|
ED Repair, complex (eyelids, nose, ears, lips) 1.1-2.5cm
|
Facility
|
IP
|
$801.00
|
|
|
Service Code
|
CPT 13151
|
| Hospital Charge Code |
6173176
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$408.19 |
| Max. Negotiated Rate |
$766.40 |
| Rate for Payer: Aetna Commercial |
$749.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$716.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$441.51
|
| Rate for Payer: Cash Price |
$240.30
|
| Rate for Payer: Cigna Commercial |
$766.40
|
| Rate for Payer: Health EOS Commercial |
$741.41
|
| Rate for Payer: HFN Commercial |
$766.40
|
| Rate for Payer: Multiplan Commercial |
$666.43
|
| Rate for Payer: Preferred Network Access Commercial |
$766.40
|
| Rate for Payer: Quartz Beloit One Network |
$408.19
|
| Rate for Payer: Quartz Commercial |
$499.82
|
| Rate for Payer: WEA Trust Commercial |
$458.17
|
| Rate for Payer: WPS Commercial |
$617.01
|
|
|
ED Repair, complex (eyelids, nose, ears, lips) 1.1-2.5cm
|
Facility
|
OP
|
$801.00
|
|
|
Service Code
|
CPT 13151
|
| Hospital Charge Code |
6173176
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$313.04 |
| Max. Negotiated Rate |
$6,807.99 |
| Rate for Payer: Aetna Commercial |
$749.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$716.41
|
| Rate for Payer: Aetna Managed Medicare |
$777.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$541.48
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$416.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$399.86
|
| Rate for Payer: Anthem Medicare Advantage |
$777.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$441.51
|
| 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 |
$240.30
|
| Rate for Payer: Cash Price |
$240.30
|
| Rate for Payer: Cash Price |
$240.30
|
| Rate for Payer: Cigna Commercial |
$766.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$777.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,807.99
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$777.80
|
| Rate for Payer: Health EOS Commercial |
$741.41
|
| Rate for Payer: HFN Commercial |
$766.40
|
| 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 |
$666.43
|
| Rate for Payer: NAPHCARE Commercial |
$1,166.69
|
| Rate for Payer: Preferred Network Access Commercial |
$766.40
|
| Rate for Payer: Quartz Beloit One Network |
$408.19
|
| Rate for Payer: Quartz Commercial |
$541.48
|
| 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 |
$458.17
|
| Rate for Payer: Wellcare Medicare |
$777.80
|
| Rate for Payer: WPS Commercial |
$617.01
|
|
|
ED Repair, complex (eyelids, nose, ears, lips) 2.6-7.5cm
|
Facility
|
IP
|
$1,493.00
|
|
|
Service Code
|
CPT 13152
|
| Hospital Charge Code |
6173177
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$760.83 |
| Max. Negotiated Rate |
$1,428.50 |
| Rate for Payer: Aetna Commercial |
$1,397.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,335.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$822.94
|
| Rate for Payer: Cash Price |
$447.90
|
| Rate for Payer: Cigna Commercial |
$1,428.50
|
| Rate for Payer: Health EOS Commercial |
$1,381.92
|
| Rate for Payer: HFN Commercial |
$1,428.50
|
| Rate for Payer: Multiplan Commercial |
$1,242.18
|
| Rate for Payer: Preferred Network Access Commercial |
$1,428.50
|
| Rate for Payer: Quartz Beloit One Network |
$760.83
|
| Rate for Payer: Quartz Commercial |
$931.63
|
| Rate for Payer: WEA Trust Commercial |
$854.00
|
| Rate for Payer: WPS Commercial |
$1,150.06
|
|
|
ED Repair, complex (eyelids, nose, ears, lips) 2.6-7.5cm
|
Facility
|
OP
|
$1,493.00
|
|
|
Service Code
|
CPT 13152
|
| Hospital Charge Code |
6173177
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$313.04 |
| Max. Negotiated Rate |
$6,807.99 |
| Rate for Payer: Aetna Commercial |
$1,397.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,335.34
|
| Rate for Payer: Aetna Managed Medicare |
$777.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,009.27
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$776.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$745.31
|
| Rate for Payer: Anthem Medicare Advantage |
$777.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$822.94
|
| 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 |
$447.90
|
| Rate for Payer: Cash Price |
$447.90
|
| Rate for Payer: Cash Price |
$447.90
|
| Rate for Payer: Cigna Commercial |
$1,428.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$777.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,807.99
