|
MUSCLE TEST, 2 LIMBS 95861
|
Professional
|
Both
|
$475.00
|
|
|
Service Code
|
CPT 95861
|
| Hospital Charge Code |
3015472
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$109.55 |
| Max. Negotiated Rate |
$590.22 |
| Rate for Payer: Aetna Commercial |
$451.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$408.50
|
| Rate for Payer: Cash Price |
$142.50
|
| Rate for Payer: Cash Price |
$142.50
|
| Rate for Payer: Cash Price |
$142.50
|
| Rate for Payer: Cigna Commercial |
$451.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$109.55
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$285.00
|
| Rate for Payer: Health EOS Commercial |
$432.25
|
| Rate for Payer: HFN Commercial |
$451.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$590.22
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$590.22
|
| Rate for Payer: Multiplan Commercial |
$380.00
|
| Rate for Payer: Preferred Network Access Commercial |
$451.25
|
| Rate for Payer: Quartz Beloit One Network |
$209.00
|
| Rate for Payer: Quartz Commercial |
$270.75
|
| Rate for Payer: The Alliance Commercial |
$237.50
|
| Rate for Payer: United Healthcare Medicaid |
$109.55
|
| Rate for Payer: WEA Trust Commercial |
$261.25
|
| Rate for Payer: WPS Commercial |
$351.83
|
|
|
MUSCLE TEST, 2 LIMBS 9586126
|
Professional
|
Both
|
$475.00
|
|
|
Service Code
|
CPT 95861 26
|
| Hospital Charge Code |
3015473
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$109.55 |
| Max. Negotiated Rate |
$451.25 |
| Rate for Payer: Aetna Commercial |
$451.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$408.50
|
| Rate for Payer: Cash Price |
$142.50
|
| Rate for Payer: Cash Price |
$142.50
|
| Rate for Payer: Cash Price |
$142.50
|
| Rate for Payer: Cigna Commercial |
$451.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$109.55
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$285.00
|
| Rate for Payer: Health EOS Commercial |
$432.25
|
| Rate for Payer: HFN Commercial |
$451.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$281.20
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$281.20
|
| Rate for Payer: Multiplan Commercial |
$380.00
|
| Rate for Payer: Preferred Network Access Commercial |
$451.25
|
| Rate for Payer: Quartz Beloit One Network |
$209.00
|
| Rate for Payer: Quartz Commercial |
$270.75
|
| Rate for Payer: The Alliance Commercial |
$237.50
|
| Rate for Payer: United Healthcare Medicaid |
$109.55
|
| Rate for Payer: WEA Trust Commercial |
$261.25
|
| Rate for Payer: WPS Commercial |
$351.83
|
|
|
MUSCLE TEST, 3 LIMBS 95863
|
Professional
|
Both
|
$1,350.00
|
|
|
Service Code
|
CPT 95863
|
| Hospital Charge Code |
3015475
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$125.62 |
| Max. Negotiated Rate |
$1,282.50 |
| Rate for Payer: Aetna Commercial |
$1,282.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,161.00
|
| Rate for Payer: Cash Price |
$405.00
|
| Rate for Payer: Cash Price |
$405.00
|
| Rate for Payer: Cash Price |
$405.00
|
| Rate for Payer: Cigna Commercial |
$1,282.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$125.62
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$810.00
|
| Rate for Payer: Health EOS Commercial |
$1,228.50
|
| Rate for Payer: HFN Commercial |
$1,282.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$770.10
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$770.10
|
| Rate for Payer: Multiplan Commercial |
$1,080.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,282.50
|
| Rate for Payer: Quartz Beloit One Network |
$594.00
|
| Rate for Payer: Quartz Commercial |
$769.50
|
| Rate for Payer: The Alliance Commercial |
$675.00
|
| Rate for Payer: United Healthcare Medicaid |
$125.62
|
| Rate for Payer: WEA Trust Commercial |
$742.50
|
| Rate for Payer: WPS Commercial |
$999.94
|
|
|
Muscle Test Cran Nerv Unilat 95867
|
Professional
|
Both
|
$308.00
|
|
|
Service Code
|
CPT 95867
|
| Hospital Charge Code |
5082940
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$68.02 |
| Max. Negotiated Rate |
$383.39 |
| Rate for Payer: Aetna Commercial |
$292.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$264.88
|
| Rate for Payer: Cash Price |
$92.40
|
| Rate for Payer: Cash Price |
$92.40
|
| Rate for Payer: Cash Price |
