|
NEEDLE EBUS ECHO-HD-22-EBUS-O G52011
|
Facility
|
IP
|
$2,345.00
|
|
| Hospital Charge Code |
5384681
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,195.01 |
| Max. Negotiated Rate |
$2,243.70 |
| Rate for Payer: Aetna Commercial |
$2,194.92
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,097.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,292.56
|
| Rate for Payer: Cash Price |
$703.50
|
| Rate for Payer: Cigna Commercial |
$2,243.70
|
| Rate for Payer: Health EOS Commercial |
$2,170.53
|
| Rate for Payer: HFN Commercial |
$2,243.70
|
| Rate for Payer: Multiplan Commercial |
$1,951.04
|
| Rate for Payer: Preferred Network Access Commercial |
$2,243.70
|
| Rate for Payer: Quartz Beloit One Network |
$1,195.01
|
| Rate for Payer: Quartz Commercial |
$1,463.28
|
| Rate for Payer: WEA Trust Commercial |
$1,341.34
|
| Rate for Payer: WPS Commercial |
$1,806.35
|
|
|
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 |
$25.36 |
| Max. Negotiated Rate |
$553.28 |
| Rate for Payer: Aetna Commercial |
$553.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$500.86
|
| Rate for Payer: Aetna Managed Medicare |
$80.50
|
| Rate for Payer: Anthem Medicare Advantage |
$80.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$80.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$80.50
|
| 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 |
$553.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$25.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$80.50
|
| Rate for Payer: Health EOS Commercial |
$529.98
|
| Rate for Payer: HFN Commercial |
$553.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$295.16
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$295.16
|
| Rate for Payer: Independent Care Health Plan Medicare |
$80.50
|
| Rate for Payer: Multiplan Commercial |
$465.92
|
| Rate for Payer: NAPHCARE Commercial |
$120.74
|
| Rate for Payer: Preferred Network Access Commercial |
$553.28
|
| Rate for Payer: Quartz Beloit One Network |
$256.26
|
| Rate for Payer: Quartz Commercial |
$331.97
|
| Rate for Payer: Quartz Medicare Advantage |
$80.50
|
| Rate for Payer: The Alliance Commercial |
$201.24
|
| Rate for Payer: United Healthcare Medicaid |
$25.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$80.50
|
| Rate for Payer: WEA Trust Commercial |
$320.32
|
| Rate for Payer: WPS Commercial |
$321.98
|
|
|
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 |
$18.54 |
| Max. Negotiated Rate |
$553.28 |
| Rate for Payer: Aetna Commercial |
$553.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$500.86
|
| Rate for Payer: Aetna Managed Medicare |
$19.94
|
| Rate for Payer: Anthem Medicare Advantage |
$19.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$19.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19.94
|
| 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 |
$553.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$18.54
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$19.94
|
| Rate for Payer: Health EOS Commercial |
$529.98
|
| Rate for Payer: HFN Commercial |
$553.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$70.71
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$70.71
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19.94
|
| Rate for Payer: Multiplan Commercial |
$465.92
|
| Rate for Payer: NAPHCARE Commercial |
$29.91
|
| Rate for Payer: Preferred Network Access Commercial |
$553.28
|
| Rate for Payer: Quartz Beloit One Network |
$256.26
|
| Rate for Payer: Quartz Commercial |
$331.97
|
| Rate for Payer: Quartz Medicare Advantage |
$19.94
|
| Rate for Payer: The Alliance Commercial |
$49.84
|
| Rate for Payer: United Healthcare Medicaid |
$18.54
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.94
|
| Rate for Payer: WEA Trust Commercial |
$320.32
|
| Rate for Payer: WPS Commercial |
$79.75
|
|
|
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 |
$62.35 |
| Max. Negotiated Rate |
$581.93 |
| Rate for Payer: Aetna Commercial |
$581.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$526.80
|
| Rate for Payer: Aetna Managed Medicare |
$88.18
|
| Rate for Payer: Anthem Medicare Advantage |
$88.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$88.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$88.18
|
| 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 |
$581.93
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$62.35
