|
CHG SONO EXAM, HYSTEROSONOGRAPHY
|
Professional
|
$214.20
|
|
|
Service Code
|
CPT 76831
|
| Hospital Charge Code |
Z12960
|
| Min. Negotiated Rate |
$107.30 |
| Max. Negotiated Rate |
$257.04 |
| Rate for Payer: Aetna Medicare |
$109.78
|
| Rate for Payer: Anthem Exchange |
$107.30
|
| Rate for Payer: Anthem Medicare |
$109.78
|
| Rate for Payer: Anthem PPO |
$107.30
|
| Rate for Payer: Anthem Traditional |
$107.30
|
| Rate for Payer: Caresource Just 4 Me |
$126.25
|
| Rate for Payer: Caresource Medicare |
$120.76
|
| Rate for Payer: Centivo/Paragon All Products |
$170.16
|
| Rate for Payer: Coventry/First Health All Products |
$257.04
|
| Rate for Payer: Frontpath All Products |
$192.75
|
| Rate for Payer: Humana ChoiceCare |
$214.20
|
| Rate for Payer: Humana Medicare |
$109.78
|
| Rate for Payer: Lucent/Coldwater Veneers |
$186.63
|
| Rate for Payer: Lutheran Preferred All Products |
$170.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$160.65
|
| Rate for Payer: PHP All Products |
$139.23
|
| Rate for Payer: Plain Church Group Ministry All Products |
$109.78
|
| Rate for Payer: Signature Care EPO |
$114.75
|
| Rate for Payer: Signature Care PPO |
$114.75
|
| Rate for Payer: Three Rivers Preferred All Products |
$159.00
|
| Rate for Payer: United Healthcare Commercial |
$110.22
|
|
|
CHG SONO EXAM, HYSTEROSONOGRAPHY
|
Professional
|
$214.20
|
|
|
Service Code
|
CPT 76831
|
| Hospital Charge Code |
Z12959
|
| Min. Negotiated Rate |
$107.30 |
| Max. Negotiated Rate |
$257.04 |
| Rate for Payer: Aetna Medicare |
$109.78
|
| Rate for Payer: Anthem Exchange |
$107.30
|
| Rate for Payer: Anthem Medicare |
$109.78
|
| Rate for Payer: Anthem PPO |
$107.30
|
| Rate for Payer: Anthem Traditional |
$107.30
|
| Rate for Payer: Caresource Just 4 Me |
$126.25
|
| Rate for Payer: Caresource Medicare |
$120.76
|
| Rate for Payer: Centivo/Paragon All Products |
$170.16
|
| Rate for Payer: Coventry/First Health All Products |
$257.04
|
| Rate for Payer: Frontpath All Products |
$192.75
|
| Rate for Payer: Humana ChoiceCare |
$214.20
|
| Rate for Payer: Humana Medicare |
$109.78
|
| Rate for Payer: Lucent/Coldwater Veneers |
$186.63
|
| Rate for Payer: Lutheran Preferred All Products |
$170.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$160.65
|
| Rate for Payer: PHP All Products |
$139.23
|
| Rate for Payer: Plain Church Group Ministry All Products |
$109.78
|
| Rate for Payer: Signature Care EPO |
$114.75
|
| Rate for Payer: Signature Care PPO |
$114.75
|
| Rate for Payer: Three Rivers Preferred All Products |
$159.00
|
| Rate for Payer: United Healthcare Commercial |
$110.22
|
|
|
CHG SONO GUIDE NEEDLE BIOPSY
|
Professional
|
$107.32
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
Z12967
|
| Min. Negotiated Rate |
$55.00 |
| Max. Negotiated Rate |
$169.34 |
| Rate for Payer: Aetna Medicare |
$55.00
|
| Rate for Payer: Anthem Medicare |
$55.00
|
| Rate for Payer: Caresource Just 4 Me |
$63.25
|
| Rate for Payer: Caresource Medicare |
$60.50
|
| Rate for Payer: Centivo/Paragon All Products |
$85.25
|
| Rate for Payer: Coventry/First Health All Products |
$128.78
|
| Rate for Payer: Frontpath All Products |
$96.34
|
| Rate for Payer: Humana ChoiceCare |
$107.32
|
| Rate for Payer: Humana Medicare |
$55.00
|
| Rate for Payer: Lucent/Coldwater Veneers |
$93.50
|
| Rate for Payer: PHCS/Multiplan All Products |
$80.49
|
| Rate for Payer: PHP All Products |
$69.75
|
| Rate for Payer: Plain Church Group Ministry All Products |
$55.00
|
| Rate for Payer: Signature Care EPO |
$93.74
|