$92.40
|
| Rate for Payer: Cigna Commercial |
$292.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$68.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$184.80
|
| Rate for Payer: Health EOS Commercial |
$280.28
|
| Rate for Payer: HFN Commercial |
$292.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$383.39
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$383.39
|
| Rate for Payer: Multiplan Commercial |
$246.40
|
| Rate for Payer: Preferred Network Access Commercial |
$292.60
|
| Rate for Payer: Quartz Beloit One Network |
$135.52
|
| Rate for Payer: Quartz Commercial |
$175.56
|
| Rate for Payer: The Alliance Commercial |
$154.00
|
| Rate for Payer: United Healthcare Medicaid |
$68.02
|
| Rate for Payer: WEA Trust Commercial |
$169.40
|
| Rate for Payer: WPS Commercial |
$228.14
|
|
|
MUSCLE TEST CRAN NERV UNILAT 9586726
|
Professional
|
Both
|
$308.00
|
|
|
Service Code
|
CPT 95867 26
|
| Hospital Charge Code |
3015478
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$68.02 |
| Max. Negotiated Rate |
$292.60 |
| Rate for Payer: Aetna Commercial |
$292.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$264.88
|
| Rate for Payer: Cash Price |
$92.40
|
| Rate for Payer: Cash Price |
$92.40
|
| Rate for Payer: Cash Price |
$92.40
|
| Rate for Payer: Cigna Commercial |
$292.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$68.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$184.80
|
| Rate for Payer: Health EOS Commercial |
$280.28
|
| Rate for Payer: HFN Commercial |
$292.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$144.02
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$144.02
|
| Rate for Payer: Multiplan Commercial |
$246.40
|
| Rate for Payer: Preferred Network Access Commercial |
$292.60
|
| Rate for Payer: Quartz Beloit One Network |
$135.52
|
| Rate for Payer: Quartz Commercial |
$175.56
|
| Rate for Payer: The Alliance Commercial |
$154.00
|
| Rate for Payer: United Healthcare Medicaid |
$68.02
|
| Rate for Payer: WEA Trust Commercial |
$169.40
|
| Rate for Payer: WPS Commercial |
$228.14
|
|
|
MUSCLE TEST, NONPARASPINAL 95870
|
Professional
|
Both
|
$534.00
|
|
|
Service Code
|
CPT 95870
|
| Hospital Charge Code |
3015480
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$25.61 |
| Max. Negotiated Rate |
$507.30 |
| Rate for Payer: Aetna Commercial |
$507.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$459.24
|
| Rate for Payer: Cash Price |
$160.20
|
| Rate for Payer: Cash Price |
$160.20
|
| Rate for Payer: Cash Price |
$160.20
|
| Rate for Payer: Cigna Commercial |
$507.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$25.61
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$320.40
|
| Rate for Payer: Health EOS Commercial |
$485.94
|
| Rate for Payer: HFN Commercial |
$507.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$311.20
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$311.20
|
| Rate for Payer: Multiplan Commercial |
$427.20
|
| Rate for Payer: Preferred Network Access Commercial |
$507.30
|
| Rate for Payer: Quartz Beloit One Network |
$234.96
|
| Rate for Payer: Quartz Commercial |
$304.38
|
| Rate for Payer: The Alliance Commercial |
$267.00
|
| Rate for Payer: United Healthcare Medicaid |
$25.61
|
| Rate for Payer: WEA Trust Commercial |
$293.70
|
| Rate for Payer: WPS Commercial |
$395.53
|
|
|
MUSCLE TEST, NONPARASPINAL 9587026
|
Professional
|
Both
|
$534.00
|
|
|
Service Code
|
CPT 95870 26
|
| Hospital Charge Code |
3015481
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$25.61 |
| Max. Negotiated Rate |
$507.30 |
| Rate for Payer: Aetna Commercial |
$507.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$459.24
|
| Rate for Payer: Cash Price |
$160.20
|
| Rate for Payer: Cash Price |
$160.20
|
| Rate for Payer: Cash Price |
$160.20
|
| Rate for Payer: Cigna Commercial |
$507.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$25.61
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$320.40
|
| Rate for Payer: Health EOS Commercial |
$485.94
|
| Rate for Payer: HFN Commercial |
$507.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$67.18
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$67.18
|
| Rate for Payer: Multiplan Commercial |
