|
Debridement, bone, includes tissue, muscle, fascia; ea add'l 20 sq cm 11047
|
Professional
|
Both
|
$800.00
|
|
|
Service Code
|
CPT 11047
|
| Hospital Charge Code |
3013523
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$48.09 |
| Max. Negotiated Rate |
$790.40 |
| Rate for Payer: Aetna Commercial |
$790.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$715.52
|
| Rate for Payer: Aetna Managed Medicare |
$79.53
|
| Rate for Payer: Anthem Medicare Advantage |
$79.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$79.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$79.53
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cigna Commercial |
$790.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$48.09
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$79.53
|
| Rate for Payer: Health EOS Commercial |
$757.12
|
| Rate for Payer: HFN Commercial |
$790.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$329.16
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$329.16
|
| Rate for Payer: Independent Care Health Plan Medicare |
$79.53
|
| Rate for Payer: Multiplan Commercial |
$665.60
|
| Rate for Payer: NAPHCARE Commercial |
$119.29
|
| Rate for Payer: Preferred Network Access Commercial |
$790.40
|
| Rate for Payer: Quartz Beloit One Network |
$366.08
|
| Rate for Payer: Quartz Commercial |
$474.24
|
| Rate for Payer: Quartz Medicare Advantage |
$79.53
|
| Rate for Payer: The Alliance Commercial |
$338.00
|
| Rate for Payer: United Healthcare Medicaid |
$48.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$79.53
|
| Rate for Payer: WEA Trust Commercial |
$457.60
|
| Rate for Payer: WPS Commercial |
$357.88
|
|
|
Debridement, bone, includes tissue, muscle, fascia; first 20 sq cm or less 11044
|
Professional
|
Both
|
$1,154.00
|
|
|
Service Code
|
CPT 11044
|
| Hospital Charge Code |
3013520
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$191.71 |
| Max. Negotiated Rate |
$1,140.15 |
| Rate for Payer: Aetna Commercial |
$1,140.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,032.14
|
| Rate for Payer: Aetna Managed Medicare |
$191.71
|
| Rate for Payer: Anthem Medicare Advantage |
$191.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$191.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$191.71
|
| Rate for Payer: Cash Price |
$346.20
|
| Rate for Payer: Cash Price |
$346.20
|
| Rate for Payer: Cash Price |
$346.20
|
| Rate for Payer: Cigna Commercial |
$1,140.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$324.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$191.71
|
| Rate for Payer: Health EOS Commercial |
$1,092.15
|
| Rate for Payer: HFN Commercial |
$1,140.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$770.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$770.29
|
| Rate for Payer: Independent Care Health Plan Medicare |
$191.71
|
| Rate for Payer: Multiplan Commercial |
$960.13
|
| Rate for Payer: NAPHCARE Commercial |
$287.57
|
| Rate for Payer: Preferred Network Access Commercial |
$1,140.15
|
| Rate for Payer: Quartz Beloit One Network |
$528.07
|
| Rate for Payer: Quartz Commercial |
$684.09
|
| Rate for Payer: Quartz Medicare Advantage |
$191.71
|
| Rate for Payer: The Alliance Commercial |
$814.78
|
| Rate for Payer: United Healthcare Medicaid |
$324.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$191.71
|
| Rate for Payer: WEA Trust Commercial |
$660.09
|
| Rate for Payer: WPS Commercial |
$862.71
|
|
|
DEBRIDEMENT (LOWER BODY)
|
Facility
|
IP
|
$1,084.00
|
|
| Hospital Charge Code |
4698606
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$552.41 |
| Max. Negotiated Rate |
$1,037.17 |
| Rate for Payer: Aetna Commercial |
$1,014.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$969.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$597.50
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$1,037.17
|
| Rate for Payer: Health EOS Commercial |
$1,003.35
|
| Rate for Payer: HFN Commercial |
$1,037.17
|
| Rate for Payer: Multiplan Commercial |
$901.89
|
| Rate for Payer: Preferred Network Access Commercial |
$1,037.17
|
| Rate for Payer: Quartz Beloit One Network |
$552.41
|
| Rate for Payer: Quartz Commercial |
$676.42
|
| Rate for Payer: WEA Trust Commercial |
$620.05
|
| Rate for Payer: WPS Commercial |
$835.01
|
|
|
DEBRIDEMENT (LOWER BODY)
|
Facility
|
OP
|
$1,084.00
|
|
| Hospital Charge Code |
4698606
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$315.66 |