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$88.18
|
| Rate for Payer: Health EOS Commercial |
$557.43
|
| Rate for Payer: HFN Commercial |
$581.93
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$314.52
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$314.52
|
| Rate for Payer: Independent Care Health Plan Medicare |
$88.18
|
| Rate for Payer: Multiplan Commercial |
$490.05
|
| Rate for Payer: NAPHCARE Commercial |
$132.27
|
| Rate for Payer: Preferred Network Access Commercial |
$581.93
|
| Rate for Payer: Quartz Beloit One Network |
$269.53
|
| Rate for Payer: Quartz Commercial |
$349.16
|
| Rate for Payer: Quartz Medicare Advantage |
$88.18
|
| Rate for Payer: The Alliance Commercial |
$220.45
|
| Rate for Payer: United Healthcare Medicaid |
$62.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$88.18
|
| Rate for Payer: WEA Trust Commercial |
$336.91
|
| Rate for Payer: WPS Commercial |
$352.73
|
|
|
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 |
$29.90 |
| Max. Negotiated Rate |
$581.93 |
| Rate for Payer: Aetna Commercial |
$581.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$526.80
|
| Rate for Payer: Aetna Managed Medicare |
$37.26
|
| Rate for Payer: Anthem Medicare Advantage |
$37.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$37.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$37.26
|
| 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 |
$581.93
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$29.90
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$37.26
|
| Rate for Payer: Health EOS Commercial |
$557.43
|
| Rate for Payer: HFN Commercial |
$581.93
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$133.48
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$133.48
|
| Rate for Payer: Independent Care Health Plan Medicare |
$37.26
|
| Rate for Payer: Multiplan Commercial |
$490.05
|
| Rate for Payer: NAPHCARE Commercial |
$55.89
|
| Rate for Payer: Preferred Network Access Commercial |
$581.93
|
| Rate for Payer: Quartz Beloit One Network |
$269.53
|
| Rate for Payer: Quartz Commercial |
$349.16
|
| Rate for Payer: Quartz Medicare Advantage |
$37.26
|
| Rate for Payer: The Alliance Commercial |
$93.16
|
| Rate for Payer: United Healthcare Medicaid |
$29.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$37.26
|
| Rate for Payer: WEA Trust Commercial |
$336.91
|
| Rate for Payer: WPS Commercial |
$149.05
|
|
|
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 |
$62.35 |
| Max. Negotiated Rate |
$1,162.88 |
| Rate for Payer: Aetna Commercial |
$1,162.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,052.71
|
| 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 |
$1,162.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$62.35
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$734.45
|
| Rate for Payer: Health EOS Commercial |
$1,113.91
|
| Rate for Payer: HFN Commercial |
$1,162.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$314.52
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$314.52
|
| Rate for Payer: Multiplan Commercial |
$979.26
|
| Rate for Payer: Preferred Network Access Commercial |
$1,162.88
|
| Rate for Payer: Quartz Beloit One Network |
$538.60
|
| Rate for Payer: Quartz Commercial |
$697.73
|
| Rate for Payer: The Alliance Commercial |
$612.04
|
| Rate for Payer: United Healthcare Medicaid |
$62.35
|
| Rate for Payer: WEA Trust Commercial |
$673.24
|
| Rate for Payer: WPS Commercial |
$906.64
|
|
|
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 |
$69.98 |
| Max. Negotiated Rate |
$432.74 |
| Rate for Payer: Aetna Commercial |
$432.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$391.75
|
| Rate for Payer: Aetna Managed Medicare |
$100.05
|
| Rate for Payer: Anthem Medicare Advantage |
$100.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$100.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$100.05
|
| 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 |
$432.74
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$69.98
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$100.05
|
| Rate for Payer: Health EOS Commercial |
$414.52
|
| Rate for Payer: HFN Commercial |
$432.74
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$363.89
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$363.89
|
| Rate for Payer: Independent Care Health Plan Medicare |
$100.05
|
