartz Commercial |
$479.58
|
| Rate for Payer: Quartz Medicare Advantage |
$193.69
|
| Rate for Payer: The Alliance Commercial |
$823.18
|
| Rate for Payer: United Healthcare Medicaid |
$134.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$193.69
|
| Rate for Payer: WEA Trust Commercial |
$462.75
|
| Rate for Payer: WPS Commercial |
$871.60
|
|
|
Repair, complex (scalp, arms, legs) 2.6-7.5cm 13121
|
Professional
|
Both
|
$882.00
|
|
|
Service Code
|
CPT 13121
|
| Hospital Charge Code |
3013610
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$210.40 |
| Max. Negotiated Rate |
$946.81 |
| Rate for Payer: Aetna Commercial |
$871.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$788.86
|
| Rate for Payer: Aetna Managed Medicare |
$210.40
|
| Rate for Payer: Anthem Medicare Advantage |
$210.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$210.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$210.40
|
| Rate for Payer: Cash Price |
$264.60
|
| Rate for Payer: Cash Price |
$264.60
|
| Rate for Payer: Cash Price |
$264.60
|
| Rate for Payer: Cigna Commercial |
$871.42
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$222.93
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$210.40
|
| Rate for Payer: Health EOS Commercial |
$834.72
|
| Rate for Payer: HFN Commercial |
$871.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$900.36
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$900.36
|
| Rate for Payer: Independent Care Health Plan Medicare |
$210.40
|
| Rate for Payer: Multiplan Commercial |
$733.82
|
| Rate for Payer: NAPHCARE Commercial |
$315.60
|
| Rate for Payer: Preferred Network Access Commercial |
$871.42
|
| Rate for Payer: Quartz Beloit One Network |
$403.60
|
| Rate for Payer: Quartz Commercial |
$522.85
|
| Rate for Payer: Quartz Medicare Advantage |
$210.40
|
| Rate for Payer: The Alliance Commercial |
$894.21
|
| Rate for Payer: United Healthcare Medicaid |
$222.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$210.40
|
| Rate for Payer: WEA Trust Commercial |
$504.50
|
| Rate for Payer: WPS Commercial |
$946.81
|
|
|
Repair, complex (scalp, arms, legs) each additional <=5cm 13122
|
Professional
|
Both
|
$375.00
|
|
|
Service Code
|
CPT 13122
|
| Hospital Charge Code |
3013611
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$64.85 |
| Max. Negotiated Rate |
$370.50 |
| Rate for Payer: Aetna Commercial |
$370.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$335.40
|
| Rate for Payer: Aetna Managed Medicare |
$64.85
|
| Rate for Payer: Anthem Medicare Advantage |
$64.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$64.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$64.85
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cigna Commercial |
$370.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$89.81
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$64.85
|
| Rate for Payer: Health EOS Commercial |
$354.90
|
| Rate for Payer: HFN Commercial |
$370.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$286.17
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$286.17
|
| Rate for Payer: Independent Care Health Plan Medicare |
$64.85
|
| Rate for Payer: Multiplan Commercial |
$312.00
|
| Rate for Payer: NAPHCARE Commercial |
$97.28
|
| Rate for Payer: Preferred Network Access Commercial |
$370.50
|
| Rate for Payer: Quartz Beloit One Network |
$171.60
|
| Rate for Payer: Quartz Commercial |
$222.30
|
| Rate for Payer: Quartz Medicare Advantage |
$64.85
|
| Rate for Payer: The Alliance Commercial |
$275.63
|
| Rate for Payer: United Healthcare Medicaid |
$89.81
|
| Rate for Payer: United Healthcare Medicare Advantage |
$64.85
|
| Rate for Payer: WEA Trust Commercial |
$214.50
|
| Rate for Payer: WPS Commercial |
$291.84
|
|
|
Repair, complex (trunk) 1.1-2.5cm 13100
|
Professional
|
Both
|
$473.00
|
|
|
Service Code
|
CPT 13100
|
| Hospital Charge Code |
3013606
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$107.54 |
| Max. Negotiated Rate |
$750.86 |
| Rate for Payer: Aetna Commercial |
$467.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$423.05
|
| Rate for Payer: Aetna Managed Medicare |
$166.86
|
| Rate for Payer: Anthem Medicare Advantage |
$166.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$166.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$166.86
|
| Rate for Payer: Cash Price |
$141.90
|
| Rate for Payer: Cash Price |
$141.90
|
| Rate for Payer: Cash Price |
$141.90
|
| Rate for Payer: Cigna Commercial |
$467.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$107.54
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$166.86
|
