|
NEEDLE BONE MARROW & ASPIRATION ILLINOIS 15GA DIN1515X
|
Facility
|
IP
|
$399.00
|
|
| Hospital Charge Code |
2963142
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$195.51 |
| Max. Negotiated Rate |
$367.08 |
| Rate for Payer: Aetna Commercial |
$359.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$343.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$211.47
|
| Rate for Payer: Cash Price |
$119.70
|
| Rate for Payer: Cigna Commercial |
$367.08
|
| Rate for Payer: Health EOS Commercial |
$355.11
|
| Rate for Payer: HFN Commercial |
$367.08
|
| Rate for Payer: Multiplan Commercial |
$319.20
|
| Rate for Payer: NAPHCARE Commercial |
$239.40
|
| Rate for Payer: Preferred Network Access Commercial |
$367.08
|
| Rate for Payer: Quartz Beloit One Network |
$195.51
|
| Rate for Payer: Quartz Commercial |
$239.40
|
| Rate for Payer: WEA Trust Commercial |
$219.45
|
| Rate for Payer: WPS Commercial |
$295.54
|
|
|
NEEDLE COUNTER 40CT MAGNET/FOAM BLOCK DYNJNC40F
|
Facility
|
OP
|
$60.00
|
|
| Hospital Charge Code |
2969222
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.80 |
| Max. Negotiated Rate |
$240.00 |
| Rate for Payer: Aetna Commercial |
$54.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$51.60
|
| Rate for Payer: Aetna Managed Medicare |
$16.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$39.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$30.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$28.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$31.80
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cigna Commercial |
$55.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$33.58
|
| Rate for Payer: Health EOS Commercial |
$53.40
|
| Rate for Payer: HFN Commercial |
$55.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$45.00
|
| Rate for Payer: Multiplan Commercial |
$48.00
|
| Rate for Payer: NAPHCARE Commercial |
$36.00
|
| Rate for Payer: Preferred Network Access Commercial |
$55.20
|
| Rate for Payer: Quartz Beloit One Network |
$29.40
|
| Rate for Payer: Quartz Commercial |
$39.00
|
| Rate for Payer: Quartz Medicare Advantage |
$36.00
|
| Rate for Payer: The Alliance Commercial |
$240.00
|
| Rate for Payer: WEA Trust Commercial |
$33.00
|
| Rate for Payer: WPS Commercial |
$44.44
|
|
|
NEEDLE COUNTER 40CT MAGNET/FOAM BLOCK DYNJNC40F
|
Facility
|
IP
|
$60.00
|
|
| Hospital Charge Code |
2969222
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$29.40 |
| Max. Negotiated Rate |
$55.20 |
| Rate for Payer: Aetna Commercial |
$54.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$51.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$31.80
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cigna Commercial |
$55.20
|
| Rate for Payer: Health EOS Commercial |
$53.40
|
| Rate for Payer: HFN Commercial |
$55.20
|
| Rate for Payer: Multiplan Commercial |
$48.00
|
| Rate for Payer: NAPHCARE Commercial |
$36.00
|
| Rate for Payer: Preferred Network Access Commercial |
$55.20
|
| Rate for Payer: Quartz Beloit One Network |
$29.40
|
| Rate for Payer: Quartz Commercial |
$36.00
|
| Rate for Payer: WEA Trust Commercial |
$33.00
|
| Rate for Payer: WPS Commercial |
$44.44
|
|
|
NEEDLE CYSTOTOME 585004
|
Facility
|
OP
|
$113.00
|
|
| Hospital Charge Code |
2968994
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.64 |
| Max. Negotiated Rate |
$452.00 |
| Rate for Payer: Aetna Commercial |
$101.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$97.18
|
| Rate for Payer: Aetna Managed Medicare |
$31.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$73.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$56.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$54.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$59.89
|
| Rate for Payer: Cash Price |
$33.90
|
| Rate for Payer: Cigna Commercial |
$103.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$63.23
|
| Rate for Payer: Health EOS Commercial |
$100.57
|
| Rate for Payer: HFN Commercial |
$103.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$84.75
|
| Rate for Payer: Multiplan Commercial |
$90.40
|
| Rate for Payer: NAPHCARE Commercial |
$67.80
|
| Rate for Payer: Preferred Network Access Commercial |
$103.96
|
