|
ED Layer closure of wounds (face, ears, eyelids, nose, lips, mucous membranes) 20.1-30.0cm
|
Facility
IP
|
$1,166.00
|
|
|
Service Code
|
CPT 12056
|
| Hospital Charge Code |
6173166
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$571.34 |
| Max. Negotiated Rate |
$1,072.72 |
| Rate for Payer: Aetna Commercial |
$1,049.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$617.98
|
| Rate for Payer: Cash Price |
$349.80
|
| Rate for Payer: Cigna Commercial |
$1,072.72
|
| Rate for Payer: Health EOS Commercial |
$1,037.74
|
| Rate for Payer: HFN Commercial |
$1,072.72
|
| Rate for Payer: Multiplan Commercial |
$932.80
|
| Rate for Payer: NAPHCARE Commercial |
$699.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,072.72
|
| Rate for Payer: Quartz Beloit One Network |
$571.34
|
| Rate for Payer: Quartz Commercial |
$699.60
|
| Rate for Payer: WEA Trust Commercial |
$641.30
|
| Rate for Payer: WPS Commercial |
$863.66
|
|
|
ED Layer closure of wounds (face, ears, eyelids, nose, lips, mucous membranes) 20.1-30.0cm
|
Facility
OP
|
$1,166.00
|
|
|
Service Code
|
CPT 12056
|
| Hospital Charge Code |
6173166
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$4,757.59 |
| Rate for Payer: Aetna Commercial |
$1,049.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,002.76
|
| Rate for Payer: Aetna Managed Medicare |
$394.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$757.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$583.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$559.68
|
| Rate for Payer: Anthem Medicare Advantage |
$394.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$617.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$394.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$394.12
|
| Rate for Payer: Cash Price |
$349.80
|
| Rate for Payer: Cash Price |
$349.80
|
| Rate for Payer: Cash Price |
$349.80
|
| Rate for Payer: Cigna Commercial |
$1,072.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$394.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,757.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$394.12
|
| Rate for Payer: Health EOS Commercial |
$1,037.74
|
| Rate for Payer: HFN Commercial |
$1,072.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,466.13
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$394.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$394.12
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$394.12
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$394.12
|
| Rate for Payer: Multiplan Commercial |
$932.80
|
| Rate for Payer: NAPHCARE Commercial |
$591.18
|
| Rate for Payer: Preferred Network Access Commercial |
$1,072.72
|
| Rate for Payer: Quartz Beloit One Network |
$571.34
|
| Rate for Payer: Quartz Commercial |
$757.90
|
| Rate for Payer: Quartz Medicare Advantage |
$394.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$394.12
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$641.30
|
| Rate for Payer: Wellcare Medicare |
$394.12
|
| Rate for Payer: WPS Commercial |
$863.66
|
|
|
ED Layer closure of wounds (face, ears, eyelids, nose, lips, mucous membranes) <=2.5cm
|
Facility
IP
|
$417.00
|
|
|
Service Code
|
CPT 12051
|
| Hospital Charge Code |
6172934
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$204.33 |
| Max. Negotiated Rate |
$383.64 |
| Rate for Payer: Aetna Commercial |
$375.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$221.01
|
| Rate for Payer: Cash Price |
$125.10
|
| Rate for Payer: Cigna Commercial |
$383.64
|
| Rate for Payer: Health EOS Commercial |
$371.13
|
| Rate for Payer: HFN Commercial |
$383.64
|
| Rate for Payer: Multiplan Commercial |
$333.60
|
| Rate for Payer: NAPHCARE Commercial |
$250.20
|
| Rate for Payer: Preferred Network Access Commercial |
$383.64
|
| Rate for Payer: Quartz Beloit One Network |
$204.33
|
| Rate for Payer: Quartz Commercial |
$250.20
|
| Rate for Payer: WEA Trust Commercial |
$229.35
|
| Rate for Payer: WPS Commercial |
$308.87
|
|
|
ED Layer closure of wounds (face, ears, eyelids, nose, lips, mucous membranes) <=2.5cm
|
Facility
OP
|
$417.00
|
|
|
Service Code
|
CPT 12051
|
| Hospital Charge Code |
6172934
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$200.16 |
| Max. Negotiated Rate |
$4,218.22 |
| Rate for Payer: Aetna Commercial |
$375.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$358.62
|
| Rate for Payer: Aetna Managed Medicare |
$394.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$271.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$208.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$200.16
|
| Rate for Payer: Anthem Medicare Advantage |
$394.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$221.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$394.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$394.12