| Rate for Payer: Multiplan Commercial |
$364.42
|
| Rate for Payer: NAPHCARE Commercial |
$150.07
|
| Rate for Payer: Preferred Network Access Commercial |
$432.74
|
| Rate for Payer: Quartz Beloit One Network |
$200.43
|
| Rate for Payer: Quartz Commercial |
$259.65
|
| Rate for Payer: Quartz Medicare Advantage |
$100.05
|
| Rate for Payer: The Alliance Commercial |
$250.12
|
| Rate for Payer: United Healthcare Medicaid |
$69.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$100.05
|
| Rate for Payer: WEA Trust Commercial |
$250.54
|
| Rate for Payer: WPS Commercial |
$400.19
|
|
|
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 |
$38.07 |
| Max. Negotiated Rate |
$358.64 |
| Rate for Payer: Aetna Commercial |
$358.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$324.67
|
| Rate for Payer: Aetna Managed Medicare |
$45.80
|
| Rate for Payer: Anthem Medicare Advantage |
$45.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$45.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$45.80
|
| 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 |
$358.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$38.07
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$45.80
|
| Rate for Payer: Health EOS Commercial |
$343.54
|
| Rate for Payer: HFN Commercial |
$358.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$163.55
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$163.55
|
| Rate for Payer: Independent Care Health Plan Medicare |
$45.80
|
| Rate for Payer: Multiplan Commercial |
$302.02
|
| Rate for Payer: NAPHCARE Commercial |
$68.70
|
| Rate for Payer: Preferred Network Access Commercial |
$358.64
|
| Rate for Payer: Quartz Beloit One Network |
$166.11
|
| Rate for Payer: Quartz Commercial |
$215.19
|
| Rate for Payer: Quartz Medicare Advantage |
$45.80
|
| Rate for Payer: The Alliance Commercial |
$114.50
|
| Rate for Payer: United Healthcare Medicaid |
$38.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$45.80
|
| Rate for Payer: WEA Trust Commercial |
$207.64
|
| Rate for Payer: WPS Commercial |
$183.21
|
|
|
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 |
$69.98 |
| Max. Negotiated Rate |
$864.50 |
| Rate for Payer: Aetna Commercial |
$864.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$782.60
|
| 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 |
$864.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$69.98
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$546.00
|
| Rate for Payer: Health EOS Commercial |
$828.10
|
| Rate for Payer: HFN Commercial |
$864.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$363.89
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$363.89
|
| Rate for Payer: Multiplan Commercial |
$728.00
|
| Rate for Payer: Preferred Network Access Commercial |
$864.50
|
| Rate for Payer: Quartz Beloit One Network |
$400.40
|
| Rate for Payer: Quartz Commercial |
$518.70
|
| Rate for Payer: The Alliance Commercial |
$455.00
|
| Rate for Payer: United Healthcare Medicaid |
$69.98
|
| Rate for Payer: WEA Trust Commercial |
$500.50
|
| Rate for Payer: WPS Commercial |
$674.01
|
|
|
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 |
$44.54 |
| Max. Negotiated Rate |
$258.00 |
| Rate for Payer: Aetna Commercial |
$198.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$179.77
|
| Rate for Payer: Aetna Managed Medicare |
$64.50
|
| Rate for Payer: Anthem Medicare Advantage |
$64.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$64.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$64.50
|
| 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 |
$198.59
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$44.54
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$64.50
|
| Rate for Payer: Health EOS Commercial |
$190.23
|
| Rate for Payer: HFN Commercial |
$198.59
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$237.09
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$237.09
|
| Rate for Payer: Independent Care Health Plan Medicare |
$64.50
|
| Rate for Payer: Multiplan Commercial |
$167.23
|
| Rate for Payer: NAPHCARE Commercial |
$96.75
|
| Rate for Payer: Preferred Network Access Commercial |
$198.59
|
| Rate for Payer: Quartz Beloit One Network |
$91.98
|
| Rate for Payer: Quartz Commercial |
$119.15
|
| Rate for Payer: Quartz Medicare Advantage |
$64.50
|
| Rate for Payer: The Alliance Commercial |
$161.25
|
