|
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 |
$282.72 |
| Max. Negotiated Rate |
$4,757.59 |
| Rate for Payer: Aetna Commercial |
$530.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$506.54
|
| Rate for Payer: Aetna Managed Medicare |
$394.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$382.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$294.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$282.72
|
| Rate for Payer: Anthem Medicare Advantage |
$394.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$312.17
|
| 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 |
$176.70
|
| Rate for Payer: Cash Price |
$176.70
|
| Rate for Payer: Cash Price |
$176.70
|
| Rate for Payer: Cigna Commercial |
$541.88
|
| 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 |
$524.21
|
| Rate for Payer: HFN Commercial |
$541.88
|
| 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 |
$471.20
|
| Rate for Payer: NAPHCARE Commercial |
$591.18
|
| Rate for Payer: Preferred Network Access Commercial |
$541.88
|
| Rate for Payer: Quartz Beloit One Network |
$288.61
|
| Rate for Payer: Quartz Commercial |
$382.85
|
| 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 |
$323.95
|
| Rate for Payer: Wellcare Medicare |
$394.12
|
| Rate for Payer: WPS Commercial |
$436.27
|
|
|
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 |
$511.56 |
| Max. Negotiated Rate |
$960.48 |
| Rate for Payer: Aetna Commercial |
$939.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$897.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$553.32
|
| Rate for Payer: Cash Price |
$313.20
|
| Rate for Payer: Cigna Commercial |
$960.48
|
| Rate for Payer: Health EOS Commercial |
$929.16
|
| Rate for Payer: HFN Commercial |
$960.48
|
| Rate for Payer: Multiplan Commercial |
$835.20
|
| Rate for Payer: NAPHCARE Commercial |
$626.40
|
| Rate for Payer: Preferred Network Access Commercial |
$960.48
|
| Rate for Payer: Quartz Beloit One Network |
$511.56
|
| Rate for Payer: Quartz Commercial |
$626.40
|
| Rate for Payer: WEA Trust Commercial |
$574.20
|
| Rate for Payer: WPS Commercial |
$773.29
|
|
|
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 |
$301.00 |
| Max. Negotiated Rate |
$6,546.14 |
| Rate for Payer: Aetna Commercial |
$939.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$897.84
|
| Rate for Payer: Aetna Managed Medicare |
$620.77
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$678.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$522.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$501.12
|
| Rate for Payer: Anthem Medicare Advantage |
$620.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$553.32
|
| 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 |
$313.20
|
| Rate for Payer: Cash Price |
$313.20
|
| Rate for Payer: Cash Price |
$313.20
|
| Rate for Payer: Cigna Commercial |
$960.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$620.77
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,546.14
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$620.77
|
| Rate for Payer: Health EOS Commercial |
$929.16
|
| Rate for Payer: HFN Commercial |
$960.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,309.26
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$620.77
|
| Rate for Payer: Independent Care Health Plan Medicare |
$620.77
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$620.77
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$620.77
|
| Rate for Payer: Multiplan Commercial |
$835.20
|
| Rate for Payer: NAPHCARE Commercial |
$931.16
|
| Rate for Payer: Preferred Network Access Commercial |
$960.48
|
| Rate for Payer: Quartz Beloit One Network |
$511.56
|
| Rate for Payer: Quartz Commercial |
$678.60
|
| 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 |
$574.20
|
| Rate for Payer: Wellcare Medicare |
$620.77
|
| Rate for Payer: WPS Commercial |
$773.29
|
|
|
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 |
$96.60 |
| Max. Negotiated Rate |
$6,546.14 |
| Rate for Payer: Aetna Commercial |
$310.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$296.70
|
| Rate for Payer: Aetna Managed Medicare |
$96.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$224.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$172.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$165.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$182.85
|
| 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 |
