|
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
|
|
|
CHG US,PREGNANT UTERUS,TRANSVAGINAL
|
Professional
|
$171.04
|
|
|
Service Code
|
CPT 76817
|
| Hospital Charge Code |
Z12949
|
| Min. Negotiated Rate |
$87.65 |
| Max. Negotiated Rate |
$205.25 |
| Rate for Payer: Aetna Medicare |
$87.65
|
| Rate for Payer: Anthem Exchange |
$96.60
|
| Rate for Payer: Anthem Medicare |
$87.65
|
| Rate for Payer: Anthem PPO |
$96.60
|
| Rate for Payer: Anthem Traditional |
$96.60
|
| Rate for Payer: Caresource Just 4 Me |
$100.80
|
| Rate for Payer: Caresource Medicare |
$96.42
|
| Rate for Payer: Centivo/Paragon All Products |
$135.86
|
| Rate for Payer: Coventry/First Health All Products |
$205.25
|
| Rate for Payer: Frontpath All Products |
$154.22
|
| Rate for Payer: Humana ChoiceCare |
$171.04
|
| Rate for Payer: Humana Medicare |
$87.65
|
| Rate for Payer: Lucent/Coldwater Veneers |
$149.00
|
| Rate for Payer: Lutheran Preferred All Products |
$136.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$128.28
|
| Rate for Payer: PHP All Products |
$111.17
|
| Rate for Payer: Plain Church Group Ministry All Products |
$87.65
|
| Rate for Payer: Signature Care EPO |
$150.86
|
| Rate for Payer: Signature Care PPO |
$150.86
|
| Rate for Payer: Three Rivers Preferred All Products |
$127.00
|
| Rate for Payer: United Healthcare Commercial |
$93.56
|
|
|
CHG US,PREGNANT UTERUS,TRANSVAGINAL
|
Professional
|
$171.04
|
|
|
Service Code
|
CPT 76817
|
| Hospital Charge Code |
Z12950
|
| Min. Negotiated Rate |
$87.65 |
| Max. Negotiated Rate |
$205.25 |
| Rate for Payer: Aetna Medicare |
$87.65
|
| Rate for Payer: Anthem Exchange |
$96.60
|
| Rate for Payer: Anthem Medicare |
$87.65
|
| Rate for Payer: Anthem PPO |
$96.60
|
| Rate for Payer: Anthem Traditional |
$96.60
|
| Rate for Payer: Caresource Just 4 Me |
$100.80
|
| Rate for Payer: Caresource Medicare |
$96.42
|
| Rate for Payer: Centivo/Paragon All Products |
$135.86
|
| Rate for Payer: Coventry/First Health All Products |
$205.25
|
| Rate for Payer: Frontpath All Products |
$154.22
|
| Rate for Payer: Humana ChoiceCare |
$171.04
|
| Rate for Payer: Humana Medicare |
$87.65
|
| Rate for Payer: Lucent/Coldwater Veneers |
$149.00
|
| Rate for Payer: Lutheran Preferred All Products |
$136.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$128.28
|
| Rate for Payer: PHP All Products |
$111.17
|
| Rate for Payer: Plain Church Group Ministry All Products |
$87.65
|
| Rate for Payer: Signature Care EPO |
$150.86
|
| Rate for Payer: Signature Care PPO |
$150.86
|
| Rate for Payer: Three Rivers Preferred All Products |
$127.00
|
| Rate for Payer: United Healthcare Commercial |
$93.56
|
|
|
CHG US,PREG UTER,FET & MAT,+ DETL FET,ADDL
|
Professional
|
$355.10
|
|
|
Service Code
|
CPT 76812
|
| Hospital Charge Code |
Z12939
|
| Min. Negotiated Rate |
$109.81 |
| Max. Negotiated Rate |
$426.12 |
| Rate for Payer: Aetna Medicare |
$181.99
|
| Rate for Payer: Anthem Exchange |
$109.81
|
| Rate for Payer: Anthem Medicare |
$181.99
|
| Rate for Payer: Anthem PPO |
$109.81
|
| Rate for Payer: Anthem Traditional |
$109.81
|
| Rate for Payer: Caresource Just 4 Me |
$209.29
|
| Rate for Payer: Caresource Medicare |
$200.19
|
| Rate for Payer: Centivo/Paragon All Products |
$282.08
|
| Rate for Payer: Coventry/First Health All Products |
$426.12
|
| Rate for Payer: Frontpath All Products |
$320.52
|
| Rate for Payer: Humana ChoiceCare |
$355.10
|
| Rate for Payer: Humana Medicare |
$181.99
|
| Rate for Payer: Lucent/Coldwater Veneers |
$309.38
|
| Rate for Payer: Lutheran Preferred All Products |
$282.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$266.33
|
| Rate for Payer: PHP All Products |
$230.82
|
| Rate for Payer: Plain Church Group Ministry All Products |
$181.99