| Rate for Payer: United Healthcare Medicaid |
$44.54
|
| Rate for Payer: United Healthcare Medicare Advantage |
$64.50
|
| Rate for Payer: WEA Trust Commercial |
$114.97
|
| Rate for Payer: WPS Commercial |
$258.00
|
|
|
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 |
$14.26 |
| Max. Negotiated Rate |
$198.59 |
| Rate for Payer: Aetna Commercial |
$198.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$179.77
|
| Rate for Payer: Aetna Managed Medicare |
$18.57
|
| Rate for Payer: Anthem Medicare Advantage |
$18.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18.57
|
| 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 |
$198.59
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$14.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$18.57
|
| Rate for Payer: Health EOS Commercial |
$190.23
|
| Rate for Payer: HFN Commercial |
$198.59
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$66.92
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$66.92
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18.57
|
| Rate for Payer: Multiplan Commercial |
$167.23
|
| Rate for Payer: NAPHCARE Commercial |
$27.86
|
| Rate for Payer: Preferred Network Access Commercial |
$198.59
|
| Rate for Payer: Quartz Beloit One Network |
$91.98
|
| Rate for Payer: Quartz Commercial |
$119.15
|
| Rate for Payer: Quartz Medicare Advantage |
$18.57
|
| Rate for Payer: The Alliance Commercial |
$46.44
|
| Rate for Payer: United Healthcare Medicaid |
$14.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.57
|
| Rate for Payer: WEA Trust Commercial |
$114.97
|
| Rate for Payer: WPS Commercial |
$74.30
|
|
|
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 |
$44.54 |
| Max. Negotiated Rate |
$397.18 |
| Rate for Payer: Aetna Commercial |
$397.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$359.55
|
| 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 |
$397.18
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$44.54
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$250.85
|
| Rate for Payer: Health EOS Commercial |
$380.45
|
| Rate for Payer: HFN Commercial |
$397.18
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$237.09
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$237.09
|
| Rate for Payer: Multiplan Commercial |
$334.46
|
| Rate for Payer: Preferred Network Access Commercial |
$397.18
|
| Rate for Payer: Quartz Beloit One Network |
$183.96
|
| Rate for Payer: Quartz Commercial |
$238.31
|
| Rate for Payer: The Alliance Commercial |
$209.04
|
| Rate for Payer: United Healthcare Medicaid |
$44.54
|
| Rate for Payer: WEA Trust Commercial |
$229.94
|
| Rate for Payer: WPS Commercial |
$309.66
|
|
|
NEEDLE EXPRESSEW II 214141
|
Facility
|
OP
|
$1,917.00
|
|
| Hospital Charge Code |
2965028
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$558.23 |
| Max. Negotiated Rate |
$1,834.19 |
| Rate for Payer: Aetna Commercial |
$1,794.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,714.56
|
| Rate for Payer: Aetna Managed Medicare |
$558.23
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,295.89
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$996.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$956.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,056.65
|
| Rate for Payer: Cash Price |
$575.10
|
| Rate for Payer: Cigna Commercial |
$1,834.19
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,115.69
|
| Rate for Payer: Health EOS Commercial |
$1,774.38
|
| Rate for Payer: HFN Commercial |
$1,834.19
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,495.26
|
| Rate for Payer: Multiplan Commercial |
$1,594.94
|
| Rate for Payer: NAPHCARE Commercial |
$1,196.21
|
| Rate for Payer: Preferred Network Access Commercial |
$1,834.19
|
| Rate for Payer: Quartz Beloit One Network |
$976.90
|
| Rate for Payer: Quartz Commercial |
$1,295.89
|
| Rate for Payer: Quartz Medicare Advantage |
$1,196.21
|
| Rate for Payer: The Alliance Commercial |
$996.84
|
| Rate for Payer: WEA Trust Commercial |
$1,096.52
|
| Rate for Payer: WPS Commercial |
$1,476.67
|
|
|
NEEDLE EXPRESSEW II 214141
|
Facility
|
IP
|
$1,917.00
|
|
| Hospital Charge Code |
2965028
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$976.90 |
| Max. Negotiated Rate |
$1,834.19 |
| Rate for Payer: Aetna Commercial |
$1,794.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,714.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,056.65