$317.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,546.14
|
| Rate for Payer: Health EOS Commercial |
$307.05
|
| Rate for Payer: HFN Commercial |
$317.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$258.75
|
| Rate for Payer: Multiplan Commercial |
$276.00
|
| Rate for Payer: NAPHCARE Commercial |
$207.00
|
| Rate for Payer: Preferred Network Access Commercial |
$317.40
|
| Rate for Payer: Quartz Beloit One Network |
$169.05
|
| Rate for Payer: Quartz Commercial |
$224.25
|
| Rate for Payer: Quartz Medicare Advantage |
$207.00
|
| Rate for Payer: The Alliance Commercial |
$1,380.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$189.75
|
| Rate for Payer: WPS Commercial |
$255.54
|
|
|
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 |
$169.05 |
| Max. Negotiated Rate |
$317.40 |
| Rate for Payer: Aetna Commercial |
$310.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$296.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$182.85
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cigna Commercial |
$317.40
|
| Rate for Payer: Health EOS Commercial |
$307.05
|
| Rate for Payer: HFN Commercial |
$317.40
|
| Rate for Payer: Multiplan Commercial |
$276.00
|
| Rate for Payer: NAPHCARE Commercial |
$207.00
|
| Rate for Payer: Preferred Network Access Commercial |
$317.40
|
| Rate for Payer: Quartz Beloit One Network |
$169.05
|
| Rate for Payer: Quartz Commercial |
$207.00
|
| Rate for Payer: WEA Trust Commercial |
$189.75
|
| Rate for Payer: WPS Commercial |
$255.54
|
|
|
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 |
$301.00 |
| Max. Negotiated Rate |
$4,757.59 |
| Rate for Payer: Aetna Commercial |
$581.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$555.56
|
| Rate for Payer: Aetna Managed Medicare |
$620.77
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$419.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$323.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$310.08
|
| Rate for Payer: Anthem Medicare Advantage |
$620.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$342.38
|
| 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 |
$193.80
|
| Rate for Payer: Cash Price |
$193.80
|
| Rate for Payer: Cash Price |
$193.80
|
| Rate for Payer: Cigna Commercial |
$594.32
|
| 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 |
$574.94
|
| Rate for Payer: HFN Commercial |
$594.32
|
| 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 |
$516.80
|
| Rate for Payer: NAPHCARE Commercial |
$931.16
|
| Rate for Payer: Preferred Network Access Commercial |
$594.32
|
| Rate for Payer: Quartz Beloit One Network |
$316.54
|
| Rate for Payer: Quartz Commercial |
$419.90
|
| 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 |
$355.30
|
| Rate for Payer: Wellcare Medicare |
$620.77
|
| Rate for Payer: WPS Commercial |
$478.49
|
|
|
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 |
$316.54 |
| Max. Negotiated Rate |
$594.32 |
| Rate for Payer: Aetna Commercial |
$581.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$555.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$342.38
|
| Rate for Payer: Cash Price |
$193.80
|
| Rate for Payer: Cigna Commercial |
$594.32
|
| Rate for Payer: Health EOS Commercial |
$574.94
|
| Rate for Payer: HFN Commercial |
$594.32
|
| Rate for Payer: Multiplan Commercial |
$516.80
|
| Rate for Payer: NAPHCARE Commercial |
$387.60
|
| Rate for Payer: Preferred Network Access Commercial |
$594.32
|
| Rate for Payer: Quartz Beloit One Network |
$316.54
|
| Rate for Payer: Quartz Commercial |
$387.60
|
| Rate for Payer: WEA Trust Commercial |
$355.30
|
| Rate for Payer: WPS Commercial |
$478.49
|
|
|
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 |
$301.00 |
| Max. Negotiated Rate |
$6,546.14 |
| Rate for Payer: Aetna Commercial |
$651.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$622.64
|
| Rate for Payer: Aetna Managed Medicare |
$620.77
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$470.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$362.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$347.52
|
| Rate for Payer: Anthem Medicare Advantage |
$620.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$383.72
|
| 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 |
$217.20
|
| Rate for Payer: Cash Price |
$217.20
|
| Rate for Payer: Cash Price |
$217.20
|
| Rate for Payer: Cigna Commercial |
$666.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$620.77
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,546.14