| Max. Negotiated Rate |
$1,037.17 |
| Rate for Payer: Aetna Commercial |
$1,014.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$969.53
|
| Rate for Payer: Aetna Managed Medicare |
$315.66
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$732.78
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$563.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$541.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$597.50
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$1,037.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$630.89
|
| Rate for Payer: Health EOS Commercial |
$1,003.35
|
| Rate for Payer: HFN Commercial |
$1,037.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$845.52
|
| Rate for Payer: Multiplan Commercial |
$901.89
|
| Rate for Payer: NAPHCARE Commercial |
$676.42
|
| Rate for Payer: Preferred Network Access Commercial |
$1,037.17
|
| Rate for Payer: Quartz Beloit One Network |
$552.41
|
| Rate for Payer: Quartz Commercial |
$732.78
|
| Rate for Payer: Quartz Medicare Advantage |
$676.42
|
| Rate for Payer: The Alliance Commercial |
$563.68
|
| Rate for Payer: WEA Trust Commercial |
$620.05
|
| Rate for Payer: WPS Commercial |
$835.01
|
|
|
Debridement, Masoidectomy Cavity, simple
|
Professional
|
Both
|
$178.00
|
|
|
Service Code
|
CPT 69220
|
| Hospital Charge Code |
1152809
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$42.73 |
| Max. Negotiated Rate |
$192.30 |
| Rate for Payer: Aetna Commercial |
$175.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$159.20
|
| Rate for Payer: Aetna Managed Medicare |
$42.73
|
| Rate for Payer: Anthem Medicare Advantage |
$42.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$42.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$42.73
|
| Rate for Payer: Cash Price |
$53.40
|
| Rate for Payer: Cash Price |
$53.40
|
| Rate for Payer: Cash Price |
$53.40
|
| Rate for Payer: Cigna Commercial |
$175.86
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$45.34
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$42.73
|
| Rate for Payer: Health EOS Commercial |
$168.46
|
| Rate for Payer: HFN Commercial |
$175.86
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$175.19
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$175.19
|
| Rate for Payer: Independent Care Health Plan Medicare |
$42.73
|
| Rate for Payer: Multiplan Commercial |
$148.10
|
| Rate for Payer: NAPHCARE Commercial |
$64.10
|
| Rate for Payer: Preferred Network Access Commercial |
$175.86
|
| Rate for Payer: Quartz Beloit One Network |
$81.45
|
| Rate for Payer: Quartz Commercial |
$105.52
|
| Rate for Payer: Quartz Medicare Advantage |
$42.73
|
| Rate for Payer: The Alliance Commercial |
$181.62
|
| Rate for Payer: United Healthcare Medicaid |
$45.34
|
| Rate for Payer: United Healthcare Medicare Advantage |
$42.73
|
| Rate for Payer: WEA Trust Commercial |
$101.82
|
| Rate for Payer: WPS Commercial |
$192.30
|
|
|
Debridement, muscle and/or fascia; ea add'l 20 sq cm 11046
|
Professional
|
Both
|
$400.00
|
|
|
Service Code
|
CPT 11046
|
| Hospital Charge Code |
3013522
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$27.82 |
| Max. Negotiated Rate |
$395.20 |
| Rate for Payer: Aetna Commercial |
$395.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$357.76
|
| Rate for Payer: Aetna Managed Medicare |
$44.76
|
| Rate for Payer: Anthem Medicare Advantage |
$44.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$44.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$44.76
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cigna Commercial |
$395.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$27.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$44.76
|
| Rate for Payer: Health EOS Commercial |
$378.56
|
| Rate for Payer: HFN Commercial |
$395.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$187.78
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$187.78
|
| Rate for Payer: Independent Care Health Plan Medicare |
$44.76
|
| Rate for Payer: Multiplan Commercial |
$332.80
|
| Rate for Payer: NAPHCARE Commercial |
$67.14
|
| Rate for Payer: Preferred Network Access Commercial |
$395.20
|
| Rate for Payer: Quartz Beloit One Network |
$183.04
|
| Rate for Payer: Quartz Commercial |
$237.12
|
| Rate for Payer: Quartz Medicare Advantage |
$44.76
|
| Rate for Payer: The Alliance Commercial |
$190.24
|
| Rate for Payer: United Healthcare Medicaid |