| Rate for Payer: Quartz Beloit One Network |
$55.37
|
| Rate for Payer: Quartz Commercial |
$73.45
|
| Rate for Payer: Quartz Medicare Advantage |
$67.80
|
| Rate for Payer: The Alliance Commercial |
$452.00
|
| Rate for Payer: WEA Trust Commercial |
$62.15
|
| Rate for Payer: WPS Commercial |
$83.70
|
|
|
NEEDLE CYSTOTOME 585004
|
Facility
|
IP
|
$113.00
|
|
| Hospital Charge Code |
2968994
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$55.37 |
| Max. Negotiated Rate |
$103.96 |
| Rate for Payer: Aetna Commercial |
$101.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$97.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$59.89
|
| Rate for Payer: Cash Price |
$33.90
|
| Rate for Payer: Cigna Commercial |
$103.96
|
| Rate for Payer: Health EOS Commercial |
$100.57
|
| Rate for Payer: HFN Commercial |
$103.96
|
| Rate for Payer: Multiplan Commercial |
$90.40
|
| Rate for Payer: NAPHCARE Commercial |
$67.80
|
| Rate for Payer: Preferred Network Access Commercial |
$103.96
|
| Rate for Payer: Quartz Beloit One Network |
$55.37
|
| Rate for Payer: Quartz Commercial |
$67.80
|
| Rate for Payer: WEA Trust Commercial |
$62.15
|
| Rate for Payer: WPS Commercial |
$83.70
|
|
|
NEEDLE DELIVERY 8G X10CM NORIAN DLS-7083-01S
|
Facility
|
OP
|
$946.00
|
|
| Hospital Charge Code |
2966303
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$264.88 |
| Max. Negotiated Rate |
$3,784.00 |
| Rate for Payer: Aetna Commercial |
$851.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$813.56
|
| Rate for Payer: Aetna Managed Medicare |
$264.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$614.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$473.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$454.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$501.38
|
| Rate for Payer: Cash Price |
$283.80
|
| Rate for Payer: Cigna Commercial |
$870.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$529.38
|
| Rate for Payer: Health EOS Commercial |
$841.94
|
| Rate for Payer: HFN Commercial |
$870.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$709.50
|
| Rate for Payer: Multiplan Commercial |
$756.80
|
| Rate for Payer: NAPHCARE Commercial |
$567.60
|
| Rate for Payer: Preferred Network Access Commercial |
$870.32
|
| Rate for Payer: Quartz Beloit One Network |
$463.54
|
| Rate for Payer: Quartz Commercial |
$614.90
|
| Rate for Payer: Quartz Medicare Advantage |
$567.60
|
| Rate for Payer: The Alliance Commercial |
$3,784.00
|
| Rate for Payer: WEA Trust Commercial |
$520.30
|
| Rate for Payer: WPS Commercial |
$700.70
|
|
|
NEEDLE DELIVERY 8G X10CM NORIAN DLS-7083-01S
|
Facility
|
IP
|
$946.00
|
|
| Hospital Charge Code |
2966303
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$463.54 |
| Max. Negotiated Rate |
$870.32 |
| Rate for Payer: Aetna Commercial |
$851.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$813.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$501.38
|
| Rate for Payer: Cash Price |
$283.80
|
| Rate for Payer: Cigna Commercial |
$870.32
|
| Rate for Payer: Health EOS Commercial |
$841.94
|
| Rate for Payer: HFN Commercial |
$870.32
|
| Rate for Payer: Multiplan Commercial |
$756.80
|
| Rate for Payer: NAPHCARE Commercial |
$567.60
|
| Rate for Payer: Preferred Network Access Commercial |
$870.32
|
| Rate for Payer: Quartz Beloit One Network |
$463.54
|
| Rate for Payer: Quartz Commercial |
$567.60
|
| Rate for Payer: WEA Trust Commercial |
$520.30
|
| Rate for Payer: WPS Commercial |
$700.70
|
|
|
NEEDLE EBUS ECHO-HD-22-EBUS-O G52011
|
Facility
|
IP
|
$2,345.00
|
|
| Hospital Charge Code |
5384681
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,149.05 |
| Max. Negotiated Rate |
$2,157.40 |
| Rate for Payer: Aetna Commercial |
$2,110.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,016.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,242.85
|
| Rate for Payer: Cash Price |
$703.50
|
| Rate for Payer: Cigna Commercial |
$2,157.40
|
| Rate for Payer: Health EOS Commercial |
$2,087.05
|
| Rate for Payer: HFN Commercial |
$2,157.40
|
| Rate for Payer: Multiplan Commercial |
$1,876.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,407.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,157.40
