|
NET RESCUE DGN-538-5
|
Facility
|
OP
|
$1,494.00
|
|
| Hospital Charge Code |
5414814
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$418.32 |
| Max. Negotiated Rate |
$5,976.00 |
| Rate for Payer: Aetna Commercial |
$1,344.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,284.84
|
| Rate for Payer: Aetna Managed Medicare |
$418.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$971.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$747.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$717.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$791.82
|
| Rate for Payer: Cash Price |
$448.20
|
| Rate for Payer: Cigna Commercial |
$1,374.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$836.04
|
| Rate for Payer: Health EOS Commercial |
$1,329.66
|
| Rate for Payer: HFN Commercial |
$1,374.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,120.50
|
| Rate for Payer: Multiplan Commercial |
$1,195.20
|
| Rate for Payer: NAPHCARE Commercial |
$896.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,374.48
|
| Rate for Payer: Quartz Beloit One Network |
$732.06
|
| Rate for Payer: Quartz Commercial |
$971.10
|
| Rate for Payer: Quartz Medicare Advantage |
$896.40
|
| Rate for Payer: The Alliance Commercial |
$5,976.00
|
| Rate for Payer: WEA Trust Commercial |
$821.70
|
| Rate for Payer: WPS Commercial |
$1,106.61
|
|
|
Neulasta 6 mg Charge
|
Professional
|
Both
|
$4,643.00
|
|
|
Service Code
|
HCPCS J2506
|
| Hospital Charge Code |
3002824
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$109.75 |
| Max. Negotiated Rate |
$4,410.85 |
| Rate for Payer: Aetna Commercial |
$4,410.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,992.98
|
| Rate for Payer: Cash Price |
$1,392.90
|
| Rate for Payer: Cash Price |
$1,392.90
|
| Rate for Payer: Cigna Commercial |
$4,410.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$109.75
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$109.75
|
| Rate for Payer: Health EOS Commercial |
$4,225.13
|
| Rate for Payer: HFN Commercial |
$4,410.85
|
| Rate for Payer: Multiplan Commercial |
$3,714.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,410.85
|
| Rate for Payer: Quartz Beloit One Network |
$2,042.92
|
| Rate for Payer: Quartz Commercial |
$2,646.51
|
| Rate for Payer: The Alliance Commercial |
$2,321.50
|
| Rate for Payer: United Healthcare Medicaid |
$109.75
|
| Rate for Payer: WEA Trust Commercial |
$2,553.65
|
| Rate for Payer: WPS Commercial |
$274.38
|
|
|
Neulasta 6 mg Charge
|
Facility
|
OP
|
$4,643.00
|
|
|
Service Code
|
HCPCS J2506
|
| Hospital Charge Code |
3002824
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$50.68 |
| Max. Negotiated Rate |
$4,271.56 |
| Rate for Payer: Aetna Commercial |
$4,178.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,992.98
|
| Rate for Payer: Aetna Managed Medicare |
$50.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$109.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$109.75
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$109.75
|
| Rate for Payer: Anthem Medicare Advantage |
$50.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,460.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$50.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$50.68
|
| Rate for Payer: Cash Price |
$1,392.90
|
| Rate for Payer: Cash Price |
$1,392.90
|
| Rate for Payer: Cigna Commercial |
$4,271.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$50.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$145.20
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$50.68
|
| Rate for Payer: Health EOS Commercial |
$4,132.27
|
| Rate for Payer: HFN Commercial |
$4,271.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$188.52
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$50.68
|
| Rate for Payer: Independent Care Health Plan Medicare |
$50.68
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$50.68
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$50.68
|
| Rate for Payer: Multiplan Commercial |
$3,714.40
|
| Rate for Payer: NAPHCARE Commercial |
$76.02
|
| Rate for Payer: Preferred Network Access Commercial |
$4,271.56
|
| Rate for Payer: Quartz Beloit One Network |
$2,275.07
|
| Rate for Payer: Quartz Commercial |
$3,017.95
|
| Rate for Payer: Quartz Medicare Advantage |
$50.68
|
| Rate for Payer: The Alliance Commercial |