$27.82
|
| Rate for Payer: United Healthcare Medicare Advantage |
$44.76
|
| Rate for Payer: WEA Trust Commercial |
$228.80
|
| Rate for Payer: WPS Commercial |
$201.43
|
|
|
Debridement, muscle and/or fascia; first 20 sq cm or less 11043
|
Professional
|
Both
|
$1,100.00
|
|
|
Service Code
|
CPT 11043
|
| Hospital Charge Code |
3013519
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$132.12 |
| Max. Negotiated Rate |
$1,086.80 |
| Rate for Payer: Aetna Commercial |
$1,086.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$983.84
|
| Rate for Payer: Aetna Managed Medicare |
$132.12
|
| Rate for Payer: Anthem Medicare Advantage |
$132.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$132.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$132.12
|
| Rate for Payer: Cash Price |
$330.00
|
| Rate for Payer: Cash Price |
$330.00
|
| Rate for Payer: Cash Price |
$330.00
|
| Rate for Payer: Cigna Commercial |
$1,086.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$237.78
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$132.12
|
| Rate for Payer: Health EOS Commercial |
$1,041.04
|
| Rate for Payer: HFN Commercial |
$1,086.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$530.74
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$530.74
|
| Rate for Payer: Independent Care Health Plan Medicare |
$132.12
|
| Rate for Payer: Multiplan Commercial |
$915.20
|
| Rate for Payer: NAPHCARE Commercial |
$198.18
|
| Rate for Payer: Preferred Network Access Commercial |
$1,086.80
|
| Rate for Payer: Quartz Beloit One Network |
$503.36
|
| Rate for Payer: Quartz Commercial |
$652.08
|
| Rate for Payer: Quartz Medicare Advantage |
$132.12
|
| Rate for Payer: The Alliance Commercial |
$561.52
|
| Rate for Payer: United Healthcare Medicaid |
$237.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$132.12
|
| Rate for Payer: WEA Trust Commercial |
$629.20
|
| Rate for Payer: WPS Commercial |
$594.55
|
|
|
DEBRIDEMENT, MUSCLE AND/OR FASCIA (INCLUDES EPIDERMIS, DERMIS, AND SUBCUTANEOUS TISSUE, IF PERFORMED); FIRST 20 SQ CM OR LESS
|
Facility
|
OP
|
$4,947.89
|
|
|
Service Code
|
CPT 11043
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$777.80 |
| Max. Negotiated Rate |
$4,947.89 |
| 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 |
$4,947.89
|
| 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
|
|
|
Debridement of Nails, 1-5
|
Professional
|
Both
|
$67.00
|
|
|
Service Code
|
CPT 11720
|
| Hospital Charge Code |
2572827
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$12.42 |
| Max. Negotiated Rate |
$66.20 |
| Rate for Payer: Aetna Commercial |
$66.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$59.92
|
| Rate for Payer: Aetna Managed Medicare |
$12.42
|
| Rate for Payer: Anthem Medicare Advantage |
$12.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.42
|
| Rate for Payer: Cash Price |
$20.10
|
| Rate for Payer: Cash Price |
$20.10
|
| Rate for Payer: Cash Price |
$20.10
|
| Rate for Payer: Cigna Commercial |
$66.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$19.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12.42
|
| Rate for Payer: Health EOS Commercial |
$63.41
|
| Rate for Payer: HFN Commercial |
$66.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$50.96
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$50.96
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.42
|
| Rate for Payer: Multiplan Commercial |
$55.74
|
| Rate for Payer: NAPHCARE Commercial |
$18.63
|
| Rate for Payer: Preferred Network Access Commercial |
$66.20
|
| Rate for Payer: Quartz Beloit One Network |
$30.66
|
| Rate for Payer: Quartz Commercial |
$39.72
|
| Rate for Payer: Quartz Medicare Advantage |
$12.42
|
| Rate for Payer: The Alliance Commercial |
$52.77
|
| Rate for Payer: United Healthcare Medicaid |
$19.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.42
|
| Rate for Payer: WEA Trust Commercial |
$38.32
|
| Rate for Payer: WPS Commercial |
$55.88
|
|
|
Debridement of Nails, >5
|
Professional
|
Both
|
$110.00
|
|
|
Service Code
|
CPT 11721
|
| Hospital Charge Code |
2572828
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$20.95 |
| Max. Negotiated Rate |
$108.68 |
| Rate for Payer: Aetna Commercial |
$108.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$98.38
|
| Rate for Payer: Aetna Managed Medicare |
$20.95
|
| Rate for Payer: Anthem Medicare Advantage |