|
| Rate for Payer: Signature Care EPO |
$166.35
|
| Rate for Payer: Signature Care PPO |
$166.35
|
| Rate for Payer: Three Rivers Preferred All Products |
$264.00
|
| Rate for Payer: United Healthcare Commercial |
$186.03
|
|
|
CHG US,PREG UTER,FET & MAT,+ DETL FET,ADDL
|
Professional
|
$355.10
|
|
|
Service Code
|
CPT 76812
|
| Hospital Charge Code |
Z12940
|
| Min. Negotiated Rate |
$109.81 |
| Max. Negotiated Rate |
$426.12 |
| Rate for Payer: Aetna Medicare |
$181.99
|
| Rate for Payer: Anthem Exchange |
$109.81
|
| Rate for Payer: Anthem Medicare |
$181.99
|
| Rate for Payer: Anthem PPO |
$109.81
|
| Rate for Payer: Anthem Traditional |
$109.81
|
| Rate for Payer: Caresource Just 4 Me |
$209.29
|
| Rate for Payer: Caresource Medicare |
$200.19
|
| Rate for Payer: Centivo/Paragon All Products |
$282.08
|
| Rate for Payer: Coventry/First Health All Products |
$426.12
|
| Rate for Payer: Frontpath All Products |
$320.52
|
| Rate for Payer: Humana ChoiceCare |
$355.10
|
| Rate for Payer: Humana Medicare |
$181.99
|
| Rate for Payer: Lucent/Coldwater Veneers |
$309.38
|
| Rate for Payer: Lutheran Preferred All Products |
$282.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$266.33
|
| Rate for Payer: PHP All Products |
$230.82
|
| Rate for Payer: Plain Church Group Ministry All Products |
$181.99
|
| Rate for Payer: Signature Care EPO |
$166.35
|
| Rate for Payer: Signature Care PPO |
$166.35
|
| Rate for Payer: Three Rivers Preferred All Products |
$264.00
|
| Rate for Payer: United Healthcare Commercial |
$186.03
|
|
|
CHG US,PREG UTER,FET & MAT,+ DETL FET EXM
|
Professional
|
$326.32
|
|
|
Service Code
|
CPT 76811
|
| Hospital Charge Code |
Z12938
|
| Min. Negotiated Rate |
$167.24 |
| Max. Negotiated Rate |
$391.58 |
| Rate for Payer: Aetna Medicare |
$167.24
|
| Rate for Payer: Anthem Exchange |
$239.97
|
| Rate for Payer: Anthem Medicare |
$167.24
|
| Rate for Payer: Anthem PPO |
$239.97
|
| Rate for Payer: Anthem Traditional |
$239.97
|
| Rate for Payer: Caresource Just 4 Me |
$192.33
|
| Rate for Payer: Caresource Medicare |
$183.96
|
| Rate for Payer: Centivo/Paragon All Products |
$259.22
|
| Rate for Payer: Coventry/First Health All Products |
$391.58
|
| Rate for Payer: Frontpath All Products |
$289.66
|
| Rate for Payer: Humana ChoiceCare |
$326.32
|
| Rate for Payer: Humana Medicare |
$167.24
|
| Rate for Payer: Lucent/Coldwater Veneers |
$284.31
|
| Rate for Payer: Lutheran Preferred All Products |
$259.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$244.74
|
| Rate for Payer: PHP All Products |
$212.11
|
| Rate for Payer: Plain Church Group Ministry All Products |
$167.24
|
| Rate for Payer: Signature Care EPO |
$283.15
|
| Rate for Payer: Signature Care PPO |
$283.15
|
| Rate for Payer: Three Rivers Preferred All Products |
$242.00
|
| Rate for Payer: United Healthcare Commercial |
$190.01
|
|
|
CHG US,PREG UTER,FET & MAT,+ DETL FET EXM
|
Professional
|
$326.32
|
|
|
Service Code
|
CPT 76811
|
| Hospital Charge Code |
Z12937
|
| Min. Negotiated Rate |
$167.24 |
| Max. Negotiated Rate |
$391.58 |
| Rate for Payer: Aetna Medicare |
$167.24
|
| Rate for Payer: Anthem Exchange |
$239.97
|
| Rate for Payer: Anthem Medicare |
$167.24
|
| Rate for Payer: Anthem PPO |
$239.97
|
| Rate for Payer: Anthem Traditional |
$239.97
|
| Rate for Payer: Caresource Just 4 Me |
$192.33
|
| Rate for Payer: Caresource Medicare |
$183.96
|
| Rate for Payer: Centivo/Paragon All Products |
$259.22
|
| Rate for Payer: Coventry/First Health All Products |
$391.58
|
| Rate for Payer: Frontpath All Products |
$289.66
|
| Rate for Payer: Humana ChoiceCare |
$326.32
|
| Rate for Payer: Humana Medicare |
$167.24
|
| Rate for Payer: Lucent/Coldwater Veneers |
$284.31
|
| Rate for Payer: Lutheran Preferred All Products |
