|
PR FEMORAL FX, OPEN TX
|
Professional
|
$2,153.46
|
|
|
Service Code
|
CPT 27236
|
| Hospital Charge Code |
Z12319
|
| Min. Negotiated Rate |
$1,076.73 |
| Max. Negotiated Rate |
$2,584.15 |
| Rate for Payer: Caresource Just 4 Me |
$1,269.20
|
| Rate for Payer: Caresource Medicare |
$1,214.02
|
| Rate for Payer: Aetna Medicare |
$1,103.65
|
| Rate for Payer: Anthem Exchange |
$1,514.40
|
| Rate for Payer: Anthem Medicare |
$1,103.65
|
| Rate for Payer: Anthem PPO |
$1,514.40
|
| Rate for Payer: Anthem Traditional |
$1,514.40
|
| Rate for Payer: Centivo/Paragon All Products |
$1,710.66
|
| Rate for Payer: Coventry/First Health All Products |
$2,584.15
|
| Rate for Payer: Frontpath All Products |
$1,551.03
|
| Rate for Payer: Humana ChoiceCare |
$2,153.46
|
| Rate for Payer: Humana Medicare |
$1,103.65
|
| Rate for Payer: Lucent/Coldwater Veneers |
$1,876.21
|
| Rate for Payer: Lutheran Preferred All Products |
$1,766.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$1,615.10
|
| Rate for Payer: PHP All Products |
$1,873.51
|
| Rate for Payer: Plain Church Group Ministry All Products |
$1,103.65
|
| Rate for Payer: Signature Care EPO |
$1,560.60
|
| Rate for Payer: Signature Care PPO |
$1,560.60
|
| Rate for Payer: Three Rivers Preferred All Products |
$1,655.00
|
| Rate for Payer: United Healthcare Commercial |
$1,302.09
|
| Rate for Payer: United Healthcare Medicare |
$1,076.73
|
|
|
PR FEMUR/KNEE SURG UNLISTED
|
Professional
|
$1,026.30
|
|
|
Service Code
|
CPT 27599
|
| Hospital Charge Code |
Z12374
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$1,231.56 |
| Rate for Payer: Anthem Exchange |
$0.01
|
| Rate for Payer: Anthem PPO |
$0.01
|
| Rate for Payer: Anthem Traditional |
$0.01
|
| Rate for Payer: Coventry/First Health All Products |
$1,231.56
|
| Rate for Payer: Humana ChoiceCare |
$1,026.30
|
| Rate for Payer: Lutheran Preferred All Products |
$872.35
|
| Rate for Payer: PHCS/Multiplan All Products |
$769.72
|
| Rate for Payer: Signature Care EPO |
$654.27
|
| Rate for Payer: Signature Care PPO |
$654.27
|
| Rate for Payer: Three Rivers Preferred All Products |
$615.78
|
|
|
PR FETAL CONTRACTN STRESS TEST
|
Professional
|
$125.50
|
|
|
Service Code
|
CPT 59020
|
| Hospital Charge Code |
Z12786
|
| Min. Negotiated Rate |
$64.32 |
| Max. Negotiated Rate |
$150.60 |
| Rate for Payer: Aetna Medicare |
$64.32
|
| Rate for Payer: Anthem Exchange |
$83.21
|
| Rate for Payer: Anthem Medicare |
$64.32
|
| Rate for Payer: Anthem PPO |
$83.21
|
| Rate for Payer: Anthem Traditional |
$83.21
|
| Rate for Payer: Caresource Just 4 Me |
$73.97
|
| Rate for Payer: Caresource Medicare |
$70.75
|
| Rate for Payer: Centivo/Paragon All Products |
$99.70
|
| Rate for Payer: Coventry/First Health All Products |
$150.60
|
| Rate for Payer: Frontpath All Products |
$88.19
|
| Rate for Payer: Humana ChoiceCare |
$125.50
|
| Rate for Payer: Humana Medicare |
$64.32
|
| Rate for Payer: Lucent/Coldwater Veneers |
$109.34
|
| Rate for Payer: Lutheran Preferred All Products |
$90.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$94.12
|
| Rate for Payer: PHP All Products |
$82.83
|
| Rate for Payer: Plain Church Group Ministry All Products |
$64.32
|
| Rate for Payer: Signature Care EPO |
$73.10
|
