|
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 |
$313.04 |
| Max. Negotiated Rate |
$4,947.89 |
| Rate for Payer: Aetna Commercial |
$1,091.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,042.87
|
| Rate for Payer: Aetna Managed Medicare |
$427.81
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$788.22
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$606.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$582.07
|
| Rate for Payer: Anthem Medicare Advantage |
$427.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$642.70
|
| 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: Cash Price |
$349.80
|
| Rate for Payer: Cash Price |
$349.80
|
| Rate for Payer: Cash Price |
$349.80
|
| Rate for Payer: Cigna Commercial |
$1,115.63
|
| 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: Health EOS Commercial |
$1,079.25
|
| Rate for Payer: HFN Commercial |
$1,115.63
|
| 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: Multiplan Commercial |
$970.11
|
| Rate for Payer: NAPHCARE Commercial |
$641.72
|
| Rate for Payer: Preferred Network Access Commercial |
$1,115.63
|
| Rate for Payer: Quartz Beloit One Network |
$594.19
|
| Rate for Payer: Quartz Commercial |
$788.22
|
| 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 |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$666.95
|
| Rate for Payer: Wellcare Medicare |
$427.81
|
| Rate for Payer: WPS Commercial |
$898.17
|
|
|
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 |
$594.19 |
| Max. Negotiated Rate |
$1,115.63 |
| Rate for Payer: Aetna Commercial |
$1,091.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,042.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$642.70
|
| Rate for Payer: Cash Price |
$349.80
|
| Rate for Payer: Cigna Commercial |
$1,115.63
|
| Rate for Payer: Health EOS Commercial |
$1,079.25
|
| Rate for Payer: HFN Commercial |
$1,115.63
|
| Rate for Payer: Multiplan Commercial |
$970.11
|
| Rate for Payer: Preferred Network Access Commercial |
$1,115.63
|
| Rate for Payer: Quartz Beloit One Network |
$594.19
|
| Rate for Payer: Quartz Commercial |
$727.58
|
| Rate for Payer: WEA Trust Commercial |
$666.95
|
| Rate for Payer: WPS Commercial |
$898.17
|
|
|
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 |
$212.50 |
| Max. Negotiated Rate |
$398.99 |
| Rate for Payer: Aetna Commercial |
$390.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$372.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$229.85
|
| Rate for Payer: Cash Price |
$125.10
|
| Rate for Payer: Cigna Commercial |
$398.99
|
| Rate for Payer: Health EOS Commercial |
$385.98
|
| Rate for Payer: HFN Commercial |
$398.99
|
| Rate for Payer: Multiplan Commercial |
$346.94
|
| Rate for Payer: Preferred Network Access Commercial |
$398.99
|
| Rate for Payer: Quartz Beloit One Network |
$212.50
|
| Rate for Payer: Quartz Commercial |
$260.21
|
| Rate for Payer: WEA Trust Commercial |
$238.52
|
| Rate for Payer: WPS Commercial |
$321.22
|
|
|
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 |
$208.17 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$390.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$372.96
|
| Rate for Payer: Aetna Managed Medicare |
$427.81
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$281.89
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$216.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$208.17
|
| Rate for Payer: Anthem Medicare Advantage |
$427.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$229.85
|
| 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: Cash Price |
$125.10
|
| Rate for Payer: Cash Price |
$125.10
|
| Rate for Payer: Cash Price |
$125.10
|
| Rate for Payer: Cigna Commercial |
$398.99
|
| 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: Health EOS Commercial |
$385.98
|
| Rate for Payer: HFN Commercial |
$398.99
|
| 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: Multiplan Commercial |
$346.94
|
| Rate for Payer: NAPHCARE Commercial |
$641.72
|
| Rate for Payer: Preferred Network Access Commercial |
$398.99
|
| Rate for Payer: Quartz Beloit One Network |
$212.50
|
| Rate for Payer: Quartz Commercial |
$281.89
|
| 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 |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$238.52
|
| Rate for Payer: Wellcare Medicare |
$427.81
|
| Rate for Payer: WPS Commercial |
$321.22
|
|
|
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 |
$280.05 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$525.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$501.76
|
| Rate for Payer: Aetna Managed Medicare |