$20.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$20.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$20.95
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cigna Commercial |
$108.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$34.37
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$20.95
|
| Rate for Payer: Health EOS Commercial |
$104.10
|
| Rate for Payer: HFN Commercial |
$108.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$85.18
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$85.18
|
| Rate for Payer: Independent Care Health Plan Medicare |
$20.95
|
| Rate for Payer: Multiplan Commercial |
$91.52
|
| Rate for Payer: NAPHCARE Commercial |
$31.42
|
| Rate for Payer: Preferred Network Access Commercial |
$108.68
|
| Rate for Payer: Quartz Beloit One Network |
$50.34
|
| Rate for Payer: Quartz Commercial |
$65.21
|
| Rate for Payer: Quartz Medicare Advantage |
$20.95
|
| Rate for Payer: The Alliance Commercial |
$89.02
|
| Rate for Payer: United Healthcare Medicaid |
$34.37
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20.95
|
| Rate for Payer: WEA Trust Commercial |
$62.92
|
| Rate for Payer: WPS Commercial |
$94.26
|
|
|
Debridement of Open Wound; 20 sq cm or less 97597
|
Professional
|
Both
|
$186.00
|
|
|
Service Code
|
CPT 97597
|
| Hospital Charge Code |
1188992
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$30.91 |
| Max. Negotiated Rate |
$183.77 |
| Rate for Payer: Aetna Commercial |
$183.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$166.36
|
| Rate for Payer: Aetna Managed Medicare |
$30.91
|
| Rate for Payer: Anthem Medicare Advantage |
$30.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$30.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$30.91
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Cigna Commercial |
$183.77
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$45.41
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$30.91
|
| Rate for Payer: Health EOS Commercial |
$176.03
|
| Rate for Payer: HFN Commercial |
$183.77
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$127.10
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$127.10
|
| Rate for Payer: Independent Care Health Plan Medicare |
$30.91
|
| Rate for Payer: Multiplan Commercial |
$154.75
|
| Rate for Payer: NAPHCARE Commercial |
$46.36
|
| Rate for Payer: Preferred Network Access Commercial |
$183.77
|
| Rate for Payer: Quartz Beloit One Network |
$85.11
|
| Rate for Payer: Quartz Commercial |
$110.26
|
| Rate for Payer: Quartz Medicare Advantage |
$30.91
|
| Rate for Payer: The Alliance Commercial |
$77.27
|
| Rate for Payer: United Healthcare Medicaid |
$45.41
|
| Rate for Payer: United Healthcare Medicare Advantage |
$30.91
|
| Rate for Payer: WEA Trust Commercial |
$106.39
|
| Rate for Payer: WPS Commercial |
$123.64
|
|
|
Debridement of Open Wound; 20 sq cm or less, EXT 9759722
|
Professional
|
Both
|
$224.00
|
|
|
Service Code
|
CPT 97597 22
|
| Hospital Charge Code |
6209774
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$45.41 |
| Max. Negotiated Rate |
$221.31 |
| Rate for Payer: Aetna Commercial |
$221.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$200.35
|
| Rate for Payer: Cash Price |
$67.20
|
| Rate for Payer: Cash Price |
$67.20
|
| Rate for Payer: Cash Price |
$67.20
|
| Rate for Payer: Cigna Commercial |
$221.31
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$45.41
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$139.78
|
| Rate for Payer: Health EOS Commercial |
$211.99
|
| Rate for Payer: HFN Commercial |
$221.31
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$127.10
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$127.10
|
| Rate for Payer: Multiplan Commercial |
$186.37
|
| Rate for Payer: Preferred Network Access Commercial |
$221.31
|
| Rate for Payer: Quartz Beloit One Network |
$102.50
|
| Rate for Payer: Quartz Commercial |
$132.79
|
| Rate for Payer: The Alliance Commercial |
$116.48
|
| Rate for Payer: United Healthcare Medicaid |
$45.41
|
| Rate for Payer: WEA Trust Commercial |
$128.13
|
| Rate for Payer: WPS Commercial |
$172.55
|
|
|
Debridement of Open Wound; addi'l 20 sq cm 97598
|
Professional
|
Both
|
$268.00
|
|
|
Service Code
|
CPT 97598
|
| Hospital Charge Code |
1188993
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$20.99 |
| Max. Negotiated Rate |
$264.78 |
| Rate for Payer: Aetna Commercial |
$264.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$239.70