$427.20
|
| Rate for Payer: Preferred Network Access Commercial |
$507.30
|
| Rate for Payer: Quartz Beloit One Network |
$234.96
|
| Rate for Payer: Quartz Commercial |
$304.38
|
| Rate for Payer: The Alliance Commercial |
$267.00
|
| Rate for Payer: United Healthcare Medicaid |
$25.61
|
| Rate for Payer: WEA Trust Commercial |
$293.70
|
| Rate for Payer: WPS Commercial |
$395.53
|
|
|
MUSCLE TEST, ONE LIMB 95860
|
Professional
|
Both
|
$946.00
|
|
|
Service Code
|
CPT 95860
|
| Hospital Charge Code |
3015470
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$74.78 |
| Max. Negotiated Rate |
$898.70 |
| Rate for Payer: Aetna Commercial |
$898.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$813.56
|
| Rate for Payer: Cash Price |
$283.80
|
| Rate for Payer: Cash Price |
$283.80
|
| Rate for Payer: Cash Price |
$283.80
|
| Rate for Payer: Cigna Commercial |
$898.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$74.78
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$567.60
|
| Rate for Payer: Health EOS Commercial |
$860.86
|
| Rate for Payer: HFN Commercial |
$898.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$407.82
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$407.82
|
| Rate for Payer: Multiplan Commercial |
$756.80
|
| Rate for Payer: Preferred Network Access Commercial |
$898.70
|
| Rate for Payer: Quartz Beloit One Network |
$416.24
|
| Rate for Payer: Quartz Commercial |
$539.22
|
| Rate for Payer: The Alliance Commercial |
$473.00
|
| Rate for Payer: United Healthcare Medicaid |
$74.78
|
| Rate for Payer: WEA Trust Commercial |
$520.30
|
| Rate for Payer: WPS Commercial |
$700.70
|
|
|
MUSCLE TEST, ONE LIMB 9586026
|
Professional
|
Both
|
$946.00
|
|
|
Service Code
|
CPT 95860 26
|
| Hospital Charge Code |
3015471
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$74.78 |
| Max. Negotiated Rate |
$898.70 |
| Rate for Payer: Aetna Commercial |
$898.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$813.56
|
| Rate for Payer: Cash Price |
$283.80
|
| Rate for Payer: Cash Price |
$283.80
|
| Rate for Payer: Cash Price |
$283.80
|
| Rate for Payer: Cigna Commercial |
$898.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$74.78
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$567.60
|
| Rate for Payer: Health EOS Commercial |
$860.86
|
| Rate for Payer: HFN Commercial |
$898.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$176.57
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$176.57
|
| Rate for Payer: Multiplan Commercial |
$756.80
|
| Rate for Payer: Preferred Network Access Commercial |
$898.70
|
| Rate for Payer: Quartz Beloit One Network |
$416.24
|
| Rate for Payer: Quartz Commercial |
$539.22
|
| Rate for Payer: The Alliance Commercial |
$473.00
|
| Rate for Payer: United Healthcare Medicaid |
$74.78
|
| Rate for Payer: WEA Trust Commercial |
$520.30
|
| Rate for Payer: WPS Commercial |
$700.70
|
|
|
Musk Antibody, Quant, Titer
|
Professional
|
Both
|
$1,613.00
|
|
|
Service Code
|
CPT 86366
|
| Hospital Charge Code |
983334
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$709.72 |
| Max. Negotiated Rate |
$1,532.35 |
| Rate for Payer: Aetna Commercial |
$1,532.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,387.18
|
| Rate for Payer: Cash Price |
$483.90
|
| Rate for Payer: Cigna Commercial |
$1,532.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$806.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$967.80
|
| Rate for Payer: Health EOS Commercial |
$1,467.83
|
| Rate for Payer: HFN Commercial |
$1,532.35
|
| Rate for Payer: Multiplan Commercial |
$1,290.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,532.35
|
| Rate for Payer: Quartz Beloit One Network |
$709.72
|
| Rate for Payer: Quartz Commercial |
$919.41
|
| Rate for Payer: The Alliance Commercial |
$806.50
|
| Rate for Payer: WEA Trust Commercial |
$887.15
|
| Rate for Payer: WPS Commercial |
$1,194.75
|
|
|
Musk Antibody, Quant, Titer
|
Facility
|
IP
|
$1,613.00
|
|
|
Service Code
|
CPT 86366
|
| Hospital Charge Code |
983334
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$790.37 |
| Max. Negotiated Rate |
$1,483.96 |
| Rate for Payer: Aetna Commercial |
