|
ED Repair of laceration 2.5 cm /<; floor of mouth &/or anterior two-thirds of tongue
|
Facility
|
IP
|
$407.00
|
|
|
Service Code
|
CPT 41250
|
| Hospital Charge Code |
6172942
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$199.43 |
| Max. Negotiated Rate |
$374.44 |
| Rate for Payer: Aetna Commercial |
$366.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$350.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$215.71
|
| Rate for Payer: Cash Price |
$122.10
|
| Rate for Payer: Cigna Commercial |
$374.44
|
| Rate for Payer: Health EOS Commercial |
$362.23
|
| Rate for Payer: HFN Commercial |
$374.44
|
| Rate for Payer: Multiplan Commercial |
$325.60
|
| Rate for Payer: NAPHCARE Commercial |
$244.20
|
| Rate for Payer: Preferred Network Access Commercial |
$374.44
|
| Rate for Payer: Quartz Beloit One Network |
$199.43
|
| Rate for Payer: Quartz Commercial |
$244.20
|
| Rate for Payer: WEA Trust Commercial |
$223.85
|
| Rate for Payer: WPS Commercial |
$301.46
|
|
|
ED Repair of laceration 2.5 cm /<; floor of mouth &/or anterior two-thirds of tongue
|
Facility
|
OP
|
$407.00
|
|
|
Service Code
|
CPT 41250
|
| Hospital Charge Code |
6172942
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$195.36 |
| Max. Negotiated Rate |
$4,757.59 |
| Rate for Payer: Aetna Commercial |
$366.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$350.02
|
| Rate for Payer: Aetna Managed Medicare |
$393.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$264.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$203.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$195.36
|
| Rate for Payer: Anthem Medicare Advantage |
$393.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$215.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$393.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$393.82
|
| Rate for Payer: Cash Price |
$122.10
|
| Rate for Payer: Cash Price |
$122.10
|
| Rate for Payer: Cash Price |
$122.10
|
| Rate for Payer: Cigna Commercial |
$374.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$393.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,757.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$393.82
|
| Rate for Payer: Health EOS Commercial |
$362.23
|
| Rate for Payer: HFN Commercial |
$374.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,465.01
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$393.82
|
| Rate for Payer: Independent Care Health Plan Medicare |
$393.82
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$393.82
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$393.82
|
| Rate for Payer: Multiplan Commercial |
$325.60
|
| Rate for Payer: NAPHCARE Commercial |
$590.73
|
| Rate for Payer: Preferred Network Access Commercial |
$374.44
|
| Rate for Payer: Quartz Beloit One Network |
$199.43
|
| Rate for Payer: Quartz Commercial |
$264.55
|
| Rate for Payer: Quartz Medicare Advantage |
$393.82
|
| Rate for Payer: The Alliance Commercial |
$1,575.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$393.82
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$223.85
|
| Rate for Payer: Wellcare Medicare |
$393.82
|
| Rate for Payer: WPS Commercial |
$301.46
|
|
|
ED Repair of nail bed
|
Facility
|
OP
|
$737.00
|
|
|
Service Code
|
CPT 11760
|
| Hospital Charge Code |
6172931
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$4,218.22 |
| Rate for Payer: Aetna Commercial |
$663.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$633.82
|
| Rate for Payer: Aetna Managed Medicare |
$620.77
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$479.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$368.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$353.76
|
| Rate for Payer: Anthem Medicare Advantage |
$620.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$390.61
|
| 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 |
$221.10
|
| Rate for Payer: Cash Price |
$221.10
|
| Rate for Payer: Cash Price |
$221.10
|
| Rate for Payer: Cigna Commercial |
$678.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$620.77
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$620.77
|
| Rate for Payer: Health EOS Commercial |
$655.93
|
| Rate for Payer: HFN Commercial |
$678.04
|
| 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 |
$589.60
|
| Rate for Payer: NAPHCARE Commercial |
$931.16
|
| Rate for Payer: Preferred Network Access Commercial |
$678.04
|