| Rate for Payer: Signature Care PPO |
$93.74
|
| Rate for Payer: United Healthcare Commercial |
$169.34
|
|
|
CHG SONO PELVIS LIMITED
|
Professional
|
$90.02
|
|
|
Service Code
|
CPT 76857
|
| Hospital Charge Code |
Z12964
|
| Min. Negotiated Rate |
$46.14 |
| Max. Negotiated Rate |
$108.02 |
| Rate for Payer: Aetna Medicare |
$46.14
|
| Rate for Payer: Anthem Exchange |
$67.50
|
| Rate for Payer: Anthem Medicare |
$46.14
|
| Rate for Payer: Anthem PPO |
$67.50
|
| Rate for Payer: Anthem Traditional |
$67.50
|
| Rate for Payer: Caresource Just 4 Me |
$53.06
|
| Rate for Payer: Caresource Medicare |
$50.75
|
| Rate for Payer: Centivo/Paragon All Products |
$71.52
|
| Rate for Payer: Coventry/First Health All Products |
$108.02
|
| Rate for Payer: Frontpath All Products |
$79.15
|
| Rate for Payer: Humana ChoiceCare |
$90.02
|
| Rate for Payer: Humana Medicare |
$46.14
|
| Rate for Payer: Lucent/Coldwater Veneers |
$78.44
|
| Rate for Payer: Lutheran Preferred All Products |
$72.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$67.52
|
| Rate for Payer: PHP All Products |
$58.51
|
| Rate for Payer: Plain Church Group Ministry All Products |
$46.14
|
| Rate for Payer: Signature Care EPO |
$76.48
|
| Rate for Payer: Signature Care PPO |
$76.48
|
| Rate for Payer: Three Rivers Preferred All Products |
$67.00
|
| Rate for Payer: United Healthcare Commercial |
$91.92
|
|
|
CHG SONO PELVIS LIMITED
|
Professional
|
$90.02
|
|
|
Service Code
|
CPT 76857
|
| Hospital Charge Code |
Z12963
|
| Min. Negotiated Rate |
$46.14 |
| Max. Negotiated Rate |
$108.02 |
| Rate for Payer: Aetna Medicare |
$46.14
|
| Rate for Payer: Anthem Exchange |
$67.50
|
| Rate for Payer: Anthem Medicare |
$46.14
|
| Rate for Payer: Anthem PPO |
$67.50
|
| Rate for Payer: Anthem Traditional |
$67.50
|
| Rate for Payer: Caresource Just 4 Me |
$53.06
|
| Rate for Payer: Caresource Medicare |
$50.75
|
| Rate for Payer: Centivo/Paragon All Products |
$71.52
|
| Rate for Payer: Coventry/First Health All Products |
$108.02
|
| Rate for Payer: Frontpath All Products |
$79.15
|
| Rate for Payer: Humana ChoiceCare |
$90.02
|
| Rate for Payer: Humana Medicare |
$46.14
|
| Rate for Payer: Lucent/Coldwater Veneers |
$78.44
|
| Rate for Payer: Lutheran Preferred All Products |
$72.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$67.52
|
| Rate for Payer: PHP All Products |
$58.51
|
| Rate for Payer: Plain Church Group Ministry All Products |
$46.14
|
| Rate for Payer: Signature Care EPO |
$76.48
|
| Rate for Payer: Signature Care PPO |
$76.48
|
| Rate for Payer: Three Rivers Preferred All Products |
$67.00
|
| Rate for Payer: United Healthcare Commercial |
$91.92
|
|
|
CHG STREP A, DNA, AMP PROBE
|
Professional
|
$70.18
|
|
|
Service Code
|
CPT 87651
|
| Hospital Charge Code |
Z12999
|
| Min. Negotiated Rate |
$30.75 |
| Max. Negotiated Rate |
$84.22 |
| Rate for Payer: Coventry/First Health All Products |
$84.22
|
| Rate for Payer: Frontpath All Products |
$35.09
|
| Rate for Payer: Humana ChoiceCare |
$70.18
|
| Rate for Payer: Lutheran Preferred All Products |
$49.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$52.64
|
| Rate for Payer: PHP All Products |
$30.88
|
| Rate for Payer: Signature Care EPO |
$45.90
|
| Rate for Payer: Signature Care PPO |
$45.90
|
| Rate for Payer: Three Rivers Preferred All Products |
$46.00
|
| Rate for Payer: United Healthcare Commercial |
$30.75
|
|
|
CHG STREP A, DNA, AMP PROBE
|
Professional
|
$70.18
|
|
|
Service Code
|
CPT 87651
|
| Hospital Charge Code |
Z13000
|
| Min. Negotiated Rate |