| Rate for Payer: Signature Care PPO |
$73.10
|
| Rate for Payer: Three Rivers Preferred All Products |
$84.00
|
| Rate for Payer: United Healthcare Commercial |
$77.75
|
|
|
PR FETAL NON-STRESS TEST
|
Professional
|
$87.32
|
|
|
Service Code
|
CPT 59025
|
| Hospital Charge Code |
Z12787
|
| Min. Negotiated Rate |
$44.75 |
| Max. Negotiated Rate |
$104.78 |
| Rate for Payer: Aetna Medicare |
$44.75
|
| Rate for Payer: Anthem Exchange |
$54.82
|
| Rate for Payer: Anthem Medicare |
$44.75
|
| Rate for Payer: Anthem PPO |
$54.82
|
| Rate for Payer: Anthem Traditional |
$54.82
|
| Rate for Payer: Caresource Just 4 Me |
$51.46
|
| Rate for Payer: Caresource Medicare |
$49.23
|
| Rate for Payer: Centivo/Paragon All Products |
$69.36
|
| Rate for Payer: Coventry/First Health All Products |
$104.78
|
| Rate for Payer: Frontpath All Products |
$60.43
|
| Rate for Payer: Humana ChoiceCare |
$87.32
|
| Rate for Payer: Humana Medicare |
$44.75
|
| Rate for Payer: Lucent/Coldwater Veneers |
$76.08
|
| Rate for Payer: Lutheran Preferred All Products |
$63.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$65.49
|
| Rate for Payer: PHP All Products |
$57.63
|
| Rate for Payer: Plain Church Group Ministry All Products |
$44.75
|
| Rate for Payer: Signature Care EPO |
$49.30
|
| Rate for Payer: Signature Care PPO |
$49.30
|
| Rate for Payer: Three Rivers Preferred All Products |
$58.00
|
| Rate for Payer: United Healthcare Commercial |
$51.95
|
|
|
PR FILTERED SPEECH HEARING TEST
|
Professional
|
$53.92
|
|
|
Service Code
|
CPT 92571
|
| Hospital Charge Code |
Z13052
|
| Min. Negotiated Rate |
$15.40 |
| Max. Negotiated Rate |
$64.70 |
| Rate for Payer: Aetna Medicare |
$27.64
|
| Rate for Payer: Anthem Exchange |
$15.40
|
| Rate for Payer: Anthem Medicare |
$27.64
|
| Rate for Payer: Anthem PPO |
$15.40
|
| Rate for Payer: Anthem Traditional |
$15.40
|
| Rate for Payer: Caresource Just 4 Me |
$31.79
|
| Rate for Payer: Caresource Medicare |
$30.40
|
| Rate for Payer: Centivo/Paragon All Products |
$42.84
|
| Rate for Payer: Coventry/First Health All Products |
$64.70
|
| Rate for Payer: Frontpath All Products |
$29.26
|
| Rate for Payer: Humana ChoiceCare |
$53.92
|
| Rate for Payer: Humana Medicare |
$27.64
|
| Rate for Payer: Lucent/Coldwater Veneers |
$46.99
|
| Rate for Payer: Lutheran Preferred All Products |
$36.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$40.44
|
| Rate for Payer: PHP All Products |
$39.10
|
| Rate for Payer: Plain Church Group Ministry All Products |
$27.64
|
| Rate for Payer: Signature Care EPO |
$22.11
|
| Rate for Payer: Signature Care PPO |
$22.11
|
| Rate for Payer: Three Rivers Preferred All Products |
$33.00
|
| Rate for Payer: United Healthcare Commercial |
$18.05
|
| Rate for Payer: United Healthcare Medicare |
$26.96
|
|
|
PR FINE NEEDLE ASPIRATION BX W/O IMG GDN 1ST LESION
|
Professional
|
$185.74
|
|
|
Service Code
|
CPT 10021
|
| Hospital Charge Code |
Z11949
|
| Min. Negotiated Rate |
$51.36 |
| Max. Negotiated Rate |
$222.89 |
| Rate for Payer: Aetna Medicare |
$51.36
|
| Rate for Payer: Anthem Exchange |
$142.98
|
| Rate for Payer: Anthem Medicare |
$51.36
|
| Rate for Payer: Anthem PPO |
$142.98
|
| Rate for Payer: Anthem Traditional |
$142.98
|
| Rate for Payer: Caresource Just 4 Me |