$1,451.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,387.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$854.89
|
| Rate for Payer: Cash Price |
$483.90
|
| Rate for Payer: Cigna Commercial |
$1,483.96
|
| Rate for Payer: Health EOS Commercial |
$1,435.57
|
| Rate for Payer: HFN Commercial |
$1,483.96
|
| Rate for Payer: Multiplan Commercial |
$1,290.40
|
| Rate for Payer: NAPHCARE Commercial |
$967.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,483.96
|
| Rate for Payer: Quartz Beloit One Network |
$790.37
|
| Rate for Payer: Quartz Commercial |
$967.80
|
| Rate for Payer: WEA Trust Commercial |
$887.15
|
| Rate for Payer: WPS Commercial |
$1,194.75
|
|
|
Musk Antibody, Quant, Titer
|
Facility
|
OP
|
$1,613.00
|
|
|
Service Code
|
CPT 86366
|
| Hospital Charge Code |
983334
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.72 |
| Max. Negotiated Rate |
$6,452.00 |
| Rate for Payer: Cash Price |
$483.90
|
| Rate for Payer: Cigna Commercial |
$1,483.96
|
| Rate for Payer: Aetna Commercial |
$1,451.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,387.18
|
| Rate for Payer: Aetna Managed Medicare |
$451.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,048.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$806.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$774.24
|
| Rate for Payer: Anthem Medicaid |
$14.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$854.89
|
| Rate for Payer: Cash Price |
$483.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$14.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$902.63
|
| Rate for Payer: Dean Health Medicaid |
$14.72
|
| Rate for Payer: Health EOS Commercial |
$1,435.57
|
| Rate for Payer: HFN Commercial |
$1,483.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,209.75
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$14.72
|
| Rate for Payer: Managed Health Services Medicaid |
$15.31
|
| Rate for Payer: Multiplan Commercial |
$1,290.40
|
| Rate for Payer: NAPHCARE Commercial |
$967.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,483.96
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$14.72
|
| Rate for Payer: Quartz Beloit One Network |
$790.37
|
| Rate for Payer: Quartz Commercial |
$1,048.45
|
| Rate for Payer: Quartz Medicare Advantage |
$967.80
|
| Rate for Payer: The Alliance Commercial |
$6,452.00
|
| Rate for Payer: United Healthcare Medicaid |
$14.72
|
| Rate for Payer: United Healthcare PPO |
$1,209.75
|
| Rate for Payer: WEA Trust Commercial |
$887.15
|
| Rate for Payer: WMAP Medicaid |
$14.72
|
| Rate for Payer: WPS Commercial |
$1,194.75
|
|
|
Mustang HPB 10mm x 40mm
|
Professional
|
Both
|
$1,708.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
2550978
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$751.52 |
| Max. Negotiated Rate |
$1,622.60 |
| Rate for Payer: Aetna Commercial |
$1,622.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,468.88
|
| Rate for Payer: Cash Price |
$512.40
|
| Rate for Payer: Cigna Commercial |
$1,622.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$854.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,024.80
|
| Rate for Payer: Health EOS Commercial |
$1,554.28
|
| Rate for Payer: HFN Commercial |
$1,622.60
|
| Rate for Payer: Multiplan Commercial |
$1,366.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,622.60
|
| Rate for Payer: Quartz Beloit One Network |
$751.52
|
| Rate for Payer: Quartz Commercial |
$973.56
|
| Rate for Payer: The Alliance Commercial |
$854.00
|
| Rate for Payer: WEA Trust Commercial |
$939.40
|
| Rate for Payer: WPS Commercial |
$1,265.12
|
|
|
Mustang HPB 10mm x 40mm
|
Facility
|
IP
|
$1,708.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
2550978
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$836.92 |
| Max. Negotiated Rate |
$1,571.36 |
| Rate for Payer: Aetna Commercial |
$1,537.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,468.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$905.24
|
| Rate for Payer: Cash Price |
$512.40
|
| Rate for Payer: Cigna Commercial |
$1,571.36
|
| Rate for Payer: Health EOS Commercial |
$1,520.12
|
| Rate for Payer: HFN Commercial |
$1,571.36
|
| Rate for Payer: Multiplan Commercial |