$30.75 |
| Max. Negotiated Rate |
$84.22 |
| Rate for Payer: Coventry/First Health All Products |
$84.22
|
| Rate for Payer: Frontpath All Products |
$35.09
|
| Rate for Payer: Humana ChoiceCare |
$70.18
|
| Rate for Payer: Lutheran Preferred All Products |
$49.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$52.64
|
| Rate for Payer: PHP All Products |
$30.88
|
| Rate for Payer: Signature Care EPO |
$45.90
|
| Rate for Payer: Signature Care PPO |
$45.90
|
| Rate for Payer: Three Rivers Preferred All Products |
$46.00
|
| Rate for Payer: United Healthcare Commercial |
$30.75
|
|
|
CHG TB INTRADERMAL TEST
|
Professional
|
$17.78
|
|
|
Service Code
|
CPT 86580
|
| Hospital Charge Code |
Z12991
|
| Min. Negotiated Rate |
$4.12 |
| Max. Negotiated Rate |
$21.34 |
| Rate for Payer: Aetna Medicare |
$9.11
|
| Rate for Payer: Anthem Exchange |
$4.12
|
| Rate for Payer: Anthem Medicare |
$9.11
|
| Rate for Payer: Anthem PPO |
$4.12
|
| Rate for Payer: Anthem Traditional |
$4.12
|
| Rate for Payer: Caresource Just 4 Me |
$10.48
|
| Rate for Payer: Caresource Medicare |
$10.02
|
| Rate for Payer: Centivo/Paragon All Products |
$14.12
|
| Rate for Payer: Coventry/First Health All Products |
$21.34
|
| Rate for Payer: Frontpath All Products |
$9.86
|
| Rate for Payer: Humana ChoiceCare |
$17.78
|
| Rate for Payer: Humana Medicare |
$9.11
|
| Rate for Payer: Lucent/Coldwater Veneers |
$15.49
|
| Rate for Payer: Lutheran Preferred All Products |
$13.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$13.34
|
| Rate for Payer: PHP All Products |
$7.82
|
| Rate for Payer: Plain Church Group Ministry All Products |
$9.11
|
| Rate for Payer: Signature Care EPO |
$8.50
|
| Rate for Payer: Signature Care PPO |
$8.50
|
| Rate for Payer: Three Rivers Preferred All Products |
$12.00
|
| Rate for Payer: United Healthcare Commercial |
$6.39
|
| Rate for Payer: United Healthcare Medicare |
$8.89
|
|
|
CHG URINALYSIS, AUTO, W/O SCOPE
|
Professional
|
$4.50
|
|
|
Service Code
|
CPT 81003
|
| Hospital Charge Code |
Z12975
|
| Min. Negotiated Rate |
$1.98 |
| Max. Negotiated Rate |
$5.40 |
| Rate for Payer: Coventry/First Health All Products |
$5.40
|
| Rate for Payer: Frontpath All Products |
$2.25
|
| Rate for Payer: Humana ChoiceCare |
$4.50
|
| Rate for Payer: Lutheran Preferred All Products |
$3.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$3.38
|
| Rate for Payer: PHP All Products |
$1.98
|
| Rate for Payer: Signature Care EPO |
$2.60
|
| Rate for Payer: Signature Care PPO |
$2.60
|
| Rate for Payer: Three Rivers Preferred All Products |
$3.00
|
| Rate for Payer: United Healthcare Commercial |
$3.28
|
|
|
CHG URINALYSIS, AUTO, W/O SCOPE
|
Professional
|
$4.50
|
|
|
Service Code
|
CPT 81003
|
| Hospital Charge Code |
Z12974
|
| Min. Negotiated Rate |
$1.98 |
| Max. Negotiated Rate |
$5.40 |
| Rate for Payer: Coventry/First Health All Products |
$5.40
|
| Rate for Payer: Frontpath All Products |
$2.25
|
| Rate for Payer: Humana ChoiceCare |
$4.50
|
| Rate for Payer: Lutheran Preferred All Products |
$3.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$3.38
|
| Rate for Payer: PHP All Products |
$1.98
|
| Rate for Payer: Signature Care EPO |
$2.60
|
| Rate for Payer: Signature Care PPO |
$2.60
|
| Rate for Payer: Three Rivers Preferred All Products |
$3.00
|
| Rate for Payer: United Healthcare Commercial |
$3.28
|
|
|
CHG URINALYSIS NONAUTO W/O SCOPE
|
Professional
|
$6.96
|
|
|
Service Code
|
CPT 81002
|
| Hospital Charge Code |
Z12973
|
| Min. Negotiated Rate |
$2.09 |
| Max. Negotiated Rate |