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$777.80
|
| Rate for Payer: Health EOS Commercial |
$1,381.92
|
| Rate for Payer: HFN Commercial |
$1,428.50
|
| 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 |
$1,242.18
|
| Rate for Payer: NAPHCARE Commercial |
$1,166.69
|
| Rate for Payer: Preferred Network Access Commercial |
$1,428.50
|
| Rate for Payer: Quartz Beloit One Network |
$760.83
|
| Rate for Payer: Quartz Commercial |
$1,009.27
|
| 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 |
$854.00
|
| Rate for Payer: Wellcare Medicare |
$777.80
|
| Rate for Payer: WPS Commercial |
$1,150.06
|
|
|
ED Repair, complex (eyelids, nose, ears, lips) each additional <= 5cm
|
Facility
|
OP
|
$515.00
|
|
|
Service Code
|
CPT 13153
|
| Hospital Charge Code |
6173178
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$149.97 |
| Max. Negotiated Rate |
$6,807.99 |
| Rate for Payer: Aetna Commercial |
$482.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$460.62
|
| Rate for Payer: Aetna Managed Medicare |
$149.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$348.14
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$267.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$257.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$283.87
|
| Rate for Payer: Cash Price |
$154.50
|
| Rate for Payer: Cash Price |
$154.50
|
| Rate for Payer: Cash Price |
$154.50
|
| Rate for Payer: Cigna Commercial |
$492.75
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,807.99
|
| Rate for Payer: Health EOS Commercial |
$476.68
|
| Rate for Payer: HFN Commercial |
$492.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$401.70
|
| Rate for Payer: Multiplan Commercial |
$428.48
|
| Rate for Payer: NAPHCARE Commercial |
$321.36
|
| Rate for Payer: Preferred Network Access Commercial |
$492.75
|
| Rate for Payer: Quartz Beloit One Network |
$262.44
|
| Rate for Payer: Quartz Commercial |
$348.14
|
| Rate for Payer: Quartz Medicare Advantage |
$321.36
|
| Rate for Payer: The Alliance Commercial |
$433.60
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$294.58
|
| Rate for Payer: WPS Commercial |
$396.70
|
|
|
ED Repair, complex (eyelids, nose, ears, lips) each additional <= 5cm
|
Facility
|
IP
|
$515.00
|
|
|
Service Code
|
CPT 13153
|
| Hospital Charge Code |
6173178
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$262.44 |
| Max. Negotiated Rate |
$492.75 |
| Rate for Payer: Aetna Commercial |
$482.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$460.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$283.87
|
| Rate for Payer: Cash Price |
$154.50
|
| Rate for Payer: Cigna Commercial |
$492.75
|
| Rate for Payer: Health EOS Commercial |
$476.68
|
| Rate for Payer: HFN Commercial |
$492.75
|
| Rate for Payer: Multiplan Commercial |
$428.48
|
| Rate for Payer: Preferred Network Access Commercial |
$492.75
|
| Rate for Payer: Quartz Beloit One Network |
$262.44
|
| Rate for Payer: Quartz Commercial |
$321.36
|
| Rate for Payer: WEA Trust Commercial |
$294.58
|
| Rate for Payer: WPS Commercial |
$396.70
|
|
|
ED Repair, complex (forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands, feet)†1.1-2.5cm
|
Facility
|
OP
|
$589.00
|
|
|
Service Code
|
CPT 13131
|
| Hospital Charge Code |
6173173
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$294.03 |
| Max. Negotiated Rate |
$4,947.89 |
| Rate for Payer: Aetna Commercial |
$551.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$526.80
|
| Rate for Payer: Aetna Managed Medicare |
$427.81
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$398.16
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$306.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$294.03
|
| Rate for Payer: Anthem Medicare Advantage |
$427.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$324.66
|
| 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 |
$176.70
|
| Rate for Payer: Cash Price |
$176.70
|
| Rate for Payer: Cash Price |
$176.70
|
| Rate for Payer: Cigna Commercial |
$563.56
|
| 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 |
$545.18
|
| Rate for Payer: HFN Commercial |
$563.56
|
| 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 |
$490.05
|
| Rate for Payer: NAPHCARE Commercial |
$641.72
|
| Rate for Payer: Preferred Network Access Commercial |
$563.56
|
| Rate for Payer: Quartz Beloit One Network |
$300.15
|
| Rate for Payer: Quartz Commercial |
$398.16
|
| 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 |
$336.91
|
| Rate for Payer: Wellcare Medicare |
$427.81
|