| Rate for Payer: Quartz Beloit One Network |
$361.13
|
| Rate for Payer: Quartz Commercial |
$479.05
|
| 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 |
$405.35
|
| Rate for Payer: Wellcare Medicare |
$620.77
|
| Rate for Payer: WPS Commercial |
$545.90
|
|
|
ED Repair of nail bed
|
Facility
|
IP
|
$737.00
|
|
|
Service Code
|
CPT 11760
|
| Hospital Charge Code |
6172931
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$361.13 |
| Max. Negotiated Rate |
$678.04 |
| Rate for Payer: Aetna Commercial |
$663.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$633.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$390.61
|
| Rate for Payer: Cash Price |
$221.10
|
| Rate for Payer: Cigna Commercial |
$678.04
|
| Rate for Payer: Health EOS Commercial |
$655.93
|
| Rate for Payer: HFN Commercial |
$678.04
|
| Rate for Payer: Multiplan Commercial |
$589.60
|
| Rate for Payer: NAPHCARE Commercial |
$442.20
|
| Rate for Payer: Preferred Network Access Commercial |
$678.04
|
| Rate for Payer: Quartz Beloit One Network |
$361.13
|
| Rate for Payer: Quartz Commercial |
$442.20
|
| Rate for Payer: WEA Trust Commercial |
$405.35
|
| Rate for Payer: WPS Commercial |
$545.90
|
|
|
ED Revision Of Cornea
|
Facility
|
OP
|
$905.00
|
|
|
Service Code
|
CPT 65600
|
| Hospital Charge Code |
6174414
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$9,238.84 |
| Rate for Payer: Aetna Commercial |
$814.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$778.30
|
| Rate for Payer: Aetna Managed Medicare |
$2,309.71
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$588.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$452.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$434.40
|
| Rate for Payer: Anthem Medicare Advantage |
$2,309.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$479.65
|
| 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 |
$271.50
|
| Rate for Payer: Cash Price |
$271.50
|
| Rate for Payer: Cash Price |
$271.50
|
| Rate for Payer: Cigna Commercial |
$832.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$2,309.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,757.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$2,309.71
|
| Rate for Payer: Health EOS Commercial |
$805.45
|
| Rate for Payer: HFN Commercial |
$832.60
|
| 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 |
$724.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,464.56
|
| Rate for Payer: Preferred Network Access Commercial |
$832.60
|
| Rate for Payer: Quartz Beloit One Network |
$443.45
|
| Rate for Payer: Quartz Commercial |
$588.25
|
| 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 |
$497.75
|
| Rate for Payer: Wellcare Medicare |
$2,309.71
|
| Rate for Payer: WPS Commercial |
$670.33
|
|
|
ED Revision Of Cornea
|
Facility
|
IP
|
$905.00
|
|
|
Service Code
|
CPT 65600
|
| Hospital Charge Code |
6174414
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$443.45 |
| Max. Negotiated Rate |
$832.60 |
| Rate for Payer: Aetna Commercial |
$814.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$778.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$479.65
|
| Rate for Payer: Cash Price |
$271.50
|
| Rate for Payer: Cigna Commercial |
$832.60
|
| Rate for Payer: Health EOS Commercial |
$805.45
|
| Rate for Payer: HFN Commercial |
$832.60
|
| Rate for Payer: Multiplan Commercial |
$724.00
|
| Rate for Payer: NAPHCARE Commercial |
$543.00
|
| Rate for Payer: Preferred Network Access Commercial |
$832.60
|
| Rate for Payer: Quartz Beloit One Network |
$443.45
|
| Rate for Payer: Quartz Commercial |
$543.00
|
| Rate for Payer: WEA Trust Commercial |
$497.75
|
| Rate for Payer: WPS Commercial |
$670.33
|
|
|
ED Serial Tonometry Exam
|
Facility
|
IP
|
$113.00
|
|
|
Service Code
|
CPT 92100
|
| Hospital Charge Code |
6210139
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$55.37 |
| Max. Negotiated Rate |
$103.96 |
| Rate for Payer: Aetna Commercial |
$101.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$97.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$59.89
|
| Rate for Payer: Cash Price |
$33.90
|
| Rate for Payer: Cigna Commercial |
$103.96
|
| Rate for Payer: Health EOS Commercial |
$100.57
|
| Rate for Payer: HFN Commercial |
$103.96
|
| Rate for Payer: Multiplan Commercial |
$90.40
|
| Rate for Payer: NAPHCARE Commercial |
$67.80
|
| Rate for Payer: Preferred Network Access Commercial |
$103.96
|
| Rate for Payer: Quartz Beloit One Network |