$8.35 |
| Rate for Payer: Anthem Exchange |
$2.09
|
| Rate for Payer: Anthem PPO |
$2.09
|
| Rate for Payer: Anthem Traditional |
$2.09
|
| Rate for Payer: Coventry/First Health All Products |
$8.35
|
| Rate for Payer: Frontpath All Products |
$3.48
|
| Rate for Payer: Humana ChoiceCare |
$6.96
|
| Rate for Payer: Lutheran Preferred All Products |
$5.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$5.22
|
| Rate for Payer: PHP All Products |
$3.06
|
| Rate for Payer: Signature Care EPO |
$3.40
|
| Rate for Payer: Signature Care PPO |
$3.40
|
| Rate for Payer: Three Rivers Preferred All Products |
$5.00
|
| Rate for Payer: United Healthcare Commercial |
$3.74
|
|
|
CHG URINE PREGNANCY TEST
|
Professional
|
$17.22
|
|
|
Service Code
|
CPT 81025
|
| Hospital Charge Code |
Z12976
|
| Min. Negotiated Rate |
$5.17 |
| Max. Negotiated Rate |
$20.66 |
| Rate for Payer: Anthem Exchange |
$5.17
|
| Rate for Payer: Anthem PPO |
$5.17
|
| Rate for Payer: Anthem Traditional |
$5.17
|
| Rate for Payer: Coventry/First Health All Products |
$20.66
|
| Rate for Payer: Frontpath All Products |
$8.61
|
| Rate for Payer: Humana ChoiceCare |
$17.22
|
| Rate for Payer: Lutheran Preferred All Products |
$12.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$12.91
|
| Rate for Payer: PHP All Products |
$7.58
|
| Rate for Payer: Signature Care EPO |
$8.50
|
| Rate for Payer: Signature Care PPO |
$8.50
|
| Rate for Payer: Three Rivers Preferred All Products |
$11.00
|
| Rate for Payer: United Healthcare Commercial |
$9.24
|
|
|
CHG US LMTD JT/FCL EVAL NONVASC XTR STRUX R-T W/IMG
|
Professional
|
$76.06
|
|
|
Service Code
|
CPT 76882
|
| Hospital Charge Code |
Z12966
|
| Min. Negotiated Rate |
$30.22 |
| Max. Negotiated Rate |
$92.53 |
| Rate for Payer: Aetna Medicare |
$40.24
|
| Rate for Payer: Anthem Medicare |
$40.24
|
| Rate for Payer: Caresource Just 4 Me |
$46.28
|
| Rate for Payer: Caresource Medicare |
$44.26
|
| Rate for Payer: Centivo/Paragon All Products |
$62.37
|
| Rate for Payer: Coventry/First Health All Products |
$91.27
|
| Rate for Payer: Frontpath All Products |
$92.53
|
| Rate for Payer: Humana ChoiceCare |
$76.06
|
| Rate for Payer: Humana Medicare |
$40.24
|
| Rate for Payer: Lucent/Coldwater Veneers |
$68.41
|
| Rate for Payer: PHCS/Multiplan All Products |
$57.05
|
| Rate for Payer: Plain Church Group Ministry All Products |
$40.24
|
| Rate for Payer: United Healthcare Commercial |
$30.22
|
|
|
CHG US LMTD JT/FCL EVAL NONVASC XTR STRUX R-T W/IMG
|
Professional
|
$76.06
|
|
|
Service Code
|
CPT 76882
|
| Hospital Charge Code |
Z12965
|
| Min. Negotiated Rate |
$30.22 |
| Max. Negotiated Rate |
$92.53 |
| Rate for Payer: Aetna Medicare |
$40.24
|
| Rate for Payer: Anthem Medicare |
$40.24
|
| Rate for Payer: Caresource Just 4 Me |
$46.28
|
| Rate for Payer: Caresource Medicare |
$44.26
|
| Rate for Payer: Centivo/Paragon All Products |
$62.37
|
| Rate for Payer: Coventry/First Health All Products |
$91.27
|
| Rate for Payer: Frontpath All Products |
$92.53
|
| Rate for Payer: Humana ChoiceCare |
$76.06
|
| Rate for Payer: Humana Medicare |
$40.24
|
| Rate for Payer: Lucent/Coldwater Veneers |
$68.41
|
| Rate for Payer: PHCS/Multiplan All Products |
$57.05
|
| Rate for Payer: Plain Church Group Ministry All Products |
$40.24
|
| Rate for Payer: United Healthcare Commercial |
$30.22
|
|
|
CHG US, OB < 14 WKS, ADD'L FETUS
|
Professional
|
$113.96
|
|
|
Service Code
|
CPT 76802
|
| Hospital Charge Code |
Z12931
|
| Min. Negotiated Rate |
$58.41 |
| Max. Negotiated Rate |
$136.75 |