|
| Rate for Payer: Cash Price |
$125.10
|
| Rate for Payer: Cash Price |
$125.10
|
| Rate for Payer: Cash Price |
$125.10
|
| Rate for Payer: Cigna Commercial |
$383.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$394.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$394.12
|
| Rate for Payer: Health EOS Commercial |
$371.13
|
| Rate for Payer: HFN Commercial |
$383.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,466.13
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$394.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$394.12
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$394.12
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$394.12
|
| Rate for Payer: Multiplan Commercial |
$333.60
|
| Rate for Payer: NAPHCARE Commercial |
$591.18
|
| Rate for Payer: Preferred Network Access Commercial |
$383.64
|
| Rate for Payer: Quartz Beloit One Network |
$204.33
|
| Rate for Payer: Quartz Commercial |
$271.05
|
| Rate for Payer: Quartz Medicare Advantage |
$394.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$394.12
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$229.35
|
| Rate for Payer: Wellcare Medicare |
$394.12
|
| Rate for Payer: WPS Commercial |
$308.87
|
|
|
ED Layer closure of wounds (face, ears, eyelids, nose, lips, mucous membranes) 2.6-5.0cm
|
Facility
IP
|
$561.00
|
|
|
Service Code
|
CPT 12052
|
| Hospital Charge Code |
6173163
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$274.89 |
| Max. Negotiated Rate |
$516.12 |
| Rate for Payer: Aetna Commercial |
$504.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$297.33
|
| Rate for Payer: Cash Price |
$168.30
|
| Rate for Payer: Cigna Commercial |
$516.12
|
| Rate for Payer: Health EOS Commercial |
$499.29
|
| Rate for Payer: HFN Commercial |
$516.12
|
| Rate for Payer: Multiplan Commercial |
$448.80
|
| Rate for Payer: NAPHCARE Commercial |
$336.60
|
| Rate for Payer: Preferred Network Access Commercial |
$516.12
|
| Rate for Payer: Quartz Beloit One Network |
$274.89
|
| Rate for Payer: Quartz Commercial |
$336.60
|
| Rate for Payer: WEA Trust Commercial |
$308.55
|
| Rate for Payer: WPS Commercial |
$415.53
|
|
|
ED Layer closure of wounds (face, ears, eyelids, nose, lips, mucous membranes) 2.6-5.0cm
|
Facility
OP
|
$561.00
|
|
|
Service Code
|
CPT 12052
|
| Hospital Charge Code |
6173163
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$269.28 |
| Max. Negotiated Rate |
$4,218.22 |
| Rate for Payer: Aetna Commercial |
$504.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$482.46
|
| Rate for Payer: Aetna Managed Medicare |
$394.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$364.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$280.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$269.28
|
| Rate for Payer: Anthem Medicare Advantage |
$394.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$297.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$394.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$394.12
|
| Rate for Payer: Cash Price |
$168.30
|
| Rate for Payer: Cash Price |
$168.30
|
| Rate for Payer: Cash Price |
$168.30
|
| Rate for Payer: Cigna Commercial |
$516.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$394.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$394.12
|
| Rate for Payer: Health EOS Commercial |
$499.29
|
| Rate for Payer: HFN Commercial |
$516.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,466.13
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$394.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$394.12
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$394.12
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$394.12
|
| Rate for Payer: Multiplan Commercial |
$448.80
|
| Rate for Payer: NAPHCARE Commercial |
$591.18
|
| Rate for Payer: Preferred Network Access Commercial |
$516.12
|
| Rate for Payer: Quartz Beloit One Network |
$274.89
|
| Rate for Payer: Quartz Commercial |
$364.65
|
| Rate for Payer: Quartz Medicare Advantage |
$394.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$394.12
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$308.55
|
| Rate for Payer: Wellcare Medicare |
$394.12
|
| Rate for Payer: WPS Commercial |
$415.53
|
|
|
ED Layer closure of wounds (face, ears, eyelids, nose, lips, mucous membranes) 5.1-7.5cm
|
Facility
IP
|
$4,435.00
|
|
|
Service Code
|
CPT 12053
|
| Hospital Charge Code |
6173164
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,173.15 |
| Max. Negotiated Rate |
$4,080.20 |
| Rate for Payer: Aetna Commercial |
$3,991.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,350.55
|
| Rate for Payer: Cash Price |
$1,330.50
|
| Rate for Payer: Cigna Commercial |
$4,080.20
|
| Rate for Payer: Health EOS Commercial |