|
| Rate for Payer: Aetna Managed Medicare |
$20.99
|
| Rate for Payer: Anthem Medicare Advantage |
$20.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$20.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$20.99
|
| Rate for Payer: Cash Price |
$80.40
|
| Rate for Payer: Cash Price |
$80.40
|
| Rate for Payer: Cash Price |
$80.40
|
| Rate for Payer: Cigna Commercial |
$264.78
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$57.18
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$20.99
|
| Rate for Payer: Health EOS Commercial |
$253.64
|
| Rate for Payer: HFN Commercial |
$264.78
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$87.67
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$87.67
|
| Rate for Payer: Independent Care Health Plan Medicare |
$20.99
|
| Rate for Payer: Multiplan Commercial |
$222.98
|
| Rate for Payer: NAPHCARE Commercial |
$31.48
|
| Rate for Payer: Preferred Network Access Commercial |
$264.78
|
| Rate for Payer: Quartz Beloit One Network |
$122.64
|
| Rate for Payer: Quartz Commercial |
$158.87
|
| Rate for Payer: Quartz Medicare Advantage |
$20.99
|
| Rate for Payer: The Alliance Commercial |
$52.47
|
| Rate for Payer: United Healthcare Medicaid |
$57.18
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20.99
|
| Rate for Payer: WEA Trust Commercial |
$153.30
|
| Rate for Payer: WPS Commercial |
$83.95
|
|
|
Debridement of partial thickness burn; initial or subsequent, lees than 5% BSA
|
Professional
|
Both
|
$234.00
|
|
|
Service Code
|
CPT 16020
|
| Hospital Charge Code |
1190878
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$30.85 |
| Max. Negotiated Rate |
$236.43 |
| Rate for Payer: Aetna Commercial |
$231.19
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$209.29
|
| Rate for Payer: Aetna Managed Medicare |
$52.54
|
| Rate for Payer: Anthem Medicare Advantage |
$52.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$52.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$52.54
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Cigna Commercial |
$231.19
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$30.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$52.54
|
| Rate for Payer: Health EOS Commercial |
$221.46
|
| Rate for Payer: HFN Commercial |
$231.19
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$188.81
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$188.81
|
| Rate for Payer: Independent Care Health Plan Medicare |
$52.54
|
| Rate for Payer: Multiplan Commercial |
$194.69
|
| Rate for Payer: NAPHCARE Commercial |
$78.81
|
| Rate for Payer: Preferred Network Access Commercial |
$231.19
|
| Rate for Payer: Quartz Beloit One Network |
$107.08
|
| Rate for Payer: Quartz Commercial |
$138.72
|
| Rate for Payer: Quartz Medicare Advantage |
$52.54
|
| Rate for Payer: The Alliance Commercial |
$223.30
|
| Rate for Payer: United Healthcare Medicaid |
$30.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$52.54
|
| Rate for Payer: WEA Trust Commercial |
$133.85
|
| Rate for Payer: WPS Commercial |
$236.43
|
|
|
Debridement, subcutaneous tissue; ea add'l 20 sq cm 11045
|
Professional
|
Both
|
$197.00
|
|
|
Service Code
|
CPT 11045
|
| Hospital Charge Code |
3013521
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$12.88 |
| Max. Negotiated Rate |
$194.64 |
| Rate for Payer: Aetna Commercial |
$194.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$176.20
|
| Rate for Payer: Aetna Managed Medicare |
$21.10
|
| Rate for Payer: Anthem Medicare Advantage |
$21.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$21.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$21.10
|
| Rate for Payer: Cash Price |
$59.10
|
| Rate for Payer: Cash Price |
$59.10
|
| Rate for Payer: Cash Price |
$59.10
|
| Rate for Payer: Cigna Commercial |
$194.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$12.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$21.10
|
| Rate for Payer: Health EOS Commercial |
$186.44
|
| Rate for Payer: HFN Commercial |
$194.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$89.17
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$89.17
|
| Rate for Payer: Independent Care Health Plan Medicare |
$21.10
|
| Rate for Payer: Multiplan Commercial |
$163.90
|
| Rate for Payer: NAPHCARE Commercial |
$31.65
|
| Rate for Payer: Preferred Network Access Commercial |
$194.64
|
| Rate for Payer: Quartz Beloit One Network |