$427.81
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$379.24
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$291.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$280.05
|
| Rate for Payer: Anthem Medicare Advantage |
$427.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$309.22
|
| 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: Cash Price |
$168.30
|
| Rate for Payer: Cash Price |
$168.30
|
| Rate for Payer: Cash Price |
$168.30
|
| Rate for Payer: Cigna Commercial |
$536.76
|
| 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: Health EOS Commercial |
$519.26
|
| Rate for Payer: HFN Commercial |
$536.76
|
| 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: Multiplan Commercial |
$466.75
|
| Rate for Payer: NAPHCARE Commercial |
$641.72
|
| Rate for Payer: Preferred Network Access Commercial |
$536.76
|
| Rate for Payer: Quartz Beloit One Network |
$285.89
|
| Rate for Payer: Quartz Commercial |
$379.24
|
| 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 |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$320.89
|
| Rate for Payer: Wellcare Medicare |
$427.81
|
| Rate for Payer: WPS Commercial |
$432.14
|
|
|
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 |
$285.89 |
| Max. Negotiated Rate |
$536.76 |
| Rate for Payer: Aetna Commercial |
$525.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$501.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$309.22
|
| Rate for Payer: Cash Price |
$168.30
|
| Rate for Payer: Cigna Commercial |
$536.76
|
| Rate for Payer: Health EOS Commercial |
$519.26
|
| Rate for Payer: HFN Commercial |
$536.76
|
| Rate for Payer: Multiplan Commercial |
$466.75
|
| Rate for Payer: Preferred Network Access Commercial |
$536.76
|
| Rate for Payer: Quartz Beloit One Network |
$285.89
|
| Rate for Payer: Quartz Commercial |
$350.06
|
| Rate for Payer: WEA Trust Commercial |
$320.89
|
| Rate for Payer: WPS Commercial |
$432.14
|
|
|
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 |
$2,260.08 |
| Max. Negotiated Rate |
$4,243.41 |
| Rate for Payer: Aetna Commercial |
$4,151.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,966.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,444.57
|
| Rate for Payer: Cash Price |
$1,330.50
|
| Rate for Payer: Cigna Commercial |
$4,243.41
|
| Rate for Payer: Health EOS Commercial |
$4,105.04
|
| Rate for Payer: HFN Commercial |
$4,243.41
|
| Rate for Payer: Multiplan Commercial |
$3,689.92
|
| Rate for Payer: Preferred Network Access Commercial |
$4,243.41
|
| Rate for Payer: Quartz Beloit One Network |
$2,260.08
|
| Rate for Payer: Quartz Commercial |
$2,767.44
|
| Rate for Payer: WEA Trust Commercial |
$2,536.82
|
| Rate for Payer: WPS Commercial |
$3,416.28
|
|
|
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 |
$313.04 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$4,151.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,966.66
|
| Rate for Payer: Aetna Managed Medicare |
$427.81
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,998.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,306.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,213.95
|
| Rate for Payer: Anthem Medicare Advantage |
$427.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,444.57
|
| 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: 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 |
$4,243.41
|
| 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: Health EOS Commercial |
$4,105.04
|
| Rate for Payer: HFN Commercial |
$4,243.41
|
| 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: Multiplan Commercial |
$3,689.92
|
| Rate for Payer: NAPHCARE Commercial |
$641.72
|
| Rate for Payer: Preferred Network Access Commercial |
$4,243.41
|
| Rate for Payer: Quartz Beloit One Network |
$2,260.08
|
| Rate for Payer: Quartz Commercial |
$2,998.06
|
| 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 |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$2,536.82
|
| Rate for Payer: Wellcare Medicare |
$427.81
|
| Rate for Payer: WPS Commercial |
$3,416.28
|
|
|
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 |
$393.41 |
| Max. Negotiated Rate |
$738.65 |
| Rate for Payer: Aetna Commercial |
$722.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$690.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$425.53
|
| Rate for Payer: Cash Price |
$231.60
|
| Rate for Payer: Cigna Commercial |
$738.65
|
| Rate for Payer: Health EOS Commercial |
$714.56
|
| Rate for Payer: HFN Commercial |
$738.65
|
| Rate for Payer: Multiplan Commercial |
$642.30
|
| Rate for Payer: Preferred Network Access Commercial |
