|
NESBIT PROCEDURE
|
Facility
|
IP
|
$4,238.00
|
|
| Hospital Charge Code |
2960248
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,159.68 |
| Max. Negotiated Rate |
$4,054.92 |
| Rate for Payer: HFN Commercial |
$4,054.92
|
| Rate for Payer: Aetna Commercial |
$3,966.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,790.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,335.99
|
| Rate for Payer: Cash Price |
$1,271.40
|
| Rate for Payer: Cigna Commercial |
$4,054.92
|
| Rate for Payer: Health EOS Commercial |
$3,922.69
|
| Rate for Payer: Multiplan Commercial |
$3,526.02
|
| Rate for Payer: Preferred Network Access Commercial |
$4,054.92
|
| Rate for Payer: Quartz Beloit One Network |
$2,159.68
|
| Rate for Payer: Quartz Commercial |
$2,644.51
|
| Rate for Payer: WEA Trust Commercial |
$2,424.14
|
| Rate for Payer: WPS Commercial |
$3,264.53
|
|
|
NET RESCUE DGN-538-5
|
Facility
|
IP
|
$1,494.00
|
|
| Hospital Charge Code |
5414814
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$761.34 |
| Max. Negotiated Rate |
$1,429.46 |
| Rate for Payer: Aetna Commercial |
$1,398.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,336.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$823.49
|
| Rate for Payer: Cash Price |
$448.20
|
| Rate for Payer: Cigna Commercial |
$1,429.46
|
| Rate for Payer: Health EOS Commercial |
$1,382.85
|
| Rate for Payer: HFN Commercial |
$1,429.46
|
| Rate for Payer: Multiplan Commercial |
$1,243.01
|
| Rate for Payer: Preferred Network Access Commercial |
$1,429.46
|
| Rate for Payer: Quartz Beloit One Network |
$761.34
|
| Rate for Payer: Quartz Commercial |
$932.26
|
| Rate for Payer: WEA Trust Commercial |
$854.57
|
| Rate for Payer: WPS Commercial |
$1,150.83
|
|
|
NET RESCUE DGN-538-5
|
Facility
|
OP
|
$1,494.00
|
|
| Hospital Charge Code |
5414814
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$435.05 |
| Max. Negotiated Rate |
$1,429.46 |
| Rate for Payer: Aetna Commercial |
$1,398.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,336.23
|
| Rate for Payer: Aetna Managed Medicare |
$435.05
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,009.94
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$776.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$745.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$823.49
|
| Rate for Payer: Cash Price |
$448.20
|
| Rate for Payer: Cigna Commercial |
$1,429.46
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$869.51
|
| Rate for Payer: Health EOS Commercial |
$1,382.85
|
| Rate for Payer: HFN Commercial |
$1,429.46
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,165.32
|
| Rate for Payer: Multiplan Commercial |
$1,243.01
|
| Rate for Payer: NAPHCARE Commercial |
$932.26
|
| Rate for Payer: Preferred Network Access Commercial |
$1,429.46
|
| Rate for Payer: Quartz Beloit One Network |
$761.34
|
| Rate for Payer: Quartz Commercial |
$1,009.94
|
| Rate for Payer: Quartz Medicare Advantage |
$932.26
|
| Rate for Payer: The Alliance Commercial |
$776.88
|
| Rate for Payer: WEA Trust Commercial |
$854.57
|
| Rate for Payer: WPS Commercial |
$1,150.83
|
|
|
Neulasta 6 mg Charge
|
Facility
|
IP
|
$4,643.00
|
|
|
Service Code
|
HCPCS J2506
|
| Hospital Charge Code |
3002824
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,366.07 |
| Max. Negotiated Rate |
$4,442.42 |
| Rate for Payer: Aetna Commercial |
$4,345.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,152.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,559.22
|
| Rate for Payer: Cash Price |
$1,392.90
|
| Rate for Payer: Cigna Commercial |
$4,442.42
|
| Rate for Payer: Health EOS Commercial |
$4,297.56
|
| Rate for Payer: HFN Commercial |
$4,442.42
|
| Rate for Payer: Multiplan Commercial |
$3,862.98
|
| Rate for Payer: Preferred Network Access Commercial |
$4,442.42
|
| Rate for Payer: Quartz Beloit One Network |
$2,366.07
|
| Rate for Payer: Quartz Commercial |
$2,897.23
|
| Rate for Payer: WEA Trust Commercial |
$2,655.80
|
| Rate for Payer: WPS Commercial |
$3,576.50
|
|
|
Neulasta 6 mg Charge
|
Professional
|
Both
|
$4,643.00
|
|
|
Service Code
|
HCPCS J2506
|
| Hospital Charge Code |
3002824
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$114.14 |
