|
ED Irrigation Corpora Cavernosa Priapism
|
Facility
|
OP
|
$413.00
|
|
|
Service Code
|
CPT 54220
|
| Hospital Charge Code |
6181647
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$198.24 |
| Max. Negotiated Rate |
$4,218.22 |
| Rate for Payer: Aetna Commercial |
$371.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$355.18
|
| Rate for Payer: Aetna Managed Medicare |
$244.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$268.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$206.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$198.24
|
| Rate for Payer: Anthem Medicare Advantage |
$244.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$218.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$244.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$244.28
|
| Rate for Payer: Cash Price |
$123.90
|
| Rate for Payer: Cash Price |
$123.90
|
| Rate for Payer: Cash Price |
$123.90
|
| Rate for Payer: Cigna Commercial |
$379.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$244.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$244.28
|
| Rate for Payer: Health EOS Commercial |
$367.57
|
| Rate for Payer: HFN Commercial |
$379.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$908.72
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$244.28
|
| Rate for Payer: Independent Care Health Plan Medicare |
$244.28
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$244.28
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$244.28
|
| Rate for Payer: Multiplan Commercial |
$330.40
|
| Rate for Payer: NAPHCARE Commercial |
$366.42
|
| Rate for Payer: Preferred Network Access Commercial |
$379.96
|
| Rate for Payer: Quartz Beloit One Network |
$202.37
|
| Rate for Payer: Quartz Commercial |
$268.45
|
| Rate for Payer: Quartz Medicare Advantage |
$244.28
|
| Rate for Payer: The Alliance Commercial |
$977.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$244.28
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$227.15
|
| Rate for Payer: Wellcare Medicare |
$244.28
|
| Rate for Payer: WPS Commercial |
$305.91
|
|
|
ED Irrigation Corpora Cavernosa Priapism
|
Facility
|
IP
|
$413.00
|
|
|
Service Code
|
CPT 54220
|
| Hospital Charge Code |
6181647
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$202.37 |
| Max. Negotiated Rate |
$379.96 |
| Rate for Payer: Aetna Commercial |
$371.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$355.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$218.89
|
| Rate for Payer: Cash Price |
$123.90
|
| Rate for Payer: Cigna Commercial |
$379.96
|
| Rate for Payer: Health EOS Commercial |
$367.57
|
| Rate for Payer: HFN Commercial |
$379.96
|
| Rate for Payer: Multiplan Commercial |
$330.40
|
| Rate for Payer: NAPHCARE Commercial |
$247.80
|
| Rate for Payer: Preferred Network Access Commercial |
$379.96
|
| Rate for Payer: Quartz Beloit One Network |
$202.37
|
| Rate for Payer: Quartz Commercial |
$247.80
|
| Rate for Payer: WEA Trust Commercial |
$227.15
|
| Rate for Payer: WPS Commercial |
$305.91
|
|
|
ED Lacrimal Closure by plug, each
|
Facility
|
IP
|
$391.00
|
|
|
Service Code
|
CPT 68761
|
| Hospital Charge Code |
6174436
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$191.59 |
| Max. Negotiated Rate |
$359.72 |
| Rate for Payer: Aetna Commercial |
$351.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$336.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$207.23
|
| Rate for Payer: Cash Price |
$117.30
|
| Rate for Payer: Cigna Commercial |
$359.72
|
| Rate for Payer: Health EOS Commercial |
$347.99
|
| Rate for Payer: HFN Commercial |
$359.72
|
| Rate for Payer: Multiplan Commercial |
$312.80
|
| Rate for Payer: NAPHCARE Commercial |
$234.60
|
| Rate for Payer: Preferred Network Access Commercial |
$359.72
|
| Rate for Payer: Quartz Beloit One Network |
$191.59
|
| Rate for Payer: Quartz Commercial |
$234.60
|
| Rate for Payer: WEA Trust Commercial |
$215.05
|
| Rate for Payer: WPS Commercial |
$289.61
|
|
|
ED Lacrimal Closure by plug, each
|
Facility
|
OP
|
$391.00
|
|
|
Service Code
|
CPT 68761
|
| Hospital Charge Code |
6174436
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$187.68 |
| Max. Negotiated Rate |
$4,218.22 |
| Rate for Payer: Aetna Commercial |
$351.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$336.26
|
| Rate for Payer: Aetna Managed Medicare |
$287.94
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$254.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$195.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$187.68
|
| Rate for Payer: Anthem Medicare Advantage |
$287.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$207.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$287.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$287.94
|
| Rate for Payer: Cash Price |
$117.30
|