|
| Rate for Payer: Quartz Beloit One Network |
$1,149.05
|
| Rate for Payer: Quartz Commercial |
$1,407.00
|
| Rate for Payer: WEA Trust Commercial |
$1,289.75
|
| Rate for Payer: WPS Commercial |
$1,736.94
|
|
|
NEEDLE EBUS ECHO-HD-22-EBUS-O G52011
|
Facility
|
OP
|
$2,345.00
|
|
| Hospital Charge Code |
5384681
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$656.60 |
| Max. Negotiated Rate |
$9,380.00 |
| Rate for Payer: Aetna Commercial |
$2,110.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,016.70
|
| Rate for Payer: Aetna Managed Medicare |
$656.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,524.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,172.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,125.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,242.85
|
| Rate for Payer: Cash Price |
$703.50
|
| Rate for Payer: Cigna Commercial |
$2,157.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,312.26
|
| Rate for Payer: Health EOS Commercial |
$2,087.05
|
| Rate for Payer: HFN Commercial |
$2,157.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,758.75
|
| Rate for Payer: Multiplan Commercial |
$1,876.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,407.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,157.40
|
| Rate for Payer: Quartz Beloit One Network |
$1,149.05
|
| Rate for Payer: Quartz Commercial |
$1,524.25
|
| Rate for Payer: Quartz Medicare Advantage |
$1,407.00
|
| Rate for Payer: The Alliance Commercial |
$9,380.00
|
| Rate for Payer: WEA Trust Commercial |
$1,289.75
|
| Rate for Payer: WPS Commercial |
$1,736.94
|
|
|
Needle EMG for Guidance w Chemodenervation 95874
|
Professional
|
Both
|
$560.00
|
|
|
Service Code
|
CPT 95874
|
| Hospital Charge Code |
5072641
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$24.38 |
| Max. Negotiated Rate |
$532.00 |
| Rate for Payer: Aetna Commercial |
$532.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$481.60
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cigna Commercial |
$532.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$24.38
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$336.00
|
| Rate for Payer: Health EOS Commercial |
$509.60
|
| Rate for Payer: HFN Commercial |
$532.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$283.81
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$283.81
|
| Rate for Payer: Multiplan Commercial |
$448.00
|
| Rate for Payer: Preferred Network Access Commercial |
$532.00
|
| Rate for Payer: Quartz Beloit One Network |
$246.40
|
| Rate for Payer: Quartz Commercial |
$319.20
|
| Rate for Payer: The Alliance Commercial |
$280.00
|
| Rate for Payer: United Healthcare Medicaid |
$24.38
|
| Rate for Payer: WEA Trust Commercial |
$308.00
|
| Rate for Payer: WPS Commercial |
$414.79
|
|
|
Needle EMG for Guidance w Chemodenervation 9587426
|
Professional
|
Both
|
$560.00
|
|
|
Service Code
|
CPT 95874 26
|
| Hospital Charge Code |
5072664
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$24.38 |
| Max. Negotiated Rate |
$532.00 |
| Rate for Payer: Aetna Commercial |
$532.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$481.60
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cigna Commercial |
$532.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$24.38
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$336.00
|
| Rate for Payer: Health EOS Commercial |
$509.60
|
| Rate for Payer: HFN Commercial |
$532.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$67.99
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$67.99
|
| Rate for Payer: Multiplan Commercial |
$448.00
|
| Rate for Payer: Preferred Network Access Commercial |
$532.00
|
| Rate for Payer: Quartz Beloit One Network |
$246.40
|
| Rate for Payer: Quartz Commercial |
$319.20
|
| Rate for Payer: The Alliance Commercial |
$280.00
|
| Rate for Payer: United Healthcare Medicaid |
$24.38
|
| Rate for Payer: WEA Trust Commercial |
$308.00
|
| Rate for Payer: WPS Commercial |
$414.79
|
|
|
Needle EMG non-extremity w/nerve conduction study 95887
|
Professional
|
Both
|
$589.00
|
|
|
Service Code
|
CPT 95887
|
| Hospital Charge Code |
3015487
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$59.95 |