| Max. Negotiated Rate |
$4,587.28 |
| Rate for Payer: Aetna Commercial |
$4,587.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,152.70
|
| Rate for Payer: Aetna Managed Medicare |
$148.96
|
| Rate for Payer: Anthem Medicare Advantage |
$148.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$148.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$148.96
|
| Rate for Payer: Cash Price |
$1,392.90
|
| Rate for Payer: Cash Price |
$1,392.90
|
| Rate for Payer: Cigna Commercial |
$4,587.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$127.75
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$114.14
|
| Rate for Payer: Health EOS Commercial |
$4,394.14
|
| Rate for Payer: HFN Commercial |
$4,587.28
|
| Rate for Payer: Independent Care Health Plan Medicare |
$148.96
|
| Rate for Payer: Multiplan Commercial |
$3,862.98
|
| Rate for Payer: NAPHCARE Commercial |
$223.44
|
| Rate for Payer: Preferred Network Access Commercial |
$4,587.28
|
| Rate for Payer: Quartz Beloit One Network |
$2,124.64
|
| Rate for Payer: Quartz Commercial |
$2,752.37
|
| Rate for Payer: Quartz Medicare Advantage |
$148.96
|
| Rate for Payer: The Alliance Commercial |
$409.64
|
| Rate for Payer: United Healthcare Medicaid |
$127.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$148.96
|
| Rate for Payer: WEA Trust Commercial |
$2,655.80
|
| Rate for Payer: WPS Commercial |
$285.36
|
|
|
Neulasta 6 mg Charge
|
Facility
|
OP
|
$4,643.00
|
|
|
Service Code
|
HCPCS J2506
|
| Hospital Charge Code |
3002824
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$114.14 |
| Max. Negotiated Rate |
$4,442.42 |
| Rate for Payer: Aetna Commercial |
$4,345.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,152.70
|
| Rate for Payer: Aetna Managed Medicare |
$148.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$114.14
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$114.14
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$114.14
|
| Rate for Payer: Anthem Medicare Advantage |
$148.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,559.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$148.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$148.96
|
| Rate for Payer: Cash Price |
$1,392.90
|
| Rate for Payer: Cash Price |
$1,392.90
|
| Rate for Payer: Cigna Commercial |
$4,442.42
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$148.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$151.01
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$148.96
|
| Rate for Payer: Health EOS Commercial |
$4,297.56
|
| Rate for Payer: HFN Commercial |
$4,442.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$554.13
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$148.96
|
| Rate for Payer: Independent Care Health Plan Medicare |
$148.96
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$148.96
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$148.96
|
| Rate for Payer: Multiplan Commercial |
$3,862.98
|
| Rate for Payer: NAPHCARE Commercial |
$223.44
|
| Rate for Payer: Preferred Network Access Commercial |
$4,442.42
|
| Rate for Payer: Quartz Beloit One Network |
$2,366.07
|
| Rate for Payer: Quartz Commercial |
$3,138.67
|
| Rate for Payer: Quartz Medicare Advantage |
$148.96
|
| Rate for Payer: The Alliance Commercial |
$595.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$148.96
|
| Rate for Payer: WEA Trust Commercial |
$2,655.80
|
| Rate for Payer: Wellcare Medicare |
$148.96
|
| Rate for Payer: WPS Commercial |
$285.36
|
|
|
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
|
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
|
|
|
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
|
|
|
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
|
|
|
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: Quartz Commercial |
$82.99
|
| 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 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
|
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
|
|
|
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
|
|
|
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
|
|
|
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
|
|
