|
Neurobehavioral Status Exam; each add hour 96121
|
Professional
|
Both
|
$305.00
|
|
|
Service Code
|
CPT 96121
|
| Hospital Charge Code |
5454796
|
| Min. Negotiated Rate |
$63.50 |
| Max. Negotiated Rate |
$301.34 |
| Rate for Payer: Aetna Commercial |
$301.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$272.79
|
| Rate for Payer: Aetna Managed Medicare |
$63.50
|
| Rate for Payer: Anthem Medicare Advantage |
$63.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$63.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$63.50
|
| Rate for Payer: Cash Price |
$91.50
|
| Rate for Payer: Cash Price |
$91.50
|
| Rate for Payer: Cigna Commercial |
$301.34
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$96.77
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$63.50
|
| Rate for Payer: Health EOS Commercial |
$288.65
|
| Rate for Payer: HFN Commercial |
$301.34
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$262.27
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$262.27
|
| Rate for Payer: Independent Care Health Plan Medicare |
$63.50
|
| Rate for Payer: Multiplan Commercial |
$253.76
|
| Rate for Payer: NAPHCARE Commercial |
$95.25
|
| Rate for Payer: Preferred Network Access Commercial |
$301.34
|
| Rate for Payer: Quartz Beloit One Network |
$139.57
|
| Rate for Payer: Quartz Commercial |
$180.80
|
| Rate for Payer: Quartz Medicare Advantage |
$63.50
|
| Rate for Payer: The Alliance Commercial |
$158.76
|
| Rate for Payer: United Healthcare Medicaid |
$96.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$63.50
|
| Rate for Payer: WEA Trust Commercial |
$174.46
|
| Rate for Payer: WPS Commercial |
$254.01
|
|
|
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 |
$73.24 |
| Max. Negotiated Rate |
$607.62 |
| Rate for Payer: Aetna Commercial |
$607.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$550.06
|
| Rate for Payer: Aetna Managed Medicare |
$73.24
|
| Rate for Payer: Anthem Medicare Advantage |
$73.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$73.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$73.24
|
| Rate for Payer: Cash Price |
$184.50
|
| Rate for Payer: Cash Price |
$184.50
|
| Rate for Payer: Cigna Commercial |
$607.62
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$112.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$73.24
|
| Rate for Payer: Health EOS Commercial |
$582.04
|
| Rate for Payer: HFN Commercial |
$607.62
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$295.97
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$295.97
|
| Rate for Payer: Independent Care Health Plan Medicare |
$73.24
|
| Rate for Payer: Multiplan Commercial |
$511.68
|
| Rate for Payer: NAPHCARE Commercial |
$109.86
|
| Rate for Payer: Preferred Network Access Commercial |
$607.62
|
| Rate for Payer: Quartz Beloit One Network |
$281.42
|
| Rate for Payer: Quartz Commercial |
$364.57
|
| Rate for Payer: Quartz Medicare Advantage |
$73.24
|
| Rate for Payer: The Alliance Commercial |
$183.09
|
| Rate for Payer: United Healthcare Medicaid |
$112.49
|
| Rate for Payer: United Healthcare Medicare Advantage |
$73.24
|
| Rate for Payer: WEA Trust Commercial |
$351.78
|
| Rate for Payer: WPS Commercial |
$292.95
|
|
|
NEUROLOGICAL EYE DISORDERS
|
Facility
|
IP
|
$22,563.84
|
|
|
Service Code
|
MSDRG 123
|
| Min. Negotiated Rate |
$6,622.61 |
| Max. Negotiated Rate |
$22,563.84 |
| Rate for Payer: Aetna Managed Medicare |
$6,622.61
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$17,424.81
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$13,355.98
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$12,689.05
|
| Rate for Payer: Anthem Medicare Advantage |
$6,622.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6,622.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6,622.61
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6,622.61
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$14,086.01
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6,622.61
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$16,305.12
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6,622.61
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6,622.61
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6,622.61
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6,622.61
|
| Rate for Payer: NAPHCARE Commercial |
$9,933.91
|
