Scott County Hospital Inc.

All Charges

Charge

Type

Setting

Price

95861 NEEDLE ELECTROMYOGRAPHY;2 EXTREMITIES WITH OR WITHOUT RELATED PARASPINAL AREAS

Facility

$353.00

Service Code	HCPCS 95861
Hospital Charge Code	3955861
Hospital Revenue Code	922
Min. Negotiated Rate	$89.78
Max. Negotiated Rate	$335.35
Rate for Payer: Aetna Commercial	$317.70
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$242.40
Rate for Payer: Humana Medicare Advantage	$148.26
Rate for Payer: UnitedHealthcare Commercial	$335.35
Rate for Payer: UnitedHealthcare Medicaid	$89.78
Rate for Payer: WPPA Medicare Advantage	$211.80

95861 NEEDLE ELECTROMYOGRAPHY;2 EXTREMITIES WITH OR WITHOUT RELATED PARASPINAL AREAS

Facility

$353.00

Service Code	HCPCS 95861
Hospital Charge Code	3955861
Hospital Revenue Code	922
Min. Negotiated Rate	$317.70
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$317.70
Rate for Payer: UnitedHealthcare Commercial	$335.35
Rate for Payer: WPPA Medicare Advantage	$1,200.00

95863 NEEDLE ELECTROMYOGRAPHY;3 EXTREMITIES WITH OR WITHOUT RELATED PARASPINAL AREAS

Facility

$401.00

Service Code	HCPCS 95863
Hospital Charge Code	3955863
Hospital Revenue Code	922
Min. Negotiated Rate	$79.42
Max. Negotiated Rate	$380.95
Rate for Payer: Aetna Commercial	$360.90
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$275.73
Rate for Payer: Humana Medicare Advantage	$168.42
Rate for Payer: UnitedHealthcare Commercial	$380.95
Rate for Payer: UnitedHealthcare Medicaid	$79.42
Rate for Payer: WPPA Medicare Advantage	$240.60

95863 NEEDLE ELECTROMYOGRAPHY;3 EXTREMITIES WITH OR WITHOUT RELATED PARASPINAL AREAS

Facility

$401.00

Service Code	HCPCS 95863
Hospital Charge Code	3955863
Hospital Revenue Code	922
Min. Negotiated Rate	$360.90
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$360.90
Rate for Payer: UnitedHealthcare Commercial	$380.95
Rate for Payer: WPPA Medicare Advantage	$1,200.00

95864 NEEDLE ELECTROMYOGRAPHY;4 EXTREMITIES WITH OR WITHOUT RELATED PARASPINAL AREAS

Facility

$426.00

Service Code	HCPCS 95864
Hospital Charge Code	3955864
Hospital Revenue Code	922
Min. Negotiated Rate	$103.79
Max. Negotiated Rate	$404.70
Rate for Payer: Aetna Commercial	$383.40
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$292.90
Rate for Payer: Humana Medicare Advantage	$178.92
Rate for Payer: UnitedHealthcare Commercial	$404.70
Rate for Payer: UnitedHealthcare Medicaid	$103.79
Rate for Payer: WPPA Medicare Advantage	$255.60

95864 NEEDLE ELECTROMYOGRAPHY;4 EXTREMITIES WITH OR WITHOUT RELATED PARASPINAL AREAS

Facility

$426.00

Service Code	HCPCS 95864
Hospital Charge Code	3955864
Hospital Revenue Code	922
Min. Negotiated Rate	$383.40
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$383.40
Rate for Payer: UnitedHealthcare Commercial	$404.70
Rate for Payer: WPPA Medicare Advantage	$1,200.00

95874 Needle electromyography for guidance in conjunction with chemodenervation

Facility

$233.00

Service Code	HCPCS 95874
Hospital Charge Code	3355874
Hospital Revenue Code	761
Min. Negotiated Rate	$209.70
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$209.70
Rate for Payer: UnitedHealthcare Commercial	$221.35
Rate for Payer: WPPA Medicare Advantage	$1,200.00

95874 Needle electromyography for guidance in conjunction with chemodenervation

Facility

$233.00

Service Code	HCPCS 95874
Hospital Charge Code	3355874
Hospital Revenue Code	761
Min. Negotiated Rate	$93.20
Max. Negotiated Rate	$221.35
Rate for Payer: Aetna Commercial	$209.70
Rate for Payer: Humana Medicare Advantage	$97.86
Rate for Payer: UnitedHealthcare Commercial	$221.35
Rate for Payer: UnitedHealthcare Medicaid	$93.20
Rate for Payer: WPPA Medicare Advantage	$139.80