$738.65
|
| Rate for Payer: Quartz Beloit One Network |
$393.41
|
| Rate for Payer: Quartz Commercial |
$481.73
|
| Rate for Payer: WEA Trust Commercial |
$441.58
|
| Rate for Payer: WPS Commercial |
$594.67
|
|
|
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 |
$313.04 |
| Max. Negotiated Rate |
$4,947.89 |
| Rate for Payer: Aetna Commercial |
$722.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$690.48
|
| Rate for Payer: Aetna Managed Medicare |
$427.81
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$521.87
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$401.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$385.38
|
| Rate for Payer: Anthem Medicare Advantage |
$427.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$425.53
|
| 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: Cash Price |
$231.60
|
| Rate for Payer: Cash Price |
$231.60
|
| Rate for Payer: Cash Price |
$231.60
|
| Rate for Payer: Cigna Commercial |
$738.65
|
| 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: Health EOS Commercial |
$714.56
|
| Rate for Payer: HFN Commercial |
$738.65
|
| 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: Multiplan Commercial |
$642.30
|
| Rate for Payer: NAPHCARE Commercial |
$641.72
|
| Rate for Payer: Preferred Network Access Commercial |
$738.65
|
| Rate for Payer: Quartz Beloit One Network |
$393.41
|
| Rate for Payer: Quartz Commercial |
$521.87
|
| 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 |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$441.58
|
| Rate for Payer: Wellcare Medicare |
$427.81
|
| Rate for Payer: WPS Commercial |
$594.67
|
|
|
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 |
$343.47 |
| Max. Negotiated Rate |
$644.88 |
| Rate for Payer: Aetna Commercial |
$630.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$602.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$371.51
|
| Rate for Payer: Cash Price |
$202.20
|
| Rate for Payer: Cigna Commercial |
$644.88
|
| Rate for Payer: Health EOS Commercial |
$623.85
|
| Rate for Payer: HFN Commercial |
$644.88
|
| Rate for Payer: Multiplan Commercial |
$560.77
|
| Rate for Payer: Preferred Network Access Commercial |
$644.88
|
| Rate for Payer: Quartz Beloit One Network |
$343.47
|
| Rate for Payer: Quartz Commercial |
$420.58
|
| Rate for Payer: WEA Trust Commercial |
$385.53
|
| Rate for Payer: WPS Commercial |
$519.18
|
|
|
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 |
$313.04 |
| Max. Negotiated Rate |
$4,947.89 |
| Rate for Payer: Aetna Commercial |
$630.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$602.83
|
| Rate for Payer: Aetna Managed Medicare |
$777.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$455.62
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$350.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$336.46
|
| Rate for Payer: Anthem Medicare Advantage |
$777.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$371.51
|
| 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: Cash Price |
$202.20
|
| Rate for Payer: Cash Price |
$202.20
|
| Rate for Payer: Cash Price |
$202.20
|
| Rate for Payer: Cigna Commercial |
$644.88
|
| 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: Health EOS Commercial |
$623.85
|
| Rate for Payer: HFN Commercial |
$644.88
|
| 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: Multiplan Commercial |
$560.77
|
| Rate for Payer: NAPHCARE Commercial |
$1,166.69
|
| Rate for Payer: Preferred Network Access Commercial |
$644.88
|
| Rate for Payer: Quartz Beloit One Network |
$343.47
|
| Rate for Payer: Quartz Commercial |
$455.62
|
| 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 |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$385.53
|
| Rate for Payer: Wellcare Medicare |
$777.80
|
| Rate for Payer: WPS Commercial |
$519.18
|
|
|
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 |
$143.20 |
| Max. Negotiated Rate |
$268.86 |
| Rate for Payer: Aetna Commercial |
$263.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$251.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$154.89
|
| Rate for Payer: Cash Price |
$84.30
|
| Rate for Payer: Cigna Commercial |
$268.86
|
| Rate for Payer: Health EOS Commercial |
$260.09
|
| Rate for Payer: HFN Commercial |
$268.86
|
| Rate for Payer: Multiplan Commercial |
$233.79
|
| Rate for Payer: Preferred Network Access Commercial |
$268.86
|
| Rate for Payer: Quartz Beloit One Network |
$143.20
|
| Rate for Payer: Quartz Commercial |
$175.34
|
| Rate for Payer: WEA Trust Commercial |
$160.73
|
| Rate for Payer: WPS Commercial |
