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Charge Type Price  
Service Code CPT 87807
Hospital Charge Code Z13005
Min. Negotiated Rate $10.51
Max. Negotiated Rate $31.44
Rate for Payer: Coventry/First Health All Products $31.44
Rate for Payer: Frontpath All Products $13.10
Rate for Payer: Humana ChoiceCare $26.20
Rate for Payer: Lutheran Preferred All Products $18.00
Rate for Payer: PHCS/Multiplan All Products $19.65
Rate for Payer: PHP All Products $11.53
Rate for Payer: Signature Care EPO $15.30
Rate for Payer: Signature Care PPO $15.30
Rate for Payer: Three Rivers Preferred All Products $17.00
Rate for Payer: United Healthcare Commercial $10.51
Service Code CPT 87807
Hospital Charge Code Z13004
Min. Negotiated Rate $10.51
Max. Negotiated Rate $31.44
Rate for Payer: Coventry/First Health All Products $31.44
Rate for Payer: Frontpath All Products $13.10
Rate for Payer: Humana ChoiceCare $26.20
Rate for Payer: Lutheran Preferred All Products $18.00
Rate for Payer: PHCS/Multiplan All Products $19.65
Rate for Payer: PHP All Products $11.53
Rate for Payer: Signature Care EPO $15.30
Rate for Payer: Signature Care PPO $15.30
Rate for Payer: Three Rivers Preferred All Products $17.00
Rate for Payer: United Healthcare Commercial $10.51
Service Code CPT 87880
Hospital Charge Code Z13006
Min. Negotiated Rate $14.55
Max. Negotiated Rate $39.67
Rate for Payer: Coventry/First Health All Products $39.67
Rate for Payer: Frontpath All Products $16.53
Rate for Payer: Humana ChoiceCare $33.06
Rate for Payer: Lutheran Preferred All Products $23.00
Rate for Payer: PHCS/Multiplan All Products $24.80
Rate for Payer: PHP All Products $14.55
Rate for Payer: Signature Care EPO $15.30
Rate for Payer: Signature Care PPO $15.30
Rate for Payer: Three Rivers Preferred All Products $21.00
Rate for Payer: United Healthcare Commercial $17.52
Service Code CPT 87880
Hospital Charge Code Z13007
Min. Negotiated Rate $14.55
Max. Negotiated Rate $39.67
Rate for Payer: Coventry/First Health All Products $39.67
Rate for Payer: Frontpath All Products $16.53
Rate for Payer: Humana ChoiceCare $33.06
Rate for Payer: Lutheran Preferred All Products $23.00
Rate for Payer: PHCS/Multiplan All Products $24.80
Rate for Payer: PHP All Products $14.55
Rate for Payer: Signature Care EPO $15.30
Rate for Payer: Signature Care PPO $15.30
Rate for Payer: Three Rivers Preferred All Products $21.00
Rate for Payer: United Healthcare Commercial $17.52
Service Code CPT 87400
Hospital Charge Code Z12994
Min. Negotiated Rate $5.67
Max. Negotiated Rate $33.91
Rate for Payer: Anthem Exchange $5.67
Rate for Payer: Anthem PPO $5.67
Rate for Payer: Anthem Traditional $5.67
Rate for Payer: Coventry/First Health All Products $33.91
Rate for Payer: Frontpath All Products $14.13
Rate for Payer: Humana ChoiceCare $28.26
Rate for Payer: Lutheran Preferred All Products $20.00
Rate for Payer: PHCS/Multiplan All Products $21.20
Rate for Payer: PHP All Products $12.43
Rate for Payer: Signature Care EPO $15.30
Rate for Payer: Signature Care PPO $15.30
Rate for Payer: Three Rivers Preferred All Products $18.00
Rate for Payer: United Healthcare Commercial $10.51
Service Code CPT 87426
Hospital Charge Code Z12995
Min. Negotiated Rate $24.83
Max. Negotiated Rate $84.79