| Rate for Payer: Health EOS Commercial |
$447.65
|
| Rate for Payer: HFN Commercial |
$467.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$698.41
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$698.41
|
| Rate for Payer: Independent Care Health Plan Medicare |
$166.86
|
| Rate for Payer: Multiplan Commercial |
$393.54
|
| Rate for Payer: NAPHCARE Commercial |
$250.29
|
| Rate for Payer: Preferred Network Access Commercial |
$467.32
|
| Rate for Payer: Quartz Beloit One Network |
$216.44
|
| Rate for Payer: Quartz Commercial |
$280.39
|
| Rate for Payer: Quartz Medicare Advantage |
$166.86
|
| Rate for Payer: The Alliance Commercial |
$709.14
|
| Rate for Payer: United Healthcare Medicaid |
$107.54
|
| Rate for Payer: United Healthcare Medicare Advantage |
$166.86
|
| Rate for Payer: WEA Trust Commercial |
$270.56
|
| Rate for Payer: WPS Commercial |
$750.86
|
|
|
Repair, complex (trunk) 2.6-7.5cm 13101
|
Professional
|
Both
|
$491.00
|
|
|
Service Code
|
CPT 13101
|
| Hospital Charge Code |
3013607
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$178.62 |
| Max. Negotiated Rate |
$923.69 |
| Rate for Payer: Aetna Commercial |
$485.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$439.15
|
| Rate for Payer: Aetna Managed Medicare |
$205.26
|
| Rate for Payer: Anthem Medicare Advantage |
$205.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$205.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$205.26
|
| Rate for Payer: Cash Price |
$147.30
|
| Rate for Payer: Cash Price |
$147.30
|
| Rate for Payer: Cash Price |
$147.30
|
| Rate for Payer: Cigna Commercial |
$485.11
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$178.62
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$205.26
|
| Rate for Payer: Health EOS Commercial |
$464.68
|
| Rate for Payer: HFN Commercial |
$485.11
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$870.99
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$870.99
|
| Rate for Payer: Independent Care Health Plan Medicare |
$205.26
|
| Rate for Payer: Multiplan Commercial |
$408.51
|
| Rate for Payer: NAPHCARE Commercial |
$307.90
|
| Rate for Payer: Preferred Network Access Commercial |
$485.11
|
| Rate for Payer: Quartz Beloit One Network |
$224.68
|
| Rate for Payer: Quartz Commercial |
$291.06
|
| Rate for Payer: Quartz Medicare Advantage |
$205.26
|
| Rate for Payer: The Alliance Commercial |
$872.38
|
| Rate for Payer: United Healthcare Medicaid |
$178.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$205.26
|
| Rate for Payer: WEA Trust Commercial |
$280.85
|
| Rate for Payer: WPS Commercial |
$923.69
|
|
|
REPAIR, COMPLEX, TRUNK; 2.6 CM TO 7.5 CM
|
Facility
|
OP
|
$6,807.99
|
|
|
Service Code
|
CPT 13101
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$777.80 |
| Max. Negotiated Rate |
$6,807.99 |
| Rate for Payer: Aetna Managed Medicare |
$777.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,030.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,388.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,270.32
|
| Rate for Payer: Anthem Medicare Advantage |
$777.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$777.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$777.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$777.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,807.99
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$777.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,893.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$777.80
|
| Rate for Payer: Independent Care Health Plan Medicare |
$777.80
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$777.80
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$777.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,166.69
|
| Rate for Payer: Quartz Medicare Advantage |
$777.80
|
| Rate for Payer: The Alliance Commercial |
$3,111.18
|
| Rate for Payer: United Healthcare Medicare Advantage |
$777.80
|
| Rate for Payer: United Healthcare PPO |
$2,347.28
|
| Rate for Payer: Wellcare Medicare |
$777.80
|
|
|
Repair, complex (trunk) each additional <= 5cm 13102
|
Professional
|
Both
|
$285.00
|
|
|
Service Code
|
CPT 13102
|
| Hospital Charge Code |
3013608
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$56.82 |
| Max. Negotiated Rate |
$281.58 |
| Rate for Payer: Aetna Commercial |
$281.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$254.90
|
| Rate for Payer: Aetna Managed Medicare |
$56.82
|
| Rate for Payer: Anthem Medicare Advantage |
$56.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$56.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$56.82
|