| Max. Negotiated Rate |
$559.55 |
| Rate for Payer: Aetna Commercial |
$559.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$506.54
|
| Rate for Payer: Cash Price |
$176.70
|
| Rate for Payer: Cash Price |
$176.70
|
| Rate for Payer: Cash Price |
$176.70
|
| Rate for Payer: Cigna Commercial |
$559.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$59.95
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$353.40
|
| Rate for Payer: Health EOS Commercial |
$535.99
|
| Rate for Payer: HFN Commercial |
$559.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$302.42
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$302.42
|
| Rate for Payer: Multiplan Commercial |
$471.20
|
| Rate for Payer: Preferred Network Access Commercial |
$559.55
|
| Rate for Payer: Quartz Beloit One Network |
$259.16
|
| Rate for Payer: Quartz Commercial |
$335.73
|
| Rate for Payer: The Alliance Commercial |
$294.50
|
| Rate for Payer: United Healthcare Medicaid |
$59.95
|
| Rate for Payer: WEA Trust Commercial |
$323.95
|
| Rate for Payer: WPS Commercial |
$436.27
|
|
|
Needle EMG non-extremity w/nerve conduction study 9588726
|
Professional
|
Both
|
$589.00
|
|
|
Service Code
|
CPT 95887 26
|
| Hospital Charge Code |
3015488
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$59.95 |
| Max. Negotiated Rate |
$559.55 |
| Rate for Payer: Aetna Commercial |
$559.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$506.54
|
| Rate for Payer: Cash Price |
$176.70
|
| Rate for Payer: Cash Price |
$176.70
|
| Rate for Payer: Cash Price |
$176.70
|
| Rate for Payer: Cigna Commercial |
$559.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$59.95
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$353.40
|
| Rate for Payer: Health EOS Commercial |
$535.99
|
| Rate for Payer: HFN Commercial |
$559.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$128.35
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$128.35
|
| Rate for Payer: Multiplan Commercial |
$471.20
|
| Rate for Payer: Preferred Network Access Commercial |
$559.55
|
| Rate for Payer: Quartz Beloit One Network |
$259.16
|
| Rate for Payer: Quartz Commercial |
$335.73
|
| Rate for Payer: The Alliance Commercial |
$294.50
|
| Rate for Payer: United Healthcare Medicaid |
$59.95
|
| Rate for Payer: WEA Trust Commercial |
$323.95
|
| Rate for Payer: WPS Commercial |
$436.27
|
|
|
Needle EMG non-extremity w/nerve conduct study - BILAT 9588750
|
Professional
|
Both
|
$1,177.00
|
|
|
Service Code
|
CPT 95887 50
|
| Hospital Charge Code |
6175630
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$59.95 |
| Max. Negotiated Rate |
$1,118.15 |
| Rate for Payer: Aetna Commercial |
$1,118.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,012.22
|
| Rate for Payer: Cash Price |
$353.10
|
| Rate for Payer: Cash Price |
$353.10
|
| Rate for Payer: Cash Price |
$353.10
|
| Rate for Payer: Cigna Commercial |
$1,118.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$59.95
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$706.20
|
| Rate for Payer: Health EOS Commercial |
$1,071.07
|
| Rate for Payer: HFN Commercial |
$1,118.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$302.42
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$302.42
|
| Rate for Payer: Multiplan Commercial |
$941.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,118.15
|
| Rate for Payer: Quartz Beloit One Network |
$517.88
|
| Rate for Payer: Quartz Commercial |
$670.89
|
| Rate for Payer: The Alliance Commercial |
$588.50
|
| Rate for Payer: United Healthcare Medicaid |
$59.95
|
| Rate for Payer: WEA Trust Commercial |
$647.35
|
| Rate for Payer: WPS Commercial |
$871.80
|
|
|
Needle EMG of extremity w/nerve conduction study; completed 95886
|
Professional
|
Both
|
$438.00
|
|
|
Service Code
|
CPT 95886
|
| Hospital Charge Code |
3015485
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$67.29 |
| Max. Negotiated Rate |
$416.10 |
| Rate for Payer: Aetna Commercial |
$416.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$376.68
|
| Rate for Payer: Cash Price |
$131.40
|
| Rate for Payer: Cash Price |
$131.40
|
| Rate for Payer: Cash Price |
$131.40
|
| Rate for Payer: Cigna Commercial |