$216.45
|
|
|
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 |
$140.28 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$263.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$251.33
|
| Rate for Payer: Aetna Managed Medicare |
$427.81
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$189.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$146.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$140.28
|
| Rate for Payer: Anthem Medicare Advantage |
$427.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$154.89
|
| 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: Cash Price |
$84.30
|
| Rate for Payer: Cash Price |
$84.30
|
| Rate for Payer: Cash Price |
$84.30
|
| Rate for Payer: Cigna Commercial |
$268.86
|
| 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: Health EOS Commercial |
$260.09
|
| Rate for Payer: HFN Commercial |
$268.86
|
| 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: Multiplan Commercial |
$233.79
|
| Rate for Payer: NAPHCARE Commercial |
$641.72
|
| Rate for Payer: Preferred Network Access Commercial |
$268.86
|
| Rate for Payer: Quartz Beloit One Network |
$143.20
|
| Rate for Payer: Quartz Commercial |
$189.96
|
| 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 |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$160.73
|
| Rate for Payer: Wellcare Medicare |
$427.81
|
| Rate for Payer: WPS Commercial |
$216.45
|
|
|
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 |
$288.43 |
| Max. Negotiated Rate |
$541.55 |
| Rate for Payer: Aetna Commercial |
$529.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$506.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$311.98
|
| Rate for Payer: Cash Price |
$169.80
|
| Rate for Payer: Cigna Commercial |
$541.55
|
| Rate for Payer: Health EOS Commercial |
$523.89
|
| Rate for Payer: HFN Commercial |
$541.55
|
| Rate for Payer: Multiplan Commercial |
$470.91
|
| Rate for Payer: Preferred Network Access Commercial |
$541.55
|
| Rate for Payer: Quartz Beloit One Network |
$288.43
|
| Rate for Payer: Quartz Commercial |
$353.18
|
| Rate for Payer: WEA Trust Commercial |
$323.75
|
| Rate for Payer: WPS Commercial |
$435.99
|
|
|
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 |
$282.55 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$529.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$506.23
|
| Rate for Payer: Aetna Managed Medicare |
$427.81
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$382.62
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$294.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$282.55
|
| Rate for Payer: Anthem Medicare Advantage |
$427.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$311.98
|
| 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: Cash Price |
$169.80
|
| Rate for Payer: Cash Price |
$169.80
|
| Rate for Payer: Cash Price |
$169.80
|
| Rate for Payer: Cigna Commercial |
$541.55
|
| 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: Health EOS Commercial |
$523.89
|
| Rate for Payer: HFN Commercial |
$541.55
|
| 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: Multiplan Commercial |
$470.91
|
| Rate for Payer: NAPHCARE Commercial |
$641.72
|
| Rate for Payer: Preferred Network Access Commercial |
$541.55
|
| Rate for Payer: Quartz Beloit One Network |
$288.43
|
| Rate for Payer: Quartz Commercial |
$382.62
|
| 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 |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$323.75
|
| Rate for Payer: Wellcare Medicare |
$427.81
|
| Rate for Payer: WPS Commercial |
$435.99
|
|
|
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 |
$313.04 |
| Max. Negotiated Rate |
$8,685.50 |
| Rate for Payer: Aetna Commercial |
$1,459.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,394.37
|
| Rate for Payer: Aetna Managed Medicare |
$2,171.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,053.88
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$810.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$778.25
|
| Rate for Payer: Anthem Medicare Advantage |
$2,171.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$859.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$2,171.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$2,171.37
|
| 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 |
$1,491.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$2,171.37
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,947.89
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$2,171.37
|
| Rate for Payer: Health EOS Commercial |
$1,443.01
|
| Rate for Payer: HFN Commercial |