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: Cigna Commercial |
$281.58
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$77.25
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$56.82
|
| Rate for Payer: Health EOS Commercial |
$269.72
|
| Rate for Payer: HFN Commercial |
$281.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$248.10
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$248.10
|
| Rate for Payer: Independent Care Health Plan Medicare |
$56.82
|
| Rate for Payer: Multiplan Commercial |
$237.12
|
| Rate for Payer: NAPHCARE Commercial |
$85.22
|
| Rate for Payer: Preferred Network Access Commercial |
$281.58
|
| Rate for Payer: Quartz Beloit One Network |
$130.42
|
| Rate for Payer: Quartz Commercial |
$168.95
|
| Rate for Payer: Quartz Medicare Advantage |
$56.82
|
| Rate for Payer: The Alliance Commercial |
$241.46
|
| Rate for Payer: United Healthcare Medicaid |
$77.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$56.82
|
| Rate for Payer: WEA Trust Commercial |
$163.02
|
| Rate for Payer: WPS Commercial |
$255.67
|
|
|
REPAIR, COMPLEX, TRUNK; EACH ADDITIONAL 5 CM OR LESS (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$6,807.99
|
|
|
Service Code
|
CPT 13102
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$227.26 |
| Max. Negotiated Rate |
$6,807.99 |
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,807.99
|
| Rate for Payer: The Alliance Commercial |
$227.26
|
|
|
REPAIR, EXTENSOR TENDON, FINGER, PRIMARY OR SECONDARY; WITHOUT FREE GRAFT, EACH TENDON
|
Facility
|
OP
|
$8,107.14
|
|
|
Service Code
|
CPT 26418
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,692.24 |
| Max. Negotiated Rate |
$8,107.14 |
| Rate for Payer: Aetna Managed Medicare |
$1,692.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,635.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,985.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,835.04
|
| Rate for Payer: Anthem Medicare Advantage |
$1,692.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,692.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,692.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,692.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,107.14
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,692.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,295.12
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,692.24
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,692.24
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,692.24
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,692.24
|
| Rate for Payer: NAPHCARE Commercial |
$2,538.35
|
| Rate for Payer: Quartz Medicare Advantage |
$1,692.24
|
| Rate for Payer: The Alliance Commercial |
$6,768.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,692.24
|
| Rate for Payer: United Healthcare PPO |
$3,726.32
|
| Rate for Payer: Wellcare Medicare |
$1,692.24
|
|
|
REPAIR EYELID DEFECT 67914
|
Professional
|
Both
|
$1,265.00
|
|
|
Service Code
|
CPT 67914
|
| Hospital Charge Code |
3015247
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$144.80 |
| Max. Negotiated Rate |
$1,296.83 |
| Rate for Payer: Aetna Commercial |
$1,249.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,131.42
|
| Rate for Payer: Aetna Managed Medicare |
$288.18
|
| Rate for Payer: Anthem Medicare Advantage |
$288.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$288.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$288.18
|
| Rate for Payer: Cash Price |
$379.50
|
| Rate for Payer: Cash Price |
$379.50
|
| Rate for Payer: Cash Price |
$379.50
|
| Rate for Payer: Cigna Commercial |
$1,249.82
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$144.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$288.18
|
| Rate for Payer: Health EOS Commercial |
$1,197.20
|
| Rate for Payer: HFN Commercial |
$1,249.82
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,143.36
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,143.36
|
| Rate for Payer: Independent Care Health Plan Medicare |
$288.18
|
| Rate for Payer: Multiplan Commercial |
$1,052.48
|
| Rate for Payer: NAPHCARE Commercial |
$432.28
|
| Rate for Payer: Preferred Network Access Commercial |
$1,249.82
|
| Rate for Payer: Quartz Beloit One Network |
$578.86
|
| Rate for Payer: Quartz Commercial |
$749.89
|
| Rate for Payer: Quartz Medicare Advantage |
$288.18
|
| Rate for Payer: The Alliance Commercial |
$1,224.78
|
| Rate for Payer: United Healthcare Medicaid |
$144.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$288.18
|
| Rate for Payer: WEA Trust Commercial |
$723.58
|
| Rate for Payer: WPS Commercial |
$1,296.83
|
|
|
REPAIR EYELID DEFECT 67923