| Rate for Payer: Quartz Medicare Advantage |
$6,622.61
|
| Rate for Payer: The Alliance Commercial |
$22,563.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,622.61
|
| Rate for Payer: United Healthcare PPO |
$12,693.74
|
| Rate for Payer: Wellcare Medicare |
$6,622.61
|
|
|
Neuromusclar Junction Test 95937
|
Professional
|
Both
|
$685.00
|
|
|
Service Code
|
CPT 95937
|
| Hospital Charge Code |
3015496
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$63.14 |
| Max. Negotiated Rate |
$676.78 |
| Rate for Payer: Aetna Commercial |
$676.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$612.66
|
| Rate for Payer: Aetna Managed Medicare |
$106.17
|
| Rate for Payer: Anthem Medicare Advantage |
$106.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$106.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$106.17
|
| 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 |
$676.78
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$63.14
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$106.17
|
| Rate for Payer: Health EOS Commercial |
$648.28
|
| Rate for Payer: HFN Commercial |
$676.78
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$371.16
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$371.16
|
| Rate for Payer: Independent Care Health Plan Medicare |
$106.17
|
| Rate for Payer: Multiplan Commercial |
$569.92
|
| Rate for Payer: NAPHCARE Commercial |
$159.26
|
| Rate for Payer: Preferred Network Access Commercial |
$676.78
|
| Rate for Payer: Quartz Beloit One Network |
$313.46
|
| Rate for Payer: Quartz Commercial |
$406.07
|
| Rate for Payer: Quartz Medicare Advantage |
$106.17
|
| Rate for Payer: The Alliance Commercial |
$265.43
|
| Rate for Payer: United Healthcare Medicaid |
$63.14
|
| Rate for Payer: United Healthcare Medicare Advantage |
$106.17
|
| Rate for Payer: WEA Trust Commercial |
$391.82
|
| Rate for Payer: WPS Commercial |
$424.69
|
|
|
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 |
$34.18 |
| Max. Negotiated Rate |
$1,169.79 |
| Rate for Payer: Aetna Commercial |
$1,169.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,058.97
|
| Rate for Payer: Aetna Managed Medicare |
$34.18
|
| Rate for Payer: Anthem Medicare Advantage |
$34.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$34.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$34.18
|
| 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 |
$1,169.79
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$50.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$34.18
|
| Rate for Payer: Health EOS Commercial |
$1,120.54
|
| Rate for Payer: HFN Commercial |
$1,169.79
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$123.39
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$123.39
|
| Rate for Payer: Independent Care Health Plan Medicare |
$34.18
|
| Rate for Payer: Multiplan Commercial |
$985.09
|
| Rate for Payer: NAPHCARE Commercial |
$51.28
|
| Rate for Payer: Preferred Network Access Commercial |
$1,169.79
|
| Rate for Payer: Quartz Beloit One Network |
$541.80
|
| Rate for Payer: Quartz Commercial |
$701.88
|
| Rate for Payer: Quartz Medicare Advantage |
$34.18
|
| Rate for Payer: The Alliance Commercial |
$85.46
|
| Rate for Payer: United Healthcare Medicaid |
$50.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$34.18
|
| Rate for Payer: WEA Trust Commercial |
$677.25
|
| Rate for Payer: WPS Commercial |
$136.74
|
|
|
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 |
$127.91 |
| Max. Negotiated Rate |
$240.16 |
| Rate for Payer: Aetna Commercial |
$234.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$224.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$138.35
|
| Rate for Payer: Cash Price |
$75.30
|
| Rate for Payer: Cigna Commercial |
$240.16
|
| Rate for Payer: Health EOS Commercial |
$232.33
|
| Rate for Payer: HFN Commercial |
$240.16
|
| Rate for Payer: Multiplan Commercial |
$208.83
|
| Rate for Payer: Preferred Network Access Commercial |
$240.16
|
| Rate for Payer: Quartz Beloit One Network |
$127.91
|
| Rate for Payer: Quartz Commercial |
$156.62
|
| Rate for Payer: WEA Trust Commercial |
$143.57
|
| Rate for Payer: WPS Commercial |
$193.35
|
|
|
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 |
$73.09 |
| Max. Negotiated Rate |
$362.96 |
| Rate for Payer: Aetna Commercial |
$234.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$224.49
|