$55.37
|
| Rate for Payer: Quartz Commercial |
$67.80
|
| Rate for Payer: WEA Trust Commercial |
$62.15
|
| Rate for Payer: WPS Commercial |
$83.70
|
|
|
ED Serial Tonometry Exam
|
Facility
|
OP
|
$113.00
|
|
|
Service Code
|
CPT 92100
|
| Hospital Charge Code |
6210139
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$31.64 |
| Max. Negotiated Rate |
$452.00 |
| Rate for Payer: Aetna Commercial |
$101.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$97.18
|
| Rate for Payer: Aetna Managed Medicare |
$31.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$73.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$56.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$54.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$59.89
|
| Rate for Payer: Cash Price |
$33.90
|
| Rate for Payer: Cash Price |
$33.90
|
| Rate for Payer: Cigna Commercial |
$103.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$63.23
|
| Rate for Payer: Health EOS Commercial |
$100.57
|
| Rate for Payer: HFN Commercial |
$103.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$84.75
|
| Rate for Payer: Multiplan Commercial |
$90.40
|
| Rate for Payer: NAPHCARE Commercial |
$67.80
|
| Rate for Payer: Preferred Network Access Commercial |
$103.96
|
| Rate for Payer: Quartz Beloit One Network |
$55.37
|
| Rate for Payer: Quartz Commercial |
$73.45
|
| Rate for Payer: Quartz Medicare Advantage |
$67.80
|
| Rate for Payer: The Alliance Commercial |
$452.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$62.15
|
| Rate for Payer: WPS Commercial |
$83.70
|
|
|
ED Severing Adhesions Of Anterior Segment Laser Technique
|
Facility
|
IP
|
$1,376.00
|
|
|
Service Code
|
CPT 65860
|
| Hospital Charge Code |
6174417
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$674.24 |
| Max. Negotiated Rate |
$1,265.92 |
| Rate for Payer: Aetna Commercial |
$1,238.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,183.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$729.28
|
| Rate for Payer: Cash Price |
$412.80
|
| Rate for Payer: Cigna Commercial |
$1,265.92
|
| Rate for Payer: Health EOS Commercial |
$1,224.64
|
| Rate for Payer: HFN Commercial |
$1,265.92
|
| Rate for Payer: Multiplan Commercial |
$1,100.80
|
| Rate for Payer: NAPHCARE Commercial |
$825.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,265.92
|
| Rate for Payer: Quartz Beloit One Network |
$674.24
|
| Rate for Payer: Quartz Commercial |
$825.60
|
| Rate for Payer: WEA Trust Commercial |
$756.80
|
| Rate for Payer: WPS Commercial |
$1,019.20
|
|
|
ED Severing Adhesions Of Anterior Segment Laser Technique
|
Facility
|
OP
|
$1,376.00
|
|
|
Service Code
|
CPT 65860
|
| Hospital Charge Code |
6174417
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$7,795.33 |
| Rate for Payer: Aetna Commercial |
$1,238.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,183.36
|
| Rate for Payer: Aetna Managed Medicare |
$574.53
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$894.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$688.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$660.48
|
| Rate for Payer: Anthem Medicare Advantage |
$574.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$729.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$574.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$574.53
|
| Rate for Payer: Cash Price |
$412.80
|
| Rate for Payer: Cash Price |
$412.80
|
| Rate for Payer: Cash Price |
$412.80
|
| Rate for Payer: Cigna Commercial |
$1,265.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$574.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,795.33
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$574.53
|
| Rate for Payer: Health EOS Commercial |
$1,224.64
|
| Rate for Payer: HFN Commercial |
$1,265.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,137.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$574.53
|
| Rate for Payer: Independent Care Health Plan Medicare |
$574.53
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$574.53
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$574.53
|
| Rate for Payer: Multiplan Commercial |
$1,100.80
|
| Rate for Payer: NAPHCARE Commercial |
$861.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,265.92
|
| Rate for Payer: Quartz Beloit One Network |
$674.24
|
| Rate for Payer: Quartz Commercial |
$894.40
|
| Rate for Payer: Quartz Medicare Advantage |
$574.53
|