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$620.77
|
| Rate for Payer: Health EOS Commercial |
$644.36
|
| Rate for Payer: HFN Commercial |
$666.08
|
| 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 |
$579.20
|
| Rate for Payer: NAPHCARE Commercial |
$931.16
|
| Rate for Payer: Preferred Network Access Commercial |
$666.08
|
| Rate for Payer: Quartz Beloit One Network |
$354.76
|
| Rate for Payer: Quartz Commercial |
$470.60
|
| 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 |
$398.20
|
| Rate for Payer: Wellcare Medicare |
$620.77
|
| Rate for Payer: WPS Commercial |
$536.27
|
|
|
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 |
$354.76 |
| Max. Negotiated Rate |
$666.08 |
| Rate for Payer: Aetna Commercial |
$651.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$622.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$383.72
|
| Rate for Payer: Cash Price |
$217.20
|
| Rate for Payer: Cigna Commercial |
$666.08
|
| Rate for Payer: Health EOS Commercial |
$644.36
|
| Rate for Payer: HFN Commercial |
$666.08
|
| Rate for Payer: Multiplan Commercial |
$579.20
|
| Rate for Payer: NAPHCARE Commercial |
$434.40
|
| Rate for Payer: Preferred Network Access Commercial |
$666.08
|
| Rate for Payer: Quartz Beloit One Network |
$354.76
|
| Rate for Payer: Quartz Commercial |
$434.40
|
| Rate for Payer: WEA Trust Commercial |
$398.20
|
| Rate for Payer: WPS Commercial |
$536.27
|
|
|
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 |
$50.40 |
| Max. Negotiated Rate |
$6,546.14 |
| Rate for Payer: Aetna Commercial |
$162.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$154.80
|
| Rate for Payer: Aetna Managed Medicare |
$50.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$117.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$90.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$86.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$95.40
|
| 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 |
$165.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,546.14
|
| Rate for Payer: Health EOS Commercial |
$160.20
|
| Rate for Payer: HFN Commercial |
$165.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$135.00
|
| Rate for Payer: Multiplan Commercial |
$144.00
|
| Rate for Payer: NAPHCARE Commercial |
$108.00
|
| Rate for Payer: Preferred Network Access Commercial |
$165.60
|
| Rate for Payer: Quartz Beloit One Network |
$88.20
|
| Rate for Payer: Quartz Commercial |
$117.00
|
| Rate for Payer: Quartz Medicare Advantage |
$108.00
|
| Rate for Payer: The Alliance Commercial |
$720.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$99.00
|
| Rate for Payer: WPS Commercial |
$133.33
|
|
|
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 |
$88.20 |
| Max. Negotiated Rate |
$165.60 |
| Rate for Payer: Aetna Commercial |
$162.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$154.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$95.40
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cigna Commercial |
$165.60
|
| Rate for Payer: Health EOS Commercial |
$160.20
|
| Rate for Payer: HFN Commercial |
$165.60
|
| Rate for Payer: Multiplan Commercial |
$144.00
|
| Rate for Payer: NAPHCARE Commercial |
$108.00
|
| Rate for Payer: Preferred Network Access Commercial |
$165.60
|
| Rate for Payer: Quartz Beloit One Network |
$88.20
|
| Rate for Payer: Quartz Commercial |
$108.00
|
| Rate for Payer: WEA Trust Commercial |
$99.00
|
| Rate for Payer: WPS Commercial |
$133.33
|
|
|
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 |
$184.24 |
| Max. Negotiated Rate |
$345.92 |
| Rate for Payer: Aetna Commercial |
$338.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$323.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$199.28
|
| Rate for Payer: Cash Price |
$112.80
|
| Rate for Payer: Cigna Commercial |
$345.92
|
| Rate for Payer: Health EOS Commercial |
$334.64
|
| Rate for Payer: HFN Commercial |
$345.92
|
| Rate for Payer: Multiplan Commercial |
$300.80
|
| Rate for Payer: NAPHCARE Commercial |
$225.60
|
| Rate for Payer: Preferred Network Access Commercial |
$345.92
|
| Rate for Payer: Quartz Beloit One Network |
$184.24
|
| Rate for Payer: Quartz Commercial |
$225.60
|
| Rate for Payer: WEA Trust Commercial |
$206.80
|
| Rate for Payer: WPS Commercial |
$278.50
|
|
|
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 |
$180.48 |
| Max. Negotiated Rate |
$4,757.59 |
| Rate for Payer: Aetna Commercial |