| Rate for Payer: Aetna Managed Medicare |
$73.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$362.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$298.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$282.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$138.35
|
| Rate for Payer: Cash Price |
$75.30
|
| Rate for Payer: Cash Price |
$75.30
|
| Rate for Payer: Cigna Commercial |
$240.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$146.08
|
| Rate for Payer: Health EOS Commercial |
$232.33
|
| Rate for Payer: HFN Commercial |
$240.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$210.08
|
| Rate for Payer: Multiplan Commercial |
$208.83
|
| Rate for Payer: NAPHCARE Commercial |
$156.62
|
| Rate for Payer: Preferred Network Access Commercial |
$240.16
|
| Rate for Payer: Quartz Beloit One Network |
$127.91
|
| Rate for Payer: Quartz Commercial |
$169.68
|
| Rate for Payer: Quartz Medicare Advantage |
$156.62
|
| Rate for Payer: The Alliance Commercial |
$130.52
|
| Rate for Payer: United Healthcare PPO |
$195.78
|
| Rate for Payer: WEA Trust Commercial |
$143.57
|
| Rate for Payer: WPS Commercial |
$193.35
|
|
|
Neuromyelitis Optical (NMO) IgG Autoantibody
|
Facility
|
IP
|
$151.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
983341
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$76.95 |
| Max. Negotiated Rate |
$144.48 |
| Rate for Payer: Aetna Commercial |
$141.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$135.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$83.23
|
| Rate for Payer: Cash Price |
$45.30
|
| Rate for Payer: Cigna Commercial |
$144.48
|
| Rate for Payer: Health EOS Commercial |
$139.77
|
| Rate for Payer: HFN Commercial |
$144.48
|
| Rate for Payer: Multiplan Commercial |
$125.63
|
| Rate for Payer: Preferred Network Access Commercial |
$144.48
|
| Rate for Payer: Quartz Beloit One Network |
$76.95
|
| Rate for Payer: Quartz Commercial |
$94.22
|
| Rate for Payer: WEA Trust Commercial |
$86.37
|
| Rate for Payer: WPS Commercial |
$116.32
|
|
|
Neuromyelitis Optical (NMO) IgG Autoantibody
|
Professional
|
Both
|
$151.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
983341
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.99 |
| Max. Negotiated Rate |
$149.19 |
| Rate for Payer: Aetna Commercial |
$149.19
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$135.05
|
| Rate for Payer: Aetna Managed Medicare |
$11.99
|
| Rate for Payer: Anthem Medicare Advantage |
$11.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11.99
|
| Rate for Payer: Cash Price |
$45.30
|
| Rate for Payer: Cash Price |
$45.30
|
| Rate for Payer: Cigna Commercial |
$149.19
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$78.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11.99
|
| Rate for Payer: Health EOS Commercial |
$142.91
|
| Rate for Payer: HFN Commercial |
$149.19
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$42.33
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$42.33
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11.99
|
| Rate for Payer: Multiplan Commercial |
$125.63
|
| Rate for Payer: NAPHCARE Commercial |
$17.99
|
| Rate for Payer: Preferred Network Access Commercial |
$149.19
|
| Rate for Payer: Quartz Beloit One Network |
$69.10
|
| Rate for Payer: Quartz Commercial |
$89.51
|
| Rate for Payer: Quartz Medicare Advantage |
$11.99
|
| Rate for Payer: The Alliance Commercial |
$47.37
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.99
|
| Rate for Payer: WEA Trust Commercial |
$86.37
|
| Rate for Payer: WPS Commercial |
$52.76
|
|
|
Neuromyelitis Optical (NMO) IgG Autoantibody
|
Facility
|
OP
|
$151.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
983341
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.99 |
| Max. Negotiated Rate |
$144.48 |
| Rate for Payer: Aetna Commercial |
$141.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$135.05
|
| Rate for Payer: Aetna Managed Medicare |
$11.99
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$44.97
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$20.98
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$19.91
|
| Rate for Payer: Anthem Medicare Advantage |
$11.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$83.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11.99
|
| Rate for Payer: Cash Price |
$45.30
|
| Rate for Payer: Cash Price |
$45.30
|