| Rate for Payer: The Alliance Commercial |
$2,298.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$574.53
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$756.80
|
| Rate for Payer: Wellcare Medicare |
$574.53
|
| Rate for Payer: WPS Commercial |
$1,019.20
|
|
|
ED Simple Repair F/E/E/N/L/M 12.6 cm-20.0 cm
|
Facility
|
OP
|
$584.00
|
|
|
Service Code
|
CPT 12016
|
| Hospital Charge Code |
6195788
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$280.32 |
| Max. Negotiated Rate |
$4,757.59 |
| Rate for Payer: Aetna Commercial |
$525.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$502.24
|
| Rate for Payer: Aetna Managed Medicare |
$394.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$379.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$292.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$280.32
|
| Rate for Payer: Anthem Medicare Advantage |
$394.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$309.52
|
| 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 |
$175.20
|
| Rate for Payer: Cash Price |
$175.20
|
| Rate for Payer: Cash Price |
$175.20
|
| Rate for Payer: Cigna Commercial |
$537.28
|
| 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 |
$519.76
|
| Rate for Payer: HFN Commercial |
$537.28
|
| 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 |
$467.20
|
| Rate for Payer: NAPHCARE Commercial |
$591.18
|
| Rate for Payer: Preferred Network Access Commercial |
$537.28
|
| Rate for Payer: Quartz Beloit One Network |
$286.16
|
| Rate for Payer: Quartz Commercial |
$379.60
|
| 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 |
$321.20
|
| Rate for Payer: Wellcare Medicare |
$394.12
|
| Rate for Payer: WPS Commercial |
$432.57
|
|
|
ED Simple Repair F/E/E/N/L/M 12.6 cm-20.0 cm
|
Facility
|
IP
|
$584.00
|
|
|
Service Code
|
CPT 12016
|
| Hospital Charge Code |
6195788
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$286.16 |
| Max. Negotiated Rate |
$537.28 |
| Rate for Payer: Aetna Commercial |
$525.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$502.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$309.52
|
| Rate for Payer: Cash Price |
$175.20
|
| Rate for Payer: Cigna Commercial |
$537.28
|
| Rate for Payer: Health EOS Commercial |
$519.76
|
| Rate for Payer: HFN Commercial |
$537.28
|
| Rate for Payer: Multiplan Commercial |
$467.20
|
| Rate for Payer: NAPHCARE Commercial |
$350.40
|
| Rate for Payer: Preferred Network Access Commercial |
$537.28
|
| Rate for Payer: Quartz Beloit One Network |
$286.16
|
| Rate for Payer: Quartz Commercial |
$350.40
|
| Rate for Payer: WEA Trust Commercial |
$321.20
|
| Rate for Payer: WPS Commercial |
$432.57
|
|
|
ED Simple repair of wounds (face, ears, eyelids, nose, lips, mucous membranes) 2.6-5.0cm
|
Facility
|
IP
|
$274.00
|
|
|
Service Code
|
CPT 12013
|
| Hospital Charge Code |
6172913
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$134.26 |
| Max. Negotiated Rate |
$252.08 |
| Rate for Payer: Aetna Commercial |
$246.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$235.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$145.22
|
| Rate for Payer: Cash Price |
$82.20
|
| Rate for Payer: Cigna Commercial |
$252.08
|
| Rate for Payer: Health EOS Commercial |
$243.86
|
| Rate for Payer: HFN Commercial |
$252.08
|
| Rate for Payer: Multiplan Commercial |
$219.20
|
| Rate for Payer: NAPHCARE Commercial |
$164.40
|
| Rate for Payer: Preferred Network Access Commercial |
$252.08
|
| Rate for Payer: Quartz Beloit One Network |
$134.26
|
| Rate for Payer: Quartz Commercial |
$164.40
|
| Rate for Payer: WEA Trust Commercial |
$150.70
|
| Rate for Payer: WPS Commercial |
$202.95
|
|
|
ED Simple repair of wounds (face, ears, eyelids, nose, lips, mucous membranes) 2.6-5.0cm
|
Facility
|
OP
|
$274.00
|
|
|
Service Code
|
CPT 12013
|
| Hospital Charge Code |
6172913
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$131.52 |
| Max. Negotiated Rate |
$4,218.22 |
| Rate for Payer: Aetna Commercial |
$246.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$235.64
|
| Rate for Payer: Aetna Managed Medicare |
$197.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$178.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$137.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$131.52
|
| Rate for Payer: Anthem Medicare Advantage |
$197.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$145.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$197.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$197.88