|
Professional
|
Both
|
$3,561.00
|
|
|
Service Code
|
CPT 67923
|
| Hospital Charge Code |
3015249
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$367.80 |
| Max. Negotiated Rate |
$3,518.27 |
| Rate for Payer: Aetna Commercial |
$3,518.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,184.96
|
| Rate for Payer: Aetna Managed Medicare |
$367.80
|
| Rate for Payer: Anthem Medicare Advantage |
$367.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$367.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$367.80
|
| Rate for Payer: Cash Price |
$1,068.30
|
| Rate for Payer: Cash Price |
$1,068.30
|
| Rate for Payer: Cash Price |
$1,068.30
|
| Rate for Payer: Cigna Commercial |
$3,518.27
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$470.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$367.80
|
| Rate for Payer: Health EOS Commercial |
$3,370.13
|
| Rate for Payer: HFN Commercial |
$3,518.27
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,500.23
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,500.23
|
| Rate for Payer: Independent Care Health Plan Medicare |
$367.80
|
| Rate for Payer: Multiplan Commercial |
$2,962.75
|
| Rate for Payer: NAPHCARE Commercial |
$551.69
|
| Rate for Payer: Preferred Network Access Commercial |
$3,518.27
|
| Rate for Payer: Quartz Beloit One Network |
$1,629.51
|
| Rate for Payer: Quartz Commercial |
$2,110.96
|
| Rate for Payer: Quartz Medicare Advantage |
$367.80
|
| Rate for Payer: The Alliance Commercial |
$1,563.13
|
| Rate for Payer: United Healthcare Medicaid |
$470.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$367.80
|
| Rate for Payer: WEA Trust Commercial |
$2,036.89
|
| Rate for Payer: WPS Commercial |
$1,655.08
|
|
|
REPAIR EYELID WOUND 67935
|
Professional
|
Both
|
$1,687.00
|
|
|
Service Code
|
CPT 67935
|
| Hospital Charge Code |
3015250
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$363.23 |
| Max. Negotiated Rate |
$1,666.76 |
| Rate for Payer: Aetna Commercial |
$1,666.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,508.85
|
| Rate for Payer: Aetna Managed Medicare |
$363.23
|
| Rate for Payer: Anthem Medicare Advantage |
$363.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$363.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$363.23
|
| Rate for Payer: Cash Price |
$506.10
|
| Rate for Payer: Cash Price |
$506.10
|
| Rate for Payer: Cash Price |
$506.10
|
| Rate for Payer: Cigna Commercial |
$1,666.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$647.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$363.23
|
| Rate for Payer: Health EOS Commercial |
$1,596.58
|
| Rate for Payer: HFN Commercial |
$1,666.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,536.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,536.29
|
| Rate for Payer: Independent Care Health Plan Medicare |
$363.23
|
| Rate for Payer: Multiplan Commercial |
$1,403.58
|
| Rate for Payer: NAPHCARE Commercial |
$544.85
|
| Rate for Payer: Preferred Network Access Commercial |
$1,666.76
|
| Rate for Payer: Quartz Beloit One Network |
$771.97
|
| Rate for Payer: Quartz Commercial |
$1,000.05
|
| Rate for Payer: Quartz Medicare Advantage |
$363.23
|
| Rate for Payer: The Alliance Commercial |
$1,543.73
|
| Rate for Payer: United Healthcare Medicaid |
$647.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$363.23
|
| Rate for Payer: WEA Trust Commercial |
$964.96
|
| Rate for Payer: WPS Commercial |
$1,634.54
|
|
|
REPAIR HALLUX RIGIDUS 28289
|
Professional
|
Both
|
$1,815.00
|
|
|
Service Code
|
CPT 28289
|
| Hospital Charge Code |
3014232
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$333.85 |
| Max. Negotiated Rate |
$1,926.57 |
| Rate for Payer: Aetna Commercial |
$1,793.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,623.34
|
| Rate for Payer: Aetna Managed Medicare |
$428.13
|
| Rate for Payer: Anthem Medicare Advantage |
$428.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$428.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$428.13
|
| Rate for Payer: Cash Price |
$544.50
|
| Rate for Payer: Cash Price |
$544.50
|
| Rate for Payer: Cash Price |
$544.50
|
| Rate for Payer: Cigna Commercial |
$1,793.22
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$333.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$428.13
|
| Rate for Payer: Health EOS Commercial |
$1,717.72
|
| Rate for Payer: HFN Commercial |
$1,793.22
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,602.56
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,602.56
|
| Rate for Payer: Independent Care Health Plan Medicare |
$428.13
|