Rate for Payer: Coventry/First Health All Products $84.79
Rate for Payer: Frontpath All Products $31.59
Rate for Payer: Humana ChoiceCare $70.66
Rate for Payer: Lutheran Preferred All Products $49.00
Rate for Payer: PHCS/Multiplan All Products $52.99
Rate for Payer: PHP All Products $31.09
Rate for Payer: Signature Care EPO $51.00
Rate for Payer: Signature Care PPO $51.00
Rate for Payer: Three Rivers Preferred All Products $46.00
Rate for Payer: United Healthcare Commercial $24.83
Rate for Payer: United Healthcare Medicare $35.33
Service Code CPT 87426
Hospital Charge Code Z12996
Min. Negotiated Rate $24.83
Max. Negotiated Rate $84.79
Rate for Payer: Coventry/First Health All Products $84.79
Rate for Payer: Frontpath All Products $31.59
Rate for Payer: Humana ChoiceCare $70.66
Rate for Payer: Lutheran Preferred All Products $49.00
Rate for Payer: PHCS/Multiplan All Products $52.99
Rate for Payer: PHP All Products $31.09
Rate for Payer: Signature Care EPO $51.00
Rate for Payer: Signature Care PPO $51.00
Rate for Payer: Three Rivers Preferred All Products $46.00
Rate for Payer: United Healthcare Commercial $24.83
Rate for Payer: United Healthcare Medicare $35.33
Service Code CPT 86318
Hospital Charge Code Z12989
Min. Negotiated Rate $15.92
Max. Negotiated Rate $43.42
Rate for Payer: Coventry/First Health All Products $43.42
Rate for Payer: Frontpath All Products $18.09
Rate for Payer: Humana ChoiceCare $36.18
Rate for Payer: Lutheran Preferred All Products $25.00
Rate for Payer: PHCS/Multiplan All Products $27.13
Rate for Payer: PHP All Products $15.92
Rate for Payer: Signature Care EPO $17.00
Rate for Payer: Signature Care PPO $17.00
Rate for Payer: Three Rivers Preferred All Products $24.00
Rate for Payer: United Healthcare Commercial $18.91
Service Code CPT 86318
Hospital Charge Code Z12990
Min. Negotiated Rate $15.92
Max. Negotiated Rate $43.42
Rate for Payer: Coventry/First Health All Products $43.42
Rate for Payer: Frontpath All Products $18.09
Rate for Payer: Humana ChoiceCare $36.18
Rate for Payer: Lutheran Preferred All Products $25.00
Rate for Payer: PHCS/Multiplan All Products $27.13
Rate for Payer: PHP All Products $15.92
Rate for Payer: Signature Care EPO $17.00
Rate for Payer: Signature Care PPO $17.00
Rate for Payer: Three Rivers Preferred All Products $24.00
Rate for Payer: United Healthcare Commercial $18.91
Service Code CPT 87502
Hospital Charge Code Z12997
Min. Negotiated Rate $71.85
Max. Negotiated Rate $229.92
Rate for Payer: Coventry/First Health All Products $229.92
Rate for Payer: Frontpath All Products $95.80
Rate for Payer: Humana ChoiceCare $191.60
Rate for Payer: Lutheran Preferred All Products $134.00
Rate for Payer: PHCS/Multiplan All Products $143.70
Rate for Payer: PHP All Products $84.30
Rate for Payer: Signature Care EPO $111.97
Rate for Payer: Signature Care PPO $111.97
Rate for Payer: Three Rivers Preferred All Products $125.00
Rate for Payer: United Healthcare Commercial $71.85
Service Code CPT 87502
Hospital Charge Code Z12998
Min. Negotiated Rate $71.85
Max. Negotiated Rate $229.92
Rate for Payer: Coventry/First Health All Products $229.92
Rate for Payer: Frontpath All Products $95.80
Rate for Payer: Humana ChoiceCare $191.60