| Rate for Payer: Cash Price |
$117.30
|
| Rate for Payer: Cash Price |
$117.30
|
| Rate for Payer: Cigna Commercial |
$359.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$287.94
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$287.94
|
| Rate for Payer: Health EOS Commercial |
$347.99
|
| Rate for Payer: HFN Commercial |
$359.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,071.14
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$287.94
|
| Rate for Payer: Independent Care Health Plan Medicare |
$287.94
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$287.94
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$287.94
|
| Rate for Payer: Multiplan Commercial |
$312.80
|
| Rate for Payer: NAPHCARE Commercial |
$431.91
|
| Rate for Payer: Preferred Network Access Commercial |
$359.72
|
| Rate for Payer: Quartz Beloit One Network |
$191.59
|
| Rate for Payer: Quartz Commercial |
$254.15
|
| Rate for Payer: Quartz Medicare Advantage |
$287.94
|
| Rate for Payer: The Alliance Commercial |
$1,151.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$287.94
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$215.05
|
| Rate for Payer: Wellcare Medicare |
$287.94
|
| Rate for Payer: WPS Commercial |
$289.61
|
|
|
ED Lacrimal Closure by plug, each BILAT
|
Facility
|
IP
|
$784.00
|
|
|
Service Code
|
CPT 68761 50
|
| Hospital Charge Code |
6174437
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$384.16 |
| Max. Negotiated Rate |
$721.28 |
| Rate for Payer: Aetna Commercial |
$705.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$674.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$415.52
|
| Rate for Payer: Cash Price |
$235.20
|
| Rate for Payer: Cigna Commercial |
$721.28
|
| Rate for Payer: Health EOS Commercial |
$697.76
|
| Rate for Payer: HFN Commercial |
$721.28
|
| Rate for Payer: Multiplan Commercial |
$627.20
|
| Rate for Payer: NAPHCARE Commercial |
$470.40
|
| Rate for Payer: Preferred Network Access Commercial |
$721.28
|
| Rate for Payer: Quartz Beloit One Network |
$384.16
|
| Rate for Payer: Quartz Commercial |
$470.40
|
| Rate for Payer: WEA Trust Commercial |
$431.20
|
| Rate for Payer: WPS Commercial |
$580.71
|
|
|
ED Lacrimal Closure by plug, each BILAT
|
Facility
|
OP
|
$784.00
|
|
|
Service Code
|
CPT 68761 50
|
| Hospital Charge Code |
6174437
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$219.52 |
| Max. Negotiated Rate |
$3,136.00 |
| Rate for Payer: Aetna Commercial |
$705.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$674.24
|
| Rate for Payer: Aetna Managed Medicare |
$219.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$509.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$392.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$376.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$415.52
|
| Rate for Payer: Cash Price |
$235.20
|
| Rate for Payer: Cash Price |
$235.20
|
| Rate for Payer: Cigna Commercial |
$721.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$438.73
|
| Rate for Payer: Health EOS Commercial |
$697.76
|
| Rate for Payer: HFN Commercial |
$721.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$588.00
|
| Rate for Payer: Multiplan Commercial |
$627.20
|
| Rate for Payer: NAPHCARE Commercial |
$470.40
|
| Rate for Payer: Preferred Network Access Commercial |
$721.28
|
| Rate for Payer: Quartz Beloit One Network |
$384.16
|
| Rate for Payer: Quartz Commercial |
$509.60
|
| Rate for Payer: Quartz Medicare Advantage |
$470.40
|
| Rate for Payer: The Alliance Commercial |
$3,136.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$431.20
|
| Rate for Payer: WPS Commercial |
$580.71
|
|
|
ED Laryngoscopy, Diagnostic
|
Facility
|
OP
|
$306.00
|
|
|
Service Code
|
CPT 31575
|
| Hospital Charge Code |
6173889
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$146.88 |
| Max. Negotiated Rate |
$4,218.22 |
| Rate for Payer: Aetna Commercial |
$275.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$263.16
|
| Rate for Payer: Aetna Managed Medicare |
$195.78
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$198.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$153.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$146.88
|
| Rate for Payer: Anthem Medicare Advantage |
$195.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$162.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$195.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$195.78
|
| Rate for Payer: Cash Price |
$91.80
|
| Rate for Payer: Cash Price |
$91.80
|
| Rate for Payer: Cash Price |
$91.80
|
| Rate for Payer: Cigna Commercial |
$281.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$195.78
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$195.78
|
| Rate for Payer: Health EOS Commercial |
$272.34
|
| Rate for Payer: HFN Commercial |