| Rate for Payer: Cigna Commercial |
$144.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$11.99
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$87.88
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$11.99
|
| Rate for Payer: Health EOS Commercial |
$139.77
|
| Rate for Payer: HFN Commercial |
$144.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$44.61
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$11.99
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11.99
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$11.99
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$11.99
|
| Rate for Payer: Multiplan Commercial |
$125.63
|
| Rate for Payer: NAPHCARE Commercial |
$17.99
|
| Rate for Payer: Preferred Network Access Commercial |
$144.48
|
| Rate for Payer: Quartz Beloit One Network |
$76.95
|
| Rate for Payer: Quartz Commercial |
$102.08
|
| Rate for Payer: Quartz Medicare Advantage |
$11.99
|
| Rate for Payer: The Alliance Commercial |
$47.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.99
|
| Rate for Payer: United Healthcare PPO |
$117.78
|
| Rate for Payer: WEA Trust Commercial |
$86.37
|
| Rate for Payer: Wellcare Medicare |
$11.99
|
| Rate for Payer: WPS Commercial |
$116.32
|
|
|
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 |
$19.14 |
| Max. Negotiated Rate |
$133.95 |
| Rate for Payer: Aetna Commercial |
$131.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$125.22
|
| Rate for Payer: Aetna Managed Medicare |
$19.14
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$71.76
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$33.49
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$31.77
|
| Rate for Payer: Anthem Medicare Advantage |
$19.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$77.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$19.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19.14
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cigna Commercial |
$133.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$19.14
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$81.48
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$19.14
|
| Rate for Payer: Health EOS Commercial |
$129.58
|
| Rate for Payer: HFN Commercial |
$133.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$71.19
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$19.14
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19.14
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$19.14
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$19.14
|
| Rate for Payer: Multiplan Commercial |
$116.48
|
| Rate for Payer: NAPHCARE Commercial |
$28.70
|
| Rate for Payer: Preferred Network Access Commercial |
$133.95
|
| Rate for Payer: Quartz Beloit One Network |
$71.34
|
| Rate for Payer: Quartz Commercial |
$94.64
|
| Rate for Payer: Quartz Medicare Advantage |
$19.14
|
| Rate for Payer: The Alliance Commercial |
$76.54
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.14
|
| Rate for Payer: United Healthcare PPO |
$109.20
|
| Rate for Payer: WEA Trust Commercial |
$80.08
|
| Rate for Payer: Wellcare Medicare |
$19.14
|
| Rate for Payer: WPS Commercial |
$107.84
|
|
|
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 |
$19.14 |
| Max. Negotiated Rate |
$138.32 |
| Rate for Payer: Aetna Commercial |
$138.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$125.22
|
| Rate for Payer: Aetna Managed Medicare |
$19.14
|
| Rate for Payer: Anthem Medicare Advantage |
$19.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$19.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19.14
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cigna Commercial |
$138.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$72.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$19.14
|
| Rate for Payer: Health EOS Commercial |
$132.50
|
| Rate for Payer: HFN Commercial |
$138.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$67.55
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$67.55
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19.14
|
| Rate for Payer: Multiplan Commercial |
$116.48
|
| Rate for Payer: NAPHCARE Commercial |
$28.70
|
| Rate for Payer: Preferred Network Access Commercial |
$138.32
|
| Rate for Payer: Quartz Beloit One Network |
$64.06
|
| Rate for Payer: Quartz Commercial |
$82.99
|
| Rate for Payer: Quartz Medicare Advantage |