$202.71
|
| Rate for Payer: United Healthcare Medicare Advantage |
$50.68
|
| Rate for Payer: WEA Trust Commercial |
$2,553.65
|
| Rate for Payer: Wellcare Medicare |
$50.68
|
| Rate for Payer: WPS Commercial |
$274.38
|
|
|
Neulasta 6 mg Charge
|
Facility
|
IP
|
$4,643.00
|
|
|
Service Code
|
HCPCS J2506
|
| Hospital Charge Code |
3002824
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,275.07 |
| Max. Negotiated Rate |
$4,271.56 |
| Rate for Payer: Aetna Commercial |
$4,178.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,992.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,460.79
|
| Rate for Payer: Cash Price |
$1,392.90
|
| Rate for Payer: Cigna Commercial |
$4,271.56
|
| Rate for Payer: Health EOS Commercial |
$4,132.27
|
| Rate for Payer: HFN Commercial |
$4,271.56
|
| Rate for Payer: Multiplan Commercial |
$3,714.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,785.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,271.56
|
| Rate for Payer: Quartz Beloit One Network |
$2,275.07
|
| Rate for Payer: Quartz Commercial |
$2,785.80
|
| Rate for Payer: WEA Trust Commercial |
$2,553.65
|
| Rate for Payer: WPS Commercial |
$3,439.07
|
|
|
Neurobehavioral Status Exam; each add hour 96121
|
Professional
|
Both
|
$305.00
|
|
|
Service Code
|
CPT 96121
|
| Hospital Charge Code |
5454796
|
| Min. Negotiated Rate |
$93.05 |
| Max. Negotiated Rate |
$289.75 |
| Rate for Payer: Aetna Commercial |
$289.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$262.30
|
| Rate for Payer: Cash Price |
$91.50
|
| Rate for Payer: Cash Price |
$91.50
|
| Rate for Payer: Cigna Commercial |
$289.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$93.05
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$183.00
|
| Rate for Payer: Health EOS Commercial |
$277.55
|
| Rate for Payer: HFN Commercial |
$289.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$252.18
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$252.18
|
| Rate for Payer: Multiplan Commercial |
$244.00
|
| Rate for Payer: Preferred Network Access Commercial |
$289.75
|
| Rate for Payer: Quartz Beloit One Network |
$134.20
|
| Rate for Payer: Quartz Commercial |
$173.85
|
| Rate for Payer: The Alliance Commercial |
$152.50
|
| Rate for Payer: United Healthcare Medicaid |
$93.05
|
| Rate for Payer: WEA Trust Commercial |
$167.75
|
| Rate for Payer: WPS Commercial |
$225.91
|
|
|
Neurobehavioral Status Exam per hour of Psychologist's or Physician's Time, Interpreting and Prepari
|
Professional
|
Both
|
$615.00
|
|
|
Service Code
|
CPT 96116
|
| Hospital Charge Code |
1122908
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$108.16 |
| Max. Negotiated Rate |
$584.25 |
| Rate for Payer: Aetna Commercial |
$584.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$528.90
|
| Rate for Payer: Cash Price |
$184.50
|
| Rate for Payer: Cash Price |
$184.50
|
| Rate for Payer: Cigna Commercial |
$584.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$108.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$369.00
|
| Rate for Payer: Health EOS Commercial |
$559.65
|
| Rate for Payer: HFN Commercial |
$584.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$284.59
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$284.59
|
| Rate for Payer: Multiplan Commercial |
$492.00
|
| Rate for Payer: Preferred Network Access Commercial |
$584.25
|
| Rate for Payer: Quartz Beloit One Network |
$270.60
|
| Rate for Payer: Quartz Commercial |
$350.55
|
| Rate for Payer: The Alliance Commercial |
$307.50
|
| Rate for Payer: United Healthcare Medicaid |
$108.16
|
| Rate for Payer: WEA Trust Commercial |
$338.25
|
| Rate for Payer: WPS Commercial |
$455.53
|
|
|
NEUROLOGICAL EYE DISORDERS
|
Facility
|
IP
|
$21,696.00
|
|
|
Service Code
|
MSDRG 123
|
| Min. Negotiated Rate |
$7,804.15 |
| Max. Negotiated Rate |
$21,696.00 |
| Rate for Payer: Aetna Managed Medicare |
$7,804.15
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$16,784.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$12,864.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$12,222.40
|
| Rate for Payer: Anthem Medicare Advantage |
$7,804.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7,804.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7,804.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$7,804.15