|
| Rate for Payer: Cash Price |
$82.20
|
| Rate for Payer: Cash Price |
$82.20
|
| Rate for Payer: Cash Price |
$82.20
|
| Rate for Payer: Cigna Commercial |
$252.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$197.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$197.88
|
| Rate for Payer: Health EOS Commercial |
$243.86
|
| Rate for Payer: HFN Commercial |
$252.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$736.11
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$197.88
|
| Rate for Payer: Independent Care Health Plan Medicare |
$197.88
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$197.88
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$197.88
|
| Rate for Payer: Multiplan Commercial |
$219.20
|
| Rate for Payer: NAPHCARE Commercial |
$296.82
|
| Rate for Payer: Preferred Network Access Commercial |
$252.08
|
| Rate for Payer: Quartz Beloit One Network |
$134.26
|
| Rate for Payer: Quartz Commercial |
$178.10
|
| Rate for Payer: Quartz Medicare Advantage |
$197.88
|
| Rate for Payer: The Alliance Commercial |
$791.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$197.88
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$150.70
|
| Rate for Payer: Wellcare Medicare |
$197.88
|
| Rate for Payer: WPS Commercial |
$202.95
|
|
|
ED Simple repair of wounds (face, ears, eyelids, nose, lips, mucous membranes) 5.1-7.5cm
|
Facility
|
IP
|
$318.00
|
|
|
Service Code
|
CPT 12014
|
| Hospital Charge Code |
6173152
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$155.82 |
| Max. Negotiated Rate |
$292.56 |
| Rate for Payer: Aetna Commercial |
$286.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$273.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$168.54
|
| Rate for Payer: Cash Price |
$95.40
|
| Rate for Payer: Cigna Commercial |
$292.56
|
| Rate for Payer: Health EOS Commercial |
$283.02
|
| Rate for Payer: HFN Commercial |
$292.56
|
| Rate for Payer: Multiplan Commercial |
$254.40
|
| Rate for Payer: NAPHCARE Commercial |
$190.80
|
| Rate for Payer: Preferred Network Access Commercial |
$292.56
|
| Rate for Payer: Quartz Beloit One Network |
$155.82
|
| Rate for Payer: Quartz Commercial |
$190.80
|
| Rate for Payer: WEA Trust Commercial |
$174.90
|
| Rate for Payer: WPS Commercial |
$235.54
|
|
|
ED Simple repair of wounds (face, ears, eyelids, nose, lips, mucous membranes) 5.1-7.5cm
|
Facility
|
OP
|
$318.00
|
|
|
Service Code
|
CPT 12014
|
| Hospital Charge Code |
6173152
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$152.64 |
| Max. Negotiated Rate |
$4,218.22 |
| Rate for Payer: Aetna Commercial |
$286.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$273.48
|
| Rate for Payer: Aetna Managed Medicare |
$197.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$206.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$159.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$152.64
|
| Rate for Payer: Anthem Medicare Advantage |
$197.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$168.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$197.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$197.88
|
| Rate for Payer: Cash Price |
$95.40
|
| Rate for Payer: Cash Price |
$95.40
|
| Rate for Payer: Cash Price |
$95.40
|
| Rate for Payer: Cigna Commercial |
$292.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$197.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$197.88
|
| Rate for Payer: Health EOS Commercial |
$283.02
|
| Rate for Payer: HFN Commercial |
$292.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$736.11
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$197.88
|
| Rate for Payer: Independent Care Health Plan Medicare |
$197.88
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$197.88
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$197.88
|
| Rate for Payer: Multiplan Commercial |
$254.40
|
| Rate for Payer: NAPHCARE Commercial |
$296.82
|
| Rate for Payer: Preferred Network Access Commercial |
$292.56
|
| Rate for Payer: Quartz Beloit One Network |
$155.82
|
| Rate for Payer: Quartz Commercial |
$206.70
|
| Rate for Payer: Quartz Medicare Advantage |
$197.88
|
| Rate for Payer: The Alliance Commercial |
$791.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$197.88
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$174.90
|
| Rate for Payer: Wellcare Medicare |