| Rate for Payer: WPS Commercial |
$453.71
|
|
|
ED Repair, complex (forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands, feet)†1.1-2.5cm
|
Facility
|
IP
|
$589.00
|
|
|
Service Code
|
CPT 13131
|
| Hospital Charge Code |
6173173
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$300.15 |
| Max. Negotiated Rate |
$563.56 |
| Rate for Payer: Aetna Commercial |
$551.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$526.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$324.66
|
| Rate for Payer: Cash Price |
$176.70
|
| Rate for Payer: Cigna Commercial |
$563.56
|
| Rate for Payer: Health EOS Commercial |
$545.18
|
| Rate for Payer: HFN Commercial |
$563.56
|
| Rate for Payer: Multiplan Commercial |
$490.05
|
| Rate for Payer: Preferred Network Access Commercial |
$563.56
|
| Rate for Payer: Quartz Beloit One Network |
$300.15
|
| Rate for Payer: Quartz Commercial |
$367.54
|
| Rate for Payer: WEA Trust Commercial |
$336.91
|
| Rate for Payer: WPS Commercial |
$453.71
|
|
|
ED Repair, complex (forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands, feet)†2.6-7.5cm
|
Facility
|
IP
|
$1,044.00
|
|
|
Service Code
|
CPT 13132
|
| Hospital Charge Code |
6173174
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$532.02 |
| Max. Negotiated Rate |
$998.90 |
| Rate for Payer: Aetna Commercial |
$977.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$933.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$575.45
|
| Rate for Payer: Cash Price |
$313.20
|
| Rate for Payer: Cigna Commercial |
$998.90
|
| Rate for Payer: Health EOS Commercial |
$966.33
|
| Rate for Payer: HFN Commercial |
$998.90
|
| Rate for Payer: Multiplan Commercial |
$868.61
|
| Rate for Payer: Preferred Network Access Commercial |
$998.90
|
| Rate for Payer: Quartz Beloit One Network |
$532.02
|
| Rate for Payer: Quartz Commercial |
$651.46
|
| Rate for Payer: WEA Trust Commercial |
$597.17
|
| Rate for Payer: WPS Commercial |
$804.19
|
|
|
ED Repair, complex (forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands, feet)†2.6-7.5cm
|
Facility
|
OP
|
$1,044.00
|
|
|
Service Code
|
CPT 13132
|
| Hospital Charge Code |
6173174
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$313.04 |
| Max. Negotiated Rate |
$6,807.99 |
| Rate for Payer: Aetna Commercial |
$977.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$933.75
|
| Rate for Payer: Aetna Managed Medicare |
$427.81
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$705.74
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$542.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$521.16
|
| Rate for Payer: Anthem Medicare Advantage |
$427.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$575.45
|
| 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 |
$313.20
|
| Rate for Payer: Cash Price |
$313.20
|
| Rate for Payer: Cash Price |
$313.20
|
| Rate for Payer: Cigna Commercial |
$998.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$427.81
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,807.99
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$427.81
|
| Rate for Payer: Health EOS Commercial |
$966.33
|
| Rate for Payer: HFN Commercial |
$998.90
|
| 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 |
$868.61
|
| Rate for Payer: NAPHCARE Commercial |
$641.72
|
| Rate for Payer: Preferred Network Access Commercial |
$998.90
|
| Rate for Payer: Quartz Beloit One Network |
$532.02
|
| Rate for Payer: Quartz Commercial |
$705.74
|
| 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 |
$597.17
|
| Rate for Payer: Wellcare Medicare |
$427.81
|
| Rate for Payer: WPS Commercial |
$804.19
|
|
|
ED Repair, complex (forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands, feet) each addit
|
Facility
|
OP
|
$345.00
|
|
|
Service Code
|
CPT 13133
|
| Hospital Charge Code |
6173175
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$100.46 |
| Max. Negotiated Rate |
$6,807.99 |
| Rate for Payer: Aetna Commercial |
$322.92
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$308.57
|
| Rate for Payer: Aetna Managed Medicare |
$100.46
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$233.22
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$179.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$172.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$190.16
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cigna Commercial |
$330.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,807.99
|
| Rate for Payer: Health EOS Commercial |
$319.33
|