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13,567.98
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$7,804.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15,678.00
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$7,804.15
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7,804.15
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$7,804.15
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$7,804.15
|
| Rate for Payer: NAPHCARE Commercial |
$11,706.22
|
| Rate for Payer: Quartz Medicare Advantage |
$7,804.15
|
| Rate for Payer: The Alliance Commercial |
$21,696.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7,804.15
|
| Rate for Payer: United Healthcare PPO |
$12,205.52
|
| Rate for Payer: Wellcare Medicare |
$7,804.15
|
|
|
Neuromusclar Junction Test 95937
|
Professional
|
Both
|
$685.00
|
|
|
Service Code
|
CPT 95937
|
| Hospital Charge Code |
3015496
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$60.71 |
| Max. Negotiated Rate |
$650.75 |
| Rate for Payer: Aetna Commercial |
$650.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$589.10
|
| Rate for Payer: Cash Price |
$205.50
|
| Rate for Payer: Cash Price |
$205.50
|
| Rate for Payer: Cash Price |
$205.50
|
| Rate for Payer: Cigna Commercial |
$650.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$60.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$411.00
|
| Rate for Payer: Health EOS Commercial |
$623.35
|
| Rate for Payer: HFN Commercial |
$650.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$356.88
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$356.88
|
| Rate for Payer: Multiplan Commercial |
$548.00
|
| Rate for Payer: Preferred Network Access Commercial |
$650.75
|
| Rate for Payer: Quartz Beloit One Network |
$301.40
|
| Rate for Payer: Quartz Commercial |
$390.45
|
| Rate for Payer: The Alliance Commercial |
$342.50
|
| Rate for Payer: United Healthcare Medicaid |
$60.71
|
| Rate for Payer: WEA Trust Commercial |
$376.75
|
| Rate for Payer: WPS Commercial |
$507.38
|
|
|
Neuromusclar Junction Test 9593726
|
Professional
|
Both
|
$1,184.00
|
|
|
Service Code
|
CPT 95937 26
|
| Hospital Charge Code |
3015497
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$60.71 |
| Max. Negotiated Rate |
$1,124.80 |
| Rate for Payer: Aetna Commercial |
$1,124.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,018.24
|
| Rate for Payer: Cash Price |
$355.20
|
| Rate for Payer: Cash Price |
$355.20
|
| Rate for Payer: Cash Price |
$355.20
|
| Rate for Payer: Cigna Commercial |
$1,124.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$60.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$710.40
|
| Rate for Payer: Health EOS Commercial |
$1,077.44
|
| Rate for Payer: HFN Commercial |
$1,124.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$118.64
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$118.64
|
| Rate for Payer: Multiplan Commercial |
$947.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,124.80
|
| Rate for Payer: Quartz Beloit One Network |
$520.96
|
| Rate for Payer: Quartz Commercial |
$674.88
|
| Rate for Payer: The Alliance Commercial |
$592.00
|
| Rate for Payer: United Healthcare Medicaid |
$60.71
|
| Rate for Payer: WEA Trust Commercial |
$651.20
|
| Rate for Payer: WPS Commercial |
$876.99
|
|
|
Neuromuscular Re-Education Charges ST
|
Facility
|
IP
|
$251.00
|
|
|
Service Code
|
CPT 97112 GN
|
| Hospital Charge Code |
753737
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$122.99 |
| Max. Negotiated Rate |
$230.92 |
| Rate for Payer: Aetna Commercial |
$225.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$215.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$133.03
|
| Rate for Payer: Cash Price |
$75.30
|
| Rate for Payer: Cigna Commercial |
$230.92
|
| Rate for Payer: Health EOS Commercial |
$223.39
|
| Rate for Payer: HFN Commercial |
$230.92
|
| Rate for Payer: Multiplan Commercial |
$200.80
|
| Rate for Payer: NAPHCARE Commercial |
$150.60
|
| Rate for Payer: Preferred Network Access Commercial |
$230.92
|
| Rate for Payer: Quartz Beloit One Network |
$122.99
|
| Rate for Payer: Quartz Commercial |
$150.60
|
| Rate for Payer: WEA Trust Commercial |
$138.05
|
| Rate for Payer: WPS Commercial |
$185.92
|
|
|
Neuromuscular Re-Education Charges ST
|
Facility
|
OP
|
$251.00
|
|
|
Service Code
|
CPT 97112 GN
|