$259.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$244.74
|
| Rate for Payer: PHP All Products |
$212.11
|
| Rate for Payer: Plain Church Group Ministry All Products |
$167.24
|
| Rate for Payer: Signature Care EPO |
$283.15
|
| Rate for Payer: Signature Care PPO |
$283.15
|
| Rate for Payer: Three Rivers Preferred All Products |
$242.00
|
| Rate for Payer: United Healthcare Commercial |
$190.01
|
|
|
CHG US,PREG UTER,NUCHAL MEAS, 1ST TRI,ADDL GEST
|
Professional
|
$139.90
|
|
|
Service Code
|
CPT 76814
|
| Hospital Charge Code |
Z12944
|
| Min. Negotiated Rate |
$71.69 |
| Max. Negotiated Rate |
$167.88 |
| Rate for Payer: Aetna Medicare |
$71.69
|
| Rate for Payer: Anthem Exchange |
$85.10
|
| Rate for Payer: Anthem Medicare |
$71.69
|
| Rate for Payer: Anthem PPO |
$85.10
|
| Rate for Payer: Anthem Traditional |
$85.10
|
| Rate for Payer: Caresource Just 4 Me |
$82.44
|
| Rate for Payer: Caresource Medicare |
$78.86
|
| Rate for Payer: Centivo/Paragon All Products |
$111.12
|
| Rate for Payer: Coventry/First Health All Products |
$167.88
|
| Rate for Payer: Frontpath All Products |
$126.99
|
| Rate for Payer: Humana ChoiceCare |
$139.90
|
| Rate for Payer: Humana Medicare |
$71.69
|
| Rate for Payer: Lucent/Coldwater Veneers |
$121.87
|
| Rate for Payer: Lutheran Preferred All Products |
$111.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$104.93
|
| Rate for Payer: PHP All Products |
$90.93
|
| Rate for Payer: Plain Church Group Ministry All Products |
$71.69
|
| Rate for Payer: Signature Care EPO |
$96.05
|
| Rate for Payer: Signature Care PPO |
$96.05
|
| Rate for Payer: Three Rivers Preferred All Products |
$104.00
|
| Rate for Payer: United Healthcare Commercial |
$77.56
|
|
|
CHG US,PREG UTER,NUCHAL MEAS, 1ST TRI,ADDL GEST
|
Professional
|
$139.90
|
|
|
Service Code
|
CPT 76814
|
| Hospital Charge Code |
Z12943
|
| Min. Negotiated Rate |
$71.69 |
| Max. Negotiated Rate |
$167.88 |
| Rate for Payer: Aetna Medicare |
$71.69
|
| Rate for Payer: Anthem Exchange |
$85.10
|
| Rate for Payer: Anthem Medicare |
$71.69
|
| Rate for Payer: Anthem PPO |
$85.10
|
| Rate for Payer: Anthem Traditional |
$85.10
|
| Rate for Payer: Caresource Just 4 Me |
$82.44
|
| Rate for Payer: Caresource Medicare |
$78.86
|
| Rate for Payer: Centivo/Paragon All Products |
$111.12
|
| Rate for Payer: Coventry/First Health All Products |
$167.88
|
| Rate for Payer: Frontpath All Products |
$126.99
|
| Rate for Payer: Humana ChoiceCare |
$139.90
|
| Rate for Payer: Humana Medicare |
$71.69
|
| Rate for Payer: Lucent/Coldwater Veneers |
$121.87
|
| Rate for Payer: Lutheran Preferred All Products |
$111.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$104.93
|
| Rate for Payer: PHP All Products |
$90.93
|
| Rate for Payer: Plain Church Group Ministry All Products |
$71.69
|
| Rate for Payer: Signature Care EPO |
$96.05
|
| Rate for Payer: Signature Care PPO |
$96.05
|
| Rate for Payer: Three Rivers Preferred All Products |
$104.00
|
| Rate for Payer: United Healthcare Commercial |
$77.56
|
|
|
CHG US,PREG UTER,NUCHAL MEAS, 1ST TRIMEST, SINGLETON
|
Professional
|
$217.54
|
|
|
Service Code
|
CPT 76813
|
| Hospital Charge Code |
Z12942
|
| Min. Negotiated Rate |
$111.49 |
| Max. Negotiated Rate |
$261.05 |
| Rate for Payer: Aetna Medicare |
$111.49
|
| Rate for Payer: Anthem Exchange |
$126.19
|
| Rate for Payer: Anthem Medicare |
$111.49
|
| Rate for Payer: Anthem PPO |
$126.19
|
| Rate for Payer: Anthem Traditional |
$126.19
|
| Rate for Payer: Caresource Just 4 Me |
$128.21
|
| Rate for Payer: Caresource Medicare |
$122.64
|
| Rate for Payer: Centivo/Paragon All Products |
$172.81
|
| Rate for Payer: Coventry/First Health All Products |
$261.05
|
| Rate for Payer: Frontpath All Products |