$19.14
|
| Rate for Payer: The Alliance Commercial |
$75.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.14
|
| Rate for Payer: WEA Trust Commercial |
$80.08
|
| Rate for Payer: WPS Commercial |
$84.20
|
|
|
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 |
$71.34 |
| Max. Negotiated Rate |
$133.95 |
| Rate for Payer: Aetna Commercial |
$131.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$125.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$77.17
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cigna Commercial |
$133.95
|
| Rate for Payer: Health EOS Commercial |
$129.58
|
| Rate for Payer: HFN Commercial |
$133.95
|
| Rate for Payer: Multiplan Commercial |
$116.48
|
| Rate for Payer: Preferred Network Access Commercial |
$133.95
|
| Rate for Payer: Quartz Beloit One Network |
$71.34
|
| Rate for Payer: Quartz Commercial |
$87.36
|
| Rate for Payer: WEA Trust Commercial |
$80.08
|
| Rate for Payer: WPS Commercial |
$107.84
|
|
|
Neuron Specific Enolase (NSE)
|
Facility
|
OP
|
$84.00
|
|
|
Service Code
|
CPT 86316
|
| Hospital Charge Code |
4619091
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.64 |
| Max. Negotiated Rate |
$86.57 |
| Rate for Payer: Aetna Commercial |
$78.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$75.13
|
| Rate for Payer: Aetna Managed Medicare |
$21.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$81.16
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$37.87
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$35.93
|
| Rate for Payer: Anthem Medicare Advantage |
$21.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$46.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$21.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$21.64
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cigna Commercial |
$80.37
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$21.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$48.89
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$21.64
|
| Rate for Payer: Health EOS Commercial |
$77.75
|
| Rate for Payer: HFN Commercial |
$80.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$80.51
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$21.64
|
| Rate for Payer: Independent Care Health Plan Medicare |
$21.64
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$21.64
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$21.64
|
| Rate for Payer: Multiplan Commercial |
$69.89
|
| Rate for Payer: NAPHCARE Commercial |
$32.46
|
| Rate for Payer: Preferred Network Access Commercial |
$80.37
|
| Rate for Payer: Quartz Beloit One Network |
$42.81
|
| Rate for Payer: Quartz Commercial |
$56.78
|
| Rate for Payer: Quartz Medicare Advantage |
$21.64
|
| Rate for Payer: The Alliance Commercial |
$86.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21.64
|
| Rate for Payer: United Healthcare PPO |
$65.52
|
| Rate for Payer: WEA Trust Commercial |
$48.05
|
| Rate for Payer: Wellcare Medicare |
$21.64
|
| Rate for Payer: WPS Commercial |
$64.71
|
|
|
Neuron Specific Enolase (NSE)
|
Professional
|
Both
|
$84.00
|
|
|
Service Code
|
CPT 86316
|
| Hospital Charge Code |
4619091
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.64 |
| Max. Negotiated Rate |
$95.23 |
| Rate for Payer: Aetna Commercial |
$82.99
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$75.13
|
| Rate for Payer: Aetna Managed Medicare |
$21.64
|
| Rate for Payer: Anthem Medicare Advantage |
$21.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$21.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$21.64
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cigna Commercial |
$82.99
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$43.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$21.64
|
| Rate for Payer: Health EOS Commercial |
$79.50
|
| Rate for Payer: HFN Commercial |
$82.99
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$76.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$76.40
|
| Rate for Payer: Independent Care Health Plan Medicare |
$21.64
|
| Rate for Payer: Multiplan Commercial |
$69.89
|
| Rate for Payer: NAPHCARE Commercial |
$32.46
|
| Rate for Payer: Preferred Network Access Commercial |
$82.99
|
| Rate for Payer: Quartz Beloit One Network |
$38.44
|
| Rate for Payer: Quartz Commercial |
$49.80
|
| Rate for Payer: Quartz Medicare Advantage |
$21.64
|
| Rate for Payer: The Alliance Commercial |