| Hospital Charge Code |
753737
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$70.28 |
| Max. Negotiated Rate |
$1,004.00 |
| Rate for Payer: Aetna Commercial |
$225.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$215.86
|
| Rate for Payer: Aetna Managed Medicare |
$70.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$349.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$287.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$272.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$133.03
|
| Rate for Payer: Cash Price |
$75.30
|
| Rate for Payer: Cash Price |
$75.30
|
| Rate for Payer: Cigna Commercial |
$230.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$140.46
|
| Rate for Payer: Health EOS Commercial |
$223.39
|
| Rate for Payer: HFN Commercial |
$230.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$202.00
|
| Rate for Payer: Multiplan Commercial |
$200.80
|
| Rate for Payer: NAPHCARE Commercial |
$150.60
|
| Rate for Payer: Preferred Network Access Commercial |
$230.92
|
| Rate for Payer: Quartz Beloit One Network |
$122.99
|
| Rate for Payer: Quartz Commercial |
$163.15
|
| Rate for Payer: Quartz Medicare Advantage |
$150.60
|
| Rate for Payer: The Alliance Commercial |
$1,004.00
|
| Rate for Payer: United Healthcare PPO |
$188.25
|
| Rate for Payer: WEA Trust Commercial |
$138.05
|
| Rate for Payer: WPS Commercial |
$185.92
|
|
|
Neuromyelitis Optical (NMO) IgG Autoantibody
|
Facility
|
OP
|
$151.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
983341
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.53 |
| Max. Negotiated Rate |
$138.92 |
| Rate for Payer: Aetna Commercial |
$135.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$129.86
|
| Rate for Payer: Aetna Managed Medicare |
$11.53
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$43.24
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$20.18
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$19.14
|
| Rate for Payer: Anthem Medicaid |
$11.91
|
| Rate for Payer: Anthem Medicare Advantage |
$11.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$80.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11.53
|
| Rate for Payer: Cash Price |
$45.30
|
| Rate for Payer: Cash Price |
$45.30
|
| Rate for Payer: Cigna Commercial |
$138.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$11.53
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$11.91
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$84.50
|
| Rate for Payer: Dean Health Medicaid |
$11.91
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$11.53
|
| Rate for Payer: Health EOS Commercial |
$134.39
|
| Rate for Payer: HFN Commercial |
$138.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$42.89
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$11.53
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$11.91
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11.53
|
| Rate for Payer: Managed Health Services Medicaid |
$12.39
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$11.53
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$11.53
|
| Rate for Payer: Multiplan Commercial |
$120.80
|
| Rate for Payer: NAPHCARE Commercial |
$17.30
|
| Rate for Payer: Preferred Network Access Commercial |
$138.92
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$11.91
|
| Rate for Payer: Quartz Beloit One Network |
$73.99
|
| Rate for Payer: Quartz Commercial |
$98.15
|
| Rate for Payer: Quartz Medicare Advantage |
$11.53
|
| Rate for Payer: The Alliance Commercial |
$46.12
|
| Rate for Payer: United Healthcare Medicaid |
$11.91
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.53
|
| Rate for Payer: United Healthcare PPO |
$113.25
|
| Rate for Payer: WEA Trust Commercial |
$83.05
|
| Rate for Payer: Wellcare Medicare |
$11.53
|
| Rate for Payer: WMAP Medicaid |
$11.91
|
| Rate for Payer: WPS Commercial |
$111.85
|
|
|
Neuromyelitis Optical (NMO) IgG Autoantibody
|
Facility
|
IP
|
$151.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
983341
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$73.99 |
| Max. Negotiated Rate |
$138.92 |
| Rate for Payer: Aetna Commercial |
$135.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$129.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$80.03
|
| Rate for Payer: Cash Price |
$45.30
|
| Rate for Payer: Cigna Commercial |