$90.15
|
| Rate for Payer: Quartz Commercial |
$116.78
|
| Rate for Payer: Quartz Medicare Advantage |
$21.10
|
| Rate for Payer: The Alliance Commercial |
$89.68
|
| Rate for Payer: United Healthcare Medicaid |
$12.88
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21.10
|
| Rate for Payer: WEA Trust Commercial |
$112.68
|
| Rate for Payer: WPS Commercial |
$94.96
|
|
|
Debridement, Subcutaneous Tissue; First 20 sq cm or less 11042
|
Professional
|
Both
|
$773.00
|
|
|
Service Code
|
CPT 11042
|
| Hospital Charge Code |
3013518
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$54.07 |
| Max. Negotiated Rate |
$763.72 |
| Rate for Payer: Aetna Commercial |
$763.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$691.37
|
| Rate for Payer: Aetna Managed Medicare |
$54.07
|
| Rate for Payer: Anthem Medicare Advantage |
$54.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$54.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$54.07
|
| Rate for Payer: Cash Price |
$231.90
|
| Rate for Payer: Cash Price |
$231.90
|
| Rate for Payer: Cash Price |
$231.90
|
| Rate for Payer: Cigna Commercial |
$763.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$64.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$54.07
|
| Rate for Payer: Health EOS Commercial |
$731.57
|
| Rate for Payer: HFN Commercial |
$763.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$209.11
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$209.11
|
| Rate for Payer: Independent Care Health Plan Medicare |
$54.07
|
| Rate for Payer: Multiplan Commercial |
$643.14
|
| Rate for Payer: NAPHCARE Commercial |
$81.10
|
| Rate for Payer: Preferred Network Access Commercial |
$763.72
|
| Rate for Payer: Quartz Beloit One Network |
$353.72
|
| Rate for Payer: Quartz Commercial |
$458.23
|
| Rate for Payer: Quartz Medicare Advantage |
$54.07
|
| Rate for Payer: The Alliance Commercial |
$229.80
|
| Rate for Payer: United Healthcare Medicaid |
$64.82
|
| Rate for Payer: United Healthcare Medicare Advantage |
$54.07
|
| Rate for Payer: WEA Trust Commercial |
$442.16
|
| Rate for Payer: WPS Commercial |
$243.31
|
|
|
DEBRIDEMENT, SUBCUTANEOUS TISSUE (INCLUDES EPIDERMIS AND DERMIS, IF PERFORMED); FIRST 20 SQ CM OR LESS
|
Facility
|
OP
|
$4,947.89
|
|
|
Service Code
|
CPT 11042
|
|
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
|
|
|
DEBRIDEMENT (UPPER BODY)
|
Facility
|
OP
|
$1,084.00
|
|
| Hospital Charge Code |
2959992
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$315.66 |
| Max. Negotiated Rate |
$1,037.17 |
| Rate for Payer: Aetna Commercial |
$1,014.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$969.53
|
| Rate for Payer: Aetna Managed Medicare |
$315.66
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$732.78
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$563.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$541.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$597.50
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$1,037.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$630.89
|
| Rate for Payer: Health EOS Commercial |
$1,003.35
|
| Rate for Payer: HFN Commercial |
$1,037.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$845.52
|
| Rate for Payer: Multiplan Commercial |
$901.89
|
| Rate for Payer: NAPHCARE Commercial |
$676.42
|
| Rate for Payer: Preferred Network Access Commercial |
$1,037.17
|
| Rate for Payer: Quartz Beloit One Network |
$552.41
|
| Rate for Payer: Quartz Commercial |
$732.78
|
| Rate for Payer: Quartz Medicare Advantage |
$676.42
|
| Rate for Payer: The Alliance Commercial |
$563.68
|
| Rate for Payer: WEA Trust Commercial |
$620.05
|
| Rate for Payer: WPS Commercial |
$835.01
|
|
|
DEBRIDEMENT (UPPER BODY)
|
Facility
|
IP
|
$1,084.00
|
|
| Hospital Charge Code |
2959992
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$552.41 |
| Max. Negotiated Rate |
$1,037.17 |
| Rate for Payer: Aetna Commercial |
$1,014.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$969.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$597.50
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$1,037.17
|
| Rate for Payer: Health EOS Commercial |
$1,003.35
|
| Rate for Payer: HFN Commercial |
$1,037.17
|
| Rate for Payer: Multiplan Commercial |
$901.89
|
| Rate for Payer: Preferred Network Access Commercial |
$1,037.17
|
| Rate for Payer: Quartz Beloit One Network |
$552.41
|