| Rate for Payer: Multiplan Commercial |
$1,510.08
|
| Rate for Payer: NAPHCARE Commercial |
$642.19
|
| Rate for Payer: Preferred Network Access Commercial |
$1,793.22
|
| Rate for Payer: Quartz Beloit One Network |
$830.54
|
| Rate for Payer: Quartz Commercial |
$1,075.93
|
| Rate for Payer: Quartz Medicare Advantage |
$428.13
|
| Rate for Payer: The Alliance Commercial |
$1,819.54
|
| Rate for Payer: United Healthcare Medicaid |
$333.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$428.13
|
| Rate for Payer: WEA Trust Commercial |
$1,038.18
|
| Rate for Payer: WPS Commercial |
$1,926.57
|
|
|
REPAIR INCOMPLETE CIRCUMCISION
|
Facility
|
OP
|
$8,799.61
|
|
|
Service Code
|
CPT 54163
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,199.90 |
| Max. Negotiated Rate |
$8,799.61 |
| Rate for Payer: Aetna Managed Medicare |
$2,199.90
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,635.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,985.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,835.04
|
| Rate for Payer: Anthem Medicare Advantage |
$2,199.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$2,199.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$2,199.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$2,199.90
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,947.89
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$2,199.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,183.63
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2,199.90
|
| Rate for Payer: Independent Care Health Plan Medicare |
$2,199.90
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$2,199.90
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$2,199.90
|
| Rate for Payer: NAPHCARE Commercial |
$3,299.85
|
| Rate for Payer: Quartz Medicare Advantage |
$2,199.90
|
| Rate for Payer: The Alliance Commercial |
$8,799.61
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,199.90
|
| Rate for Payer: United Healthcare PPO |
$3,726.32
|
| Rate for Payer: Wellcare Medicare |
$2,199.90
|
|
|
REPAIR INITIAL INGUINAL HERNIA, AGE 5 YEARS OR OLDER; INCARCERATED OR STRANGULATED
|
Facility
|
OP
|
$15,071.89
|
|
|
Service Code
|
CPT 49507
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,767.97 |
| Max. Negotiated Rate |
$15,071.89 |
| Rate for Payer: Aetna Managed Medicare |
$3,767.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$10,303.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,364.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,944.56
|
| Rate for Payer: Anthem Medicare Advantage |
$3,767.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,767.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,767.97
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,767.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,107.14
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,767.97
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$14,016.86
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,767.97
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,767.97
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,767.97
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,767.97
|
| Rate for Payer: NAPHCARE Commercial |
$5,651.96
|
| Rate for Payer: Quartz Medicare Advantage |
$3,767.97
|
| Rate for Payer: The Alliance Commercial |
$15,071.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,767.97
|
| Rate for Payer: United Healthcare PPO |
$4,267.12
|
| Rate for Payer: Wellcare Medicare |
$3,767.97
|
|
|
REPAIR INITIAL INGUINAL HERNIA, AGE 5 YEARS OR OLDER; REDUCIBLE
|
Facility
|
OP
|
$15,071.89
|
|
|
Service Code
|
CPT 49505
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,767.97 |
| Max. Negotiated Rate |
$15,071.89 |
| Rate for Payer: Aetna Managed Medicare |
$3,767.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$10,303.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,364.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,944.56
|
| Rate for Payer: Anthem Medicare Advantage |
$3,767.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,767.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,767.97
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,767.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,107.14
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,767.97
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$14,016.86
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,767.97
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,767.97
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,767.97
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,767.97
|
| Rate for Payer: NAPHCARE Commercial |