$138.92
|
| Rate for Payer: Health EOS Commercial |
$134.39
|
| Rate for Payer: HFN Commercial |
$138.92
|
| Rate for Payer: Multiplan Commercial |
$120.80
|
| Rate for Payer: NAPHCARE Commercial |
$90.60
|
| Rate for Payer: Preferred Network Access Commercial |
$138.92
|
| Rate for Payer: Quartz Beloit One Network |
$73.99
|
| Rate for Payer: Quartz Commercial |
$90.60
|
| Rate for Payer: WEA Trust Commercial |
$83.05
|
| Rate for Payer: WPS Commercial |
$111.85
|
|
|
Neuromyelitis Optical (NMO) IgG Autoantibody
|
Professional
|
Both
|
$151.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
983341
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$40.70 |
| Max. Negotiated Rate |
$143.45 |
| Rate for Payer: The Alliance Commercial |
$75.50
|
| Rate for Payer: WEA Trust Commercial |
$83.05
|
| Rate for Payer: WPS Commercial |
$111.85
|
| Rate for Payer: Aetna Commercial |
$143.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$129.86
|
| Rate for Payer: Cash Price |
$45.30
|
| Rate for Payer: Cash Price |
$45.30
|
| Rate for Payer: Cigna Commercial |
$143.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$75.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$90.60
|
| Rate for Payer: Health EOS Commercial |
$137.41
|
| Rate for Payer: HFN Commercial |
$143.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$40.70
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$40.70
|
| Rate for Payer: Multiplan Commercial |
$120.80
|
| Rate for Payer: Preferred Network Access Commercial |
$143.45
|
| Rate for Payer: Quartz Beloit One Network |
$66.44
|
| Rate for Payer: Quartz Commercial |
$86.07
|
|
|
Neuronal V-G Potassium Channel Antibody
|
Facility
|
OP
|
$140.00
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
2942965
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.40 |
| Max. Negotiated Rate |
$128.80 |
| Rate for Payer: Aetna Commercial |
$126.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$120.40
|
| Rate for Payer: Aetna Managed Medicare |
$18.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$69.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$32.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$30.54
|
| Rate for Payer: Anthem Medicaid |
$19.00
|
| Rate for Payer: Anthem Medicare Advantage |
$18.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$74.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18.40
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cigna Commercial |
$128.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$18.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$19.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$78.34
|
| Rate for Payer: Dean Health Medicaid |
$19.00
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$18.40
|
| Rate for Payer: Health EOS Commercial |
$124.60
|
| Rate for Payer: HFN Commercial |
$128.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$68.45
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18.40
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$19.00
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18.40
|
| Rate for Payer: Managed Health Services Medicaid |
$19.76
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$18.40
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$18.40
|
| Rate for Payer: Multiplan Commercial |
$112.00
|
| Rate for Payer: NAPHCARE Commercial |
$27.60
|
| Rate for Payer: Preferred Network Access Commercial |
$128.80
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$19.00
|
| Rate for Payer: Quartz Beloit One Network |
$68.60
|
| Rate for Payer: Quartz Commercial |
$91.00
|
| Rate for Payer: Quartz Medicare Advantage |
$18.40
|
| Rate for Payer: The Alliance Commercial |
$73.60
|
| Rate for Payer: United Healthcare Medicaid |
$19.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.40
|
| Rate for Payer: United Healthcare PPO |
$105.00
|
| Rate for Payer: WEA Trust Commercial |
$77.00
|
| Rate for Payer: Wellcare Medicare |
$18.40
|
| Rate for Payer: WMAP Medicaid |
$19.00
|
| Rate for Payer: WPS Commercial |
$103.70
|
|
|
Neuronal V-G Potassium Channel Antibody
|
Facility
|
IP
|
$140.00
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
2942965
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$68.60 |
| Max. Negotiated Rate |
$128.80 |
| Rate for Payer: Aetna Commercial |