$59.06
|
| Rate for Payer: Caresource Medicare |
$56.50
|
| Rate for Payer: Centivo/Paragon All Products |
$79.61
|
| Rate for Payer: Coventry/First Health All Products |
$222.89
|
| Rate for Payer: Frontpath All Products |
$70.73
|
| Rate for Payer: Humana ChoiceCare |
$185.74
|
| Rate for Payer: Humana Medicare |
$51.36
|
| Rate for Payer: Lucent/Coldwater Veneers |
$87.31
|
| Rate for Payer: Lutheran Preferred All Products |
$67.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$139.31
|
| Rate for Payer: PHP All Products |
$70.15
|
| Rate for Payer: Plain Church Group Ministry All Products |
$51.36
|
| Rate for Payer: Signature Care EPO |
$139.40
|
| Rate for Payer: Signature Care PPO |
$139.40
|
| Rate for Payer: Three Rivers Preferred All Products |
$62.00
|
| Rate for Payer: United Healthcare Commercial |
$77.75
|
| Rate for Payer: United Healthcare Medicare |
$92.87
|
|
|
PR FIT/INSERT INTRAVAG SUPPORT DEVICE
|
Professional
|
$136.14
|
|
|
Service Code
|
CPT 57160
|
| Hospital Charge Code |
Z12703
|
| Min. Negotiated Rate |
$42.91 |
| Max. Negotiated Rate |
$163.37 |
| Rate for Payer: Aetna Medicare |
$42.91
|
| Rate for Payer: Anthem Exchange |
$97.90
|
| Rate for Payer: Anthem Medicare |
$42.91
|
| Rate for Payer: Anthem PPO |
$97.90
|
| Rate for Payer: Anthem Traditional |
$97.90
|
| Rate for Payer: Caresource Just 4 Me |
$49.35
|
| Rate for Payer: Caresource Medicare |
$47.20
|
| Rate for Payer: Centivo/Paragon All Products |
$66.51
|
| Rate for Payer: Coventry/First Health All Products |
$163.37
|
| Rate for Payer: Frontpath All Products |
$59.50
|
| Rate for Payer: Humana ChoiceCare |
$136.14
|
| Rate for Payer: Humana Medicare |
$42.91
|
| Rate for Payer: Lucent/Coldwater Veneers |
$72.95
|
| Rate for Payer: Lutheran Preferred All Products |
$60.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$102.10
|
| Rate for Payer: PHP All Products |
$55.26
|
| Rate for Payer: Plain Church Group Ministry All Products |
$42.91
|
| Rate for Payer: Signature Care EPO |
$96.05
|
| Rate for Payer: Signature Care PPO |
$96.05
|
| Rate for Payer: Three Rivers Preferred All Products |
$56.00
|
| Rate for Payer: United Healthcare Commercial |
$54.83
|
| Rate for Payer: United Healthcare Medicare |
$68.07
|
|
|
PR FIX INFRAPATELLA TENDON,PRIMARY
|
Professional
|
$1,139.64
|
|
|
Service Code
|
CPT 27380
|
| Hospital Charge Code |
Z12342
|
| Min. Negotiated Rate |
$569.82 |
| Max. Negotiated Rate |
$1,367.57 |
| Rate for Payer: Aetna Medicare |
$583.76
|
| Rate for Payer: Anthem Exchange |
$744.30
|
| Rate for Payer: Anthem Medicare |
$583.76
|
| Rate for Payer: Anthem PPO |
$744.30
|
| Rate for Payer: Anthem Traditional |
$744.30
|
| Rate for Payer: Caresource Just 4 Me |
$671.32
|
| Rate for Payer: Caresource Medicare |
$642.14
|
| Rate for Payer: Centivo/Paragon All Products |
$904.83
|
| Rate for Payer: Coventry/First Health All Products |
$1,367.57
|
| Rate for Payer: Frontpath All Products |
$809.04
|
| Rate for Payer: Humana ChoiceCare |
$1,139.64
|
| Rate for Payer: Humana Medicare |
$583.76
|
| Rate for Payer: Lucent/Coldwater Veneers |
$992.39
|
| Rate for Payer: Lutheran Preferred All Products |
$934.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$854.73
|
| Rate for Payer: PHP All Products |