95886 EMG Muscle with NCV Combined

Facility

$426.00

Service Code	HCPCS 95886
Hospital Charge Code	3955886
Hospital Revenue Code	922
Min. Negotiated Rate	$383.40
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$383.40
Rate for Payer: UnitedHealthcare Commercial	$404.70
Rate for Payer: WPPA Medicare Advantage	$1,200.00

95886 EMG Muscle with NCV Combined

Facility

$426.00

Service Code	HCPCS 95886
Hospital Charge Code	3955886
Hospital Revenue Code	922
Min. Negotiated Rate	$56.86
Max. Negotiated Rate	$404.70
Rate for Payer: Aetna Commercial	$383.40
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$292.90
Rate for Payer: Humana Medicare Advantage	$178.92
Rate for Payer: UnitedHealthcare Commercial	$404.70
Rate for Payer: UnitedHealthcare Medicaid	$56.86
Rate for Payer: WPPA Medicare Advantage	$255.60

95907 PT NERVE CONDUCTION 1-2 STUDIES CHARGE

Facility

$233.00

Service Code	HCPCS 95907
Hospital Charge Code	3955907
Hospital Revenue Code	922
Min. Negotiated Rate	$29.14
Max. Negotiated Rate	$221.35
Rate for Payer: Aetna Commercial	$209.70
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$127.26
Rate for Payer: Humana Medicare Advantage	$97.86
Rate for Payer: UnitedHealthcare Commercial	$221.35
Rate for Payer: UnitedHealthcare Medicaid	$29.14
Rate for Payer: WPPA Medicare Advantage	$139.80

95907 PT NERVE CONDUCTION 1-2 STUDIES CHARGE

Facility

$233.00

Service Code	HCPCS 95907
Hospital Charge Code	3955907
Hospital Revenue Code	922
Min. Negotiated Rate	$209.70
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$209.70
Rate for Payer: UnitedHealthcare Commercial	$221.35
Rate for Payer: WPPA Medicare Advantage	$1,200.00

95908 PT NERVE CONDUCTION 3-4 STUDIES CHARGES

Facility

$459.00

Service Code	HCPCS 95908
Hospital Charge Code	3955908
Hospital Revenue Code	922
Min. Negotiated Rate	$413.10
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$413.10
Rate for Payer: UnitedHealthcare Commercial	$436.05
Rate for Payer: WPPA Medicare Advantage	$1,200.00

95908 PT NERVE CONDUCTION 3-4 STUDIES CHARGES

Facility

$459.00

Service Code	HCPCS 95908
Hospital Charge Code	3955908
Hospital Revenue Code	922
Min. Negotiated Rate	$107.34
Max. Negotiated Rate	$436.05
Rate for Payer: Aetna Commercial	$413.10
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$254.52
Rate for Payer: Humana Medicare Advantage	$192.78
Rate for Payer: UnitedHealthcare Commercial	$436.05
Rate for Payer: UnitedHealthcare Medicaid	$107.34
Rate for Payer: WPPA Medicare Advantage	$275.40

95909 PT NERVE CONDUCTION 5-6 STUDIES CHARGES

Facility

$684.00

Service Code	HCPCS 95909
Hospital Charge Code	3955909
Hospital Revenue Code	922
Min. Negotiated Rate	$170.56
Max. Negotiated Rate	$649.80
Rate for Payer: Aetna Commercial	$615.60
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$381.78
Rate for Payer: Humana Medicare Advantage	$287.28
Rate for Payer: UnitedHealthcare Commercial	$649.80
Rate for Payer: UnitedHealthcare Medicaid	$170.56
Rate for Payer: WPPA Medicare Advantage	$410.40

95909 PT NERVE CONDUCTION 5-6 STUDIES CHARGES

Facility

$684.00

Service Code	HCPCS 95909
Hospital Charge Code	3955909
Hospital Revenue Code	922
Min. Negotiated Rate	$615.60
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$615.60
Rate for Payer: UnitedHealthcare Commercial	$649.80
Rate for Payer: WPPA Medicare Advantage	$1,200.00