$196.18
|
| Rate for Payer: Humana ChoiceCare |
$217.54
|
| Rate for Payer: Humana Medicare |
$111.49
|
| Rate for Payer: Lucent/Coldwater Veneers |
$189.53
|
| Rate for Payer: Lutheran Preferred All Products |
$173.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$163.16
|
| Rate for Payer: PHP All Products |
$141.40
|
| Rate for Payer: Plain Church Group Ministry All Products |
$111.49
|
| Rate for Payer: Signature Care EPO |
$145.35
|
| Rate for Payer: Signature Care PPO |
$145.35
|
| Rate for Payer: Three Rivers Preferred All Products |
$162.00
|
| Rate for Payer: United Healthcare Commercial |
$118.51
|
|
|
CHG US,PREG UTER,NUCHAL MEAS, 1ST TRIMEST, SINGLETON
|
Professional
|
$217.54
|
|
|
Service Code
|
CPT 76813
|
| Hospital Charge Code |
Z12941
|
| Min. Negotiated Rate |
$111.49 |
| Max. Negotiated Rate |
$261.05 |
| Rate for Payer: Aetna Medicare |
$111.49
|
| Rate for Payer: Anthem Exchange |
$126.19
|
| Rate for Payer: Anthem Medicare |
$111.49
|
| Rate for Payer: Anthem PPO |
$126.19
|
| Rate for Payer: Anthem Traditional |
$126.19
|
| Rate for Payer: Caresource Just 4 Me |
$128.21
|
| Rate for Payer: Caresource Medicare |
$122.64
|
| Rate for Payer: Centivo/Paragon All Products |
$172.81
|
| Rate for Payer: Coventry/First Health All Products |
$261.05
|
| Rate for Payer: Frontpath All Products |
$196.18
|
| Rate for Payer: Humana ChoiceCare |
$217.54
|
| Rate for Payer: Humana Medicare |
$111.49
|
| Rate for Payer: Lucent/Coldwater Veneers |
$189.53
|
| Rate for Payer: Lutheran Preferred All Products |
$173.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$163.16
|
| Rate for Payer: PHP All Products |
$141.40
|
| Rate for Payer: Plain Church Group Ministry All Products |
$111.49
|
| Rate for Payer: Signature Care EPO |
$145.35
|
| Rate for Payer: Signature Care PPO |
$145.35
|
| Rate for Payer: Three Rivers Preferred All Products |
$162.00
|
| Rate for Payer: United Healthcare Commercial |
$118.51
|
|
|
CHG VENOGRAM EXTREM UNILAT
|
Professional
|
$200.56
|
|
|
Service Code
|
CPT 75820
|
| Hospital Charge Code |
Z12928
|
| Min. Negotiated Rate |
$81.20 |
| Max. Negotiated Rate |
$240.67 |
| Rate for Payer: Aetna Medicare |
$102.79
|
| Rate for Payer: Anthem Exchange |
$81.20
|
| Rate for Payer: Anthem Medicare |
$102.79
|
| Rate for Payer: Anthem PPO |
$81.20
|
| Rate for Payer: Anthem Traditional |
$81.20
|
| Rate for Payer: Caresource Just 4 Me |
$118.21
|
| Rate for Payer: Caresource Medicare |
$113.07
|
| Rate for Payer: Centivo/Paragon All Products |
$159.32
|
| Rate for Payer: Coventry/First Health All Products |
$240.67
|
| Rate for Payer: Frontpath All Products |
$183.68
|
| Rate for Payer: Humana ChoiceCare |
$200.56
|
| Rate for Payer: Humana Medicare |
$102.79
|
| Rate for Payer: Lucent/Coldwater Veneers |
$174.74
|
| Rate for Payer: Lutheran Preferred All Products |
$159.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$150.42
|
| Rate for Payer: PHP All Products |
$130.36
|
| Rate for Payer: Plain Church Group Ministry All Products |
$102.79
|
| Rate for Payer: Signature Care EPO |
$91.91
|
| Rate for Payer: Signature Care PPO |
$91.91
|
| Rate for Payer: Three Rivers Preferred All Products |
$149.00
|
| Rate for Payer: United Healthcare Commercial |
$109.63
|
|
|
CHG X-RAY AC JTS
|
Professional
|
$52.28
|
|
|
Service Code
|
CPT 73050
|
| Hospital Charge Code |
Z12897
|
| Min. Negotiated Rate |
$26.80 |
| Max. Negotiated Rate |
$62.74 |
| Rate for Payer: Aetna Medicare |
$26.80
|
| Rate for Payer: Anthem Medicare |
$26.80
|
| Rate for Payer: Caresource Just 4 Me |
$30.82
|
| Rate for Payer: Caresource Medicare |
$29.48
|
| Rate for Payer: Centivo/Paragon All Products |
$41.54
|
| Rate for Payer: Coventry/First Health All Products |
$62.74
|