$416.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$67.29
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$262.80
|
| Rate for Payer: Health EOS Commercial |
$398.58
|
| Rate for Payer: HFN Commercial |
$416.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$349.89
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$349.89
|
| Rate for Payer: Multiplan Commercial |
$350.40
|
| Rate for Payer: Preferred Network Access Commercial |
$416.10
|
| Rate for Payer: Quartz Beloit One Network |
$192.72
|
| Rate for Payer: Quartz Commercial |
$249.66
|
| Rate for Payer: The Alliance Commercial |
$219.00
|
| Rate for Payer: United Healthcare Medicaid |
$67.29
|
| Rate for Payer: WEA Trust Commercial |
$240.90
|
| Rate for Payer: WPS Commercial |
$324.43
|
|
|
Needle EMG of extremity w/nerve conduction study; completed 9588626
|
Professional
|
Both
|
$363.00
|
|
|
Service Code
|
CPT 95886 26
|
| Hospital Charge Code |
3015486
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$67.29 |
| Max. Negotiated Rate |
$344.85 |
| Rate for Payer: Aetna Commercial |
$344.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$312.18
|
| Rate for Payer: Cash Price |
$108.90
|
| Rate for Payer: Cash Price |
$108.90
|
| Rate for Payer: Cash Price |
$108.90
|
| Rate for Payer: Cigna Commercial |
$344.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$67.29
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$217.80
|
| Rate for Payer: Health EOS Commercial |
$330.33
|
| Rate for Payer: HFN Commercial |
$344.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$157.26
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$157.26
|
| Rate for Payer: Multiplan Commercial |
$290.40
|
| Rate for Payer: Preferred Network Access Commercial |
$344.85
|
| Rate for Payer: Quartz Beloit One Network |
$159.72
|
| Rate for Payer: Quartz Commercial |
$206.91
|
| Rate for Payer: The Alliance Commercial |
$181.50
|
| Rate for Payer: United Healthcare Medicaid |
$67.29
|
| Rate for Payer: WEA Trust Commercial |
$199.65
|
| Rate for Payer: WPS Commercial |
$268.87
|
|
|
Needle EMG of extremity w/nerve conduction study; completed 9588650
|
Professional
|
Both
|
$875.00
|
|
|
Service Code
|
CPT 95886 50
|
| Hospital Charge Code |
5577700
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$67.29 |
| Max. Negotiated Rate |
$831.25 |
| Rate for Payer: Aetna Commercial |
$831.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$752.50
|
| Rate for Payer: Cash Price |
$262.50
|
| Rate for Payer: Cash Price |
$262.50
|
| Rate for Payer: Cash Price |
$262.50
|
| Rate for Payer: Cigna Commercial |
$831.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$67.29
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$525.00
|
| Rate for Payer: Health EOS Commercial |
$796.25
|
| Rate for Payer: HFN Commercial |
$831.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$349.89
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$349.89
|
| Rate for Payer: Multiplan Commercial |
$700.00
|
| Rate for Payer: Preferred Network Access Commercial |
$831.25
|
| Rate for Payer: Quartz Beloit One Network |
$385.00
|
| Rate for Payer: Quartz Commercial |
$498.75
|
| Rate for Payer: The Alliance Commercial |
$437.50
|
| Rate for Payer: United Healthcare Medicaid |
$67.29
|
| Rate for Payer: WEA Trust Commercial |
$481.25
|
| Rate for Payer: WPS Commercial |
$648.11
|
|
|
Needle EMG of extremity w/nerve conduction study; limited 95885
|
Professional
|
Both
|
$201.00
|
|
|
Service Code
|
CPT 95885
|
| Hospital Charge Code |
3015483
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$42.83 |
| Max. Negotiated Rate |
$227.97 |
| Rate for Payer: Aetna Commercial |
$190.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$172.86
|
| Rate for Payer: Cash Price |
$60.30
|
| Rate for Payer: Cash Price |
$60.30
|
| Rate for Payer: Cash Price |
$60.30
|
| Rate for Payer: Cigna Commercial |
$190.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$42.83
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$120.60
|
| Rate for Payer: Health EOS Commercial |
$182.91
|
| Rate for Payer: HFN Commercial |
$190.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$227.97