$3,947.15
|
| Rate for Payer: HFN Commercial |
$4,080.20
|
| Rate for Payer: Multiplan Commercial |
$3,548.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,661.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,080.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,173.15
|
| Rate for Payer: Quartz Commercial |
$2,661.00
|
| Rate for Payer: WEA Trust Commercial |
$2,439.25
|
| Rate for Payer: WPS Commercial |
$3,285.00
|
|
|
ED Layer closure of wounds (face, ears, eyelids, nose, lips, mucous membranes) 5.1-7.5cm
|
Facility
OP
|
$4,435.00
|
|
|
Service Code
|
CPT 12053
|
| Hospital Charge Code |
6173164
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$4,218.22 |
| Rate for Payer: Aetna Commercial |
$3,991.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,814.10
|
| Rate for Payer: Aetna Managed Medicare |
$394.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,882.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,217.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,128.80
|
| Rate for Payer: Anthem Medicare Advantage |
$394.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,350.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$394.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$394.12
|
| Rate for Payer: Cash Price |
$1,330.50
|
| Rate for Payer: Cash Price |
$1,330.50
|
| Rate for Payer: Cash Price |
$1,330.50
|
| Rate for Payer: Cigna Commercial |
$4,080.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$394.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$394.12
|
| Rate for Payer: Health EOS Commercial |
$3,947.15
|
| Rate for Payer: HFN Commercial |
$4,080.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,466.13
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$394.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$394.12
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$394.12
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$394.12
|
| Rate for Payer: Multiplan Commercial |
$3,548.00
|
| Rate for Payer: NAPHCARE Commercial |
$591.18
|
| Rate for Payer: Preferred Network Access Commercial |
$4,080.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,173.15
|
| Rate for Payer: Quartz Commercial |
$2,882.75
|
| Rate for Payer: Quartz Medicare Advantage |
$394.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$394.12
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$2,439.25
|
| Rate for Payer: Wellcare Medicare |
$394.12
|
| Rate for Payer: WPS Commercial |
$3,285.00
|
|
|
ED Layer closure of wounds (face, ears, eyelids, nose, lips, mucous membranes) 7.6-12.5cm
|
Facility
OP
|
$772.00
|
|
|
Service Code
|
CPT 12054
|
| Hospital Charge Code |
6173165
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$4,757.59 |
| Rate for Payer: Aetna Commercial |
$694.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$663.92
|
| Rate for Payer: Aetna Managed Medicare |
$394.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$501.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$386.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$370.56
|
| Rate for Payer: Anthem Medicare Advantage |
$394.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$409.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$394.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$394.12
|
| Rate for Payer: Cash Price |
$231.60
|
| Rate for Payer: Cash Price |
$231.60
|
| Rate for Payer: Cash Price |
$231.60
|
| Rate for Payer: Cigna Commercial |
$710.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$394.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,757.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$394.12
|
| Rate for Payer: Health EOS Commercial |
$687.08
|
| Rate for Payer: HFN Commercial |
$710.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,466.13
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$394.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$394.12
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$394.12
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$394.12
|
| Rate for Payer: Multiplan Commercial |
$617.60
|
| Rate for Payer: NAPHCARE Commercial |
$591.18
|
| Rate for Payer: Preferred Network Access Commercial |
$710.24
|
| Rate for Payer: Quartz Beloit One Network |
$378.28
|
| Rate for Payer: Quartz Commercial |
$501.80
|
| Rate for Payer: Quartz Medicare Advantage |
$394.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$394.12
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$424.60
|
| Rate for Payer: Wellcare Medicare |
$394.12
|
| Rate for Payer: WPS Commercial |
$571.82
|
|
|
ED Layer closure of wounds (face, ears, eyelids, nose, lips, mucous membranes) 7.6-12.5cm
|
Facility
IP
|
$772.00
|
|
|
Service Code
|
CPT 12054
|
| Hospital Charge Code |