| Rate for Payer: HFN Commercial |
$330.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$269.10
|
| Rate for Payer: Multiplan Commercial |
$287.04
|
| Rate for Payer: NAPHCARE Commercial |
$215.28
|
| Rate for Payer: Preferred Network Access Commercial |
$330.10
|
| Rate for Payer: Quartz Beloit One Network |
$175.81
|
| Rate for Payer: Quartz Commercial |
$233.22
|
| Rate for Payer: Quartz Medicare Advantage |
$215.28
|
| Rate for Payer: The Alliance Commercial |
$395.41
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$197.34
|
| Rate for Payer: WPS Commercial |
$265.75
|
|
|
ED Repair, complex (forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands, feet) each addit
|
Facility
|
IP
|
$345.00
|
|
|
Service Code
|
CPT 13133
|
| Hospital Charge Code |
6173175
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$175.81 |
| Max. Negotiated Rate |
$330.10 |
| Rate for Payer: Aetna Commercial |
$322.92
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$308.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$190.16
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cigna Commercial |
$330.10
|
| Rate for Payer: Health EOS Commercial |
$319.33
|
| Rate for Payer: HFN Commercial |
$330.10
|
| Rate for Payer: Multiplan Commercial |
$287.04
|
| Rate for Payer: Preferred Network Access Commercial |
$330.10
|
| Rate for Payer: Quartz Beloit One Network |
$175.81
|
| Rate for Payer: Quartz Commercial |
$215.28
|
| Rate for Payer: WEA Trust Commercial |
$197.34
|
| Rate for Payer: WPS Commercial |
$265.75
|
|
|
ED Repair, complex (scalp, arms, legs) 1.1-2.5cm
|
Facility
|
OP
|
$646.00
|
|
|
Service Code
|
CPT 13120
|
| Hospital Charge Code |
6173170
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$313.04 |
| Max. Negotiated Rate |
$4,947.89 |
| Rate for Payer: Aetna Commercial |
$604.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$577.78
|
| Rate for Payer: Aetna Managed Medicare |
$427.81
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$436.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$335.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$322.48
|
| Rate for Payer: Anthem Medicare Advantage |
$427.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$356.08
|
| 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 |
$193.80
|
| Rate for Payer: Cash Price |
$193.80
|
| Rate for Payer: Cash Price |
$193.80
|
| Rate for Payer: Cigna Commercial |
$618.09
|
| 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 |
$597.94
|
| Rate for Payer: HFN Commercial |
$618.09
|
| 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 |
$537.47
|
| Rate for Payer: NAPHCARE Commercial |
$641.72
|
| Rate for Payer: Preferred Network Access Commercial |
$618.09
|
| Rate for Payer: Quartz Beloit One Network |
$329.20
|
| Rate for Payer: Quartz Commercial |
$436.70
|
| 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 |
$369.51
|
| Rate for Payer: Wellcare Medicare |
$427.81
|
| Rate for Payer: WPS Commercial |
$497.61
|
|
|
ED Repair, complex (scalp, arms, legs) 1.1-2.5cm
|
Facility
|
IP
|
$646.00
|
|
|
Service Code
|
CPT 13120
|
| Hospital Charge Code |
6173170
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$329.20 |
| Max. Negotiated Rate |
$618.09 |
| Rate for Payer: Aetna Commercial |
$604.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$577.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$356.08
|
| Rate for Payer: Cash Price |
$193.80
|
| Rate for Payer: Cigna Commercial |
$618.09
|
| Rate for Payer: Health EOS Commercial |
$597.94
|
| Rate for Payer: HFN Commercial |
$618.09
|
| Rate for Payer: Multiplan Commercial |
$537.47
|
| Rate for Payer: Preferred Network Access Commercial |
$618.09
|
| Rate for Payer: Quartz Beloit One Network |
$329.20
|
| Rate for Payer: Quartz Commercial |
$403.10
|
| Rate for Payer: WEA Trust Commercial |
$369.51
|
| Rate for Payer: WPS Commercial |
$497.61
|
|
|
ED Repair, complex (scalp, arms, legs) 2.6-7.5cm
|
Facility
|
IP
|
$724.00
|
|
|
Service Code
|
CPT 13121
|
| Hospital Charge Code |
6173171
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$368.95 |
| Max. Negotiated Rate |
$692.72 |
| Rate for Payer: Aetna Commercial |
$677.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$647.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$399.07
|
| Rate for Payer: Cash Price |
$217.20
|
| Rate for Payer: Cigna Commercial |
$692.72
|
| Rate for Payer: Health EOS Commercial |
$670.13
|
| Rate for Payer: HFN Commercial |
$692.72
|
| Rate for Payer: Multiplan Commercial |