$281.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$728.30
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$195.78
|
| Rate for Payer: Independent Care Health Plan Medicare |
$195.78
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$195.78
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$195.78
|
| Rate for Payer: Multiplan Commercial |
$244.80
|
| Rate for Payer: NAPHCARE Commercial |
$293.67
|
| Rate for Payer: Preferred Network Access Commercial |
$281.52
|
| Rate for Payer: Quartz Beloit One Network |
$149.94
|
| Rate for Payer: Quartz Commercial |
$198.90
|
| Rate for Payer: Quartz Medicare Advantage |
$195.78
|
| Rate for Payer: The Alliance Commercial |
$783.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$195.78
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$168.30
|
| Rate for Payer: Wellcare Medicare |
$195.78
|
| Rate for Payer: WPS Commercial |
$226.65
|
|
|
ED Laryngoscopy, Diagnostic
|
Facility
|
IP
|
$306.00
|
|
|
Service Code
|
CPT 31575
|
| Hospital Charge Code |
6173889
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$149.94 |
| Max. Negotiated Rate |
$281.52 |
| Rate for Payer: Aetna Commercial |
$275.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$263.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$162.18
|
| Rate for Payer: Cash Price |
$91.80
|
| Rate for Payer: Cigna Commercial |
$281.52
|
| Rate for Payer: Health EOS Commercial |
$272.34
|
| Rate for Payer: HFN Commercial |
$281.52
|
| Rate for Payer: Multiplan Commercial |
$244.80
|
| Rate for Payer: NAPHCARE Commercial |
$183.60
|
| Rate for Payer: Preferred Network Access Commercial |
$281.52
|
| Rate for Payer: Quartz Beloit One Network |
$149.94
|
| Rate for Payer: Quartz Commercial |
$183.60
|
| Rate for Payer: WEA Trust Commercial |
$168.30
|
| Rate for Payer: WPS Commercial |
$226.65
|
|
|
ED Laryngoscopy with Operating Microscope or Telescope
|
Facility
|
OP
|
$1,478.00
|
|
|
Service Code
|
CPT 31536
|
| Hospital Charge Code |
6173888
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$14,805.68 |
| Rate for Payer: Aetna Commercial |
$1,330.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,271.08
|
| Rate for Payer: Aetna Managed Medicare |
$3,701.42
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$960.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$739.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$709.44
|
| Rate for Payer: Anthem Medicare Advantage |
$3,701.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$783.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,701.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,701.42
|
| Rate for Payer: Cash Price |
$443.40
|
| Rate for Payer: Cash Price |
$443.40
|
| Rate for Payer: Cash Price |
$443.40
|
| Rate for Payer: Cigna Commercial |
$1,359.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,701.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,546.14
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,701.42
|
| Rate for Payer: Health EOS Commercial |
$1,315.42
|
| Rate for Payer: HFN Commercial |
$1,359.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13,769.28
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,701.42
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,701.42
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,701.42
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,701.42
|
| Rate for Payer: Multiplan Commercial |
$1,182.40
|
| Rate for Payer: NAPHCARE Commercial |
$5,552.13
|
| Rate for Payer: Preferred Network Access Commercial |
$1,359.76
|
| Rate for Payer: Quartz Beloit One Network |
$724.22
|
| Rate for Payer: Quartz Commercial |
$960.70
|
| Rate for Payer: Quartz Medicare Advantage |
$3,701.42
|
| Rate for Payer: The Alliance Commercial |
$14,805.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,701.42
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$812.90
|
| Rate for Payer: Wellcare Medicare |
$3,701.42
|
| Rate for Payer: WPS Commercial |
$1,094.75
|
|
|
ED Laryngoscopy with Operating Microscope or Telescope
|
Facility
|
IP
|
$1,478.00
|
|
|
Service Code
|
CPT 31536
|
| Hospital Charge Code |
6173888
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$724.22 |
| Max. Negotiated Rate |
$1,359.76 |
| Rate for Payer: Aetna Commercial |
$1,330.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,271.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$783.34
|
| Rate for Payer: Cash Price |
$443.40
|
| Rate for Payer: Cigna Commercial |
$1,359.76
|
| Rate for Payer: Health EOS Commercial |
$1,315.42
|
| Rate for Payer: HFN Commercial |
$1,359.76
|
| Rate for Payer: Multiplan Commercial |
$1,182.40
|
| Rate for Payer: NAPHCARE Commercial |
$886.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,359.76
|
| Rate for Payer: Quartz Beloit One Network |
$724.22
|