|
| Rate for Payer: Cash Price |
$575.10
|
| Rate for Payer: Cigna Commercial |
$1,834.19
|
| Rate for Payer: Health EOS Commercial |
$1,774.38
|
| Rate for Payer: HFN Commercial |
$1,834.19
|
| Rate for Payer: Multiplan Commercial |
$1,594.94
|
| Rate for Payer: Preferred Network Access Commercial |
$1,834.19
|
| Rate for Payer: Quartz Beloit One Network |
$976.90
|
| Rate for Payer: Quartz Commercial |
$1,196.21
|
| Rate for Payer: WEA Trust Commercial |
$1,096.52
|
| Rate for Payer: WPS Commercial |
$1,476.67
|
|
|
NEEDLE FISTULA MEDISYSTEM 16GA X 1 D9-2006MG"
|
Facility
|
IP
|
$32.00
|
|
| Hospital Charge Code |
2973051
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.31 |
| Max. Negotiated Rate |
$30.62 |
| Rate for Payer: Aetna Commercial |
$29.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$28.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$17.64
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Cigna Commercial |
$30.62
|
| Rate for Payer: Health EOS Commercial |
$29.62
|
| Rate for Payer: HFN Commercial |
$30.62
|
| Rate for Payer: Multiplan Commercial |
$26.62
|
| Rate for Payer: Preferred Network Access Commercial |
$30.62
|
| Rate for Payer: Quartz Beloit One Network |
$16.31
|
| Rate for Payer: Quartz Commercial |
$19.97
|
| Rate for Payer: WEA Trust Commercial |
$18.30
|
| Rate for Payer: WPS Commercial |
$24.65
|
|
|
NEEDLE FISTULA MEDISYSTEM 16GA X 1 D9-2006MG"
|
Facility
|
OP
|
$32.00
|
|
| Hospital Charge Code |
2973051
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.32 |
| Max. Negotiated Rate |
$30.62 |
| Rate for Payer: Aetna Commercial |
$29.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$28.62
|
| Rate for Payer: Aetna Managed Medicare |
$9.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$21.63
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$16.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$15.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$17.64
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Cigna Commercial |
$30.62
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$18.62
|
| Rate for Payer: Health EOS Commercial |
$29.62
|
| Rate for Payer: HFN Commercial |
$30.62
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$24.96
|
| Rate for Payer: Multiplan Commercial |
$26.62
|
| Rate for Payer: NAPHCARE Commercial |
$19.97
|
| Rate for Payer: Preferred Network Access Commercial |
$30.62
|
| Rate for Payer: Quartz Beloit One Network |
$16.31
|
| Rate for Payer: Quartz Commercial |
$21.63
|
| Rate for Payer: Quartz Medicare Advantage |
$19.97
|
| Rate for Payer: The Alliance Commercial |
$16.64
|
| Rate for Payer: WEA Trust Commercial |
$18.30
|
| Rate for Payer: WPS Commercial |
$24.65
|
|
|
NEEDLE FISTULA MEDISYSTEM 17GA X 1 D9-2007MGLB"
|
Facility
|
IP
|
$32.00
|
|
| Hospital Charge Code |
2973052
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.31 |
| Max. Negotiated Rate |
$30.62 |
| Rate for Payer: Aetna Commercial |
$29.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$28.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$17.64
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Cigna Commercial |
$30.62
|
| Rate for Payer: Health EOS Commercial |
$29.62
|
| Rate for Payer: HFN Commercial |
$30.62
|
| Rate for Payer: Multiplan Commercial |
$26.62
|
| Rate for Payer: Preferred Network Access Commercial |
$30.62
|
| Rate for Payer: Quartz Beloit One Network |
$16.31
|
| Rate for Payer: Quartz Commercial |
$19.97
|
| Rate for Payer: WEA Trust Commercial |
$18.30
|
| Rate for Payer: WPS Commercial |
$24.65
|
|
|
NEEDLE FISTULA MEDISYSTEM 17GA X 1 D9-2007MGLB"
|
Facility
|
OP
|
$32.00
|
|
| Hospital Charge Code |
2973052
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.32 |
| Max. Negotiated Rate |
$30.62 |
| Rate for Payer: Aetna Commercial |
$29.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$28.62
|
| Rate for Payer: Aetna Managed Medicare |
$9.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$21.63
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$16.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$15.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$17.64
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Cigna Commercial |
$30.62
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$18.62
|
| Rate for Payer: Health EOS Commercial |
$29.62
|
| Rate for Payer: HFN Commercial |
$30.62