$991.49
|
| Rate for Payer: Plain Church Group Ministry All Products |
$583.76
|
| Rate for Payer: Signature Care EPO |
$835.55
|
| Rate for Payer: Signature Care PPO |
$835.55
|
| Rate for Payer: Three Rivers Preferred All Products |
$876.00
|
| Rate for Payer: United Healthcare Commercial |
$631.75
|
| Rate for Payer: United Healthcare Medicare |
$569.82
|
|
|
PR FIX QUAD/HAMSTR MUSC RUPT,PRIMARY
|
Professional
|
$1,109.90
|
|
|
Service Code
|
CPT 27385
|
| Hospital Charge Code |
Z12343
|
| Min. Negotiated Rate |
$554.95 |
| Max. Negotiated Rate |
$1,331.88 |
| Rate for Payer: Humana Medicare |
$568.82
|
| Rate for Payer: Aetna Medicare |
$568.82
|
| Rate for Payer: Anthem Exchange |
$802.90
|
| Rate for Payer: Anthem Medicare |
$568.82
|
| Rate for Payer: Anthem PPO |
$802.90
|
| Rate for Payer: Anthem Traditional |
$802.90
|
| Rate for Payer: Caresource Just 4 Me |
$654.14
|
| Rate for Payer: Caresource Medicare |
$625.70
|
| Rate for Payer: Centivo/Paragon All Products |
$881.67
|
| Rate for Payer: Coventry/First Health All Products |
$1,331.88
|
| Rate for Payer: Frontpath All Products |
$786.40
|
| Rate for Payer: Humana ChoiceCare |
$1,109.90
|
| Rate for Payer: Lucent/Coldwater Veneers |
$966.99
|
| Rate for Payer: Lutheran Preferred All Products |
$910.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$832.43
|
| Rate for Payer: PHP All Products |
$965.61
|
| Rate for Payer: Plain Church Group Ministry All Products |
$568.82
|
| Rate for Payer: Signature Care EPO |
$891.65
|
| Rate for Payer: Signature Care PPO |
$891.65
|
| Rate for Payer: Three Rivers Preferred All Products |
$853.00
|
| Rate for Payer: United Healthcare Commercial |
$677.16
|
| Rate for Payer: United Healthcare Medicare |
$554.95
|
|
|
PR FOOT/TOES SURGERY PROC UNLISTED
|
Professional
|
$508.53
|
|
|
Service Code
|
CPT 28899
|
| Hospital Charge Code |
Z12450
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$610.24 |
| Rate for Payer: Anthem Exchange |
$0.01
|
| Rate for Payer: Anthem PPO |
$0.01
|
| Rate for Payer: Anthem Traditional |
$0.01
|
| Rate for Payer: Coventry/First Health All Products |
$610.24
|
| Rate for Payer: Humana ChoiceCare |
$508.53
|
| Rate for Payer: Lutheran Preferred All Products |
$432.25
|
| Rate for Payer: PHCS/Multiplan All Products |
$381.40
|
| Rate for Payer: Signature Care EPO |
$324.19
|
| Rate for Payer: Signature Care PPO |
$324.19
|
| Rate for Payer: Three Rivers Preferred All Products |
$305.12
|
|
|
PR FOREARM/WRIST SURGERY UNLISTED
|
Professional
|
$805.13
|
|
|
Service Code
|
CPT 25999
|
| Hospital Charge Code |
Z12255
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$966.16 |
| Rate for Payer: Anthem Exchange |
$0.01
|
| Rate for Payer: Anthem PPO |
$0.01
|
| Rate for Payer: Anthem Traditional |
$0.01
|
| Rate for Payer: Coventry/First Health All Products |
$966.16
|
| Rate for Payer: Humana ChoiceCare |
$805.13
|
| Rate for Payer: Lutheran Preferred All Products |
$684.36
|
| Rate for Payer: PHCS/Multiplan All Products |
$603.85
|
| Rate for Payer: Signature Care EPO |
$513.27
|
| Rate for Payer: Signature Care PPO |
$513.27
|
| Rate for Payer: Three Rivers Preferred All Products |
$483.08
|
|
|
PR FORM SKIN PEDICLE FLAP FACE,GEN,HAND
|
Professional
|
$1,599.26
|
|