$602.37
|
| Rate for Payer: Preferred Network Access Commercial |
$692.72
|
| Rate for Payer: Quartz Beloit One Network |
$368.95
|
| Rate for Payer: Quartz Commercial |
$451.78
|
| Rate for Payer: WEA Trust Commercial |
$414.13
|
| Rate for Payer: WPS Commercial |
$557.70
|
|
|
ED Repair, complex (scalp, arms, legs) 2.6-7.5cm
|
Facility
|
OP
|
$724.00
|
|
|
Service Code
|
CPT 13121
|
| Hospital Charge Code |
6173171
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$313.04 |
| Max. Negotiated Rate |
$6,807.99 |
| Rate for Payer: Aetna Commercial |
$677.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$647.55
|
| Rate for Payer: Aetna Managed Medicare |
$427.81
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$489.42
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$376.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$361.42
|
| Rate for Payer: Anthem Medicare Advantage |
$427.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$399.07
|
| 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 |
$217.20
|
| Rate for Payer: Cash Price |
$217.20
|
| Rate for Payer: Cash Price |
$217.20
|
| Rate for Payer: Cigna Commercial |
$692.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$427.81
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,807.99
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$427.81
|
| Rate for Payer: Health EOS Commercial |
$670.13
|
| Rate for Payer: HFN Commercial |
$692.72
|
| 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 |
$602.37
|
| Rate for Payer: NAPHCARE Commercial |
$641.72
|
| Rate for Payer: Preferred Network Access Commercial |
$692.72
|
| Rate for Payer: Quartz Beloit One Network |
$368.95
|
| Rate for Payer: Quartz Commercial |
$489.42
|
| 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 |
$414.13
|
| Rate for Payer: Wellcare Medicare |
$427.81
|
| Rate for Payer: WPS Commercial |
$557.70
|
|
|
ED Repair, complex (scalp, arms, legs) each additional <=5cm
|
Facility
|
IP
|
$180.00
|
|
|
Service Code
|
CPT 13122
|
| Hospital Charge Code |
6173172
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$91.73 |
| Max. Negotiated Rate |
$172.22 |
| Rate for Payer: Aetna Commercial |
$168.48
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$160.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$99.22
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cigna Commercial |
$172.22
|
| Rate for Payer: Health EOS Commercial |
$166.61
|
| Rate for Payer: HFN Commercial |
$172.22
|
| Rate for Payer: Multiplan Commercial |
$149.76
|
| Rate for Payer: Preferred Network Access Commercial |
$172.22
|
| Rate for Payer: Quartz Beloit One Network |
$91.73
|
| Rate for Payer: Quartz Commercial |
$112.32
|
| Rate for Payer: WEA Trust Commercial |
$102.96
|
| Rate for Payer: WPS Commercial |
$138.65
|
|
|
ED Repair, complex (scalp, arms, legs) each additional <=5cm
|
Facility
|
OP
|
$180.00
|
|
|
Service Code
|
CPT 13122
|
| Hospital Charge Code |
6173172
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$52.42 |
| Max. Negotiated Rate |
$6,807.99 |
| Rate for Payer: Aetna Commercial |
$168.48
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$160.99
|
| Rate for Payer: Aetna Managed Medicare |
$52.42
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$121.68
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$93.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$89.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$99.22
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cigna Commercial |
$172.22
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,807.99
|
| Rate for Payer: Health EOS Commercial |
$166.61
|
| Rate for Payer: HFN Commercial |
$172.22
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$140.40
|
| Rate for Payer: Multiplan Commercial |
$149.76
|
| Rate for Payer: NAPHCARE Commercial |
$112.32
|
| Rate for Payer: Preferred Network Access Commercial |
$172.22
|
| Rate for Payer: Quartz Beloit One Network |
$91.73
|
| Rate for Payer: Quartz Commercial |
$121.68
|
| Rate for Payer: Quartz Medicare Advantage |
$112.32
|
| Rate for Payer: The Alliance Commercial |
$259.42
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$102.96
|
| Rate for Payer: WPS Commercial |
$138.65
|
|
|
ED Repair, complex (trunk) 1.1-2.5cm
|
Facility
|
OP
|
$376.00
|
|
|
Service Code
|
CPT 13100
|
| Hospital Charge Code |
6173167
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$187.70 |
| Max. Negotiated Rate |
$4,947.89 |
| Rate for Payer: Aetna Commercial |