6173165
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$378.28 |
| Max. Negotiated Rate |
$710.24 |
| Rate for Payer: Aetna Commercial |
$694.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$409.16
|
| Rate for Payer: Cash Price |
$231.60
|
| Rate for Payer: Cigna Commercial |
$710.24
|
| Rate for Payer: Health EOS Commercial |
$687.08
|
| Rate for Payer: HFN Commercial |
$710.24
|
| Rate for Payer: Multiplan Commercial |
$617.60
|
| Rate for Payer: NAPHCARE Commercial |
$463.20
|
| Rate for Payer: Preferred Network Access Commercial |
$710.24
|
| Rate for Payer: Quartz Beloit One Network |
$378.28
|
| Rate for Payer: Quartz Commercial |
$463.20
|
| Rate for Payer: WEA Trust Commercial |
$424.60
|
| Rate for Payer: WPS Commercial |
$571.82
|
|
|
ED Layer closure of wounds (neck, hands, feet, external genitalia) 12.6-20.0cm
|
Facility
OP
|
$674.00
|
|
|
Service Code
|
CPT 12045
|
| Hospital Charge Code |
6173161
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$4,757.59 |
| Rate for Payer: Aetna Commercial |
$606.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$579.64
|
| Rate for Payer: Aetna Managed Medicare |
$620.77
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$438.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$337.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$323.52
|
| Rate for Payer: Anthem Medicare Advantage |
$620.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$357.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$620.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$620.77
|
| Rate for Payer: Cash Price |
$202.20
|
| Rate for Payer: Cash Price |
$202.20
|
| Rate for Payer: Cash Price |
$202.20
|
| Rate for Payer: Cigna Commercial |
$620.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$620.77
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,757.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$620.77
|
| Rate for Payer: Health EOS Commercial |
$599.86
|
| Rate for Payer: HFN Commercial |
$620.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,309.26
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$620.77
|
| Rate for Payer: Independent Care Health Plan Medicare |
$620.77
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$620.77
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$620.77
|
| Rate for Payer: Multiplan Commercial |
$539.20
|
| Rate for Payer: NAPHCARE Commercial |
$931.16
|
| Rate for Payer: Preferred Network Access Commercial |
$620.08
|
| Rate for Payer: Quartz Beloit One Network |
$330.26
|
| Rate for Payer: Quartz Commercial |
$438.10
|
| Rate for Payer: Quartz Medicare Advantage |
$620.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$620.77
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$370.70
|
| Rate for Payer: Wellcare Medicare |
$620.77
|
| Rate for Payer: WPS Commercial |
$499.23
|
|
|
ED Layer closure of wounds (neck, hands, feet, external genitalia) 12.6-20.0cm
|
Facility
IP
|
$674.00
|
|
|
Service Code
|
CPT 12045
|
| Hospital Charge Code |
6173161
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$330.26 |
| Max. Negotiated Rate |
$620.08 |
| Rate for Payer: Aetna Commercial |
$606.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$357.22
|
| Rate for Payer: Cash Price |
$202.20
|
| Rate for Payer: Cigna Commercial |
$620.08
|
| Rate for Payer: Health EOS Commercial |
$599.86
|
| Rate for Payer: HFN Commercial |
$620.08
|
| Rate for Payer: Multiplan Commercial |
$539.20
|
| Rate for Payer: NAPHCARE Commercial |
$404.40
|
| Rate for Payer: Preferred Network Access Commercial |
$620.08
|
| Rate for Payer: Quartz Beloit One Network |
$330.26
|
| Rate for Payer: Quartz Commercial |
$404.40
|
| Rate for Payer: WEA Trust Commercial |
$370.70
|
| Rate for Payer: WPS Commercial |
$499.23
|
|
|
ED Layer closure of wounds (neck, hands, feet, external genitalia) <=2.5cm
|
Facility
IP
|
$281.00
|
|
|
Service Code
|
CPT 12041
|
| Hospital Charge Code |
6173158
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$137.69 |
| Max. Negotiated Rate |
$258.52 |
| Rate for Payer: Aetna Commercial |
$252.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$148.93
|
| Rate for Payer: Cash Price |
$84.30
|
| Rate for Payer: Cigna Commercial |
$258.52
|
| Rate for Payer: Health EOS Commercial |
$250.09
|
| Rate for Payer: HFN Commercial |
$258.52
|
| Rate for Payer: Multiplan Commercial |
$224.80
|
| Rate for Payer: NAPHCARE Commercial |
$168.60
|
| Rate for Payer: Preferred Network Access Commercial |
$258.52
|
| Rate for Payer: Quartz Beloit One Network |
$137.69
|
| Rate for Payer: Quartz Commercial |
$168.60
|
| Rate for Payer: WEA Trust Commercial |
$154.55
|
| Rate for Payer: WPS Commercial |
$208.14
|
|
|
ED Layer closure of wounds (neck, hands, feet, external genitalia) <=2.5cm