| Rate for Payer: Frontpath All Products |
$46.78
|
| Rate for Payer: Humana ChoiceCare |
$52.28
|
| Rate for Payer: Humana Medicare |
$26.80
|
| Rate for Payer: Lucent/Coldwater Veneers |
$45.56
|
| Rate for Payer: PHCS/Multiplan All Products |
$39.21
|
| Rate for Payer: PHP All Products |
$33.99
|
| Rate for Payer: Plain Church Group Ministry All Products |
$26.80
|
| Rate for Payer: Signature Care EPO |
$43.35
|
| Rate for Payer: Signature Care PPO |
$43.35
|
| Rate for Payer: United Healthcare Commercial |
$32.46
|
|
|
CHG X-RAY ANKLE 2 VW
|
Professional
|
$59.40
|
|
|
Service Code
|
CPT 73600
|
| Hospital Charge Code |
Z12918
|
| Min. Negotiated Rate |
$24.30 |
| Max. Negotiated Rate |
$71.28 |
| Rate for Payer: Aetna Medicare |
$30.44
|
| Rate for Payer: Anthem Medicare |
$30.44
|
| Rate for Payer: Caresource Just 4 Me |
$35.01
|
| Rate for Payer: Caresource Medicare |
$33.48
|
| Rate for Payer: Centivo/Paragon All Products |
$47.18
|
| Rate for Payer: Coventry/First Health All Products |
$71.28
|
| Rate for Payer: Frontpath All Products |
$52.60
|
| Rate for Payer: Humana ChoiceCare |
$59.40
|
| Rate for Payer: Humana Medicare |
$30.44
|
| Rate for Payer: Lucent/Coldwater Veneers |
$51.75
|
| Rate for Payer: PHCS/Multiplan All Products |
$44.55
|
| Rate for Payer: Plain Church Group Ministry All Products |
$30.44
|
| Rate for Payer: United Healthcare Commercial |
$24.30
|
|
|
CHG X-RAY ANKLE 3+ VW
|
Professional
|
$67.28
|
|
|
Service Code
|
CPT 73610
|
| Hospital Charge Code |
Z12919
|
| Min. Negotiated Rate |
$27.97 |
| Max. Negotiated Rate |
$80.74 |
| Rate for Payer: Aetna Medicare |
$34.48
|
| Rate for Payer: Anthem Exchange |
$51.40
|
| Rate for Payer: Anthem Medicare |
$34.48
|
| Rate for Payer: Anthem PPO |
$51.40
|
| Rate for Payer: Anthem Traditional |
$51.40
|
| Rate for Payer: Caresource Just 4 Me |
$39.65
|
| Rate for Payer: Caresource Medicare |
$37.93
|
| Rate for Payer: Centivo/Paragon All Products |
$53.44
|
| Rate for Payer: Coventry/First Health All Products |
$80.74
|
| Rate for Payer: Frontpath All Products |
$60.16
|
| Rate for Payer: Humana ChoiceCare |
$67.28
|
| Rate for Payer: Humana Medicare |
$34.48
|
| Rate for Payer: Lucent/Coldwater Veneers |
$58.62
|
| Rate for Payer: Lutheran Preferred All Products |
$53.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$50.46
|
| Rate for Payer: PHP All Products |
$43.74
|
| Rate for Payer: Plain Church Group Ministry All Products |
$34.48
|
| Rate for Payer: Signature Care EPO |
$34.85
|
| Rate for Payer: Signature Care PPO |
$34.85
|
| Rate for Payer: Three Rivers Preferred All Products |
$50.00
|
| Rate for Payer: United Healthcare Commercial |
$27.97
|
|
|
CHG X-RAY CERV SPINE 4 VW
|
Professional
|
$97.40
|
|
|
Service Code
|
CPT 72050
|
| Hospital Charge Code |
Z12884
|
| Min. Negotiated Rate |
$47.46 |
| Max. Negotiated Rate |
$116.88 |
| Rate for Payer: Aetna Medicare |
$49.91
|
| Rate for Payer: Anthem Exchange |
$110.10
|
| Rate for Payer: Anthem Medicare |
$49.91
|
| Rate for Payer: Anthem PPO |
$110.10
|
| Rate for Payer: Anthem Traditional |
$110.10
|
| Rate for Payer: Caresource Just 4 Me |
$57.40
|
| Rate for Payer: Caresource Medicare |
$54.90
|
| Rate for Payer: Centivo/Paragon All Products |
$77.36
|
| Rate for Payer: Coventry/First Health All Products |
$116.88
|
| Rate for Payer: Frontpath All Products |
$86.99
|
| Rate for Payer: Humana ChoiceCare |
$97.40
|
| Rate for Payer: Humana Medicare |
$49.91
|
| Rate for Payer: Lucent/Coldwater Veneers |
$84.85
|
| Rate for Payer: Lutheran Preferred All Products |
$77.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$73.05
|
| Rate for Payer: PHP All Products |
$63.30
|
| Rate for Payer: Plain Church Group Ministry All Products |
$49.91
|
| Rate for Payer: Signature Care EPO |