$126.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$120.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$74.20
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cigna Commercial |
$128.80
|
| Rate for Payer: Health EOS Commercial |
$124.60
|
| Rate for Payer: HFN Commercial |
$128.80
|
| Rate for Payer: Multiplan Commercial |
$112.00
|
| Rate for Payer: NAPHCARE Commercial |
$84.00
|
| Rate for Payer: Preferred Network Access Commercial |
$128.80
|
| Rate for Payer: Quartz Beloit One Network |
$68.60
|
| Rate for Payer: Quartz Commercial |
$84.00
|
| Rate for Payer: WEA Trust Commercial |
$77.00
|
| Rate for Payer: WPS Commercial |
$103.70
|
|
|
Neuronal V-G Potassium Channel Antibody
|
Professional
|
Both
|
$140.00
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
2942965
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$61.60 |
| Max. Negotiated Rate |
$133.00 |
| Rate for Payer: Aetna Commercial |
$133.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$120.40
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cigna Commercial |
$133.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$70.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$84.00
|
| Rate for Payer: Health EOS Commercial |
$127.40
|
| Rate for Payer: HFN Commercial |
$133.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$64.95
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$64.95
|
| Rate for Payer: Multiplan Commercial |
$112.00
|
| Rate for Payer: Preferred Network Access Commercial |
$133.00
|
| Rate for Payer: Quartz Beloit One Network |
$61.60
|
| Rate for Payer: Quartz Commercial |
$79.80
|
| Rate for Payer: The Alliance Commercial |
$70.00
|
| Rate for Payer: WEA Trust Commercial |
$77.00
|
| Rate for Payer: WPS Commercial |
$103.70
|
|
|
Neuron Specific Enolase (NSE)
|
Facility
|
OP
|
$84.00
|
|
|
Service Code
|
CPT 86316
|
| Hospital Charge Code |
4619091
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.81 |
| Max. Negotiated Rate |
$83.24 |
| Rate for Payer: Aetna Commercial |
$75.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$72.24
|
| Rate for Payer: Aetna Managed Medicare |
$20.81
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$78.04
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$36.42
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$34.54
|
| Rate for Payer: Anthem Medicaid |
$21.50
|
| Rate for Payer: Anthem Medicare Advantage |
$20.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$44.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$20.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$20.81
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cigna Commercial |
$77.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$20.81
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$21.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$47.01
|
| Rate for Payer: Dean Health Medicaid |
$21.50
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$20.81
|
| Rate for Payer: Health EOS Commercial |
$74.76
|
| Rate for Payer: HFN Commercial |
$77.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$77.41
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$20.81
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$21.50
|
| Rate for Payer: Independent Care Health Plan Medicare |
$20.81
|
| Rate for Payer: Managed Health Services Medicaid |
$22.36
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$20.81
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$20.81
|
| Rate for Payer: Multiplan Commercial |
$67.20
|
| Rate for Payer: NAPHCARE Commercial |
$31.22
|
| Rate for Payer: Preferred Network Access Commercial |
$77.28
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$21.50
|
| Rate for Payer: Quartz Beloit One Network |
$41.16
|
| Rate for Payer: Quartz Commercial |
$54.60
|
| Rate for Payer: Quartz Medicare Advantage |
$20.81
|
| Rate for Payer: The Alliance Commercial |
$83.24
|
| Rate for Payer: United Healthcare Medicaid |
$21.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20.81
|
| Rate for Payer: United Healthcare PPO |
$63.00
|
| Rate for Payer: WEA Trust Commercial |
$46.20
|
| Rate for Payer: Wellcare Medicare |
$20.81
|
| Rate for Payer: WMAP Medicaid |
$21.50
|
| Rate for Payer: WPS Commercial |
$62.22
|
|
|
Neuron Specific Enolase (NSE)
|
Professional
|
Both
|
$84.00
|
|
|
Service Code
|
CPT 86316
|
| Hospital Charge Code |