|
Facility
OP
|
$281.00
|
|
|
Service Code
|
CPT 12041
|
| Hospital Charge Code |
6173158
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$134.88 |
| Max. Negotiated Rate |
$4,218.22 |
| Rate for Payer: Aetna Commercial |
$252.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$241.66
|
| Rate for Payer: Aetna Managed Medicare |
$394.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$182.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$140.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$134.88
|
| Rate for Payer: Anthem Medicare Advantage |
$394.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$148.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$394.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$394.12
|
| Rate for Payer: Cash Price |
$84.30
|
| Rate for Payer: Cash Price |
$84.30
|
| Rate for Payer: Cash Price |
$84.30
|
| Rate for Payer: Cigna Commercial |
$258.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$394.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$394.12
|
| Rate for Payer: Health EOS Commercial |
$250.09
|
| Rate for Payer: HFN Commercial |
$258.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,466.13
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$394.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$394.12
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$394.12
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$394.12
|
| Rate for Payer: Multiplan Commercial |
$224.80
|
| Rate for Payer: NAPHCARE Commercial |
$591.18
|
| Rate for Payer: Preferred Network Access Commercial |
$258.52
|
| Rate for Payer: Quartz Beloit One Network |
$137.69
|
| Rate for Payer: Quartz Commercial |
$182.65
|
| Rate for Payer: Quartz Medicare Advantage |
$394.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$394.12
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$154.55
|
| Rate for Payer: Wellcare Medicare |
$394.12
|
| Rate for Payer: WPS Commercial |
$208.14
|
|
|
ED Layer closure of wounds (neck, hands, feet, external genitalia) 2.6-7.5cm
|
Facility
OP
|
$566.00
|
|
|
Service Code
|
CPT 12042
|
| Hospital Charge Code |
6173159
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$271.68 |
| Max. Negotiated Rate |
$4,218.22 |
| Rate for Payer: Aetna Commercial |
$509.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$486.76
|
| Rate for Payer: Aetna Managed Medicare |
$394.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$367.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$283.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$271.68
|
| Rate for Payer: Anthem Medicare Advantage |
$394.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$299.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$394.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$394.12
|
| Rate for Payer: Cash Price |
$169.80
|
| Rate for Payer: Cash Price |
$169.80
|
| Rate for Payer: Cash Price |
$169.80
|
| Rate for Payer: Cigna Commercial |
$520.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$394.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$394.12
|
| Rate for Payer: Health EOS Commercial |
$503.74
|
| Rate for Payer: HFN Commercial |
$520.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,466.13
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$394.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$394.12
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$394.12
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$394.12
|
| Rate for Payer: Multiplan Commercial |
$452.80
|
| Rate for Payer: NAPHCARE Commercial |
$591.18
|
| Rate for Payer: Preferred Network Access Commercial |
$520.72
|
| Rate for Payer: Quartz Beloit One Network |
$277.34
|
| Rate for Payer: Quartz Commercial |
$367.90
|
| Rate for Payer: Quartz Medicare Advantage |
$394.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$394.12
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$311.30
|
| Rate for Payer: Wellcare Medicare |
$394.12
|
| Rate for Payer: WPS Commercial |
$419.24
|
|
|
ED Layer closure of wounds (neck, hands, feet, external genitalia) 2.6-7.5cm
|
Facility
IP
|
$566.00
|
|
|
Service Code
|
CPT 12042
|
| Hospital Charge Code |
6173159
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$277.34 |
| Max. Negotiated Rate |
$520.72 |
| Rate for Payer: Aetna Commercial |
$509.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$299.98
|
| Rate for Payer: Cash Price |
$169.80
|
| Rate for Payer: Cigna Commercial |
$520.72
|
| Rate for Payer: Health EOS Commercial |
$503.74
|
| Rate for Payer: HFN Commercial |
$520.72
|
| Rate for Payer: Multiplan Commercial |
$452.80
|
| Rate for Payer: NAPHCARE Commercial |
$339.60
|
| Rate for Payer: Preferred Network Access Commercial |
$520.72
|
| Rate for Payer: Quartz Beloit One Network |