$60.35
|
| Rate for Payer: Signature Care PPO |
$60.35
|
| Rate for Payer: Three Rivers Preferred All Products |
$72.00
|
| Rate for Payer: United Healthcare Commercial |
$47.46
|
|
|
CHG X-RAY CLAVICLE
|
Professional
|
$58.80
|
|
|
Service Code
|
CPT 73000
|
| Hospital Charge Code |
Z12894
|
| Min. Negotiated Rate |
$24.96 |
| Max. Negotiated Rate |
$70.56 |
| Rate for Payer: Aetna Medicare |
$30.13
|
| Rate for Payer: Anthem Exchange |
$28.37
|
| Rate for Payer: Anthem Medicare |
$30.13
|
| Rate for Payer: Anthem PPO |
$28.37
|
| Rate for Payer: Anthem Traditional |
$28.37
|
| Rate for Payer: Caresource Just 4 Me |
$34.65
|
| Rate for Payer: Caresource Medicare |
$33.14
|
| Rate for Payer: Centivo/Paragon All Products |
$46.70
|
| Rate for Payer: Coventry/First Health All Products |
$70.56
|
| Rate for Payer: Frontpath All Products |
$52.60
|
| Rate for Payer: Humana ChoiceCare |
$58.80
|
| Rate for Payer: Humana Medicare |
$30.13
|
| Rate for Payer: Lucent/Coldwater Veneers |
$51.22
|
| Rate for Payer: Lutheran Preferred All Products |
$47.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$44.10
|
| Rate for Payer: PHP All Products |
$38.22
|
| Rate for Payer: Plain Church Group Ministry All Products |
$30.13
|
| Rate for Payer: Signature Care EPO |
$33.15
|
| Rate for Payer: Signature Care PPO |
$33.15
|
| Rate for Payer: Three Rivers Preferred All Products |
$44.00
|
| Rate for Payer: United Healthcare Commercial |
$24.96
|
|
|
CHG X-RAY CLAVICLE
|
Professional
|
$58.80
|
|
|
Service Code
|
CPT 73000
|
| Hospital Charge Code |
Z12892
|
| Min. Negotiated Rate |
$24.96 |
| Max. Negotiated Rate |
$70.56 |
| Rate for Payer: Aetna Medicare |
$30.13
|
| Rate for Payer: Anthem Exchange |
$28.37
|
| Rate for Payer: Anthem Medicare |
$30.13
|
| Rate for Payer: Anthem PPO |
$28.37
|
| Rate for Payer: Anthem Traditional |
$28.37
|
| Rate for Payer: Caresource Just 4 Me |
$34.65
|
| Rate for Payer: Caresource Medicare |
$33.14
|
| Rate for Payer: Centivo/Paragon All Products |
$46.70
|
| Rate for Payer: Coventry/First Health All Products |
$70.56
|
| Rate for Payer: Frontpath All Products |
$52.60
|
| Rate for Payer: Humana ChoiceCare |
$58.80
|
| Rate for Payer: Humana Medicare |
$30.13
|
| Rate for Payer: Lucent/Coldwater Veneers |
$51.22
|
| Rate for Payer: Lutheran Preferred All Products |
$47.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$44.10
|
| Rate for Payer: PHP All Products |
$38.22
|
| Rate for Payer: Plain Church Group Ministry All Products |
$30.13
|
| Rate for Payer: Signature Care EPO |
$33.15
|
| Rate for Payer: Signature Care PPO |
$33.15
|
| Rate for Payer: Three Rivers Preferred All Products |
$44.00
|
| Rate for Payer: United Healthcare Commercial |
$24.96
|
|
|
CHG X-RAY CLAVICLE
|
Professional
|
$58.80
|
|
|
Service Code
|
CPT 73000
|
| Hospital Charge Code |
Z12893
|
| Min. Negotiated Rate |
$24.96 |
| Max. Negotiated Rate |
$70.56 |
| Rate for Payer: Aetna Medicare |
$30.13
|
| Rate for Payer: Anthem Exchange |
$28.37
|
| Rate for Payer: Anthem Medicare |
$30.13
|
| Rate for Payer: Anthem PPO |
$28.37
|
| Rate for Payer: Anthem Traditional |
$28.37
|
| Rate for Payer: Caresource Just 4 Me |
$34.65
|
| Rate for Payer: Caresource Medicare |
$33.14
|
| Rate for Payer: Centivo/Paragon All Products |
$46.70
|
| Rate for Payer: Coventry/First Health All Products |
$70.56
|
| Rate for Payer: Frontpath All Products |
$52.60
|
| Rate for Payer: Humana ChoiceCare |
$58.80
|
| Rate for Payer: Humana Medicare |
$30.13
|
| Rate for Payer: Lucent/Coldwater Veneers |
$51.22
|
| Rate for Payer: Lutheran Preferred All Products |
$47.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$44.10
|
| Rate for Payer: PHP All Products |
$38.22
|
| Rate for Payer: Plain Church Group Ministry All Products |