4619091
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$36.96 |
| Max. Negotiated Rate |
$79.80 |
| Rate for Payer: Aetna Commercial |
$79.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$72.24
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cigna Commercial |
$79.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$42.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$50.40
|
| Rate for Payer: Health EOS Commercial |
$76.44
|
| Rate for Payer: HFN Commercial |
$79.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$73.46
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$73.46
|
| Rate for Payer: Multiplan Commercial |
$67.20
|
| Rate for Payer: Preferred Network Access Commercial |
$79.80
|
| Rate for Payer: Quartz Beloit One Network |
$36.96
|
| Rate for Payer: Quartz Commercial |
$47.88
|
| Rate for Payer: The Alliance Commercial |
$42.00
|
| Rate for Payer: WEA Trust Commercial |
$46.20
|
| Rate for Payer: WPS Commercial |
$62.22
|
|
|
Neuron Specific Enolase (NSE)
|
Facility
|
IP
|
$84.00
|
|
|
Service Code
|
CPT 86316
|
| Hospital Charge Code |
4619091
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$41.16 |
| Max. Negotiated Rate |
$77.28 |
| Rate for Payer: Aetna Commercial |
$75.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$72.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$44.52
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cigna Commercial |
$77.28
|
| Rate for Payer: Health EOS Commercial |
$74.76
|
| Rate for Payer: HFN Commercial |
$77.28
|
| Rate for Payer: Multiplan Commercial |
$67.20
|
| Rate for Payer: NAPHCARE Commercial |
$50.40
|
| Rate for Payer: Preferred Network Access Commercial |
$77.28
|
| Rate for Payer: Quartz Beloit One Network |
$41.16
|
| Rate for Payer: Quartz Commercial |
$50.40
|
| Rate for Payer: WEA Trust Commercial |
$46.20
|
| Rate for Payer: WPS Commercial |
$62.22
|
|
|
NEUROPLASTY AND/OR TRANSPOSITION; MEDIAN NERVE AT CARPAL TUNNEL
|
Facility
|
OP
|
$7,633.60
|
|
|
Service Code
|
CPT 64721
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,908.40 |
| Max. Negotiated Rate |
$7,633.60 |
| Rate for Payer: Aetna Managed Medicare |
$1,908.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,496.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,871.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,726.00
|
| Rate for Payer: Anthem Medicare Advantage |
$1,908.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,908.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,908.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,908.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,757.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,908.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,099.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,908.40
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,908.40
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,908.40
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,908.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,862.60
|
| Rate for Payer: Quartz Medicare Advantage |
$1,908.40
|
| Rate for Payer: The Alliance Commercial |
$7,633.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,908.40
|
| Rate for Payer: United Healthcare PPO |
$3,583.00
|
| Rate for Payer: Wellcare Medicare |
$1,908.40
|
|
|
NEUROPLASTY AND/OR TRANSPOSITION; ULNAR NERVE AT ELBOW
|
Facility
|
OP
|
$7,633.60
|
|
|
Service Code
|
CPT 64718
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,908.40 |
| Max. Negotiated Rate |
$7,633.60 |
| Rate for Payer: Aetna Managed Medicare |
$1,908.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,496.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,871.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,726.00
|
| Rate for Payer: Anthem Medicare Advantage |
$1,908.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,908.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,908.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,908.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,757.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,908.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,099.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,908.40
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,908.40
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,908.40