$85.49
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21.64
|
| Rate for Payer: WEA Trust Commercial |
$48.05
|
| Rate for Payer: WPS Commercial |
$95.23
|
|
|
Neuron Specific Enolase (NSE)
|
Facility
|
IP
|
$84.00
|
|
|
Service Code
|
CPT 86316
|
| Hospital Charge Code |
4619091
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$42.81 |
| Max. Negotiated Rate |
$80.37 |
| Rate for Payer: Aetna Commercial |
$78.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$75.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$46.30
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cigna Commercial |
$80.37
|
| Rate for Payer: Health EOS Commercial |
$77.75
|
| Rate for Payer: HFN Commercial |
$80.37
|
| Rate for Payer: Multiplan Commercial |
$69.89
|
| Rate for Payer: Preferred Network Access Commercial |
$80.37
|
| Rate for Payer: Quartz Beloit One Network |
$42.81
|
| Rate for Payer: Quartz Commercial |
$52.42
|
| Rate for Payer: WEA Trust Commercial |
$48.05
|
| Rate for Payer: WPS Commercial |
$64.71
|
|
|
NEUROPLASTY AND/OR TRANSPOSITION; MEDIAN NERVE AT CARPAL TUNNEL
|
Facility
|
OP
|
$8,220.12
|
|
|
Service Code
|
CPT 64721
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,055.03 |
| Max. Negotiated Rate |
$8,220.12 |
| Rate for Payer: Aetna Managed Medicare |
$2,055.03
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,635.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,985.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,835.04
|
| Rate for Payer: Anthem Medicare Advantage |
$2,055.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$2,055.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$2,055.03
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$2,055.03
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,947.89
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$2,055.03
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,644.71
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2,055.03
|
| Rate for Payer: Independent Care Health Plan Medicare |
$2,055.03
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$2,055.03
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$2,055.03
|
| Rate for Payer: NAPHCARE Commercial |
$3,082.54
|
| Rate for Payer: Quartz Medicare Advantage |
$2,055.03
|
| Rate for Payer: The Alliance Commercial |
$8,220.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,055.03
|
| Rate for Payer: United Healthcare PPO |
$3,726.32
|
| Rate for Payer: Wellcare Medicare |
$2,055.03
|
|
|
NEUROPLASTY AND/OR TRANSPOSITION; ULNAR NERVE AT ELBOW
|
Facility
|
OP
|
$8,220.12
|
|
|
Service Code
|
CPT 64718
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,055.03 |
| Max. Negotiated Rate |
$8,220.12 |
| Rate for Payer: Aetna Managed Medicare |
$2,055.03
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,635.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,985.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,835.04
|
| Rate for Payer: Anthem Medicare Advantage |
$2,055.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$2,055.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$2,055.03
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$2,055.03
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,947.89
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$2,055.03
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,644.71
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2,055.03
|
| Rate for Payer: Independent Care Health Plan Medicare |
$2,055.03
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$2,055.03
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$2,055.03
|
| Rate for Payer: NAPHCARE Commercial |
$3,082.54
|
| Rate for Payer: Quartz Medicare Advantage |
$2,055.03
|
| Rate for Payer: The Alliance Commercial |
$8,220.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,055.03
|
| Rate for Payer: United Healthcare PPO |
$3,726.32
|
| Rate for Payer: Wellcare Medicare |
$2,055.03
|
|
|
NEUROPLASTY AND/OR TRANSPOSITION; ULNAR NERVE AT WRIST
|
Facility
|
OP
|
$8,220.12
|
|
|
Service Code
|
CPT 64719
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,055.03 |
| Max. Negotiated Rate |
$8,220.12 |
| Rate for Payer: Aetna Managed Medicare |
$2,055.03
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,635.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,985.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,835.04