95910 PT NERVE CONDUCTION 7-8 STUDIES CHARGES

Facility

$908.00

Service Code	HCPCS 95910
Hospital Charge Code	3955910
Hospital Revenue Code	922
Min. Negotiated Rate	$70.88
Max. Negotiated Rate	$862.60
Rate for Payer: Aetna Commercial	$817.20
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$509.04
Rate for Payer: Humana Medicare Advantage	$381.36
Rate for Payer: UnitedHealthcare Commercial	$862.60
Rate for Payer: UnitedHealthcare Medicaid	$70.88
Rate for Payer: WPPA Medicare Advantage	$544.80

95910 PT NERVE CONDUCTION 7-8 STUDIES CHARGES

Facility

$908.00

Service Code	HCPCS 95910
Hospital Charge Code	3955910
Hospital Revenue Code	922
Min. Negotiated Rate	$817.20
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$817.20
Rate for Payer: UnitedHealthcare Commercial	$862.60
Rate for Payer: WPPA Medicare Advantage	$1,200.00

95913 PT NERVE CONDUCTION 13+ STUDIES CHARGES

Facility

$1,514.00

Service Code	HCPCS 95913
Hospital Charge Code	3955913
Hospital Revenue Code	922
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$1,438.30
Rate for Payer: Aetna Commercial	$1,362.60
Rate for Payer: UnitedHealthcare Commercial	$1,438.30
Rate for Payer: WPPA Medicare Advantage	$1,200.00

95913 PT NERVE CONDUCTION 13+ STUDIES CHARGES

Facility

$1,514.00

Service Code	HCPCS 95913
Hospital Charge Code	3955913
Hospital Revenue Code	922
Min. Negotiated Rate	$173.63
Max. Negotiated Rate	$1,438.30
Rate for Payer: Aetna Commercial	$1,362.60
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$890.82
Rate for Payer: Humana Medicare Advantage	$635.88
Rate for Payer: UnitedHealthcare Commercial	$1,438.30
Rate for Payer: UnitedHealthcare Medicaid	$173.63
Rate for Payer: WPPA Medicare Advantage	$908.40

95971 Electronic analysis SIMPLE SPINAL CORD/PERIPHERAL neurostimulator; w/ program

Facility

$182.00

Service Code	HCPCS 95971
Hospital Charge Code	3355971
Hospital Revenue Code	761
Min. Negotiated Rate	$76.44
Max. Negotiated Rate	$172.90
Rate for Payer: Aetna Commercial	$163.80
Rate for Payer: Humana Medicare Advantage	$76.44
Rate for Payer: UnitedHealthcare Commercial	$172.90
Rate for Payer: UnitedHealthcare Medicaid	$82.89
Rate for Payer: WPPA Medicare Advantage	$109.20

95971 Electronic analysis SIMPLE SPINAL CORD/PERIPHERAL neurostimulator; w/ program

Facility

$182.00

Service Code	HCPCS 95971
Hospital Charge Code	3355971
Hospital Revenue Code	761
Min. Negotiated Rate	$163.80
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$163.80
Rate for Payer: UnitedHealthcare Commercial	$172.90
Rate for Payer: WPPA Medicare Advantage	$1,200.00

95976 Pro Fee Electro analysis neuro w/ Programing;

Facility

$97.00

Service Code	HCPCS 95976
Hospital Charge Code	3365976
Hospital Revenue Code	761
Min. Negotiated Rate	$87.30
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$87.30
Rate for Payer: UnitedHealthcare Commercial	$92.15
Rate for Payer: WPPA Medicare Advantage	$1,200.00

95976 Pro Fee Electro analysis neuro w/ Programing;

Facility

$97.00

Service Code	HCPCS 95976
Hospital Charge Code	3365976
Hospital Revenue Code	761
Min. Negotiated Rate	$26.57
Max. Negotiated Rate	$92.15
Rate for Payer: Aetna Commercial	$87.30
Rate for Payer: Humana Medicare Advantage	$40.74
Rate for Payer: UnitedHealthcare Commercial	$92.15
Rate for Payer: UnitedHealthcare Medicaid	$26.57
Rate for Payer: WPPA Medicare Advantage	$58.20

95976 Simple cranial nerve neurostimulator pulse generator/transmitter programming

Facility

$275.00

Service Code	HCPCS 95976
Hospital Charge Code	3355976
Hospital Revenue Code	761
Min. Negotiated Rate	$247.50
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$247.50
Rate for Payer: UnitedHealthcare Commercial	$261.25
Rate for Payer: WPPA Medicare Advantage	$1,200.00

Know your out-of-pocket cost for care.

All Charges