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,908.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,862.60
|
| Rate for Payer: Quartz Medicare Advantage |
$1,908.40
|
| Rate for Payer: The Alliance Commercial |
$7,633.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,908.40
|
| Rate for Payer: United Healthcare PPO |
$3,583.00
|
| Rate for Payer: Wellcare Medicare |
$1,908.40
|
|
|
NEUROPLASTY AND/OR TRANSPOSITION; ULNAR NERVE AT WRIST
|
Facility
|
OP
|
$7,633.60
|
|
|
Service Code
|
CPT 64719
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,908.40 |
| Max. Negotiated Rate |
$7,633.60 |
| Rate for Payer: Aetna Managed Medicare |
$1,908.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,496.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,871.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,726.00
|
| Rate for Payer: Anthem Medicare Advantage |
$1,908.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,908.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,908.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,908.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,757.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,908.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,099.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,908.40
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,908.40
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,908.40
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,908.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,862.60
|
| Rate for Payer: Quartz Medicare Advantage |
$1,908.40
|
| Rate for Payer: The Alliance Commercial |
$7,633.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,908.40
|
| Rate for Payer: United Healthcare PPO |
$3,583.00
|
| Rate for Payer: Wellcare Medicare |
$1,908.40
|
|
|
Neuropsychological Testing Evaluation; each add hour 96133
|
Professional
|
Both
|
$363.00
|
|
|
Service Code
|
CPT 96133
|
| Hospital Charge Code |
5454800
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$113.97 |
| Max. Negotiated Rate |
$344.85 |
| Rate for Payer: Aetna Commercial |
$344.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$312.18
|
| Rate for Payer: Cash Price |
$108.90
|
| Rate for Payer: Cash Price |
$108.90
|
| Rate for Payer: Cigna Commercial |
$344.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$113.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$217.80
|
| Rate for Payer: Health EOS Commercial |
$330.33
|
| Rate for Payer: HFN Commercial |
$344.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$274.92
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$274.92
|
| Rate for Payer: Multiplan Commercial |
$290.40
|
| Rate for Payer: Preferred Network Access Commercial |
$344.85
|
| Rate for Payer: Quartz Beloit One Network |
$159.72
|
| Rate for Payer: Quartz Commercial |
$206.91
|
| Rate for Payer: The Alliance Commercial |
$181.50
|
| Rate for Payer: United Healthcare Medicaid |
$113.97
|
| Rate for Payer: WEA Trust Commercial |
$199.65
|
| Rate for Payer: WPS Commercial |
$268.87
|
|
|
Neuropsychological Testing Evaluation; first hour 96132
|
Professional
|
Both
|
$466.00
|
|
|
Service Code
|
CPT 96132
|
| Hospital Charge Code |
5454799
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$149.43 |
| Max. Negotiated Rate |
$442.70 |
| Rate for Payer: Aetna Commercial |
$442.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$400.76
|
| Rate for Payer: Cash Price |
$139.80
|
| Rate for Payer: Cash Price |
$139.80
|
| Rate for Payer: Cigna Commercial |
$442.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$149.43
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$279.60
|
| Rate for Payer: Health EOS Commercial |
$424.06
|
| Rate for Payer: HFN Commercial |
$442.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$363.06
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$363.06
|
| Rate for Payer: Multiplan Commercial |
$372.80
|
| Rate for Payer: Preferred Network Access Commercial |
$442.70
|
| Rate for Payer: Quartz Beloit One Network |
$205.04
|
| Rate for Payer: Quartz Commercial |
$265.62
|
| Rate for Payer: The Alliance Commercial |
$233.00
|
| Rate for Payer: United Healthcare Medicaid |
$149.43
|
| Rate for Payer: WEA Trust Commercial |
$256.30
|
| Rate for Payer: WPS Commercial |
$345.17
|
|