| Rate for Payer: Aetna Medicare |
$58.41
|
| Rate for Payer: Anthem Exchange |
$65.09
|
| Rate for Payer: Anthem Medicare |
$58.41
|
| Rate for Payer: Anthem PPO |
$65.09
|
| Rate for Payer: Anthem Traditional |
$65.09
|
| Rate for Payer: Caresource Just 4 Me |
$67.17
|
| Rate for Payer: Caresource Medicare |
$64.25
|
| Rate for Payer: Centivo/Paragon All Products |
$90.54
|
| Rate for Payer: Coventry/First Health All Products |
$136.75
|
| Rate for Payer: Frontpath All Products |
$102.42
|
| Rate for Payer: Humana ChoiceCare |
$113.96
|
| Rate for Payer: Humana Medicare |
$58.41
|
| Rate for Payer: Lucent/Coldwater Veneers |
$99.30
|
| Rate for Payer: Lutheran Preferred All Products |
$91.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$85.47
|
| Rate for Payer: PHP All Products |
$74.08
|
| Rate for Payer: Plain Church Group Ministry All Products |
$58.41
|
| Rate for Payer: Signature Care EPO |
$100.23
|
| Rate for Payer: Signature Care PPO |
$100.23
|
| Rate for Payer: Three Rivers Preferred All Products |
$85.00
|
| Rate for Payer: United Healthcare Commercial |
$68.82
|
|
|
CHG US, OB < 14 WKS, ADD'L FETUS
|
Professional
|
$113.96
|
|
|
Service Code
|
CPT 76802
|
| Hospital Charge Code |
Z12932
|
| Min. Negotiated Rate |
$58.41 |
| Max. Negotiated Rate |
$136.75 |
| Rate for Payer: Aetna Medicare |
$58.41
|
| Rate for Payer: Anthem Exchange |
$65.09
|
| Rate for Payer: Anthem Medicare |
$58.41
|
| Rate for Payer: Anthem PPO |
$65.09
|
| Rate for Payer: Anthem Traditional |
$65.09
|
| Rate for Payer: Caresource Just 4 Me |
$67.17
|
| Rate for Payer: Caresource Medicare |
$64.25
|
| Rate for Payer: Centivo/Paragon All Products |
$90.54
|
| Rate for Payer: Coventry/First Health All Products |
$136.75
|
| Rate for Payer: Frontpath All Products |
$102.42
|
| Rate for Payer: Humana ChoiceCare |
$113.96
|
| Rate for Payer: Humana Medicare |
$58.41
|
| Rate for Payer: Lucent/Coldwater Veneers |
$99.30
|
| Rate for Payer: Lutheran Preferred All Products |
$91.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$85.47
|
| Rate for Payer: PHP All Products |
$74.08
|
| Rate for Payer: Plain Church Group Ministry All Products |
$58.41
|
| Rate for Payer: Signature Care EPO |
$100.23
|
| Rate for Payer: Signature Care PPO |
$100.23
|
| Rate for Payer: Three Rivers Preferred All Products |
$85.00
|
| Rate for Payer: United Healthcare Commercial |
$68.82
|
|
|
CHG US, OB >/= 14 WKS, ADDL FETUS
|
Professional
|
$163.96
|
|
|
Service Code
|
CPT 76810
|
| Hospital Charge Code |
Z12935
|
| Min. Negotiated Rate |
$84.03 |
| Max. Negotiated Rate |
$196.75 |
| Rate for Payer: Aetna Medicare |
$84.03
|
| Rate for Payer: Anthem Exchange |
$170.72
|
| Rate for Payer: Anthem Medicare |
$84.03
|
| Rate for Payer: Anthem PPO |
$170.72
|
| Rate for Payer: Anthem Traditional |
$170.72
|
| Rate for Payer: Caresource Just 4 Me |
$96.63
|
| Rate for Payer: Caresource Medicare |
$92.43
|
| Rate for Payer: Centivo/Paragon All Products |
$130.25
|
| Rate for Payer: Coventry/First Health All Products |
$196.75
|
| Rate for Payer: Frontpath All Products |
$146.81
|
| Rate for Payer: Humana ChoiceCare |
$163.96
|
| Rate for Payer: Humana Medicare |
$84.03
|
| Rate for Payer: Lucent/Coldwater Veneers |
$142.85
|
| Rate for Payer: Lutheran Preferred All Products |
$130.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$122.97
|
| Rate for Payer: PHP All Products |
$106.57
|
| Rate for Payer: Plain Church Group Ministry All Products |
$84.03
|
| Rate for Payer: Signature Care EPO |
$114.75
|
| Rate for Payer: Signature Care PPO |