$30.13
|
| Rate for Payer: Signature Care EPO |
$33.15
|
| Rate for Payer: Signature Care PPO |
$33.15
|
| Rate for Payer: Three Rivers Preferred All Products |
$44.00
|
| Rate for Payer: United Healthcare Commercial |
$24.96
|
|
|
CHG X-RAY ELBOW 2 VW
|
Professional
|
$53.38
|
|
|
Service Code
|
CPT 73070
|
| Hospital Charge Code |
Z12901
|
| Min. Negotiated Rate |
$24.27 |
| Max. Negotiated Rate |
$64.06 |
| Rate for Payer: Aetna Medicare |
$27.35
|
| Rate for Payer: Anthem Exchange |
$27.87
|
| Rate for Payer: Anthem Medicare |
$27.35
|
| Rate for Payer: Anthem PPO |
$27.87
|
| Rate for Payer: Anthem Traditional |
$27.87
|
| Rate for Payer: Caresource Just 4 Me |
$31.45
|
| Rate for Payer: Caresource Medicare |
$30.09
|
| Rate for Payer: Centivo/Paragon All Products |
$42.39
|
| Rate for Payer: Coventry/First Health All Products |
$64.06
|
| Rate for Payer: Frontpath All Products |
$47.77
|
| Rate for Payer: Humana ChoiceCare |
$53.38
|
| Rate for Payer: Humana Medicare |
$27.35
|
| Rate for Payer: Lucent/Coldwater Veneers |
$46.50
|
| Rate for Payer: Lutheran Preferred All Products |
$42.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$40.04
|
| Rate for Payer: PHP All Products |
$34.69
|
| Rate for Payer: Plain Church Group Ministry All Products |
$27.35
|
| Rate for Payer: Signature Care EPO |
$33.15
|
| Rate for Payer: Signature Care PPO |
$33.15
|
| Rate for Payer: Three Rivers Preferred All Products |
$40.00
|
| Rate for Payer: United Healthcare Commercial |
$24.27
|
|
|
CHG X-RAY ELBOW 2 VW
|
Professional
|
$53.38
|
|
|
Service Code
|
CPT 73070
|
| Hospital Charge Code |
Z12900
|
| Min. Negotiated Rate |
$24.27 |
| Max. Negotiated Rate |
$64.06 |
| Rate for Payer: Aetna Medicare |
$27.35
|
| Rate for Payer: Anthem Exchange |
$27.87
|
| Rate for Payer: Anthem Medicare |
$27.35
|
| Rate for Payer: Anthem PPO |
$27.87
|
| Rate for Payer: Anthem Traditional |
$27.87
|
| Rate for Payer: Caresource Just 4 Me |
$31.45
|
| Rate for Payer: Caresource Medicare |
$30.09
|
| Rate for Payer: Centivo/Paragon All Products |
$42.39
|
| Rate for Payer: Coventry/First Health All Products |
$64.06
|
| Rate for Payer: Frontpath All Products |
$47.77
|
| Rate for Payer: Humana ChoiceCare |
$53.38
|
| Rate for Payer: Humana Medicare |
$27.35
|
| Rate for Payer: Lucent/Coldwater Veneers |
$46.50
|
| Rate for Payer: Lutheran Preferred All Products |
$42.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$40.04
|
| Rate for Payer: PHP All Products |
$34.69
|
| Rate for Payer: Plain Church Group Ministry All Products |
$27.35
|
| Rate for Payer: Signature Care EPO |
$33.15
|
| Rate for Payer: Signature Care PPO |
$33.15
|
| Rate for Payer: Three Rivers Preferred All Products |
$40.00
|
| Rate for Payer: United Healthcare Commercial |
$24.27
|
|
|
CHG X-RAY ELBOW 2 VW
|
Professional
|
$53.38
|
|
|
Service Code
|
CPT 73070
|
| Hospital Charge Code |
Z12899
|
| Min. Negotiated Rate |
$24.27 |
| Max. Negotiated Rate |
$64.06 |
| Rate for Payer: Aetna Medicare |
$27.35
|
| Rate for Payer: Anthem Exchange |
$27.87
|
| Rate for Payer: Anthem Medicare |
$27.35
|
| Rate for Payer: Anthem PPO |
$27.87
|
| Rate for Payer: Anthem Traditional |
$27.87
|
| Rate for Payer: Caresource Just 4 Me |
$31.45
|
| Rate for Payer: Caresource Medicare |
$30.09
|
| Rate for Payer: Centivo/Paragon All Products |
$42.39
|
| Rate for Payer: Coventry/First Health All Products |
$64.06
|
| Rate for Payer: Frontpath All Products |
$47.77
|
| Rate for Payer: Humana ChoiceCare |
$53.38
|
| Rate for Payer: Humana Medicare |
$27.35
|
| Rate for Payer: Lucent/Coldwater Veneers |
$46.50
|
| Rate for Payer: Lutheran Preferred All Products |
$42.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$40.04
|
| Rate for Payer: PHP All Products |