|
Service Code
|
CPT 15574
|
| Hospital Charge Code |
Z12081
|
| Min. Negotiated Rate |
$685.33 |
| Max. Negotiated Rate |
$1,919.11 |
| Rate for Payer: Aetna Medicare |
$685.33
|
| Rate for Payer: Anthem Exchange |
$912.73
|
| Rate for Payer: Anthem Medicare |
$685.33
|
| Rate for Payer: Anthem PPO |
$912.73
|
| Rate for Payer: Anthem Traditional |
$912.73
|
| Rate for Payer: Caresource Just 4 Me |
$788.13
|
| Rate for Payer: Caresource Medicare |
$753.86
|
| Rate for Payer: Centivo/Paragon All Products |
$1,062.26
|
| Rate for Payer: Coventry/First Health All Products |
$1,919.11
|
| Rate for Payer: Frontpath All Products |
$948.52
|
| Rate for Payer: Humana ChoiceCare |
$1,599.26
|
| Rate for Payer: Humana Medicare |
$685.33
|
| Rate for Payer: Lucent/Coldwater Veneers |
$1,165.06
|
| Rate for Payer: Lutheran Preferred All Products |
$891.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$1,199.44
|
| Rate for Payer: PHP All Products |
$936.06
|
| Rate for Payer: Plain Church Group Ministry All Products |
$685.33
|
| Rate for Payer: Signature Care EPO |
$774.35
|
| Rate for Payer: Signature Care PPO |
$774.35
|
| Rate for Payer: Three Rivers Preferred All Products |
$822.00
|
| Rate for Payer: United Healthcare Commercial |
$819.98
|
| Rate for Payer: United Healthcare Medicare |
$799.63
|
|
|
PR FREEING BOWEL ADHESION,ENTEROLYSIS
|
Professional
|
$1,943.32
|
|
|
Service Code
|
CPT 44005
|
| Hospital Charge Code |
Z12599
|
| Min. Negotiated Rate |
$971.66 |
| Max. Negotiated Rate |
$2,331.98 |
| Rate for Payer: Aetna Medicare |
$995.95
|
| Rate for Payer: Anthem Exchange |
$1,079.60
|
| Rate for Payer: Anthem Medicare |
$995.95
|
| Rate for Payer: Anthem PPO |
$1,079.60
|
| Rate for Payer: Anthem Traditional |
$1,079.60
|
| Rate for Payer: Caresource Just 4 Me |
$1,145.34
|
| Rate for Payer: Caresource Medicare |
$1,095.55
|
| Rate for Payer: Centivo/Paragon All Products |
$1,543.72
|
| Rate for Payer: Coventry/First Health All Products |
$2,331.98
|
| Rate for Payer: Frontpath All Products |
$1,445.21
|
| Rate for Payer: Humana ChoiceCare |
$1,943.32
|
| Rate for Payer: Humana Medicare |
$995.95
|
| Rate for Payer: Lucent/Coldwater Veneers |
$1,693.12
|
| Rate for Payer: Lutheran Preferred All Products |
$1,494.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$1,457.49
|
| Rate for Payer: PHP All Products |
$1,700.41
|
| Rate for Payer: Plain Church Group Ministry All Products |
$995.95
|
| Rate for Payer: Signature Care EPO |
$1,326.85
|
| Rate for Payer: Signature Care PPO |
$1,326.85
|
| Rate for Payer: Three Rivers Preferred All Products |
$1,394.00
|
| Rate for Payer: United Healthcare Commercial |
$1,170.19
|
| Rate for Payer: United Healthcare Medicare |
$971.66
|
|
|
PR FULL ROUT OBSTE CARE,CESAREAN DELIV
|
Professional
|
$4,683.82
|
|
|
Service Code
|
CPT 59510
|
| Hospital Charge Code |
Z12804
|
| Min. Negotiated Rate |
$2,177.70 |
| Max. Negotiated Rate |
$5,620.58 |
| Rate for Payer: Aetna Medicare |
$2,400.15
|
| Rate for Payer: Anthem Exchange |
$2,200.00
|
| Rate for Payer: Anthem Medicare |
$2,400.15
|
| Rate for Payer: Anthem PPO |
$2,200.00
|
| Rate for Payer: Anthem Traditional |
$2,200.00
|
| Rate for Payer: Caresource Just 4 Me |
$2,760.17
|
| Rate for Payer: Caresource Medicare |