$338.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$323.36
|
| Rate for Payer: Aetna Managed Medicare |
$620.77
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$244.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$188.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$180.48
|
| Rate for Payer: Anthem Medicare Advantage |
$620.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$199.28
|
| 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 |
$112.80
|
| Rate for Payer: Cash Price |
$112.80
|
| Rate for Payer: Cash Price |
$112.80
|
| Rate for Payer: Cigna Commercial |
$345.92
|
| 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 |
$334.64
|
| Rate for Payer: HFN Commercial |
$345.92
|
| 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 |
$300.80
|
| Rate for Payer: NAPHCARE Commercial |
$931.16
|
| Rate for Payer: Preferred Network Access Commercial |
$345.92
|
| Rate for Payer: Quartz Beloit One Network |
$184.24
|
| Rate for Payer: Quartz Commercial |
$244.40
|
| 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 |
$206.80
|
| Rate for Payer: Wellcare Medicare |
$620.77
|
| Rate for Payer: WPS Commercial |
$278.50
|
|
|
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 |
$240.10 |
| Max. Negotiated Rate |
$450.80 |
| Rate for Payer: Aetna Commercial |
$441.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$421.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$259.70
|
| Rate for Payer: Cash Price |
$147.00
|
| Rate for Payer: Cigna Commercial |
$450.80
|
| Rate for Payer: Health EOS Commercial |
$436.10
|
| Rate for Payer: HFN Commercial |
$450.80
|
| Rate for Payer: Multiplan Commercial |
$392.00
|
| Rate for Payer: NAPHCARE Commercial |
$294.00
|
| Rate for Payer: Preferred Network Access Commercial |
$450.80
|
| Rate for Payer: Quartz Beloit One Network |
$240.10
|
| Rate for Payer: Quartz Commercial |
$294.00
|
| Rate for Payer: WEA Trust Commercial |
$269.50
|
| Rate for Payer: WPS Commercial |
$362.94
|
|
|
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 |
$235.20 |
| Max. Negotiated Rate |
$6,546.14 |
| Rate for Payer: Aetna Commercial |
$441.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$421.40
|
| Rate for Payer: Aetna Managed Medicare |
$620.77
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$318.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$245.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$235.20
|
| Rate for Payer: Anthem Medicare Advantage |
$620.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$259.70
|
| 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 |
$147.00
|
| Rate for Payer: Cash Price |
$147.00
|
| Rate for Payer: Cash Price |
$147.00
|
| Rate for Payer: Cigna Commercial |
$450.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$620.77
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,546.14
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$620.77
|
| Rate for Payer: Health EOS Commercial |
$436.10
|
| Rate for Payer: HFN Commercial |
$450.80
|
| 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 |
$392.00
|
| Rate for Payer: NAPHCARE Commercial |
$931.16
|
| Rate for Payer: Preferred Network Access Commercial |
$450.80
|
| Rate for Payer: Quartz Beloit One Network |
$240.10
|
| Rate for Payer: Quartz Commercial |
$318.50
|
| 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 |
$269.50
|
| Rate for Payer: Wellcare Medicare |
$620.77
|
| Rate for Payer: WPS Commercial |
$362.94
|
|
|
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 |
$92.61 |
| Max. Negotiated Rate |
$173.88 |
| Rate for Payer: Aetna Commercial |
$170.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$162.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$100.17
|
| Rate for Payer: Cash Price |
$56.70
|
| Rate for Payer: Cigna Commercial |
$173.88
|
| Rate for Payer: Health EOS Commercial |
$168.21
|
| Rate for Payer: HFN Commercial |
$173.88
|
| Rate for Payer: Multiplan Commercial |
$151.20
|
| Rate for Payer: NAPHCARE Commercial |
$113.40
|
| Rate for Payer: Preferred Network Access Commercial |
$173.88
|
| Rate for Payer: Quartz Beloit One Network |
$92.61
|
| Rate for Payer: Quartz Commercial |
$113.40
|
| Rate for Payer: WEA Trust Commercial |
$103.95
|
| Rate for Payer: WPS Commercial |
$139.99
|
|
|
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 |
$52.92 |
| Max. Negotiated Rate |
$6,546.14 |
| Rate for Payer: Aetna Commercial |
$170.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$162.54