$277.34
|
| Rate for Payer: Quartz Commercial |
$339.60
|
| Rate for Payer: WEA Trust Commercial |
$311.30
|
| Rate for Payer: WPS Commercial |
$419.24
|
|
|
ED Layer closure of wounds (neck, hands, feet, external genitalia) >30.0cm
|
Facility
IP
|
$1,559.00
|
|
|
Service Code
|
CPT 12047
|
| Hospital Charge Code |
6173162
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$763.91 |
| Max. Negotiated Rate |
$1,434.28 |
| Rate for Payer: Aetna Commercial |
$1,403.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$826.27
|
| Rate for Payer: Cash Price |
$467.70
|
| Rate for Payer: Cigna Commercial |
$1,434.28
|
| Rate for Payer: Health EOS Commercial |
$1,387.51
|
| Rate for Payer: HFN Commercial |
$1,434.28
|
| Rate for Payer: Multiplan Commercial |
$1,247.20
|
| Rate for Payer: NAPHCARE Commercial |
$935.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,434.28
|
| Rate for Payer: Quartz Beloit One Network |
$763.91
|
| Rate for Payer: Quartz Commercial |
$935.40
|
| Rate for Payer: WEA Trust Commercial |
$857.45
|
| Rate for Payer: WPS Commercial |
$1,154.75
|
|
|
ED Layer closure of wounds (neck, hands, feet, external genitalia) >30.0cm
|
Facility
OP
|
$1,559.00
|
|
|
Service Code
|
CPT 12047
|
| Hospital Charge Code |
6173162
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$6,705.23 |
| Rate for Payer: Aetna Commercial |
$1,403.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,340.74
|
| Rate for Payer: Aetna Managed Medicare |
$1,802.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,013.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$779.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$748.32
|
| Rate for Payer: Anthem Medicare Advantage |
$1,802.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$826.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,802.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,802.48
|
| Rate for Payer: Cash Price |
$467.70
|
| Rate for Payer: Cash Price |
$467.70
|
| Rate for Payer: Cash Price |
$467.70
|
| Rate for Payer: Cigna Commercial |
$1,434.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,802.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,757.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,802.48
|
| Rate for Payer: Health EOS Commercial |
$1,387.51
|
| Rate for Payer: HFN Commercial |
$1,434.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,705.23
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,802.48
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,802.48
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,802.48
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,802.48
|
| Rate for Payer: Multiplan Commercial |
$1,247.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,703.72
|
| Rate for Payer: Preferred Network Access Commercial |
$1,434.28
|
| Rate for Payer: Quartz Beloit One Network |
$763.91
|
| Rate for Payer: Quartz Commercial |
$1,013.35
|
| Rate for Payer: Quartz Medicare Advantage |
$1,802.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,802.48
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$857.45
|
| Rate for Payer: Wellcare Medicare |
$1,802.48
|
| Rate for Payer: WPS Commercial |
$1,154.75
|
|
|
ED Layer closure of wounds (neck, hands, feet, external genitalia) 7.6-12.5cm
|
Facility
IP
|
$489.00
|
|
|
Service Code
|
CPT 12044
|
| Hospital Charge Code |
6173160
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$239.61 |
| Max. Negotiated Rate |
$449.88 |
| Rate for Payer: Aetna Commercial |
$440.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$259.17
|
| Rate for Payer: Cash Price |
$146.70
|
| Rate for Payer: Cigna Commercial |
$449.88
|
| Rate for Payer: Health EOS Commercial |
$435.21
|
| Rate for Payer: HFN Commercial |
$449.88
|
| Rate for Payer: Multiplan Commercial |
$391.20
|
| Rate for Payer: NAPHCARE Commercial |
$293.40
|
| Rate for Payer: Preferred Network Access Commercial |
$449.88
|
| Rate for Payer: Quartz Beloit One Network |
$239.61
|
| Rate for Payer: Quartz Commercial |
$293.40
|
| Rate for Payer: WEA Trust Commercial |
$268.95
|
| Rate for Payer: WPS Commercial |
$362.20
|
|
|
ED Layer closure of wounds (neck, hands, feet, external genitalia) 7.6-12.5cm
|
Facility
OP
|
$489.00
|
|
|
Service Code
|
CPT 12044
|
| Hospital Charge Code |
6173160
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$234.72 |
| Max. Negotiated Rate |
$4,757.59 |
| Rate for Payer: Aetna Commercial |
$440.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$420.54
|
| Rate for Payer: Aetna Managed Medicare |
$620.77
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$317.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$244.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$234.72
|
| Rate for Payer: Anthem Medicare Advantage |