$1,491.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,077.51
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2,171.37
|
| Rate for Payer: Independent Care Health Plan Medicare |
$2,171.37
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$2,171.37
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$2,171.37
|
| Rate for Payer: Multiplan Commercial |
$1,297.09
|
| Rate for Payer: NAPHCARE Commercial |
$3,257.06
|
| Rate for Payer: Preferred Network Access Commercial |
$1,491.65
|
| Rate for Payer: Quartz Beloit One Network |
$794.47
|
| Rate for Payer: Quartz Commercial |
$1,053.88
|
| Rate for Payer: Quartz Medicare Advantage |
$2,171.37
|
| Rate for Payer: The Alliance Commercial |
$8,685.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,171.37
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$891.75
|
| Rate for Payer: Wellcare Medicare |
$2,171.37
|
| Rate for Payer: WPS Commercial |
$1,200.90
|
|
|
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 |
$794.47 |
| Max. Negotiated Rate |
$1,491.65 |
| Rate for Payer: Aetna Commercial |
$1,459.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,394.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$859.32
|
| Rate for Payer: Cash Price |
$467.70
|
| Rate for Payer: Cigna Commercial |
$1,491.65
|
| Rate for Payer: Health EOS Commercial |
$1,443.01
|
| Rate for Payer: HFN Commercial |
$1,491.65
|
| Rate for Payer: Multiplan Commercial |
$1,297.09
|
| Rate for Payer: Preferred Network Access Commercial |
$1,491.65
|
| Rate for Payer: Quartz Beloit One Network |
$794.47
|
| Rate for Payer: Quartz Commercial |
$972.82
|
| Rate for Payer: WEA Trust Commercial |
$891.75
|
| Rate for Payer: WPS Commercial |
$1,200.90
|
|
|
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 |
$244.11 |
| Max. Negotiated Rate |
$4,947.89 |
| Rate for Payer: Aetna Commercial |
$457.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$437.36
|
| Rate for Payer: Aetna Managed Medicare |
$777.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$330.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$254.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$244.11
|
| Rate for Payer: Anthem Medicare Advantage |
$777.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$269.54
|
| 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: Cash Price |
$146.70
|
| Rate for Payer: Cash Price |
$146.70
|
| Rate for Payer: Cash Price |
$146.70
|
| Rate for Payer: Cigna Commercial |
$467.88
|
| 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: Health EOS Commercial |
$452.62
|
| Rate for Payer: HFN Commercial |
$467.88
|
| 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: Multiplan Commercial |
$406.85
|
| Rate for Payer: NAPHCARE Commercial |
$1,166.69
|
| Rate for Payer: Preferred Network Access Commercial |
$467.88
|
| Rate for Payer: Quartz Beloit One Network |
$249.19
|
| Rate for Payer: Quartz Commercial |
$330.56
|
| 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 |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$279.71
|
| Rate for Payer: Wellcare Medicare |
$777.80
|
| Rate for Payer: WPS Commercial |
$376.68
|
|
|
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 |
$249.19 |
| Max. Negotiated Rate |
$467.88 |
| Rate for Payer: Aetna Commercial |
$457.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$437.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$269.54
|
| Rate for Payer: Cash Price |
$146.70
|
| Rate for Payer: Cigna Commercial |
$467.88
|
| Rate for Payer: Health EOS Commercial |
$452.62
|
| Rate for Payer: HFN Commercial |
$467.88
|
| Rate for Payer: Multiplan Commercial |
$406.85
|
| Rate for Payer: Preferred Network Access Commercial |
$467.88
|
| Rate for Payer: Quartz Beloit One Network |
$249.19
|
| Rate for Payer: Quartz Commercial |
$305.14
|
| Rate for Payer: WEA Trust Commercial |
$279.71
|
| Rate for Payer: WPS Commercial |
$376.68
|
|
|
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 |
$345.00 |
| Max. Negotiated Rate |
$647.75 |
| Rate for Payer: Aetna Commercial |
$633.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$605.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$373.16
|
| Rate for Payer: Cash Price |
$203.10
|
| Rate for Payer: Cigna Commercial |
$647.75
|
| Rate for Payer: Health EOS Commercial |
$626.63
|
| Rate for Payer: HFN Commercial |
$647.75
|
| Rate for Payer: Multiplan Commercial |
$563.26
|
| Rate for Payer: Preferred Network Access Commercial |
$647.75
|
| Rate for Payer: Quartz Beloit One Network |
$345.00
|
| Rate for Payer: Quartz Commercial |
$422.45
|
| Rate for Payer: WEA Trust Commercial |