$2,640.17
|
| Rate for Payer: Centivo/Paragon All Products |
$3,720.23
|
| Rate for Payer: Coventry/First Health All Products |
$5,620.58
|
| Rate for Payer: Frontpath All Products |
$3,422.49
|
| Rate for Payer: Humana ChoiceCare |
$4,683.82
|
| Rate for Payer: Humana Medicare |
$2,400.15
|
| Rate for Payer: Lucent/Coldwater Veneers |
$4,080.26
|
| Rate for Payer: Lutheran Preferred All Products |
$3,360.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$3,512.86
|
| Rate for Payer: PHP All Products |
$3,091.32
|
| Rate for Payer: Plain Church Group Ministry All Products |
$2,400.15
|
| Rate for Payer: Signature Care EPO |
$2,177.70
|
| Rate for Payer: Signature Care PPO |
$2,177.70
|
| Rate for Payer: Three Rivers Preferred All Products |
$3,120.00
|
| Rate for Payer: United Healthcare Commercial |
$2,225.69
|
| Rate for Payer: United Healthcare Medicare |
$2,341.91
|
|
|
PR FULL ROUT OBSTE CARE,VAGINAL DELIV
|
Professional
|
$4,262.28
|
|
|
Service Code
|
CPT 59400
|
| Hospital Charge Code |
Z12797
|
| Min. Negotiated Rate |
$1,922.70 |
| Max. Negotiated Rate |
$5,114.74 |
| Rate for Payer: Aetna Medicare |
$2,184.26
|
| Rate for Payer: Anthem Exchange |
$2,200.00
|
| Rate for Payer: Anthem Medicare |
$2,184.26
|
| Rate for Payer: Anthem PPO |
$2,200.00
|
| Rate for Payer: Anthem Traditional |
$2,200.00
|
| Rate for Payer: Caresource Just 4 Me |
$2,511.90
|
| Rate for Payer: Caresource Medicare |
$2,402.69
|
| Rate for Payer: Centivo/Paragon All Products |
$3,385.60
|
| Rate for Payer: Coventry/First Health All Products |
$5,114.74
|
| Rate for Payer: Frontpath All Products |
$3,092.42
|
| Rate for Payer: Humana ChoiceCare |
$4,262.28
|
| Rate for Payer: Humana Medicare |
$2,184.26
|
| Rate for Payer: Lucent/Coldwater Veneers |
$3,713.24
|
| Rate for Payer: Lutheran Preferred All Products |
$3,058.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$3,196.71
|
| Rate for Payer: PHP All Products |
$2,813.11
|
| Rate for Payer: Plain Church Group Ministry All Products |
$2,184.26
|
| Rate for Payer: Signature Care EPO |
$1,922.70
|
| Rate for Payer: Signature Care PPO |
$1,922.70
|
| Rate for Payer: Three Rivers Preferred All Products |
$2,840.00
|
| Rate for Payer: United Healthcare Commercial |
$1,965.55
|
| Rate for Payer: United Healthcare Medicare |
$2,131.14
|
|
|
PR FULL THICK GRFT HEAD,FAC,HAND <20SQC
|
Professional
|
$1,694.84
|
|
|
Service Code
|
CPT 15240
|
| Hospital Charge Code |
Z12079
|
| Min. Negotiated Rate |
$741.11 |
| Max. Negotiated Rate |
$2,033.81 |
| Rate for Payer: Aetna Medicare |
$741.11
|
| Rate for Payer: Anthem Exchange |
$925.61
|
| Rate for Payer: Anthem Medicare |
$741.11
|
| Rate for Payer: Anthem PPO |
$925.61
|
| Rate for Payer: Anthem Traditional |
$925.61
|
| Rate for Payer: Caresource Just 4 Me |
$852.28
|
| Rate for Payer: Caresource Medicare |
$815.22
|
| Rate for Payer: Centivo/Paragon All Products |
$1,148.72
|
| Rate for Payer: Coventry/First Health All Products |
$2,033.81
|
| Rate for Payer: Frontpath All Products |
$1,006.54
|
| Rate for Payer: Humana ChoiceCare |
$1,694.84
|
| Rate for Payer: Humana Medicare |
$741.11
|
| Rate for Payer: Lucent/Coldwater Veneers |
$1,259.89
|
| Rate for Payer: Lutheran Preferred All Products |