Rate for Payer: Lutheran Preferred All Products $134.00
Rate for Payer: PHCS/Multiplan All Products $143.70
Rate for Payer: PHP All Products $84.30
Rate for Payer: Signature Care EPO $111.97
Rate for Payer: Signature Care PPO $111.97
Rate for Payer: Three Rivers Preferred All Products $125.00
Rate for Payer: United Healthcare Commercial $71.85
Service Code CPT 77071
Hospital Charge Code Z12968
Min. Negotiated Rate $36.61
Max. Negotiated Rate $119.02
Rate for Payer: Aetna Medicare $50.83
Rate for Payer: Anthem Medicare $50.83
Rate for Payer: Caresource Just 4 Me $58.45
Rate for Payer: Caresource Medicare $55.91
Rate for Payer: Centivo/Paragon All Products $78.79
Rate for Payer: Coventry/First Health All Products $119.02
Rate for Payer: Frontpath All Products $91.58
Rate for Payer: Humana ChoiceCare $99.18
Rate for Payer: Humana Medicare $50.83
Rate for Payer: Lucent/Coldwater Veneers $86.41
Rate for Payer: PHCS/Multiplan All Products $74.39
Rate for Payer: Plain Church Group Ministry All Products $50.83
Rate for Payer: United Healthcare Commercial $36.61
Rate for Payer: United Healthcare Medicare $49.59
Service Code CPT 78452
Hospital Charge Code Z12970
Min. Negotiated Rate $389.30
Max. Negotiated Rate $954.58
Rate for Payer: Aetna Medicare $407.69
Rate for Payer: Anthem Exchange $422.14
Rate for Payer: Anthem Medicare $407.69
Rate for Payer: Anthem PPO $422.14
Rate for Payer: Anthem Traditional $422.14
Rate for Payer: Caresource Just 4 Me $468.84
Rate for Payer: Caresource Medicare $448.46
Rate for Payer: Centivo/Paragon All Products $631.92
Rate for Payer: Coventry/First Health All Products $954.58
Rate for Payer: Frontpath All Products $730.71
Rate for Payer: Humana ChoiceCare $795.48
Rate for Payer: Humana Medicare $407.69
Rate for Payer: Lucent/Coldwater Veneers $693.07
Rate for Payer: Lutheran Preferred All Products $632.00
Rate for Payer: PHCS/Multiplan All Products $596.61
Rate for Payer: PHP All Products $517.07
Rate for Payer: Plain Church Group Ministry All Products $407.69
Rate for Payer: Signature Care EPO $389.30
Rate for Payer: Signature Care PPO $389.30
Rate for Payer: Three Rivers Preferred All Products $591.00
Rate for Payer: United Healthcare Commercial $514.77
Service Code CPT 78451
Hospital Charge Code Z12969
Min. Negotiated Rate $248.24
Max. Negotiated Rate $690.07
Rate for Payer: Aetna Medicare $294.71
Rate for Payer: Anthem Exchange $248.24
Rate for Payer: Anthem Medicare $294.71
Rate for Payer: Anthem PPO $248.24
Rate for Payer: Anthem Traditional $248.24
Rate for Payer: Caresource Just 4 Me $338.92
Rate for Payer: Caresource Medicare $324.18
Rate for Payer: Centivo/Paragon All Products $456.80
Rate for Payer: Coventry/First Health All Products $690.07
Rate for Payer: Frontpath All Products $525.38
Rate for Payer: Humana ChoiceCare $575.06
Rate for Payer: Humana Medicare $294.71
Rate for Payer: Lucent/Coldwater Veneers $501.01
Rate for Payer: Lutheran Preferred All Products $457.00
Rate for Payer: PHCS/Multiplan All Products $431.29
Rate for Payer: PHP All Products $373.78
Rate for Payer: Plain Church Group Ministry All Products $294.71
Rate for Payer: Signature Care EPO $279.59
Rate for Payer: Signature Care PPO $279.59
Rate for Payer: Three Rivers Preferred All Products $427.00