|
| Rate for Payer: Aetna Managed Medicare |
$52.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$122.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$94.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$90.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$100.17
|
| 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 |
$173.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,546.14
|
| Rate for Payer: Health EOS Commercial |
$168.21
|
| Rate for Payer: HFN Commercial |
$173.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$141.75
|
| Rate for Payer: Multiplan Commercial |
$151.20
|
| Rate for Payer: NAPHCARE Commercial |
$113.40
|
| Rate for Payer: Preferred Network Access Commercial |
$173.88
|
| Rate for Payer: Quartz Beloit One Network |
$92.61
|
| Rate for Payer: Quartz Commercial |
$122.85
|
| Rate for Payer: Quartz Medicare Advantage |
$113.40
|
| Rate for Payer: The Alliance Commercial |
$756.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$103.95
|
| Rate for Payer: WPS Commercial |
$139.99
|
|
|
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 |
$301.00 |
| Max. Negotiated Rate |
$6,546.14 |
| Rate for Payer: Aetna Commercial |
$900.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$860.00
|
| Rate for Payer: Aetna Managed Medicare |
$543.83
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$650.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$500.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$480.00
|
| Rate for Payer: Anthem Medicare Advantage |
$543.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$530.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$543.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$543.83
|
| 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 |
$920.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$543.83
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,546.14
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$543.83
|
| Rate for Payer: Health EOS Commercial |
$890.00
|
| Rate for Payer: HFN Commercial |
$920.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,023.05
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$543.83
|
| Rate for Payer: Independent Care Health Plan Medicare |
$543.83
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$543.83
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$543.83
|
| Rate for Payer: Multiplan Commercial |
$800.00
|
| Rate for Payer: NAPHCARE Commercial |
$815.74
|
| Rate for Payer: Preferred Network Access Commercial |
$920.00
|
| Rate for Payer: Quartz Beloit One Network |
$490.00
|
| Rate for Payer: Quartz Commercial |
$650.00
|
| Rate for Payer: Quartz Medicare Advantage |
$543.83
|
| Rate for Payer: The Alliance Commercial |
$2,175.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$543.83
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$550.00
|
| Rate for Payer: Wellcare Medicare |
$543.83
|
| Rate for Payer: WPS Commercial |
$740.70
|
|
|
ED Repair lip, full thickness; vermilion only
|
Facility
|
IP
|
$1,000.00
|
|
|
Service Code
|
CPT 40650
|
| Hospital Charge Code |
6173864
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$490.00 |
| Max. Negotiated Rate |
$920.00 |
| Rate for Payer: Aetna Commercial |
$900.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$860.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$530.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cigna Commercial |
$920.00
|
| Rate for Payer: Health EOS Commercial |
$890.00
|
| Rate for Payer: HFN Commercial |
$920.00
|
| Rate for Payer: Multiplan Commercial |
$800.00
|
| Rate for Payer: NAPHCARE Commercial |
$600.00
|
| Rate for Payer: Preferred Network Access Commercial |
$920.00
|
| Rate for Payer: Quartz Beloit One Network |
$490.00
|
| Rate for Payer: Quartz Commercial |
$600.00
|
| Rate for Payer: WEA Trust Commercial |
$550.00
|
| Rate for Payer: WPS Commercial |
$740.70
|
|
|
ED Repair Of Blepharoptosis: Levator Resection Or Advancement, Exteranl Approach
|
Facility
|
IP
|
$4,473.00
|
|
|
Service Code
|
CPT 67904
|
| Hospital Charge Code |
6174428
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,191.77 |
| Max. Negotiated Rate |
$4,115.16 |
| Rate for Payer: Aetna Commercial |
$4,025.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,846.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,370.69
|
| Rate for Payer: Cash Price |
$1,341.90
|
| Rate for Payer: Cigna Commercial |
$4,115.16
|