$197.88
|
| Rate for Payer: WPS Commercial |
$235.54
|
|
|
ED Simple repair of wounds (face, ears, eyelids, nose, lips, mucous membranes) 7.6-12.5cm
|
Facility
|
OP
|
$341.00
|
|
|
Service Code
|
CPT 12015
|
| Hospital Charge Code |
6173153
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$163.68 |
| Max. Negotiated Rate |
$4,218.22 |
| Rate for Payer: Aetna Commercial |
$306.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$293.26
|
| Rate for Payer: Aetna Managed Medicare |
$197.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$221.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$170.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$163.68
|
| Rate for Payer: Anthem Medicare Advantage |
$197.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$180.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$197.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$197.88
|
| Rate for Payer: Cash Price |
$102.30
|
| Rate for Payer: Cash Price |
$102.30
|
| Rate for Payer: Cash Price |
$102.30
|
| Rate for Payer: Cigna Commercial |
$313.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$197.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$197.88
|
| Rate for Payer: Health EOS Commercial |
$303.49
|
| Rate for Payer: HFN Commercial |
$313.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$736.11
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$197.88
|
| Rate for Payer: Independent Care Health Plan Medicare |
$197.88
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$197.88
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$197.88
|
| Rate for Payer: Multiplan Commercial |
$272.80
|
| Rate for Payer: NAPHCARE Commercial |
$296.82
|
| Rate for Payer: Preferred Network Access Commercial |
$313.72
|
| Rate for Payer: Quartz Beloit One Network |
$167.09
|
| Rate for Payer: Quartz Commercial |
$221.65
|
| Rate for Payer: Quartz Medicare Advantage |
$197.88
|
| Rate for Payer: The Alliance Commercial |
$791.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$197.88
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$187.55
|
| Rate for Payer: Wellcare Medicare |
$197.88
|
| Rate for Payer: WPS Commercial |
$252.58
|
|
|
ED Simple repair of wounds (face, ears, eyelids, nose, lips, mucous membranes) 7.6-12.5cm
|
Facility
|
IP
|
$341.00
|
|
|
Service Code
|
CPT 12015
|
| Hospital Charge Code |
6173153
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$167.09 |
| Max. Negotiated Rate |
$313.72 |
| Rate for Payer: Aetna Commercial |
$306.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$293.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$180.73
|
| Rate for Payer: Cash Price |
$102.30
|
| Rate for Payer: Cigna Commercial |
$313.72
|
| Rate for Payer: Health EOS Commercial |
$303.49
|
| Rate for Payer: HFN Commercial |
$313.72
|
| Rate for Payer: Multiplan Commercial |
$272.80
|
| Rate for Payer: NAPHCARE Commercial |
$204.60
|
| Rate for Payer: Preferred Network Access Commercial |
$313.72
|
| Rate for Payer: Quartz Beloit One Network |
$167.09
|
| Rate for Payer: Quartz Commercial |
$204.60
|
| Rate for Payer: WEA Trust Commercial |
$187.55
|
| Rate for Payer: WPS Commercial |
$252.58
|
|
|
ED Simple repair of wounds (face,ears,mucous membranes) <=2.5 cm
|
Facility
|
IP
|
$208.00
|
|
|
Service Code
|
CPT 12011
|
| Hospital Charge Code |
6172841
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$101.92 |
| Max. Negotiated Rate |
$191.36 |
| Rate for Payer: Aetna Commercial |
$187.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$178.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$110.24
|
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Cigna Commercial |
$191.36
|
| Rate for Payer: Health EOS Commercial |
$185.12
|
| Rate for Payer: HFN Commercial |
$191.36
|
| Rate for Payer: Multiplan Commercial |
$166.40
|
| Rate for Payer: NAPHCARE Commercial |
$124.80
|
| Rate for Payer: Preferred Network Access Commercial |
$191.36
|
| Rate for Payer: Quartz Beloit One Network |
$101.92
|
| Rate for Payer: Quartz Commercial |
$124.80
|
| Rate for Payer: WEA Trust Commercial |
$114.40
|
| Rate for Payer: WPS Commercial |
$154.07
|
|
|
ED Simple repair of wounds (face,ears,mucous membranes) <=2.5 cm
|
Facility
|
OP
|
$208.00
|
|
|
Service Code
|
CPT 12011
|
| Hospital Charge Code |
6172841
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$99.84 |
| Max. Negotiated Rate |
$4,218.22 |