Rate for Payer: United Healthcare Commercial $332.88
Service Code CPT 73522
Hospital Charge Code Z12912
Min. Negotiated Rate $45.87
Max. Negotiated Rate $117.74
Rate for Payer: Aetna Medicare $50.28
Rate for Payer: Anthem Medicare $50.28
Rate for Payer: Caresource Just 4 Me $57.82
Rate for Payer: Caresource Medicare $55.31
Rate for Payer: Centivo/Paragon All Products $77.93
Rate for Payer: Coventry/First Health All Products $117.74
Rate for Payer: Frontpath All Products $87.64
Rate for Payer: Humana ChoiceCare $98.12
Rate for Payer: Humana Medicare $50.28
Rate for Payer: Lucent/Coldwater Veneers $85.48
Rate for Payer: PHCS/Multiplan All Products $73.59
Rate for Payer: Plain Church Group Ministry All Products $50.28
Rate for Payer: United Healthcare Commercial $45.87
Service Code CPT 73502
Hospital Charge Code Z12911
Min. Negotiated Rate $38.83
Max. Negotiated Rate $102.79
Rate for Payer: Aetna Medicare $43.90
Rate for Payer: Anthem Exchange $50.72
Rate for Payer: Anthem Medicare $43.90
Rate for Payer: Anthem PPO $50.72
Rate for Payer: Anthem Traditional $50.72
Rate for Payer: Caresource Just 4 Me $50.48
Rate for Payer: Caresource Medicare $48.29
Rate for Payer: Centivo/Paragon All Products $68.05
Rate for Payer: Coventry/First Health All Products $102.79
Rate for Payer: Frontpath All Products $76.53
Rate for Payer: Humana ChoiceCare $85.66
Rate for Payer: Humana Medicare $43.90
Rate for Payer: Lucent/Coldwater Veneers $74.63
Rate for Payer: Lutheran Preferred All Products $68.00
Rate for Payer: PHCS/Multiplan All Products $64.25
Rate for Payer: PHP All Products $55.67
Rate for Payer: Plain Church Group Ministry All Products $43.90
Rate for Payer: Signature Care EPO $49.32
Rate for Payer: Signature Care PPO $49.32
Rate for Payer: Three Rivers Preferred All Products $64.00
Rate for Payer: United Healthcare Commercial $38.83
Service Code CPT 72040
Hospital Charge Code Z12883
Min. Negotiated Rate $33.52
Max. Negotiated Rate $86.88
Rate for Payer: Humana Medicare $37.10
Rate for Payer: Aetna Medicare $37.10
Rate for Payer: Anthem Exchange $51.56
Rate for Payer: Anthem Medicare $37.10
Rate for Payer: Anthem PPO $51.56
Rate for Payer: Anthem Traditional $51.56
Rate for Payer: Caresource Just 4 Me $42.66
Rate for Payer: Caresource Medicare $40.81
Rate for Payer: Centivo/Paragon All Products $57.51
Rate for Payer: Coventry/First Health All Products $86.88
Rate for Payer: Frontpath All Products $64.72
Rate for Payer: Humana ChoiceCare $72.40
Rate for Payer: Lucent/Coldwater Veneers $63.07
Rate for Payer: Lutheran Preferred All Products $58.00
Rate for Payer: PHCS/Multiplan All Products $54.30
Rate for Payer: PHP All Products $47.06
Rate for Payer: Plain Church Group Ministry All Products $37.10
Rate for Payer: Signature Care EPO $40.80
Rate for Payer: Signature Care PPO $40.80
Rate for Payer: Three Rivers Preferred All Products $54.00
Rate for Payer: United Healthcare Commercial $33.52
Service Code CPT 74018
Hospital Charge Code Z12924
Min. Negotiated Rate $25.41
Max. Negotiated Rate $65.64
Rate for Payer: Aetna Medicare $28.03
Rate for Payer: Anthem Exchange $25.41
Rate for Payer: Anthem Medicare $28.03
Rate for Payer: Anthem PPO $25.41
Rate for Payer: Anthem Traditional $25.41