$1,366.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,024.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,571.36
|
| Rate for Payer: Quartz Beloit One Network |
$836.92
|
| Rate for Payer: Quartz Commercial |
$1,024.80
|
| Rate for Payer: WEA Trust Commercial |
$939.40
|
| Rate for Payer: WPS Commercial |
$1,265.12
|
|
|
Mustang HPB 10mm x 40mm
|
Facility
|
OP
|
$1,708.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
2550978
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$478.24 |
| Max. Negotiated Rate |
$6,832.00 |
| Rate for Payer: Aetna Commercial |
$1,537.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,468.88
|
| Rate for Payer: Aetna Managed Medicare |
$478.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,110.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$854.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$819.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$905.24
|
| Rate for Payer: Cash Price |
$512.40
|
| Rate for Payer: Cigna Commercial |
$1,571.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$955.80
|
| Rate for Payer: Health EOS Commercial |
$1,520.12
|
| Rate for Payer: HFN Commercial |
$1,571.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,281.00
|
| Rate for Payer: Multiplan Commercial |
$1,366.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,024.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,571.36
|
| Rate for Payer: Quartz Beloit One Network |
$836.92
|
| Rate for Payer: Quartz Commercial |
$1,110.20
|
| Rate for Payer: Quartz Medicare Advantage |
$1,024.80
|
| Rate for Payer: The Alliance Commercial |
$6,832.00
|
| Rate for Payer: WEA Trust Commercial |
$939.40
|
| Rate for Payer: WPS Commercial |
$1,265.12
|
|
|
Mustang HPB 12mm x 40mm
|
Facility
|
IP
|
$1,708.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
2550980
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$836.92 |
| Max. Negotiated Rate |
$1,571.36 |
| Rate for Payer: Aetna Commercial |
$1,537.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,468.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$905.24
|
| Rate for Payer: Cash Price |
$512.40
|
| Rate for Payer: Cigna Commercial |
$1,571.36
|
| Rate for Payer: Health EOS Commercial |
$1,520.12
|
| Rate for Payer: HFN Commercial |
$1,571.36
|
| Rate for Payer: Multiplan Commercial |
$1,366.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,024.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,571.36
|
| Rate for Payer: Quartz Beloit One Network |
$836.92
|
| Rate for Payer: Quartz Commercial |
$1,024.80
|
| Rate for Payer: WEA Trust Commercial |
$939.40
|
| Rate for Payer: WPS Commercial |
$1,265.12
|
|
|
Mustang HPB 12mm x 40mm
|
Professional
|
Both
|
$1,708.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
2550980
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$751.52 |
| Max. Negotiated Rate |
$1,622.60 |
| Rate for Payer: Aetna Commercial |
$1,622.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,468.88
|
| Rate for Payer: Cash Price |
$512.40
|
| Rate for Payer: Cigna Commercial |
$1,622.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$854.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,024.80
|
| Rate for Payer: Health EOS Commercial |
$1,554.28
|
| Rate for Payer: HFN Commercial |
$1,622.60
|
| Rate for Payer: Multiplan Commercial |
$1,366.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,622.60
|
| Rate for Payer: Quartz Beloit One Network |
$751.52
|
| Rate for Payer: Quartz Commercial |
$973.56
|
| Rate for Payer: The Alliance Commercial |
$854.00
|
| Rate for Payer: WEA Trust Commercial |
$939.40
|
| Rate for Payer: WPS Commercial |
$1,265.12
|
|
|
Mustang HPB 12mm x 40mm
|
Facility
|
OP
|
$1,708.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
2550980
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$478.24 |
| Max. Negotiated Rate |
$6,832.00 |
| Rate for Payer: Aetna Commercial |
$1,537.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,468.88
|
| Rate for Payer: Aetna Managed Medicare |
$478.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,110.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$854.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$819.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$905.24
|