| Rate for Payer: Aetna Commercial |
$187.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$178.88
|
| Rate for Payer: Aetna Managed Medicare |
$197.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$135.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$104.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$99.84
|
| Rate for Payer: Anthem Medicare Advantage |
$197.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$110.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$197.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$197.88
|
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Cigna Commercial |
$191.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$197.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$197.88
|
| Rate for Payer: Health EOS Commercial |
$185.12
|
| Rate for Payer: HFN Commercial |
$191.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$736.11
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$197.88
|
| Rate for Payer: Independent Care Health Plan Medicare |
$197.88
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$197.88
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$197.88
|
| Rate for Payer: Multiplan Commercial |
$166.40
|
| Rate for Payer: NAPHCARE Commercial |
$296.82
|
| Rate for Payer: Preferred Network Access Commercial |
$191.36
|
| Rate for Payer: Quartz Beloit One Network |
$101.92
|
| Rate for Payer: Quartz Commercial |
$135.20
|
| Rate for Payer: Quartz Medicare Advantage |
$197.88
|
| Rate for Payer: The Alliance Commercial |
$791.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$197.88
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$114.40
|
| Rate for Payer: Wellcare Medicare |
$197.88
|
| Rate for Payer: WPS Commercial |
$154.07
|
|
|
ED Simple repair of wounds (scalp, neck, axillae, external genitalia, trunk) 12.6-20.0cm
|
Facility
|
OP
|
$339.00
|
|
|
Service Code
|
CPT 12005
|
| Hospital Charge Code |
6173150
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$162.72 |
| Max. Negotiated Rate |
$4,757.59 |
| Rate for Payer: Aetna Commercial |
$305.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$291.54
|
| Rate for Payer: Aetna Managed Medicare |
$394.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$220.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$169.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$162.72
|
| Rate for Payer: Anthem Medicare Advantage |
$394.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$179.67
|
| 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 |
$101.70
|
| Rate for Payer: Cash Price |
$101.70
|
| Rate for Payer: Cash Price |
$101.70
|
| Rate for Payer: Cigna Commercial |
$311.88
|
| 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 |
$301.71
|
| Rate for Payer: HFN Commercial |
$311.88
|
| 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 |
$271.20
|
| Rate for Payer: NAPHCARE Commercial |
$591.18
|
| Rate for Payer: Preferred Network Access Commercial |
$311.88
|
| Rate for Payer: Quartz Beloit One Network |
$166.11
|
| Rate for Payer: Quartz Commercial |
$220.35
|
| 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 |
$186.45
|
| Rate for Payer: Wellcare Medicare |
$394.12
|
| Rate for Payer: WPS Commercial |
$251.10
|
|
|
ED Simple repair of wounds (scalp, neck, axillae, external genitalia, trunk) 12.6-20.0cm
|
Facility
|
IP
|
$339.00
|
|
|
Service Code
|
CPT 12005
|
| Hospital Charge Code |
6173150
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$166.11 |
| Max. Negotiated Rate |
$311.88 |
| Rate for Payer: Aetna Commercial |
$305.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$291.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$179.67
|
| Rate for Payer: Cash Price |
$101.70
|
| Rate for Payer: Cigna Commercial |
$311.88
|
| Rate for Payer: Health EOS Commercial |
$301.71
|
| Rate for Payer: HFN Commercial |
$311.88
|
| Rate for Payer: Multiplan Commercial |
$271.20
|
| Rate for Payer: NAPHCARE Commercial |
$203.40
|
| Rate for Payer: Preferred Network Access Commercial |
$311.88
|
| Rate for Payer: Quartz Beloit One Network |
$166.11
|
| Rate for Payer: Quartz Commercial |
$203.40
|
| Rate for Payer: WEA Trust Commercial |
$186.45
|
| Rate for Payer: WPS Commercial |
$251.10
|
|
|
ED Simple repair of wounds (scalp, neck, axillae, external genitalia, trunk) 20.1-30.0cm
|
Facility
|
OP
|
$401.00
|
|
|
Service Code
|
CPT 12006
|
| Hospital Charge Code |
6173151