Rate for Payer: Caresource Just 4 Me $32.23
Rate for Payer: Caresource Medicare $30.83
Rate for Payer: Centivo/Paragon All Products $43.45
Rate for Payer: Coventry/First Health All Products $65.64
Rate for Payer: Frontpath All Products $49.47
Rate for Payer: Humana ChoiceCare $54.70
Rate for Payer: Humana Medicare $28.03
Rate for Payer: Lucent/Coldwater Veneers $47.65
Rate for Payer: Lutheran Preferred All Products $43.00
Rate for Payer: PHCS/Multiplan All Products $41.03
Rate for Payer: PHP All Products $35.55
Rate for Payer: Plain Church Group Ministry All Products $28.03
Rate for Payer: Signature Care EPO $30.23
Rate for Payer: Signature Care PPO $30.23
Rate for Payer: Three Rivers Preferred All Products $41.00
Rate for Payer: United Healthcare Commercial $25.80
Service Code CPT 74021
Hospital Charge Code Z12925
Min. Negotiated Rate $36.87
Max. Negotiated Rate $94.46
Rate for Payer: Aetna Medicare $40.34
Rate for Payer: Anthem Medicare $40.34
Rate for Payer: Caresource Just 4 Me $46.39
Rate for Payer: Caresource Medicare $44.37
Rate for Payer: Centivo/Paragon All Products $62.53
Rate for Payer: Coventry/First Health All Products $94.46
Rate for Payer: Frontpath All Products $70.89
Rate for Payer: Humana ChoiceCare $78.72
Rate for Payer: Humana Medicare $40.34
Rate for Payer: Lucent/Coldwater Veneers $68.58
Rate for Payer: PHCS/Multiplan All Products $59.04
Rate for Payer: PHP All Products $51.17
Rate for Payer: Plain Church Group Ministry All Products $40.34
Rate for Payer: Signature Care EPO $43.19
Rate for Payer: Signature Care PPO $43.19
Rate for Payer: United Healthcare Commercial $36.87
Service Code CPT 71046
Hospital Charge Code Z12878
Min. Negotiated Rate $28.46
Max. Negotiated Rate $73.87
Rate for Payer: Aetna Medicare $31.55
Rate for Payer: Anthem Exchange $28.46
Rate for Payer: Anthem Medicare $31.55
Rate for Payer: Anthem PPO $28.46
Rate for Payer: Anthem Traditional $28.46
Rate for Payer: Caresource Just 4 Me $36.28
Rate for Payer: Caresource Medicare $34.71
Rate for Payer: Centivo/Paragon All Products $48.90
Rate for Payer: Coventry/First Health All Products $73.87
Rate for Payer: Frontpath All Products $55.05
Rate for Payer: Humana ChoiceCare $61.56
Rate for Payer: Humana Medicare $31.55
Rate for Payer: Lucent/Coldwater Veneers $53.63
Rate for Payer: Lutheran Preferred All Products $49.00
Rate for Payer: PHCS/Multiplan All Products $46.17
Rate for Payer: PHP All Products $40.01
Rate for Payer: Plain Church Group Ministry All Products $31.55
Rate for Payer: Signature Care EPO $33.86
Rate for Payer: Signature Care PPO $33.86
Rate for Payer: Three Rivers Preferred All Products $46.00
Rate for Payer: United Healthcare Commercial $28.89
Service Code CPT 71045
Hospital Charge Code Z12877
Min. Negotiated Rate $18.84
Max. Negotiated Rate $56.95
Rate for Payer: Aetna Medicare $24.33
Rate for Payer: Anthem Medicare $24.33
Rate for Payer: Caresource Just 4 Me $27.98
Rate for Payer: Caresource Medicare $26.76
Rate for Payer: Centivo/Paragon All Products $37.71
Rate for Payer: Coventry/First Health All Products $56.95
Rate for Payer: Frontpath All Products $42.50
Rate for Payer: Humana ChoiceCare $47.46
Rate for Payer: Humana Medicare $24.33
Rate for Payer: Lucent/Coldwater Veneers $41.36