| Rate for Payer: Cash Price |
$512.40
|
| Rate for Payer: Cigna Commercial |
$1,571.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$955.80
|
| Rate for Payer: Health EOS Commercial |
$1,520.12
|
| Rate for Payer: HFN Commercial |
$1,571.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,281.00
|
| Rate for Payer: Multiplan Commercial |
$1,366.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,024.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,571.36
|
| Rate for Payer: Quartz Beloit One Network |
$836.92
|
| Rate for Payer: Quartz Commercial |
$1,110.20
|
| Rate for Payer: Quartz Medicare Advantage |
$1,024.80
|
| Rate for Payer: The Alliance Commercial |
$6,832.00
|
| Rate for Payer: WEA Trust Commercial |
$939.40
|
| Rate for Payer: WPS Commercial |
$1,265.12
|
|
|
Mustang HPB 4mm x 20mm
|
Facility
|
IP
|
$1,708.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
2550966
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$836.92 |
| Max. Negotiated Rate |
$1,571.36 |
| Rate for Payer: Aetna Commercial |
$1,537.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,468.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$905.24
|
| Rate for Payer: Cash Price |
$512.40
|
| Rate for Payer: Cigna Commercial |
$1,571.36
|
| Rate for Payer: Health EOS Commercial |
$1,520.12
|
| Rate for Payer: HFN Commercial |
$1,571.36
|
| Rate for Payer: Multiplan Commercial |
$1,366.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,024.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,571.36
|
| Rate for Payer: Quartz Beloit One Network |
$836.92
|
| Rate for Payer: Quartz Commercial |
$1,024.80
|
| Rate for Payer: WEA Trust Commercial |
$939.40
|
| Rate for Payer: WPS Commercial |
$1,265.12
|
|
|
Mustang HPB 4mm x 20mm
|
Facility
|
OP
|
$1,708.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
2550966
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$478.24 |
| Max. Negotiated Rate |
$6,832.00 |
| Rate for Payer: Aetna Commercial |
$1,537.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,468.88
|
| Rate for Payer: Aetna Managed Medicare |
$478.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,110.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$854.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$819.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$905.24
|
| Rate for Payer: Cash Price |
$512.40
|
| Rate for Payer: Cigna Commercial |
$1,571.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$955.80
|
| Rate for Payer: Health EOS Commercial |
$1,520.12
|
| Rate for Payer: HFN Commercial |
$1,571.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,281.00
|
| Rate for Payer: Multiplan Commercial |
$1,366.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,024.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,571.36
|
| Rate for Payer: Quartz Beloit One Network |
$836.92
|
| Rate for Payer: Quartz Commercial |
$1,110.20
|
| Rate for Payer: Quartz Medicare Advantage |
$1,024.80
|
| Rate for Payer: The Alliance Commercial |
$6,832.00
|
| Rate for Payer: WEA Trust Commercial |
$939.40
|
| Rate for Payer: WPS Commercial |
$1,265.12
|
|
|
Mustang HPB 4mm x 20mm
|
Professional
|
Both
|
$1,708.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
2550966
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$751.52 |
| Max. Negotiated Rate |
$1,622.60 |
| Rate for Payer: Aetna Commercial |
$1,622.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,468.88
|
| Rate for Payer: Cash Price |
$512.40
|
| Rate for Payer: Cigna Commercial |
$1,622.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$854.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,024.80
|
| Rate for Payer: Health EOS Commercial |
$1,554.28
|
| Rate for Payer: HFN Commercial |
$1,622.60
|
| Rate for Payer: Multiplan Commercial |
$1,366.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,622.60
|
| Rate for Payer: Quartz Beloit One Network |
$751.52
|
| Rate for Payer: Quartz Commercial |
$973.56
|
| Rate for Payer: The Alliance Commercial |
$854.00
|
| Rate for Payer: WEA Trust Commercial |
$939.40
|
| Rate for Payer: WPS Commercial |
$1,265.12
|
|
|
Mustang HPB 5mm x 20mm
|
Facility
|
IP
|
$1,708.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