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$24.96
|
| Rate for Payer: Multiplan Commercial |
$26.62
|
| Rate for Payer: NAPHCARE Commercial |
$19.97
|
| Rate for Payer: Preferred Network Access Commercial |
$30.62
|
| Rate for Payer: Quartz Beloit One Network |
$16.31
|
| Rate for Payer: Quartz Commercial |
$21.63
|
| Rate for Payer: Quartz Medicare Advantage |
$19.97
|
| Rate for Payer: The Alliance Commercial |
$16.64
|
| Rate for Payer: WEA Trust Commercial |
$18.30
|
| Rate for Payer: WPS Commercial |
$24.65
|
|
|
NEEDLE FORAMEN 5.0 X 18.5G INTERSTIM 041839
|
Facility
|
IP
|
$1,597.00
|
|
| Hospital Charge Code |
5603702
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$813.83 |
| Max. Negotiated Rate |
$1,528.01 |
| Rate for Payer: Aetna Commercial |
$1,494.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,428.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$880.27
|
| Rate for Payer: Cash Price |
$479.10
|
| Rate for Payer: Cigna Commercial |
$1,528.01
|
| Rate for Payer: Health EOS Commercial |
$1,478.18
|
| Rate for Payer: HFN Commercial |
$1,528.01
|
| Rate for Payer: Multiplan Commercial |
$1,328.70
|
| Rate for Payer: Preferred Network Access Commercial |
$1,528.01
|
| Rate for Payer: Quartz Beloit One Network |
$813.83
|
| Rate for Payer: Quartz Commercial |
$996.53
|
| Rate for Payer: WEA Trust Commercial |
$913.48
|
| Rate for Payer: WPS Commercial |
$1,230.17
|
|
|
NEEDLE FORAMEN 5.0 X 18.5G INTERSTIM 041839
|
Facility
|
OP
|
$1,597.00
|
|
| Hospital Charge Code |
5603702
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$465.05 |
| Max. Negotiated Rate |
$1,528.01 |
| Rate for Payer: Aetna Commercial |
$1,494.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,428.36
|
| Rate for Payer: Aetna Managed Medicare |
$465.05
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,079.57
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$830.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$797.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$880.27
|
| Rate for Payer: Cash Price |
$479.10
|
| Rate for Payer: Cigna Commercial |
$1,528.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$929.45
|
| Rate for Payer: Health EOS Commercial |
$1,478.18
|
| Rate for Payer: HFN Commercial |
$1,528.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,245.66
|
| Rate for Payer: Multiplan Commercial |
$1,328.70
|
| Rate for Payer: NAPHCARE Commercial |
$996.53
|
| Rate for Payer: Preferred Network Access Commercial |
$1,528.01
|
| Rate for Payer: Quartz Beloit One Network |
$813.83
|
| Rate for Payer: Quartz Commercial |
$1,079.57
|
| Rate for Payer: Quartz Medicare Advantage |
$996.53
|
| Rate for Payer: The Alliance Commercial |
$830.44
|
| Rate for Payer: WEA Trust Commercial |
$913.48
|
| Rate for Payer: WPS Commercial |
$1,230.17
|
|
|
NEEDLE FRENCH SPRING 1/2 CIR SIZE 3 1862
|
Facility
|
IP
|
$150.00
|
|
| Hospital Charge Code |
4400974
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$76.44 |
| Max. Negotiated Rate |
$143.52 |
| Rate for Payer: Aetna Commercial |
$140.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$134.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$82.68
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cigna Commercial |
$143.52
|
| Rate for Payer: Health EOS Commercial |
$138.84
|
| Rate for Payer: HFN Commercial |
$143.52
|
| Rate for Payer: Multiplan Commercial |
$124.80
|
| Rate for Payer: Preferred Network Access Commercial |
$143.52
|
| Rate for Payer: Quartz Beloit One Network |
$76.44
|
| Rate for Payer: Quartz Commercial |
$93.60
|
| Rate for Payer: WEA Trust Commercial |
$85.80
|
| Rate for Payer: WPS Commercial |
$115.55
|
|
|
NEEDLE FRENCH SPRING 1/2 CIR SIZE 3 1862
|
Facility
|
OP
|
$150.00
|
|
| Hospital Charge Code |
4400974
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$43.68 |
| Max. Negotiated Rate |
$143.52 |
| Rate for Payer: Aetna Commercial |
$140.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$134.16
|
| Rate for Payer: Aetna Managed Medicare |
$43.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$101.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$78.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$74.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$82.68
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cigna Commercial |
$143.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$87.30