Rate for Payer: PHCS/Multiplan All Products $35.59
Rate for Payer: Plain Church Group Ministry All Products $24.33
Rate for Payer: United Healthcare Commercial $18.84
Service Code CPT 74022
Hospital Charge Code Z12926
Min. Negotiated Rate $44.29
Max. Negotiated Rate $109.66
Rate for Payer: Aetna Medicare $46.83
Rate for Payer: Anthem Exchange $47.62
Rate for Payer: Anthem Medicare $46.83
Rate for Payer: Anthem PPO $47.62
Rate for Payer: Anthem Traditional $47.62
Rate for Payer: Caresource Just 4 Me $53.85
Rate for Payer: Caresource Medicare $51.51
Rate for Payer: Centivo/Paragon All Products $72.59
Rate for Payer: Coventry/First Health All Products $109.66
Rate for Payer: Frontpath All Products $81.89
Rate for Payer: Humana ChoiceCare $91.38
Rate for Payer: Humana Medicare $46.83
Rate for Payer: Lucent/Coldwater Veneers $79.61
Rate for Payer: Lutheran Preferred All Products $73.00
Rate for Payer: PHCS/Multiplan All Products $68.53
Rate for Payer: PHP All Products $59.39
Rate for Payer: Plain Church Group Ministry All Products $46.83
Rate for Payer: Signature Care EPO $53.55
Rate for Payer: Signature Care PPO $53.55
Rate for Payer: Three Rivers Preferred All Products $68.00
Rate for Payer: United Healthcare Commercial $44.29
Service Code CPT 73552
Hospital Charge Code Z12913
Min. Negotiated Rate $30.43
Max. Negotiated Rate $77.93
Rate for Payer: Aetna Medicare $33.28
Rate for Payer: Anthem Medicare $33.28
Rate for Payer: Caresource Just 4 Me $38.27
Rate for Payer: Caresource Medicare $36.61
Rate for Payer: Centivo/Paragon All Products $51.58
Rate for Payer: Coventry/First Health All Products $77.93
Rate for Payer: Frontpath All Products $57.53
Rate for Payer: Humana ChoiceCare $64.94
Rate for Payer: Humana Medicare $33.28
Rate for Payer: Lucent/Coldwater Veneers $56.58
Rate for Payer: PHCS/Multiplan All Products $48.70
Rate for Payer: PHP All Products $42.21
Rate for Payer: Plain Church Group Ministry All Products $33.28
Rate for Payer: Signature Care EPO $38.63
Rate for Payer: Signature Care PPO $38.63
Rate for Payer: United Healthcare Commercial $30.43
Service Code CPT 87210
Hospital Charge Code Z12992
Min. Negotiated Rate $5.12
Max. Negotiated Rate $13.97
Rate for Payer: Coventry/First Health All Products $13.97
Rate for Payer: Frontpath All Products $5.82
Rate for Payer: Humana ChoiceCare $11.64
Rate for Payer: Lutheran Preferred All Products $8.00
Rate for Payer: PHCS/Multiplan All Products $8.73
Rate for Payer: PHP All Products $5.12
Rate for Payer: Signature Care EPO $5.95
Rate for Payer: Signature Care PPO $5.95
Rate for Payer: Three Rivers Preferred All Products $8.00
Rate for Payer: United Healthcare Commercial $6.23
Service Code CPT 87210
Hospital Charge Code Z12993
Min. Negotiated Rate $5.12
Max. Negotiated Rate $13.97
Rate for Payer: Coventry/First Health All Products $13.97
Rate for Payer: Frontpath All Products $5.82
Rate for Payer: Humana ChoiceCare $11.64
Rate for Payer: Lutheran Preferred All Products $8.00
Rate for Payer: PHCS/Multiplan All Products $8.73
Rate for Payer: PHP All Products $5.12
Rate for Payer: Signature Care EPO $5.95
Rate for Payer: Signature Care PPO $5.95
Rate for Payer: Three Rivers Preferred All Products $8.00
Rate for Payer: United Healthcare Commercial $6.23