$620.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$259.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$620.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$620.77
|
| Rate for Payer: Cash Price |
$146.70
|
| Rate for Payer: Cash Price |
$146.70
|
| Rate for Payer: Cash Price |
$146.70
|
| Rate for Payer: Cigna Commercial |
$449.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$620.77
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,757.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$620.77
|
| Rate for Payer: Health EOS Commercial |
$435.21
|
| Rate for Payer: HFN Commercial |
$449.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,309.26
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$620.77
|
| Rate for Payer: Independent Care Health Plan Medicare |
$620.77
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$620.77
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$620.77
|
| Rate for Payer: Multiplan Commercial |
$391.20
|
| Rate for Payer: NAPHCARE Commercial |
$931.16
|
| Rate for Payer: Preferred Network Access Commercial |
$449.88
|
| Rate for Payer: Quartz Beloit One Network |
$239.61
|
| Rate for Payer: Quartz Commercial |
$317.85
|
| Rate for Payer: Quartz Medicare Advantage |
$620.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$620.77
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$268.95
|
| Rate for Payer: Wellcare Medicare |
$620.77
|
| Rate for Payer: WPS Commercial |
$362.20
|
|
|
ED Layer closure of wounds (scalp, axillae, trunk, extremities) 12.6-20.0cm
|
Facility
IP
|
$677.00
|
|
|
Service Code
|
CPT 12035
|
| Hospital Charge Code |
6173155
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$331.73 |
| Max. Negotiated Rate |
$622.84 |
| Rate for Payer: Aetna Commercial |
$609.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$358.81
|
| Rate for Payer: Cash Price |
$203.10
|
| Rate for Payer: Cigna Commercial |
$622.84
|
| Rate for Payer: Health EOS Commercial |
$602.53
|
| Rate for Payer: HFN Commercial |
$622.84
|
| Rate for Payer: Multiplan Commercial |
$541.60
|
| Rate for Payer: NAPHCARE Commercial |
$406.20
|
| Rate for Payer: Preferred Network Access Commercial |
$622.84
|
| Rate for Payer: Quartz Beloit One Network |
$331.73
|
| Rate for Payer: Quartz Commercial |
$406.20
|
| Rate for Payer: WEA Trust Commercial |
$372.35
|
| Rate for Payer: WPS Commercial |
$501.45
|
|
|
ED Layer closure of wounds (scalp, axillae, trunk, extremities) 12.6-20.0cm
|
Facility
OP
|
$677.00
|
|
|
Service Code
|
CPT 12035
|
| Hospital Charge Code |
6173155
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$4,757.59 |
| Rate for Payer: Aetna Commercial |
$609.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$582.22
|
| Rate for Payer: Aetna Managed Medicare |
$394.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$440.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$338.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$324.96
|
| Rate for Payer: Anthem Medicare Advantage |
$394.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$358.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$394.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$394.12
|
| Rate for Payer: Cash Price |
$203.10
|
| Rate for Payer: Cash Price |
$203.10
|
| Rate for Payer: Cash Price |
$203.10
|
| Rate for Payer: Cigna Commercial |
$622.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$394.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,757.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$394.12
|
| Rate for Payer: Health EOS Commercial |
$602.53
|
| Rate for Payer: HFN Commercial |
$622.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,466.13
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$394.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$394.12
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$394.12
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$394.12
|
| Rate for Payer: Multiplan Commercial |
$541.60
|
| Rate for Payer: NAPHCARE Commercial |
$591.18
|
| Rate for Payer: Preferred Network Access Commercial |
$622.84
|
| Rate for Payer: Quartz Beloit One Network |
$331.73
|
| Rate for Payer: Quartz Commercial |
$440.05
|
| Rate for Payer: Quartz Medicare Advantage |
$394.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$394.12
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$372.35
|
| Rate for Payer: Wellcare Medicare |
$394.12
|
| Rate for Payer: WPS Commercial |
$501.45
|
|
|
ED Layer closure of wounds (scalp, axillae, trunk, extremities) 20.1-30.0cm
|
Facility
IP
|
$919.00
|
|
|
Service Code
|
CPT 12036
|
| Hospital Charge Code |
6173156
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.31 |
| Max. Negotiated Rate |
$845.48 |
| Rate for Payer: Aetna Commercial |