| Rate for Payer: Quartz Commercial |
$676.42
|
| Rate for Payer: WEA Trust Commercial |
$620.05
|
| Rate for Payer: WPS Commercial |
$835.01
|
|
|
DEBRIDE SKIN, FX 11010
|
Professional
|
Both
|
$1,341.00
|
|
|
Service Code
|
CPT 11010
|
| Hospital Charge Code |
3013515
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$237.62 |
| Max. Negotiated Rate |
$1,324.91 |
| Rate for Payer: Aetna Commercial |
$1,324.91
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,199.39
|
| Rate for Payer: Aetna Managed Medicare |
$237.62
|
| Rate for Payer: Anthem Medicare Advantage |
$237.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$237.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$237.62
|
| Rate for Payer: Cash Price |
$402.30
|
| Rate for Payer: Cash Price |
$402.30
|
| Rate for Payer: Cash Price |
$402.30
|
| Rate for Payer: Cigna Commercial |
$1,324.91
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$352.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$237.62
|
| Rate for Payer: Health EOS Commercial |
$1,269.12
|
| Rate for Payer: HFN Commercial |
$1,324.91
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$941.37
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$941.37
|
| Rate for Payer: Independent Care Health Plan Medicare |
$237.62
|
| Rate for Payer: Multiplan Commercial |
$1,115.71
|
| Rate for Payer: NAPHCARE Commercial |
$356.43
|
| Rate for Payer: Preferred Network Access Commercial |
$1,324.91
|
| Rate for Payer: Quartz Beloit One Network |
$613.64
|
| Rate for Payer: Quartz Commercial |
$794.94
|
| Rate for Payer: Quartz Medicare Advantage |
$237.62
|
| Rate for Payer: The Alliance Commercial |
$1,009.88
|
| Rate for Payer: United Healthcare Medicaid |
$352.66
|
| Rate for Payer: United Healthcare Medicare Advantage |
$237.62
|
| Rate for Payer: WEA Trust Commercial |
$767.05
|
| Rate for Payer: WPS Commercial |
$1,069.29
|
|
|
DEBRIDE SKIN/MUSCLE/BONE, FX 11012
|
Professional
|
Both
|
$3,656.00
|
|
|
Service Code
|
CPT 11012
|
| Hospital Charge Code |
3013517
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$341.04 |
| Max. Negotiated Rate |
$3,612.13 |
| Rate for Payer: Aetna Commercial |
$3,612.13
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,269.93
|
| Rate for Payer: Aetna Managed Medicare |
$341.04
|
| Rate for Payer: Anthem Medicare Advantage |
$341.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$341.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$341.04
|
| Rate for Payer: Cash Price |
$1,096.80
|
| Rate for Payer: Cash Price |
$1,096.80
|
| Rate for Payer: Cash Price |
$1,096.80
|
| Rate for Payer: Cigna Commercial |
$3,612.13
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$568.81
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$341.04
|
| Rate for Payer: Health EOS Commercial |
$3,460.04
|
| Rate for Payer: HFN Commercial |
$3,612.13
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,416.10
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,416.10
|
| Rate for Payer: Independent Care Health Plan Medicare |
$341.04
|
| Rate for Payer: Multiplan Commercial |
$3,041.79
|
| Rate for Payer: NAPHCARE Commercial |
$511.56
|
| Rate for Payer: Preferred Network Access Commercial |
$3,612.13
|
| Rate for Payer: Quartz Beloit One Network |
$1,672.99
|
| Rate for Payer: Quartz Commercial |
$2,167.28
|
| Rate for Payer: Quartz Medicare Advantage |
$341.04
|
| Rate for Payer: The Alliance Commercial |
$1,449.41
|
| Rate for Payer: United Healthcare Medicaid |
$568.81
|
| Rate for Payer: United Healthcare Medicare Advantage |
$341.04
|
| Rate for Payer: WEA Trust Commercial |
$2,091.23
|
| Rate for Payer: WPS Commercial |
$1,534.67
|
|
|
DEBRIDE SKIN/MUSCLE, FX 11011
|
Professional
|
Both
|
$3,031.00
|
|
|
Service Code
|
CPT 11011
|
| Hospital Charge Code |
3013516
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$249.48 |
| Max. Negotiated Rate |
$2,994.63 |
| Rate for Payer: Aetna Commercial |
$2,994.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,710.93
|
| Rate for Payer: Aetna Managed Medicare |
$249.48
|
| Rate for Payer: Anthem Medicare Advantage |
$249.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$249.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$249.48
|
| Rate for Payer: Cash Price |
$909.30
|
| Rate for Payer: Cash Price |
$909.30
|
| Rate for Payer: Cash Price |
$909.30
|
| Rate for Payer: Cigna Commercial |
$2,994.63