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$227.97
|
| Rate for Payer: Multiplan Commercial |
$160.80
|
| Rate for Payer: Preferred Network Access Commercial |
$190.95
|
| Rate for Payer: Quartz Beloit One Network |
$88.44
|
| Rate for Payer: Quartz Commercial |
$114.57
|
| Rate for Payer: The Alliance Commercial |
$100.50
|
| Rate for Payer: United Healthcare Medicaid |
$42.83
|
| Rate for Payer: WEA Trust Commercial |
$110.55
|
| Rate for Payer: WPS Commercial |
$148.88
|
|
|
Needle EMG of extremity w/nerve conduction study; limited 9588526
|
Professional
|
Both
|
$201.00
|
|
|
Service Code
|
CPT 95885 26
|
| Hospital Charge Code |
3015484
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$42.83 |
| Max. Negotiated Rate |
$190.95 |
| Rate for Payer: Aetna Commercial |
$190.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$172.86
|
| Rate for Payer: Cash Price |
$60.30
|
| Rate for Payer: Cash Price |
$60.30
|
| Rate for Payer: Cash Price |
$60.30
|
| Rate for Payer: Cigna Commercial |
$190.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$42.83
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$120.60
|
| Rate for Payer: Health EOS Commercial |
$182.91
|
| Rate for Payer: HFN Commercial |
$190.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$64.35
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$64.35
|
| Rate for Payer: Multiplan Commercial |
$160.80
|
| Rate for Payer: Preferred Network Access Commercial |
$190.95
|
| Rate for Payer: Quartz Beloit One Network |
$88.44
|
| Rate for Payer: Quartz Commercial |
$114.57
|
| Rate for Payer: The Alliance Commercial |
$100.50
|
| Rate for Payer: United Healthcare Medicaid |
$42.83
|
| Rate for Payer: WEA Trust Commercial |
$110.55
|
| Rate for Payer: WPS Commercial |
$148.88
|
|
|
Needle EMG of extremity w/nerve conduction study; limited, BILAT 9588550
|
Professional
|
Both
|
$402.00
|
|
|
Service Code
|
CPT 95885 50
|
| Hospital Charge Code |
6175490
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$42.83 |
| Max. Negotiated Rate |
$381.90 |
| Rate for Payer: Aetna Commercial |
$381.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$345.72
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Cigna Commercial |
$381.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$42.83
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$241.20
|
| Rate for Payer: Health EOS Commercial |
$365.82
|
| Rate for Payer: HFN Commercial |
$381.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$227.97
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$227.97
|
| Rate for Payer: Multiplan Commercial |
$321.60
|
| Rate for Payer: Preferred Network Access Commercial |
$381.90
|
| Rate for Payer: Quartz Beloit One Network |
$176.88
|
| Rate for Payer: Quartz Commercial |
$229.14
|
| Rate for Payer: The Alliance Commercial |
$201.00
|
| Rate for Payer: United Healthcare Medicaid |
$42.83
|
| Rate for Payer: WEA Trust Commercial |
$221.10
|
| Rate for Payer: WPS Commercial |
$297.76
|
|
|
NEEDLE EXPRESSEW II 214141
|
Facility
|
OP
|
$1,917.00
|
|
| Hospital Charge Code |
2965028
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$536.76 |
| Max. Negotiated Rate |
$7,668.00 |
| Rate for Payer: Aetna Commercial |
$1,725.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,648.62
|
| Rate for Payer: Aetna Managed Medicare |
$536.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,246.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$958.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$920.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,016.01
|
| Rate for Payer: Cash Price |
$575.10
|
| Rate for Payer: Cigna Commercial |
$1,763.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,072.75
|
| Rate for Payer: Health EOS Commercial |
$1,706.13
|
| Rate for Payer: HFN Commercial |
$1,763.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,437.75
|
| Rate for Payer: Multiplan Commercial |
$1,533.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,150.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,763.64
|
| Rate for Payer: Quartz Beloit One Network |
$939.33
|
| Rate for Payer: Quartz Commercial |
$1,246.05
|
| Rate for Payer: Quartz Medicare Advantage |
$1,150.20
|