$827.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$487.07
|
| Rate for Payer: Cash Price |
$275.70
|
| Rate for Payer: Cigna Commercial |
$845.48
|
| Rate for Payer: Health EOS Commercial |
$817.91
|
| Rate for Payer: HFN Commercial |
$845.48
|
| Rate for Payer: Multiplan Commercial |
$735.20
|
| Rate for Payer: NAPHCARE Commercial |
$551.40
|
| Rate for Payer: Preferred Network Access Commercial |
$845.48
|
| Rate for Payer: Quartz Beloit One Network |
$450.31
|
| Rate for Payer: Quartz Commercial |
$551.40
|
| Rate for Payer: WEA Trust Commercial |
$505.45
|
| Rate for Payer: WPS Commercial |
$680.70
|
|
|
ED Layer closure of wounds (scalp, axillae, trunk, extremities) 20.1-30.0cm
|
Facility
OP
|
$919.00
|
|
|
Service Code
|
CPT 12036
|
| Hospital Charge Code |
6173156
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$4,757.59 |
| Rate for Payer: Aetna Commercial |
$827.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$790.34
|
| Rate for Payer: Aetna Managed Medicare |
$620.77
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$597.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$459.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$441.12
|
| Rate for Payer: Anthem Medicare Advantage |
$620.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$487.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$620.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$620.77
|
| Rate for Payer: Cash Price |
$275.70
|
| Rate for Payer: Cash Price |
$275.70
|
| Rate for Payer: Cash Price |
$275.70
|
| Rate for Payer: Cigna Commercial |
$845.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$620.77
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,757.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$620.77
|
| Rate for Payer: Health EOS Commercial |
$817.91
|
| Rate for Payer: HFN Commercial |
$845.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,309.26
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$620.77
|
| Rate for Payer: Independent Care Health Plan Medicare |
$620.77
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$620.77
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$620.77
|
| Rate for Payer: Multiplan Commercial |
$735.20
|
| Rate for Payer: NAPHCARE Commercial |
$931.16
|
| Rate for Payer: Preferred Network Access Commercial |
$845.48
|
| Rate for Payer: Quartz Beloit One Network |
$450.31
|
| Rate for Payer: Quartz Commercial |
$597.35
|
| Rate for Payer: Quartz Medicare Advantage |
$620.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$620.77
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$505.45
|
| Rate for Payer: Wellcare Medicare |
$620.77
|
| Rate for Payer: WPS Commercial |
$680.70
|
|
|
ED Layer closure of wounds (scalp, axillae, trunk, extremities) <= 2.5cm
|
Facility
OP
|
$431.00
|
|
|
Service Code
|
CPT 12031
|
| Hospital Charge Code |
6173154
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$206.88 |
| Max. Negotiated Rate |
$4,218.22 |
| Rate for Payer: Aetna Commercial |
$387.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$370.66
|
| Rate for Payer: Aetna Managed Medicare |
$394.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$280.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$215.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$206.88
|
| Rate for Payer: Anthem Medicare Advantage |
$394.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$228.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$394.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$394.12
|
| Rate for Payer: Cash Price |
$129.30
|
| Rate for Payer: Cash Price |
$129.30
|
| Rate for Payer: Cash Price |
$129.30
|
| Rate for Payer: Cigna Commercial |
$396.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$394.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$394.12
|
| Rate for Payer: Health EOS Commercial |
$383.59
|
| Rate for Payer: HFN Commercial |
$396.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,466.13
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$394.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$394.12
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$394.12
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$394.12
|
| Rate for Payer: Multiplan Commercial |
$344.80
|
| Rate for Payer: NAPHCARE Commercial |
$591.18
|
| Rate for Payer: Preferred Network Access Commercial |
$396.52
|
| Rate for Payer: Quartz Beloit One Network |
$211.19
|
| Rate for Payer: Quartz Commercial |
$280.15
|
| Rate for Payer: Quartz Medicare Advantage |
$394.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$394.12
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$237.05
|
| Rate for Payer: Wellcare Medicare |
$394.12
|
| Rate for Payer: WPS Commercial |
$319.24
|
|