| Rate for Payer: Quartz Commercial |
$886.80
|
| Rate for Payer: WEA Trust Commercial |
$812.90
|
| Rate for Payer: WPS Commercial |
$1,094.75
|
|
|
ED Laryngoscopy w/removal foreign body
|
Facility
|
OP
|
$321.00
|
|
|
Service Code
|
CPT 31577
|
| Hospital Charge Code |
6173545
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$154.08 |
| Max. Negotiated Rate |
$4,757.59 |
| Rate for Payer: Aetna Commercial |
$288.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$276.06
|
| Rate for Payer: Aetna Managed Medicare |
$403.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$208.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$160.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$154.08
|
| Rate for Payer: Anthem Medicare Advantage |
$403.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$170.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$403.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$403.59
|
| Rate for Payer: Cash Price |
$96.30
|
| Rate for Payer: Cash Price |
$96.30
|
| Rate for Payer: Cash Price |
$96.30
|
| Rate for Payer: Cigna Commercial |
$295.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$403.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,757.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$403.59
|
| Rate for Payer: Health EOS Commercial |
$285.69
|
| Rate for Payer: HFN Commercial |
$295.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,501.35
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$403.59
|
| Rate for Payer: Independent Care Health Plan Medicare |
$403.59
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$403.59
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$403.59
|
| Rate for Payer: Multiplan Commercial |
$256.80
|
| Rate for Payer: NAPHCARE Commercial |
$605.38
|
| Rate for Payer: Preferred Network Access Commercial |
$295.32
|
| Rate for Payer: Quartz Beloit One Network |
$157.29
|
| Rate for Payer: Quartz Commercial |
$208.65
|
| Rate for Payer: Quartz Medicare Advantage |
$403.59
|
| Rate for Payer: The Alliance Commercial |
$1,614.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$403.59
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$176.55
|
| Rate for Payer: Wellcare Medicare |
$403.59
|
| Rate for Payer: WPS Commercial |
$237.76
|
|
|
ED Laryngoscopy w/removal foreign body
|
Facility
|
IP
|
$321.00
|
|
|
Service Code
|
CPT 31577
|
| Hospital Charge Code |
6173545
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$157.29 |
| Max. Negotiated Rate |
$295.32 |
| Rate for Payer: Aetna Commercial |
$288.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$276.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$170.13
|
| Rate for Payer: Cash Price |
$96.30
|
| Rate for Payer: Cigna Commercial |
$295.32
|
| Rate for Payer: Health EOS Commercial |
$285.69
|
| Rate for Payer: HFN Commercial |
$295.32
|
| Rate for Payer: Multiplan Commercial |
$256.80
|
| Rate for Payer: NAPHCARE Commercial |
$192.60
|
| Rate for Payer: Preferred Network Access Commercial |
$295.32
|
| Rate for Payer: Quartz Beloit One Network |
$157.29
|
| Rate for Payer: Quartz Commercial |
$192.60
|
| Rate for Payer: WEA Trust Commercial |
$176.55
|
| Rate for Payer: WPS Commercial |
$237.76
|
|
|
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: The Alliance Commercial |
$1,576.48
|
| 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) 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: Aetna Gatekeeper/Not Gatekeeper |
$1,002.76
|
| 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) <=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: The Alliance Commercial |
$1,576.48
|
| 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) <=2.5cm
|
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: Aetna Gatekeeper/Not Gatekeeper |
$358.62
|
| 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) 2.6-5.0cm
|
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: Aetna Gatekeeper/Not Gatekeeper |
$482.46
|
| 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: The Alliance Commercial |
$1,576.48
|
| 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: Aetna Gatekeeper/Not Gatekeeper |
$3,814.10
|
| 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: The Alliance Commercial |
$1,576.48
|
| 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: The Alliance Commercial |
$1,576.48
|
| 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: Aetna Gatekeeper/Not Gatekeeper |
$663.92
|
| 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: The Alliance Commercial |
$2,483.08
|
| 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: Aetna Gatekeeper/Not Gatekeeper |
$579.64
|
| 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: Aetna Gatekeeper/Not Gatekeeper |
$241.66
|
| 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
|
|