$34.69
|
| Rate for Payer: Plain Church Group Ministry All Products |
$27.35
|
| Rate for Payer: Signature Care EPO |
$33.15
|
| Rate for Payer: Signature Care PPO |
$33.15
|
| Rate for Payer: Three Rivers Preferred All Products |
$40.00
|
| Rate for Payer: United Healthcare Commercial |
$24.27
|
|
|
CHG X-RAY ELBOW 3+ VW
|
Professional
|
$59.46
|
|
|
Service Code
|
CPT 73080
|
| Hospital Charge Code |
Z12902
|
| Min. Negotiated Rate |
$30.47 |
| Max. Negotiated Rate |
$71.35 |
| Rate for Payer: Aetna Medicare |
$30.47
|
| Rate for Payer: Anthem Exchange |
$32.70
|
| Rate for Payer: Anthem Medicare |
$30.47
|
| Rate for Payer: Anthem PPO |
$32.70
|
| Rate for Payer: Anthem Traditional |
$32.70
|
| Rate for Payer: Caresource Just 4 Me |
$35.04
|
| Rate for Payer: Caresource Medicare |
$33.52
|
| Rate for Payer: Centivo/Paragon All Products |
$47.23
|
| Rate for Payer: Coventry/First Health All Products |
$71.35
|
| Rate for Payer: Frontpath All Products |
$53.18
|
| Rate for Payer: Humana ChoiceCare |
$59.46
|
| Rate for Payer: Humana Medicare |
$30.47
|
| Rate for Payer: Lucent/Coldwater Veneers |
$51.80
|
| Rate for Payer: Lutheran Preferred All Products |
$47.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$44.59
|
| Rate for Payer: PHP All Products |
$38.65
|
| Rate for Payer: Plain Church Group Ministry All Products |
$30.47
|
| Rate for Payer: Signature Care EPO |
$36.55
|
| Rate for Payer: Signature Care PPO |
$36.55
|
| Rate for Payer: Three Rivers Preferred All Products |
$44.00
|
| Rate for Payer: United Healthcare Commercial |
$31.05
|
|
|
CHG X-RAY EXAM OF FINGER(S)
|
Professional
|
$68.86
|
|
|
Service Code
|
CPT 73140
|
| Hospital Charge Code |
Z12910
|
| Min. Negotiated Rate |
$25.86 |
| Max. Negotiated Rate |
$82.63 |
| Rate for Payer: Aetna Medicare |
$35.29
|
| Rate for Payer: Anthem Exchange |
$49.10
|
| Rate for Payer: Anthem Medicare |
$35.29
|
| Rate for Payer: Anthem PPO |
$49.10
|
| Rate for Payer: Anthem Traditional |
$49.10
|
| Rate for Payer: Caresource Just 4 Me |
$40.58
|
| Rate for Payer: Caresource Medicare |
$38.82
|
| Rate for Payer: Centivo/Paragon All Products |
$54.70
|
| Rate for Payer: Coventry/First Health All Products |
$82.63
|
| Rate for Payer: Frontpath All Products |
$61.03
|
| Rate for Payer: Humana ChoiceCare |
$68.86
|
| Rate for Payer: Humana Medicare |
$35.29
|
| Rate for Payer: Lucent/Coldwater Veneers |
$59.99
|
| Rate for Payer: Lutheran Preferred All Products |
$55.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$51.64
|
| Rate for Payer: PHP All Products |
$44.76
|
| Rate for Payer: Plain Church Group Ministry All Products |
$35.29
|
| Rate for Payer: Signature Care EPO |
$29.78
|
| Rate for Payer: Signature Care PPO |
$29.78
|
| Rate for Payer: Three Rivers Preferred All Products |
$51.00
|
| Rate for Payer: United Healthcare Commercial |
$25.86
|
|
|
CHG X-RAY FACIAL BONES <3 VW
|
Professional
|
$58.98
|
|
|
Service Code
|
CPT 70140
|
| Hospital Charge Code |
Z12870
|
| Min. Negotiated Rate |
$27.14 |
| Max. Negotiated Rate |
$70.78 |
| Rate for Payer: Aetna Medicare |
$30.22
|
| Rate for Payer: Anthem Medicare |
$30.22
|
| Rate for Payer: Caresource Just 4 Me |
$34.75
|
| Rate for Payer: Caresource Medicare |
$33.24
|
| Rate for Payer: Centivo/Paragon All Products |
$46.84
|
| Rate for Payer: Coventry/First Health All Products |
$70.78
|
| Rate for Payer: Frontpath All Products |
$52.75
|
| Rate for Payer: Humana ChoiceCare |
$58.98
|
| Rate for Payer: Humana Medicare |
$30.22
|
| Rate for Payer: Lucent/Coldwater Veneers |
$51.37
|
| Rate for Payer: PHCS/Multiplan All Products |
$44.23
|
| Rate for Payer: Plain Church Group Ministry All Products |
$30.22
|
| Rate for Payer: United Healthcare Commercial |
$27.14
|
|