$114.75
|
| Rate for Payer: Three Rivers Preferred All Products |
$122.00
|
| Rate for Payer: United Healthcare Commercial |
$93.27
|
|
|
CHG US, OB >/= 14 WKS, ADDL FETUS
|
Professional
|
$163.96
|
|
|
Service Code
|
CPT 76810
|
| Hospital Charge Code |
Z12936
|
| Min. Negotiated Rate |
$84.03 |
| Max. Negotiated Rate |
$196.75 |
| Rate for Payer: Aetna Medicare |
$84.03
|
| Rate for Payer: Anthem Exchange |
$170.72
|
| Rate for Payer: Anthem Medicare |
$84.03
|
| Rate for Payer: Anthem PPO |
$170.72
|
| Rate for Payer: Anthem Traditional |
$170.72
|
| Rate for Payer: Caresource Just 4 Me |
$96.63
|
| Rate for Payer: Caresource Medicare |
$92.43
|
| Rate for Payer: Centivo/Paragon All Products |
$130.25
|
| Rate for Payer: Coventry/First Health All Products |
$196.75
|
| Rate for Payer: Frontpath All Products |
$146.81
|
| Rate for Payer: Humana ChoiceCare |
$163.96
|
| Rate for Payer: Humana Medicare |
$84.03
|
| Rate for Payer: Lucent/Coldwater Veneers |
$142.85
|
| Rate for Payer: Lutheran Preferred All Products |
$130.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$122.97
|
| Rate for Payer: PHP All Products |
$106.57
|
| Rate for Payer: Plain Church Group Ministry All Products |
$84.03
|
| Rate for Payer: Signature Care EPO |
$114.75
|
| Rate for Payer: Signature Care PPO |
$114.75
|
| Rate for Payer: Three Rivers Preferred All Products |
$122.00
|
| Rate for Payer: United Healthcare Commercial |
$93.27
|
|
|
CHG US, OB < 14 WKS, SINGLE FETUS
|
Professional
|
$217.62
|
|
|
Service Code
|
CPT 76801
|
| Hospital Charge Code |
Z12929
|
| Min. Negotiated Rate |
$111.53 |
| Max. Negotiated Rate |
$261.14 |
| Rate for Payer: Aetna Medicare |
$111.53
|
| Rate for Payer: Anthem Exchange |
$134.41
|
| Rate for Payer: Anthem Medicare |
$111.53
|
| Rate for Payer: Anthem PPO |
$134.41
|
| Rate for Payer: Anthem Traditional |
$134.41
|
| Rate for Payer: Caresource Just 4 Me |
$128.26
|
| Rate for Payer: Caresource Medicare |
$122.68
|
| Rate for Payer: Centivo/Paragon All Products |
$172.87
|
| Rate for Payer: Coventry/First Health All Products |
$261.14
|
| Rate for Payer: Frontpath All Products |
$194.67
|
| Rate for Payer: Humana ChoiceCare |
$217.62
|
| Rate for Payer: Humana Medicare |
$111.53
|
| Rate for Payer: Lucent/Coldwater Veneers |
$189.60
|
| Rate for Payer: Lutheran Preferred All Products |
$173.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$163.22
|
| Rate for Payer: PHP All Products |
$141.45
|
| Rate for Payer: Plain Church Group Ministry All Products |
$111.53
|
| Rate for Payer: Signature Care EPO |
$165.33
|
| Rate for Payer: Signature Care PPO |
$165.33
|
| Rate for Payer: Three Rivers Preferred All Products |
$162.00
|
| Rate for Payer: United Healthcare Commercial |
$120.94
|
|
|
CHG US, OB < 14 WKS, SINGLE FETUS
|
Professional
|
$217.62
|
|
|
Service Code
|
CPT 76801
|
| Hospital Charge Code |
Z12930
|
| Min. Negotiated Rate |
$111.53 |
| Max. Negotiated Rate |
$261.14 |
| Rate for Payer: Aetna Medicare |
$111.53
|
| Rate for Payer: Anthem Exchange |
$134.41
|
| Rate for Payer: Anthem Medicare |
$111.53
|
| Rate for Payer: Anthem PPO |
$134.41
|
| Rate for Payer: Anthem Traditional |
$134.41
|
| Rate for Payer: Caresource Just 4 Me |
$128.26
|
| Rate for Payer: Caresource Medicare |
$122.68
|
| Rate for Payer: Centivo/Paragon All Products |
$172.87
|
| Rate for Payer: Coventry/First Health All Products |
$261.14
|
| Rate for Payer: Frontpath All Products |
$194.67
|
| Rate for Payer: Humana ChoiceCare |
$217.62
|
| Rate for Payer: Humana Medicare |