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$415.22
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$249.48
|
| Rate for Payer: Health EOS Commercial |
$2,868.54
|
| Rate for Payer: HFN Commercial |
$2,994.63
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,011.93
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,011.93
|
| Rate for Payer: Independent Care Health Plan Medicare |
$249.48
|
| Rate for Payer: Multiplan Commercial |
$2,521.79
|
| Rate for Payer: NAPHCARE Commercial |
$374.21
|
| Rate for Payer: Preferred Network Access Commercial |
$2,994.63
|
| Rate for Payer: Quartz Beloit One Network |
$1,386.99
|
| Rate for Payer: Quartz Commercial |
$1,796.78
|
| Rate for Payer: Quartz Medicare Advantage |
$249.48
|
| Rate for Payer: The Alliance Commercial |
$1,060.27
|
| Rate for Payer: United Healthcare Medicaid |
$415.22
|
| Rate for Payer: United Healthcare Medicare Advantage |
$249.48
|
| Rate for Payer: WEA Trust Commercial |
$1,733.73
|
| Rate for Payer: WPS Commercial |
$1,122.64
|
|
|
Debride Skin/Tissue First 20 sq or 1104222
|
Professional
|
Both
|
$929.00
|
|
|
Service Code
|
CPT 11042 22
|
| Hospital Charge Code |
5250607
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$64.82 |
| Max. Negotiated Rate |
$917.85 |
| Rate for Payer: Aetna Commercial |
$917.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$830.90
|
| Rate for Payer: Cash Price |
$278.70
|
| Rate for Payer: Cash Price |
$278.70
|
| Rate for Payer: Cash Price |
$278.70
|
| Rate for Payer: Cigna Commercial |
$917.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$64.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$579.70
|
| Rate for Payer: Health EOS Commercial |
$879.21
|
| Rate for Payer: HFN Commercial |
$917.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$209.11
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$209.11
|
| Rate for Payer: Multiplan Commercial |
$772.93
|
| Rate for Payer: Preferred Network Access Commercial |
$917.85
|
| Rate for Payer: Quartz Beloit One Network |
$425.11
|
| Rate for Payer: Quartz Commercial |
$550.71
|
| Rate for Payer: The Alliance Commercial |
$483.08
|
| Rate for Payer: United Healthcare Medicaid |
$64.82
|
| Rate for Payer: WEA Trust Commercial |
$531.39
|
| Rate for Payer: WPS Commercial |
$715.61
|
|
|
DECANTER BAG 10-102
|
Facility
|
OP
|
$27.00
|
|
| Hospital Charge Code |
6207063
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.86 |
| Max. Negotiated Rate |
$25.83 |
| Rate for Payer: Aetna Commercial |
$25.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$24.15
|
| Rate for Payer: Aetna Managed Medicare |
$7.86
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$18.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$14.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$13.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$14.88
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cigna Commercial |
$25.83
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$15.71
|
| Rate for Payer: Health EOS Commercial |
$24.99
|
| Rate for Payer: HFN Commercial |
$25.83
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$21.06
|
| Rate for Payer: Multiplan Commercial |
$22.46
|
| Rate for Payer: NAPHCARE Commercial |
$16.85
|
| Rate for Payer: Preferred Network Access Commercial |
$25.83
|
| Rate for Payer: Quartz Beloit One Network |
$13.76
|
| Rate for Payer: Quartz Commercial |
$18.25
|
| Rate for Payer: Quartz Medicare Advantage |
$16.85
|
| Rate for Payer: The Alliance Commercial |
$14.04
|
| Rate for Payer: WEA Trust Commercial |
$15.44
|
| Rate for Payer: WPS Commercial |
$20.80
|
|
|
DECANTER BAG 10-102
|
Facility
|
IP
|
$27.00
|
|
| Hospital Charge Code |
6207063
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.76 |
| Max. Negotiated Rate |
$25.83 |
| Rate for Payer: Aetna Commercial |
$25.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$24.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$14.88
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cigna Commercial |
$25.83
|
| Rate for Payer: Health EOS Commercial |
$24.99
|
| Rate for Payer: HFN Commercial |
$25.83
|
| Rate for Payer: Multiplan Commercial |
$22.46
|
| Rate for Payer: Preferred Network Access Commercial |
$25.83
|
| Rate for Payer: Quartz Beloit One Network |
$13.76
|
| Rate for Payer: Quartz Commercial |
$16.85
|
| Rate for Payer: WEA Trust Commercial |
$15.44
|
| Rate for Payer: WPS Commercial |
$20.80
|
|