$351.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$336.29
|
| Rate for Payer: Aetna Managed Medicare |
$777.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$254.18
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$195.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$187.70
|
| Rate for Payer: Anthem Medicare Advantage |
$777.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$207.25
|
| 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 |
$112.80
|
| Rate for Payer: Cash Price |
$112.80
|
| Rate for Payer: Cash Price |
$112.80
|
| Rate for Payer: Cigna Commercial |
$359.76
|
| 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 |
$348.03
|
| Rate for Payer: HFN Commercial |
$359.76
|
| 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 |
$312.83
|
| Rate for Payer: NAPHCARE Commercial |
$1,166.69
|
| Rate for Payer: Preferred Network Access Commercial |
$359.76
|
| Rate for Payer: Quartz Beloit One Network |
$191.61
|
| Rate for Payer: Quartz Commercial |
$254.18
|
| 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 |
$215.07
|
| Rate for Payer: Wellcare Medicare |
$777.80
|
| Rate for Payer: WPS Commercial |
$289.63
|
|
|
ED Repair, complex (trunk) 1.1-2.5cm
|
Facility
|
IP
|
$376.00
|
|
|
Service Code
|
CPT 13100
|
| Hospital Charge Code |
6173167
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$191.61 |
| Max. Negotiated Rate |
$359.76 |
| Rate for Payer: Aetna Commercial |
$351.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$336.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$207.25
|
| Rate for Payer: Cash Price |
$112.80
|
| Rate for Payer: Cigna Commercial |
$359.76
|
| Rate for Payer: Health EOS Commercial |
$348.03
|
| Rate for Payer: HFN Commercial |
$359.76
|
| Rate for Payer: Multiplan Commercial |
$312.83
|
| Rate for Payer: Preferred Network Access Commercial |
$359.76
|
| Rate for Payer: Quartz Beloit One Network |
$191.61
|
| Rate for Payer: Quartz Commercial |
$234.62
|
| Rate for Payer: WEA Trust Commercial |
$215.07
|
| Rate for Payer: WPS Commercial |
$289.63
|
|
|
ED Repair, complex (trunk) 2.6-7.5cm
|
Facility
|
IP
|
$490.00
|
|
|
Service Code
|
CPT 13101
|
| Hospital Charge Code |
6173168
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$249.70 |
| Max. Negotiated Rate |
$468.83 |
| Rate for Payer: Aetna Commercial |
$458.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$438.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$270.09
|
| Rate for Payer: Cash Price |
$147.00
|
| Rate for Payer: Cigna Commercial |
$468.83
|
| Rate for Payer: Health EOS Commercial |
$453.54
|
| Rate for Payer: HFN Commercial |
$468.83
|
| Rate for Payer: Multiplan Commercial |
$407.68
|
| Rate for Payer: Preferred Network Access Commercial |
$468.83
|
| Rate for Payer: Quartz Beloit One Network |
$249.70
|
| Rate for Payer: Quartz Commercial |
$305.76
|
| Rate for Payer: WEA Trust Commercial |
$280.28
|
| Rate for Payer: WPS Commercial |
$377.45
|
|
|
ED Repair, complex (trunk) 2.6-7.5cm
|
Facility
|
OP
|
$490.00
|
|
|
Service Code
|
CPT 13101
|
| Hospital Charge Code |
6173168
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$244.61 |
| Max. Negotiated Rate |
$6,807.99 |
| Rate for Payer: Aetna Commercial |
$458.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$438.26
|
| Rate for Payer: Aetna Managed Medicare |
$777.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$331.24
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$254.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$244.61
|
| Rate for Payer: Anthem Medicare Advantage |
$777.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$270.09
|
| 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 |
$147.00
|
| Rate for Payer: Cash Price |
$147.00
|
| Rate for Payer: Cash Price |
$147.00
|
| Rate for Payer: Cigna Commercial |
$468.83
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$777.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,807.99
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$777.80
|
| Rate for Payer: Health EOS Commercial |
$453.54
|
| Rate for Payer: HFN Commercial |
$468.83
|
| 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 |
$407.68
|
| Rate for Payer: NAPHCARE Commercial |
$1,166.69
|
| Rate for Payer: Preferred Network Access Commercial |
$468.83
|
| Rate for Payer: Quartz Beloit One Network |
$249.70
|
| Rate for Payer: Quartz Commercial |
$331.24
|
| 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 |
$280.28
|
| Rate for Payer: Wellcare Medicare |
$777.80