|
| Rate for Payer: Anthem Medicare Advantage |
$2,055.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$2,055.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$2,055.03
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$2,055.03
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,947.89
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$2,055.03
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,644.71
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2,055.03
|
| Rate for Payer: Independent Care Health Plan Medicare |
$2,055.03
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$2,055.03
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$2,055.03
|
| Rate for Payer: NAPHCARE Commercial |
$3,082.54
|
| Rate for Payer: Quartz Medicare Advantage |
$2,055.03
|
| Rate for Payer: The Alliance Commercial |
$8,220.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,055.03
|
| Rate for Payer: United Healthcare PPO |
$3,726.32
|
| Rate for Payer: Wellcare Medicare |
$2,055.03
|
|
|
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 |
$72.62 |
| Max. Negotiated Rate |
$358.64 |
| Rate for Payer: Aetna Commercial |
$358.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$324.67
|
| Rate for Payer: Aetna Managed Medicare |
$72.62
|
| Rate for Payer: Anthem Medicare Advantage |
$72.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$72.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$72.62
|
| Rate for Payer: Cash Price |
$108.90
|
| Rate for Payer: Cash Price |
$108.90
|
| Rate for Payer: Cigna Commercial |
$358.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$118.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$72.62
|
| Rate for Payer: Health EOS Commercial |
$343.54
|
| Rate for Payer: HFN Commercial |
$358.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$285.92
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$285.92
|
| Rate for Payer: Independent Care Health Plan Medicare |
$72.62
|
| Rate for Payer: Multiplan Commercial |
$302.02
|
| Rate for Payer: NAPHCARE Commercial |
$108.93
|
| Rate for Payer: Preferred Network Access Commercial |
$358.64
|
| Rate for Payer: Quartz Beloit One Network |
$166.11
|
| Rate for Payer: Quartz Commercial |
$215.19
|
| Rate for Payer: Quartz Medicare Advantage |
$72.62
|
| Rate for Payer: The Alliance Commercial |
$181.56
|
| Rate for Payer: United Healthcare Medicaid |
$118.53
|
| Rate for Payer: United Healthcare Medicare Advantage |
$72.62
|
| Rate for Payer: WEA Trust Commercial |
$207.64
|
| Rate for Payer: WPS Commercial |
$290.49
|
|
|
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 |
$100.33 |
| Max. Negotiated Rate |
$460.41 |
| Rate for Payer: Aetna Commercial |
$460.41
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$416.79
|
| Rate for Payer: Aetna Managed Medicare |
$100.33
|
| Rate for Payer: Anthem Medicare Advantage |
$100.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$100.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$100.33
|
| Rate for Payer: Cash Price |
$139.80
|
| Rate for Payer: Cash Price |
$139.80
|
| Rate for Payer: Cigna Commercial |
$460.41
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$155.41
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$100.33
|
| Rate for Payer: Health EOS Commercial |
$441.02
|
| Rate for Payer: HFN Commercial |
$460.41
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$377.58
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$377.58
|
| Rate for Payer: Independent Care Health Plan Medicare |
$100.33
|
| Rate for Payer: Multiplan Commercial |
$387.71
|
| Rate for Payer: NAPHCARE Commercial |
$150.49
|
| Rate for Payer: Preferred Network Access Commercial |
$460.41
|
| Rate for Payer: Quartz Beloit One Network |
$213.24
|
| Rate for Payer: Quartz Commercial |
$276.24
|
| Rate for Payer: Quartz Medicare Advantage |
$100.33
|
| Rate for Payer: The Alliance Commercial |
$250.82
|
| Rate for Payer: United Healthcare Medicaid |
$155.41
|
| Rate for Payer: United Healthcare Medicare Advantage |
$100.33
|
| Rate for Payer: WEA Trust Commercial |
$266.55
|
| Rate for Payer: WPS Commercial |
$401.32
|
|
|
NEUROSES EXCEPT DEPRESSIVE
|
Facility
|
IP
|
$26,304.72
|
|
|
Service Code
|
MSDRG 882
|
| Min. Negotiated Rate |
$8,730.16 |
| Max. Negotiated Rate |
$26,304.72 |
| Rate for Payer: Aetna Managed Medicare |