$5,651.96
|
| Rate for Payer: Quartz Medicare Advantage |
$3,767.97
|
| Rate for Payer: The Alliance Commercial |
$15,071.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,767.97
|
| Rate for Payer: United Healthcare PPO |
$4,267.12
|
| Rate for Payer: Wellcare Medicare |
$3,767.97
|
|
|
REPAIR, INTERMEDIATE, WOUNDS OF NECK, HANDS, FEET AND/OR EXTERNAL GENITALIA; 2.6 CM TO 7.5 CM
|
Facility
|
OP
|
$4,386.95
|
|
|
Service Code
|
CPT 12042
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$427.81 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Managed Medicare |
$427.81
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,030.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,388.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,270.32
|
| Rate for Payer: Anthem Medicare Advantage |
$427.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$427.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$427.81
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$427.81
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$427.81
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,591.47
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$427.81
|
| Rate for Payer: Independent Care Health Plan Medicare |
$427.81
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$427.81
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$427.81
|
| Rate for Payer: NAPHCARE Commercial |
$641.72
|
| Rate for Payer: Quartz Medicare Advantage |
$427.81
|
| Rate for Payer: The Alliance Commercial |
$1,711.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$427.81
|
| Rate for Payer: United Healthcare PPO |
$2,347.28
|
| Rate for Payer: Wellcare Medicare |
$427.81
|
|
|
REPAIR, INTERMEDIATE, WOUNDS OF SCALP, AXILLAE, TRUNK AND/OR EXTREMITIES (EXCLUDING HANDS AND FEET); 12.6 CM TO 20.0 CM
|
Facility
|
OP
|
$4,947.89
|
|
|
Service Code
|
CPT 12035
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$427.81 |
| Max. Negotiated Rate |
$4,947.89 |
| Rate for Payer: Aetna Managed Medicare |
$427.81
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,030.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,388.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,270.32
|
| Rate for Payer: Anthem Medicare Advantage |
$427.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$427.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$427.81
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$427.81
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,947.89
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$427.81
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,591.47
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$427.81
|
| Rate for Payer: Independent Care Health Plan Medicare |
$427.81
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$427.81
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$427.81
|
| Rate for Payer: NAPHCARE Commercial |
$641.72
|
| Rate for Payer: Quartz Medicare Advantage |
$427.81
|
| Rate for Payer: The Alliance Commercial |
$1,711.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$427.81
|
| Rate for Payer: United Healthcare PPO |
$2,347.28
|
| Rate for Payer: Wellcare Medicare |
$427.81
|
|
|
REPAIR, INTERMEDIATE, WOUNDS OF SCALP, AXILLAE, TRUNK AND/OR EXTREMITIES (EXCLUDING HANDS AND FEET); 2.6 CM TO 7.5 CM
|
Facility
|
OP
|
$4,386.95
|
|
|
Service Code
|
CPT 12032
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$427.81 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Managed Medicare |
$427.81
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,030.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,388.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,270.32
|
| Rate for Payer: Anthem Medicare Advantage |
$427.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$427.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$427.81
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$427.81
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$427.81
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,591.47
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$427.81
|
| Rate for Payer: Independent Care Health Plan Medicare |
$427.81
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$427.81
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$427.81
|
| Rate for Payer: NAPHCARE Commercial |
$641.72
|
| Rate for Payer: Quartz Medicare Advantage |
$427.81
|
| Rate for Payer: The Alliance Commercial |
$1,711.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$427.81
|
| Rate for Payer: United Healthcare PPO |
$2,347.28
|
| Rate for Payer: Wellcare Medicare |
$427.81
|
|