|
| Rate for Payer: WPS Commercial |
$377.45
|
|
|
ED Repair, complex (trunk) each additional <= 5cm
|
Facility
|
OP
|
$189.00
|
|
|
Service Code
|
CPT 13102
|
| Hospital Charge Code |
6173169
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$55.04 |
| Max. Negotiated Rate |
$6,807.99 |
| Rate for Payer: Aetna Commercial |
$176.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$169.04
|
| Rate for Payer: Aetna Managed Medicare |
$55.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$127.76
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$98.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$94.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$104.18
|
| Rate for Payer: Cash Price |
$56.70
|
| Rate for Payer: Cash Price |
$56.70
|
| Rate for Payer: Cash Price |
$56.70
|
| Rate for Payer: Cigna Commercial |
$180.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,807.99
|
| Rate for Payer: Health EOS Commercial |
$174.94
|
| Rate for Payer: HFN Commercial |
$180.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$147.42
|
| Rate for Payer: Multiplan Commercial |
$157.25
|
| Rate for Payer: NAPHCARE Commercial |
$117.94
|
| Rate for Payer: Preferred Network Access Commercial |
$180.84
|
| Rate for Payer: Quartz Beloit One Network |
$96.31
|
| Rate for Payer: Quartz Commercial |
$127.76
|
| Rate for Payer: Quartz Medicare Advantage |
$117.94
|
| Rate for Payer: The Alliance Commercial |
$227.26
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$108.11
|
| Rate for Payer: WPS Commercial |
$145.59
|
|
|
ED Repair, complex (trunk) each additional <= 5cm
|
Facility
|
IP
|
$189.00
|
|
|
Service Code
|
CPT 13102
|
| Hospital Charge Code |
6173169
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$96.31 |
| Max. Negotiated Rate |
$180.84 |
| Rate for Payer: Aetna Commercial |
$176.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$169.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$104.18
|
| Rate for Payer: Cash Price |
$56.70
|
| Rate for Payer: Cigna Commercial |
$180.84
|
| Rate for Payer: Health EOS Commercial |
$174.94
|
| Rate for Payer: HFN Commercial |
$180.84
|
| Rate for Payer: Multiplan Commercial |
$157.25
|
| Rate for Payer: Preferred Network Access Commercial |
$180.84
|
| Rate for Payer: Quartz Beloit One Network |
$96.31
|
| Rate for Payer: Quartz Commercial |
$117.94
|
| Rate for Payer: WEA Trust Commercial |
$108.11
|
| Rate for Payer: WPS Commercial |
$145.59
|
|
|
ED Repair lip, full thickness; vermilion only
|
Facility
|
OP
|
$1,000.00
|
|
|
Service Code
|
CPT 40650
|
| Hospital Charge Code |
6173864
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$313.04 |
| Max. Negotiated Rate |
$6,807.99 |
| Rate for Payer: Aetna Commercial |
$936.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$894.40
|
| Rate for Payer: Aetna Managed Medicare |
$567.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$676.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$520.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$499.20
|
| Rate for Payer: Anthem Medicare Advantage |
$567.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$551.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$567.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$567.58
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cigna Commercial |
$956.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$567.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,807.99
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$567.58
|
| Rate for Payer: Health EOS Commercial |
$925.60
|
| Rate for Payer: HFN Commercial |
$956.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,111.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$567.58
|
| Rate for Payer: Independent Care Health Plan Medicare |
$567.58
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$567.58
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$567.58
|
| Rate for Payer: Multiplan Commercial |
$832.00
|
| Rate for Payer: NAPHCARE Commercial |
$851.37
|
| Rate for Payer: Preferred Network Access Commercial |
$956.80
|
| Rate for Payer: Quartz Beloit One Network |
$509.60
|
| Rate for Payer: Quartz Commercial |
$676.00
|
| Rate for Payer: Quartz Medicare Advantage |
$567.58
|
| Rate for Payer: The Alliance Commercial |
$2,270.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$567.58
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$572.00
|
| Rate for Payer: Wellcare Medicare |
$567.58
|
| Rate for Payer: WPS Commercial |
$770.30
|
|