|
| Rate for Payer: Health EOS Commercial |
$138.84
|
| Rate for Payer: HFN Commercial |
$143.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$117.00
|
| Rate for Payer: Multiplan Commercial |
$124.80
|
| Rate for Payer: NAPHCARE Commercial |
$93.60
|
| Rate for Payer: Preferred Network Access Commercial |
$143.52
|
| Rate for Payer: Quartz Beloit One Network |
$76.44
|
| Rate for Payer: Quartz Commercial |
$101.40
|
| Rate for Payer: Quartz Medicare Advantage |
$93.60
|
| Rate for Payer: The Alliance Commercial |
$78.00
|
| Rate for Payer: WEA Trust Commercial |
$85.80
|
| Rate for Payer: WPS Commercial |
$115.55
|
|
|
NEEDLE GUIDE SONOSITE L25 21G 58 PROBE COVER & GEL STERILE P09073-01
|
Facility
|
OP
|
$447.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
6201017
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$130.17 |
| Max. Negotiated Rate |
$427.69 |
| Rate for Payer: Aetna Commercial |
$418.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$399.80
|
| Rate for Payer: Aetna Managed Medicare |
$130.17
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$302.17
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$232.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$223.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$246.39
|
| Rate for Payer: Cash Price |
$134.10
|
| Rate for Payer: Cigna Commercial |
$427.69
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$260.15
|
| Rate for Payer: Health EOS Commercial |
$413.74
|
| Rate for Payer: HFN Commercial |
$427.69
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$348.66
|
| Rate for Payer: Multiplan Commercial |
$371.90
|
| Rate for Payer: NAPHCARE Commercial |
$278.93
|
| Rate for Payer: Preferred Network Access Commercial |
$427.69
|
| Rate for Payer: Quartz Beloit One Network |
$227.79
|
| Rate for Payer: Quartz Commercial |
$302.17
|
| Rate for Payer: Quartz Medicare Advantage |
$278.93
|
| Rate for Payer: The Alliance Commercial |
$232.44
|
| Rate for Payer: WEA Trust Commercial |
$255.68
|
| Rate for Payer: WPS Commercial |
$344.32
|
|
|
NEEDLE GUIDE SONOSITE L25 21G 58 PROBE COVER & GEL STERILE P09073-01
|
Facility
|
IP
|
$447.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
6201017
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$227.79 |
| Max. Negotiated Rate |
$427.69 |
| Rate for Payer: Aetna Commercial |
$418.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$399.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$246.39
|
| Rate for Payer: Cash Price |
$134.10
|
| Rate for Payer: Cigna Commercial |
$427.69
|
| Rate for Payer: Health EOS Commercial |
$413.74
|
| Rate for Payer: HFN Commercial |
$427.69
|
| Rate for Payer: Multiplan Commercial |
$371.90
|
| Rate for Payer: Preferred Network Access Commercial |
$427.69
|
| Rate for Payer: Quartz Beloit One Network |
$227.79
|
| Rate for Payer: Quartz Commercial |
$278.93
|
| Rate for Payer: WEA Trust Commercial |
$255.68
|
| Rate for Payer: WPS Commercial |
$344.32
|
|
|
NEEDLE HD SCORPION WITH MEGALOADER AR-13999HDN
|
Facility
|
OP
|
$1,936.00
|
|
| Hospital Charge Code |
6226159
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$563.76 |
| Max. Negotiated Rate |
$1,852.36 |
| Rate for Payer: Aetna Commercial |
$1,812.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,731.56
|
| Rate for Payer: Aetna Managed Medicare |
$563.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,308.74
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,006.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$966.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,067.12
|
| Rate for Payer: Cash Price |
$580.80
|
| Rate for Payer: Cigna Commercial |
$1,852.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,126.75
|
| Rate for Payer: Health EOS Commercial |
$1,791.96
|
| Rate for Payer: HFN Commercial |
$1,852.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,510.08
|
| Rate for Payer: Multiplan Commercial |
$1,610.75
|
| Rate for Payer: NAPHCARE Commercial |
$1,208.06
|
| Rate for Payer: Preferred Network Access Commercial |
$1,852.36
|
| Rate for Payer: Quartz Beloit One Network |
$986.59
|
| Rate for Payer: Quartz Commercial |
$1,308.74
|
| Rate for Payer: Quartz Medicare Advantage |
$1,208.06
|
| Rate for Payer: The Alliance Commercial |
$1,006.72
|
| Rate for Payer: WEA Trust Commercial |
$1,107.39
|
| Rate for Payer: WPS Commercial |
$1,491.30
|
|