| Rate for Payer: Health EOS Commercial |
$3,980.97
|
| Rate for Payer: HFN Commercial |
$4,115.16
|
| Rate for Payer: Multiplan Commercial |
$3,578.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,683.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,115.16
|
| Rate for Payer: Quartz Beloit One Network |
$2,191.77
|
| Rate for Payer: Quartz Commercial |
$2,683.80
|
| Rate for Payer: WEA Trust Commercial |
$2,460.15
|
| Rate for Payer: WPS Commercial |
$3,313.15
|
|
|
ED Repair Of Blepharoptosis: Levator Resection Or Advancement, Exteranl Approach
|
Facility
|
OP
|
$4,473.00
|
|
|
Service Code
|
CPT 67904
|
| Hospital Charge Code |
6174428
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$9,238.84 |
| Rate for Payer: Aetna Commercial |
$4,025.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,846.78
|
| Rate for Payer: Aetna Managed Medicare |
$2,309.71
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,907.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,236.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,147.04
|
| Rate for Payer: Anthem Medicare Advantage |
$2,309.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,370.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$2,309.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$2,309.71
|
| Rate for Payer: Cash Price |
$1,341.90
|
| Rate for Payer: Cash Price |
$1,341.90
|
| Rate for Payer: Cash Price |
$1,341.90
|
| Rate for Payer: Cigna Commercial |
$4,115.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$2,309.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,795.33
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$2,309.71
|
| Rate for Payer: Health EOS Commercial |
$3,980.97
|
| Rate for Payer: HFN Commercial |
$4,115.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,592.12
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2,309.71
|
| Rate for Payer: Independent Care Health Plan Medicare |
$2,309.71
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$2,309.71
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$2,309.71
|
| Rate for Payer: Multiplan Commercial |
$3,578.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,464.56
|
| Rate for Payer: Preferred Network Access Commercial |
$4,115.16
|
| Rate for Payer: Quartz Beloit One Network |
$2,191.77
|
| Rate for Payer: Quartz Commercial |
$2,907.45
|
| Rate for Payer: Quartz Medicare Advantage |
$2,309.71
|
| Rate for Payer: The Alliance Commercial |
$9,238.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,309.71
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$2,460.15
|
| Rate for Payer: Wellcare Medicare |
$2,309.71
|
| Rate for Payer: WPS Commercial |
$3,313.15
|
|
|
ED Repair of Ectropion, Extensive
|
Facility
|
OP
|
$2,891.00
|
|
|
Service Code
|
CPT 67917
|
| Hospital Charge Code |
6174429
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$9,238.84 |
| Rate for Payer: Aetna Commercial |
$2,601.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,486.26
|
| Rate for Payer: Aetna Managed Medicare |
$2,309.71
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,879.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,445.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,387.68
|
| Rate for Payer: Anthem Medicare Advantage |
$2,309.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,532.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$2,309.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$2,309.71
|
| Rate for Payer: Cash Price |
$867.30
|
| Rate for Payer: Cash Price |
$867.30
|
| Rate for Payer: Cash Price |
$867.30
|
| Rate for Payer: Cigna Commercial |
$2,659.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$2,309.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,795.33
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$2,309.71
|
| Rate for Payer: Health EOS Commercial |
$2,572.99
|
| Rate for Payer: HFN Commercial |
$2,659.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,592.12
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2,309.71
|
| Rate for Payer: Independent Care Health Plan Medicare |
$2,309.71
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$2,309.71
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$2,309.71
|
| Rate for Payer: Multiplan Commercial |
$2,312.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,464.56
|
| Rate for Payer: Preferred Network Access Commercial |
$2,659.72
|
| Rate for Payer: Quartz Beloit One Network |
$1,416.59
|