$111.53
|
| Rate for Payer: Lucent/Coldwater Veneers |
$189.60
|
| Rate for Payer: Lutheran Preferred All Products |
$173.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$163.22
|
| Rate for Payer: PHP All Products |
$141.45
|
| Rate for Payer: Plain Church Group Ministry All Products |
$111.53
|
| Rate for Payer: Signature Care EPO |
$165.33
|
| Rate for Payer: Signature Care PPO |
$165.33
|
| Rate for Payer: Three Rivers Preferred All Products |
$162.00
|
| Rate for Payer: United Healthcare Commercial |
$120.94
|
|
|
CHG US, OB >/= 14 WKS, SNGL FETUS
|
Professional
|
$249.86
|
|
|
Service Code
|
CPT 76805
|
| Hospital Charge Code |
Z12934
|
| Min. Negotiated Rate |
$128.05 |
| Max. Negotiated Rate |
$299.83 |
| Rate for Payer: Aetna Medicare |
$128.05
|
| Rate for Payer: Anthem Exchange |
$143.89
|
| Rate for Payer: Anthem Medicare |
$128.05
|
| Rate for Payer: Anthem PPO |
$143.89
|
| Rate for Payer: Anthem Traditional |
$143.89
|
| Rate for Payer: Caresource Just 4 Me |
$147.26
|
| Rate for Payer: Caresource Medicare |
$140.86
|
| Rate for Payer: Centivo/Paragon All Products |
$198.48
|
| Rate for Payer: Coventry/First Health All Products |
$299.83
|
| Rate for Payer: Frontpath All Products |
$223.14
|
| Rate for Payer: Humana ChoiceCare |
$249.86
|
| Rate for Payer: Humana Medicare |
$128.05
|
| Rate for Payer: Lucent/Coldwater Veneers |
$217.69
|
| Rate for Payer: Lutheran Preferred All Products |
$198.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$187.40
|
| Rate for Payer: PHP All Products |
$162.41
|
| Rate for Payer: Plain Church Group Ministry All Products |
$128.05
|
| Rate for Payer: Signature Care EPO |
$158.10
|
| Rate for Payer: Signature Care PPO |
$158.10
|
| Rate for Payer: Three Rivers Preferred All Products |
$186.00
|
| Rate for Payer: United Healthcare Commercial |
$134.52
|
|
|
CHG US, OB >/= 14 WKS, SNGL FETUS
|
Professional
|
$249.86
|
|
|
Service Code
|
CPT 76805
|
| Hospital Charge Code |
Z12933
|
| Min. Negotiated Rate |
$128.05 |
| Max. Negotiated Rate |
$299.83 |
| Rate for Payer: Aetna Medicare |
$128.05
|
| Rate for Payer: Anthem Exchange |
$143.89
|
| Rate for Payer: Anthem Medicare |
$128.05
|
| Rate for Payer: Anthem PPO |
$143.89
|
| Rate for Payer: Anthem Traditional |
$143.89
|
| Rate for Payer: Caresource Just 4 Me |
$147.26
|
| Rate for Payer: Caresource Medicare |
$140.86
|
| Rate for Payer: Centivo/Paragon All Products |
$198.48
|
| Rate for Payer: Coventry/First Health All Products |
$299.83
|
| Rate for Payer: Frontpath All Products |
$223.14
|
| Rate for Payer: Humana ChoiceCare |
$249.86
|
| Rate for Payer: Humana Medicare |
$128.05
|
| Rate for Payer: Lucent/Coldwater Veneers |
$217.69
|
| Rate for Payer: Lutheran Preferred All Products |
$198.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$187.40
|
| Rate for Payer: PHP All Products |
$162.41
|
| Rate for Payer: Plain Church Group Ministry All Products |
$128.05
|
| Rate for Payer: Signature Care EPO |
$158.10
|
| Rate for Payer: Signature Care PPO |
$158.10
|
| Rate for Payer: Three Rivers Preferred All Products |
$186.00
|
| Rate for Payer: United Healthcare Commercial |
$134.52
|
|
|
CHG US,PREGNANT UTERUS,F/U,TRANSABD APP
|
Professional
|
$202.32
|
|
|
Service Code
|
CPT 76816
|
| Hospital Charge Code |
Z12947
|
| Min. Negotiated Rate |
$81.20 |
| Max. Negotiated Rate |
$242.78 |
| Rate for Payer: Aetna Medicare |
$103.69
|
| Rate for Payer: Anthem Exchange |
$81.20
|
| Rate for Payer: Anthem Medicare |
$103.69
|
| Rate for Payer: Anthem PPO |
$81.20
|