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$192.48 |
| Max. Negotiated Rate |
$4,757.59 |
| Rate for Payer: Aetna Commercial |
$360.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$344.86
|
| Rate for Payer: Aetna Managed Medicare |
$394.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$260.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$200.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$192.48
|
| Rate for Payer: Anthem Medicare Advantage |
$394.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$212.53
|
| 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 |
$120.30
|
| Rate for Payer: Cash Price |
$120.30
|
| Rate for Payer: Cash Price |
$120.30
|
| Rate for Payer: Cigna Commercial |
$368.92
|
| 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 |
$356.89
|
| Rate for Payer: HFN Commercial |
$368.92
|
| 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 |
$320.80
|
| Rate for Payer: NAPHCARE Commercial |
$591.18
|
| Rate for Payer: Preferred Network Access Commercial |
$368.92
|
| Rate for Payer: Quartz Beloit One Network |
$196.49
|
| Rate for Payer: Quartz Commercial |
$260.65
|
| 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 |
$220.55
|
| Rate for Payer: Wellcare Medicare |
$394.12
|
| Rate for Payer: WPS Commercial |
$297.02
|
|
|
ED Simple repair of wounds (scalp, neck, axillae, external genitalia, trunk) 20.1-30.0cm
|
Facility
|
IP
|
$401.00
|
|
|
Service Code
|
CPT 12006
|
| Hospital Charge Code |
6173151
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$196.49 |
| Max. Negotiated Rate |
$368.92 |
| Rate for Payer: Aetna Commercial |
$360.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$344.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$212.53
|
| Rate for Payer: Cash Price |
$120.30
|
| Rate for Payer: Cigna Commercial |
$368.92
|
| Rate for Payer: Health EOS Commercial |
$356.89
|
| Rate for Payer: HFN Commercial |
$368.92
|
| Rate for Payer: Multiplan Commercial |
$320.80
|
| Rate for Payer: NAPHCARE Commercial |
$240.60
|
| Rate for Payer: Preferred Network Access Commercial |
$368.92
|
| Rate for Payer: Quartz Beloit One Network |
$196.49
|
| Rate for Payer: Quartz Commercial |
$240.60
|
| Rate for Payer: WEA Trust Commercial |
$220.55
|
| Rate for Payer: WPS Commercial |
$297.02
|
|
|
ED Simple repair of wounds (scalp, neck, axillae, external genitalia, trunk) 7.6-12.5cm
|
Facility
|
OP
|
$287.00
|
|
|
Service Code
|
CPT 12004
|
| Hospital Charge Code |
6172917
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$137.76 |
| Max. Negotiated Rate |
$4,218.22 |
| Rate for Payer: Aetna Commercial |
$258.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$246.82
|
| Rate for Payer: Aetna Managed Medicare |
$197.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$186.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$143.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$137.76
|
| Rate for Payer: Anthem Medicare Advantage |
$197.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$152.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$197.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$197.88
|
| Rate for Payer: Cash Price |
$86.10
|
| Rate for Payer: Cash Price |
$86.10
|
| Rate for Payer: Cash Price |
$86.10
|
| Rate for Payer: Cigna Commercial |
$264.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$197.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$197.88
|
| Rate for Payer: Health EOS Commercial |
$255.43
|
| Rate for Payer: HFN Commercial |
$264.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$736.11
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$197.88
|
| Rate for Payer: Independent Care Health Plan Medicare |
$197.88
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$197.88
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$197.88
|
| Rate for Payer: Multiplan Commercial |
$229.60
|
| Rate for Payer: NAPHCARE Commercial |
$296.82
|
| Rate for Payer: Preferred Network Access Commercial |
$264.04
|
| Rate for Payer: Quartz Beloit One Network |
$140.63
|
| Rate for Payer: Quartz Commercial |
$186.55
|
| Rate for Payer: Quartz Medicare Advantage |
$197.88
|
| Rate for Payer: The Alliance Commercial |
$791.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$197.88
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$157.85
|
| Rate for Payer: Wellcare Medicare |
$197.88
|
| Rate for Payer: WPS Commercial |
$212.58
|
|