| Rate for Payer: Quartz Commercial |
$1,879.15
|
| Rate for Payer: Quartz Medicare Advantage |
$2,309.71
|
| Rate for Payer: The Alliance Commercial |
$9,238.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,309.71
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$1,590.05
|
| Rate for Payer: Wellcare Medicare |
$2,309.71
|
| Rate for Payer: WPS Commercial |
$2,141.36
|
|
|
ED Repair of Ectropion, Extensive
|
Facility
|
IP
|
$2,891.00
|
|
|
Service Code
|
CPT 67917
|
| Hospital Charge Code |
6174429
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,416.59 |
| Max. Negotiated Rate |
$2,659.72 |
| Rate for Payer: Aetna Commercial |
$2,601.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,486.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,532.23
|
| Rate for Payer: Cash Price |
$867.30
|
| Rate for Payer: Cigna Commercial |
$2,659.72
|
| Rate for Payer: Health EOS Commercial |
$2,572.99
|
| Rate for Payer: HFN Commercial |
$2,659.72
|
| Rate for Payer: Multiplan Commercial |
$2,312.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,734.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,659.72
|
| Rate for Payer: Quartz Beloit One Network |
$1,416.59
|
| Rate for Payer: Quartz Commercial |
$1,734.60
|
| Rate for Payer: WEA Trust Commercial |
$1,590.05
|
| Rate for Payer: WPS Commercial |
$2,141.36
|
|
|
ED Repair Of Entropion,Extensive
|
Facility
|
IP
|
$3,837.00
|
|
|
Service Code
|
CPT 67924
|
| Hospital Charge Code |
6174430
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,880.13 |
| Max. Negotiated Rate |
$3,530.04 |
| Rate for Payer: Aetna Commercial |
$3,453.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,299.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,033.61
|
| Rate for Payer: Cash Price |
$1,151.10
|
| Rate for Payer: Cigna Commercial |
$3,530.04
|
| Rate for Payer: Health EOS Commercial |
$3,414.93
|
| Rate for Payer: HFN Commercial |
$3,530.04
|
| Rate for Payer: Multiplan Commercial |
$3,069.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,302.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,530.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,880.13
|
| Rate for Payer: Quartz Commercial |
$2,302.20
|
| Rate for Payer: WEA Trust Commercial |
$2,110.35
|
| Rate for Payer: WPS Commercial |
$2,842.07
|
|
|
ED Repair Of Entropion,Extensive
|
Facility
|
OP
|
$3,837.00
|
|
|
Service Code
|
CPT 67924
|
| Hospital Charge Code |
6174430
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$9,238.84 |
| Rate for Payer: Aetna Commercial |
$3,453.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,299.82
|
| Rate for Payer: Aetna Managed Medicare |
$2,309.71
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,494.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,918.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,841.76
|
| Rate for Payer: Anthem Medicare Advantage |
$2,309.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,033.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$2,309.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$2,309.71
|
| Rate for Payer: Cash Price |
$1,151.10
|
| Rate for Payer: Cash Price |
$1,151.10
|
| Rate for Payer: Cash Price |
$1,151.10
|
| Rate for Payer: Cigna Commercial |
$3,530.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$2,309.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,795.33
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$2,309.71
|
| Rate for Payer: Health EOS Commercial |
$3,414.93
|
| Rate for Payer: HFN Commercial |
$3,530.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,592.12
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2,309.71
|
| Rate for Payer: Independent Care Health Plan Medicare |
$2,309.71
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$2,309.71
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$2,309.71
|
| Rate for Payer: Multiplan Commercial |
$3,069.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,464.56
|
| Rate for Payer: Preferred Network Access Commercial |
$3,530.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,880.13
|
| Rate for Payer: Quartz Commercial |
$2,494.05
|
| Rate for Payer: Quartz Medicare Advantage |
$2,309.71
|
| Rate for Payer: The Alliance Commercial |
$9,238.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,309.71
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$2,110.35
|
| Rate for Payer: Wellcare Medicare |
$2,309.71
|
| Rate for Payer: WPS Commercial |
$2,842.07
|
|