| Rate for Payer: The Alliance Commercial |
$7,668.00
|
| Rate for Payer: WEA Trust Commercial |
$1,054.35
|
| Rate for Payer: WPS Commercial |
$1,419.92
|
|
|
NEEDLE EXPRESSEW II 214141
|
Facility
|
IP
|
$1,917.00
|
|
| Hospital Charge Code |
2965028
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$939.33 |
| Max. Negotiated Rate |
$1,763.64 |
| Rate for Payer: Aetna Commercial |
$1,725.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,648.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,016.01
|
| Rate for Payer: Cash Price |
$575.10
|
| Rate for Payer: Cigna Commercial |
$1,763.64
|
| Rate for Payer: Health EOS Commercial |
$1,706.13
|
| Rate for Payer: HFN Commercial |
$1,763.64
|
| Rate for Payer: Multiplan Commercial |
$1,533.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,150.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,763.64
|
| Rate for Payer: Quartz Beloit One Network |
$939.33
|
| Rate for Payer: Quartz Commercial |
$1,150.20
|
| Rate for Payer: WEA Trust Commercial |
$1,054.35
|
| Rate for Payer: WPS Commercial |
$1,419.92
|
|
|
NEEDLE FISTULA MEDISYSTEM 16GA X 1 D9-2006MG"
|
Facility
|
IP
|
$32.00
|
|
| Hospital Charge Code |
2973051
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.68 |
| Max. Negotiated Rate |
$29.44 |
| Rate for Payer: Aetna Commercial |
$28.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$27.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$16.96
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Cigna Commercial |
$29.44
|
| Rate for Payer: Health EOS Commercial |
$28.48
|
| Rate for Payer: HFN Commercial |
$29.44
|
| Rate for Payer: Multiplan Commercial |
$25.60
|
| Rate for Payer: NAPHCARE Commercial |
$19.20
|
| Rate for Payer: Preferred Network Access Commercial |
$29.44
|
| Rate for Payer: Quartz Beloit One Network |
$15.68
|
| Rate for Payer: Quartz Commercial |
$19.20
|
| Rate for Payer: WEA Trust Commercial |
$17.60
|
| Rate for Payer: WPS Commercial |
$23.70
|
|
|
NEEDLE FISTULA MEDISYSTEM 16GA X 1 D9-2006MG"
|
Facility
|
OP
|
$32.00
|
|
| Hospital Charge Code |
2973051
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.96 |
| Max. Negotiated Rate |
$128.00 |
| Rate for Payer: Aetna Commercial |
$28.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$27.52
|
| Rate for Payer: Aetna Managed Medicare |
$8.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$20.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$16.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$15.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$16.96
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Cigna Commercial |
$29.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$17.91
|
| Rate for Payer: Health EOS Commercial |
$28.48
|
| Rate for Payer: HFN Commercial |
$29.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$24.00
|
| Rate for Payer: Multiplan Commercial |
$25.60
|
| Rate for Payer: NAPHCARE Commercial |
$19.20
|
| Rate for Payer: Preferred Network Access Commercial |
$29.44
|
| Rate for Payer: Quartz Beloit One Network |
$15.68
|
| Rate for Payer: Quartz Commercial |
$20.80
|
| Rate for Payer: Quartz Medicare Advantage |
$19.20
|
| Rate for Payer: The Alliance Commercial |
$128.00
|
| Rate for Payer: WEA Trust Commercial |
$17.60
|
| Rate for Payer: WPS Commercial |
$23.70
|
|
|
NEEDLE FISTULA MEDISYSTEM 17GA X 1 D9-2007MGLB"
|
Facility
|
IP
|
$32.00
|
|
| Hospital Charge Code |
2973052
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.68 |
| Max. Negotiated Rate |
$29.44 |
| Rate for Payer: Aetna Commercial |
$28.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$27.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$16.96
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Cigna Commercial |
$29.44
|
| Rate for Payer: Health EOS Commercial |
$28.48
|
| Rate for Payer: HFN Commercial |
$29.44
|
| Rate for Payer: Multiplan Commercial |
$25.60
|
| Rate for Payer: NAPHCARE Commercial |
$19.20
|
| Rate for Payer: Preferred Network Access Commercial |
$29.44
|
| Rate for Payer: Quartz Beloit One Network |
$15.68
|
| Rate for Payer: Quartz Commercial |
$19.20
|
| Rate for Payer: WEA Trust Commercial |
$17.60
|
| Rate for Payer: WPS Commercial |
$23.70
|
|