$387.24
|
| Rate for Payer: WPS Commercial |
$521.49
|
|
|
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 |
$313.04 |
| Max. Negotiated Rate |
$4,947.89 |
| Rate for Payer: Aetna Commercial |
$633.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$605.51
|
| Rate for Payer: Aetna Managed Medicare |
$427.81
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$457.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$352.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$337.96
|
| Rate for Payer: Anthem Medicare Advantage |
$427.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$373.16
|
| 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: Cash Price |
$203.10
|
| Rate for Payer: Cash Price |
$203.10
|
| Rate for Payer: Cash Price |
$203.10
|
| Rate for Payer: Cigna Commercial |
$647.75
|
| 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: Health EOS Commercial |
$626.63
|
| Rate for Payer: HFN Commercial |
$647.75
|
| 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: Multiplan Commercial |
$563.26
|
| Rate for Payer: NAPHCARE Commercial |
$641.72
|
| Rate for Payer: Preferred Network Access Commercial |
$647.75
|
| Rate for Payer: Quartz Beloit One Network |
$345.00
|
| Rate for Payer: Quartz Commercial |
$457.65
|
| 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 |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$387.24
|
| Rate for Payer: Wellcare Medicare |
$427.81
|
| Rate for Payer: WPS Commercial |
$521.49
|
|
|
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 |
$313.04 |
| Max. Negotiated Rate |
$4,947.89 |
| Rate for Payer: Aetna Commercial |
$860.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$821.95
|
| Rate for Payer: Aetna Managed Medicare |
$777.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$621.24
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$477.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$458.76
|
| Rate for Payer: Anthem Medicare Advantage |
$777.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$506.55
|
| 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: Cash Price |
$275.70
|
| Rate for Payer: Cash Price |
$275.70
|
| Rate for Payer: Cash Price |
$275.70
|
| Rate for Payer: Cigna Commercial |
$879.30
|
| 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: Health EOS Commercial |
$850.63
|
| Rate for Payer: HFN Commercial |
$879.30
|
| 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: Multiplan Commercial |
$764.61
|
| Rate for Payer: NAPHCARE Commercial |
$1,166.69
|
| Rate for Payer: Preferred Network Access Commercial |
$879.30
|
| Rate for Payer: Quartz Beloit One Network |
$468.32
|
| Rate for Payer: Quartz Commercial |
$621.24
|
| 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 |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$525.67
|
| Rate for Payer: Wellcare Medicare |
$777.80
|
| Rate for Payer: WPS Commercial |
$707.91
|
|
|
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 |
$468.32 |
| Max. Negotiated Rate |
$879.30 |
| Rate for Payer: Aetna Commercial |
$860.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$821.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$506.55
|
| Rate for Payer: Cash Price |
$275.70
|
| Rate for Payer: Cigna Commercial |
$879.30
|
| Rate for Payer: Health EOS Commercial |
$850.63
|
| Rate for Payer: HFN Commercial |
$879.30
|
| Rate for Payer: Multiplan Commercial |
$764.61
|
| Rate for Payer: Preferred Network Access Commercial |
$879.30
|
| Rate for Payer: Quartz Beloit One Network |
$468.32
|
| Rate for Payer: Quartz Commercial |
$573.46
|
| Rate for Payer: WEA Trust Commercial |
$525.67
|
| Rate for Payer: WPS Commercial |
$707.91
|
|
|
ED Layer closure of wounds (scalp, axillae, trunk, extremities) <= 2.5cm
|
Facility
|
IP
|
$431.00
|
|
|
Service Code
|
CPT 12031
|
| Hospital Charge Code |
6173154
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$219.64 |
| Max. Negotiated Rate |
$412.38 |
| Rate for Payer: Aetna Commercial |
$403.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$385.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$237.57
|
| Rate for Payer: Cash Price |
$129.30
|
| Rate for Payer: Cigna Commercial |
$412.38
|
| Rate for Payer: Health EOS Commercial |
$398.93
|
| Rate for Payer: HFN Commercial |
$412.38
|
| Rate for Payer: Multiplan Commercial |
$358.59
|
| Rate for Payer: Preferred Network Access Commercial |
$412.38
|
| Rate for Payer: Quartz Beloit One Network |
$219.64
|
| Rate for Payer: Quartz Commercial |
$268.94
|
| Rate for Payer: WEA Trust Commercial |
$246.53
|
| Rate for Payer: WPS Commercial |
$332.00
|
|