| Rate for Payer: Anthem Traditional |
$81.20
|
| Rate for Payer: Caresource Just 4 Me |
$119.24
|
| Rate for Payer: Caresource Medicare |
$114.06
|
| Rate for Payer: Centivo/Paragon All Products |
$160.72
|
| Rate for Payer: Coventry/First Health All Products |
$242.78
|
| Rate for Payer: Frontpath All Products |
$181.59
|
| Rate for Payer: Humana ChoiceCare |
$202.32
|
| Rate for Payer: Humana Medicare |
$103.69
|
| Rate for Payer: Lucent/Coldwater Veneers |
$176.27
|
| Rate for Payer: Lutheran Preferred All Products |
$161.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$151.74
|
| Rate for Payer: PHP All Products |
$131.51
|
| Rate for Payer: Plain Church Group Ministry All Products |
$103.69
|
| Rate for Payer: Signature Care EPO |
$92.55
|
| Rate for Payer: Signature Care PPO |
$92.55
|
| Rate for Payer: Three Rivers Preferred All Products |
$150.00
|
| Rate for Payer: United Healthcare Commercial |
$103.01
|
|
|
CHG US,PREGNANT UTERUS,F/U,TRANSABD APP
|
Professional
|
$202.32
|
|
|
Service Code
|
CPT 76816
|
| Hospital Charge Code |
Z12948
|
| Min. Negotiated Rate |
$81.20 |
| Max. Negotiated Rate |
$242.78 |
| Rate for Payer: Aetna Medicare |
$103.69
|
| Rate for Payer: Anthem Exchange |
$81.20
|
| Rate for Payer: Anthem Medicare |
$103.69
|
| Rate for Payer: Anthem PPO |
$81.20
|
| Rate for Payer: Anthem Traditional |
$81.20
|
| Rate for Payer: Caresource Just 4 Me |
$119.24
|
| Rate for Payer: Caresource Medicare |
$114.06
|
| Rate for Payer: Centivo/Paragon All Products |
$160.72
|
| Rate for Payer: Coventry/First Health All Products |
$242.78
|
| Rate for Payer: Frontpath All Products |
$181.59
|
| Rate for Payer: Humana ChoiceCare |
$202.32
|
| Rate for Payer: Humana Medicare |
$103.69
|
| Rate for Payer: Lucent/Coldwater Veneers |
$176.27
|
| Rate for Payer: Lutheran Preferred All Products |
$161.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$151.74
|
| Rate for Payer: PHP All Products |
$131.51
|
| Rate for Payer: Plain Church Group Ministry All Products |
$103.69
|
| Rate for Payer: Signature Care EPO |
$92.55
|
| Rate for Payer: Signature Care PPO |
$92.55
|
| Rate for Payer: Three Rivers Preferred All Products |
$150.00
|
| Rate for Payer: United Healthcare Commercial |
$103.01
|
|
|
CHG US,PREGNANT UTERUS,LIMITED, 1/> FETUSES
|
Professional
|
$149.96
|
|
|
Service Code
|
CPT 76815
|
| Hospital Charge Code |
Z12946
|
| Min. Negotiated Rate |
$76.86 |
| Max. Negotiated Rate |
$179.95 |
| Rate for Payer: Aetna Medicare |
$76.86
|
| Rate for Payer: Anthem Exchange |
$94.10
|
| Rate for Payer: Anthem Medicare |
$76.86
|
| Rate for Payer: Anthem PPO |
$94.10
|
| Rate for Payer: Anthem Traditional |
$94.10
|
| Rate for Payer: Caresource Just 4 Me |
$88.39
|
| Rate for Payer: Caresource Medicare |
$84.55
|
| Rate for Payer: Centivo/Paragon All Products |
$119.13
|
| Rate for Payer: Coventry/First Health All Products |
$179.95
|
| Rate for Payer: Frontpath All Products |
$134.91
|
| Rate for Payer: Humana ChoiceCare |
$149.96
|
| Rate for Payer: Humana Medicare |
$76.86
|
| Rate for Payer: Lucent/Coldwater Veneers |
$130.66
|
| Rate for Payer: Lutheran Preferred All Products |
$119.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$112.47
|
| Rate for Payer: PHP All Products |
$97.48
|
| Rate for Payer: Plain Church Group Ministry All Products |
$76.86
|
| Rate for Payer: Signature Care EPO |
$106.25
|
| Rate for Payer: Signature Care PPO |
$106.25
|
| Rate for Payer: Three Rivers Preferred All Products |
$111.00
|
| Rate for Payer: United Healthcare Commercial |
$83.76
|
|