$8,730.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$23,429.46
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$17,958.49
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$17,061.74
|
| Rate for Payer: Anthem Medicare Advantage |
$8,730.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8,730.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8,730.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$8,730.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$18,940.09
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$8,730.16
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8,730.16
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8,730.16
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$8,730.16
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$8,730.16
|
| Rate for Payer: NAPHCARE Commercial |
$13,095.23
|
| Rate for Payer: Quartz Medicare Advantage |
$8,730.16
|
| Rate for Payer: The Alliance Commercial |
$26,304.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8,730.16
|
| Rate for Payer: United Healthcare PPO |
$14,829.89
|
| Rate for Payer: Wellcare Medicare |
$8,730.16
|
|
|
NEURO SPINAL SURGERY
|
Facility
|
OP
|
$4,324.00
|
|
| Hospital Charge Code |
2960249
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,259.15 |
| Max. Negotiated Rate |
$4,137.20 |
| Rate for Payer: Aetna Commercial |
$4,047.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,867.39
|
| Rate for Payer: Aetna Managed Medicare |
$1,259.15
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,923.02
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,248.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,158.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,383.39
|
| Rate for Payer: Cash Price |
$1,297.20
|
| Rate for Payer: Cigna Commercial |
$4,137.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,516.57
|
| Rate for Payer: Health EOS Commercial |
$4,002.29
|
| Rate for Payer: HFN Commercial |
$4,137.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,372.72
|
| Rate for Payer: Multiplan Commercial |
$3,597.57
|
| Rate for Payer: NAPHCARE Commercial |
$2,698.18
|
| Rate for Payer: Preferred Network Access Commercial |
$4,137.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,203.51
|
| Rate for Payer: Quartz Commercial |
$2,923.02
|
| Rate for Payer: Quartz Medicare Advantage |
$2,698.18
|
| Rate for Payer: The Alliance Commercial |
$2,248.48
|
| Rate for Payer: WEA Trust Commercial |
$2,473.33
|
| Rate for Payer: WPS Commercial |
$3,330.78
|
|
|
NEURO SPINAL SURGERY
|
Facility
|
IP
|
$4,324.00
|
|
| Hospital Charge Code |
2960249
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,203.51 |
| Max. Negotiated Rate |
$4,137.20 |
| Rate for Payer: Aetna Commercial |
$4,047.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,867.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,383.39
|
| Rate for Payer: Cash Price |
$1,297.20
|
| Rate for Payer: Cigna Commercial |
$4,137.20
|
| Rate for Payer: Health EOS Commercial |
$4,002.29
|
| Rate for Payer: HFN Commercial |
$4,137.20
|
| Rate for Payer: Multiplan Commercial |
$3,597.57
|
| Rate for Payer: Preferred Network Access Commercial |
$4,137.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,203.51
|
| Rate for Payer: Quartz Commercial |
$2,698.18
|
| Rate for Payer: WEA Trust Commercial |
$2,473.33
|
| Rate for Payer: WPS Commercial |
$3,330.78
|
|
|
NEUROSTIMULATOR IMPLANTABLE INTERSTIM II (RECHARGE FREE) 3058
|
Facility
|
IP
|
$71,120.00
|
|
|
Service Code
|
HCPCS C1767
|
| Hospital Charge Code |
5349493
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$36,242.75 |
| Max. Negotiated Rate |
$68,047.62 |
| Rate for Payer: Aetna Commercial |
$66,568.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$63,609.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$39,201.34
|
| Rate for Payer: Cash Price |
$21,336.00
|
| Rate for Payer: Cigna Commercial |
$68,047.62
|
| Rate for Payer: Health EOS Commercial |
$65,828.67
|
| Rate for Payer: HFN Commercial |
$68,047.62
|
| Rate for Payer: Multiplan Commercial |
$59,171.84
|
| Rate for Payer: Preferred Network Access Commercial |
$68,047.62
|
| Rate for Payer: Quartz Beloit One Network |
$36,242.75
|
| Rate for Payer: Quartz Commercial |
$44,378.88
|
| Rate for Payer: WEA Trust Commercial |
$40,680.64
|
| Rate for Payer: WPS Commercial |
$54,783.74
|
|