2550968
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$836.92 |
| Max. Negotiated Rate |
$1,571.36 |
| Rate for Payer: Aetna Commercial |
$1,537.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,468.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$905.24
|
| Rate for Payer: Cash Price |
$512.40
|
| Rate for Payer: Cigna Commercial |
$1,571.36
|
| Rate for Payer: Health EOS Commercial |
$1,520.12
|
| Rate for Payer: HFN Commercial |
$1,571.36
|
| Rate for Payer: Multiplan Commercial |
$1,366.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,024.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,571.36
|
| Rate for Payer: Quartz Beloit One Network |
$836.92
|
| Rate for Payer: Quartz Commercial |
$1,024.80
|
| Rate for Payer: WEA Trust Commercial |
$939.40
|
| Rate for Payer: WPS Commercial |
$1,265.12
|
|
|
Mustang HPB 5mm x 20mm
|
Professional
|
Both
|
$1,708.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
2550968
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$751.52 |
| Max. Negotiated Rate |
$1,622.60 |
| Rate for Payer: Aetna Commercial |
$1,622.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,468.88
|
| Rate for Payer: Cash Price |
$512.40
|
| Rate for Payer: Cigna Commercial |
$1,622.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$854.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,024.80
|
| Rate for Payer: Health EOS Commercial |
$1,554.28
|
| Rate for Payer: HFN Commercial |
$1,622.60
|
| Rate for Payer: Multiplan Commercial |
$1,366.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,622.60
|
| Rate for Payer: Quartz Beloit One Network |
$751.52
|
| Rate for Payer: Quartz Commercial |
$973.56
|
| Rate for Payer: The Alliance Commercial |
$854.00
|
| Rate for Payer: WEA Trust Commercial |
$939.40
|
| Rate for Payer: WPS Commercial |
$1,265.12
|
|
|
Mustang HPB 5mm x 20mm
|
Facility
|
OP
|
$1,708.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
2550968
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$478.24 |
| Max. Negotiated Rate |
$6,832.00 |
| Rate for Payer: Aetna Commercial |
$1,537.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,468.88
|
| Rate for Payer: Aetna Managed Medicare |
$478.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,110.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$854.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$819.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$905.24
|
| Rate for Payer: Cash Price |
$512.40
|
| Rate for Payer: Cigna Commercial |
$1,571.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$955.80
|
| Rate for Payer: Health EOS Commercial |
$1,520.12
|
| Rate for Payer: HFN Commercial |
$1,571.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,281.00
|
| Rate for Payer: Multiplan Commercial |
$1,366.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,024.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,571.36
|
| Rate for Payer: Quartz Beloit One Network |
$836.92
|
| Rate for Payer: Quartz Commercial |
$1,110.20
|
| Rate for Payer: Quartz Medicare Advantage |
$1,024.80
|
| Rate for Payer: The Alliance Commercial |
$6,832.00
|
| Rate for Payer: WEA Trust Commercial |
$939.40
|
| Rate for Payer: WPS Commercial |
$1,265.12
|
|
|
Mustang HPB 6mm x 20mm
|
Professional
|
Both
|
$1,708.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
2550970
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$751.52 |
| Max. Negotiated Rate |
$1,622.60 |
| Rate for Payer: Aetna Commercial |
$1,622.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,468.88
|
| Rate for Payer: Cash Price |
$512.40
|
| Rate for Payer: Cigna Commercial |
$1,622.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$854.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,024.80
|
| Rate for Payer: Health EOS Commercial |
$1,554.28
|
| Rate for Payer: HFN Commercial |
$1,622.60
|
| Rate for Payer: Multiplan Commercial |
$1,366.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,622.60
|
| Rate for Payer: Quartz Beloit One Network |
$751.52
|
| Rate for Payer: Quartz Commercial |
$973.56
|
| Rate for Payer: The Alliance Commercial |
$854.00
|
| Rate for Payer: WEA Trust Commercial |
$939.40
|
| Rate for Payer: WPS Commercial |
$1,265.12
|
|