$963.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$1,271.13
|
| Rate for Payer: PHP All Products |
$1,012.25
|
| Rate for Payer: Plain Church Group Ministry All Products |
$741.11
|
| Rate for Payer: Signature Care EPO |
$788.80
|
| Rate for Payer: Signature Care PPO |
$788.80
|
| Rate for Payer: Three Rivers Preferred All Products |
$889.00
|
| Rate for Payer: United Healthcare Commercial |
$846.64
|
| Rate for Payer: United Healthcare Medicare |
$847.42
|
|
|
PR FULL THICK GRFT NOS,EAR,LID <20 SQCM
|
Professional
|
$1,827.32
|
|
|
Service Code
|
CPT 15260
|
| Hospital Charge Code |
Z12080
|
| Min. Negotiated Rate |
$790.48 |
| Max. Negotiated Rate |
$2,192.78 |
| Rate for Payer: Aetna Medicare |
$790.48
|
| Rate for Payer: Anthem Exchange |
$896.30
|
| Rate for Payer: Anthem Medicare |
$790.48
|
| Rate for Payer: Anthem PPO |
$896.30
|
| Rate for Payer: Anthem Traditional |
$896.30
|
| Rate for Payer: Caresource Just 4 Me |
$909.05
|
| Rate for Payer: Caresource Medicare |
$869.53
|
| Rate for Payer: Centivo/Paragon All Products |
$1,225.24
|
| Rate for Payer: Coventry/First Health All Products |
$2,192.78
|
| Rate for Payer: Frontpath All Products |
$1,068.78
|
| Rate for Payer: Humana ChoiceCare |
$1,827.32
|
| Rate for Payer: Humana Medicare |
$790.48
|
| Rate for Payer: Lucent/Coldwater Veneers |
$1,343.82
|
| Rate for Payer: Lutheran Preferred All Products |
$1,028.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$1,370.49
|
| Rate for Payer: PHP All Products |
$1,079.69
|
| Rate for Payer: Plain Church Group Ministry All Products |
$790.48
|
| Rate for Payer: Signature Care EPO |
$816.85
|
| Rate for Payer: Signature Care PPO |
$816.85
|
| Rate for Payer: Three Rivers Preferred All Products |
$949.00
|
| Rate for Payer: United Healthcare Commercial |
$919.10
|
| Rate for Payer: United Healthcare Medicare |
$913.66
|
|
|
PR FUSION FINGER TENDONS,DIP JT STABIL
|
Professional
|
$1,198.72
|
|
|
Service Code
|
CPT 26474
|
| Hospital Charge Code |
Z12276
|
| Min. Negotiated Rate |
$599.36 |
| Max. Negotiated Rate |
$1,438.46 |
| Rate for Payer: Aetna Medicare |
$614.35
|
| Rate for Payer: Anthem Medicare |
$614.35
|
| Rate for Payer: Caresource Just 4 Me |
$706.50
|
| Rate for Payer: Caresource Medicare |
$675.79
|
| Rate for Payer: Centivo/Paragon All Products |
$952.24
|
| Rate for Payer: Coventry/First Health All Products |
$1,438.46
|
| Rate for Payer: Frontpath All Products |
$844.61
|
| Rate for Payer: Humana ChoiceCare |
$1,198.72
|
| Rate for Payer: Humana Medicare |
$614.35
|
| Rate for Payer: Lucent/Coldwater Veneers |
$1,044.39
|
| Rate for Payer: PHCS/Multiplan All Products |
$899.04
|
| Rate for Payer: PHP All Products |
$1,042.89
|
| Rate for Payer: Plain Church Group Ministry All Products |
$614.35
|
| Rate for Payer: Signature Care EPO |
$956.79
|
| Rate for Payer: Signature Care PPO |
$956.79
|
| Rate for Payer: United Healthcare Commercial |
$614.85
|
| Rate for Payer: United Healthcare Medicare |
$599.36
|
|
|
PR FUSION MC-P JT
|
Professional
|
$1,351.46
|
|
|
Service Code
|
CPT 26850
|
| Hospital Charge Code |
Z12301
|
| Min. Negotiated Rate |
$675.73 |
| Max. Negotiated Rate |
$1,621.75 |
| Rate for Payer: Aetna Medicare |
$692.62
|
| Rate for Payer: Anthem Exchange |
$750.40
|
| Rate for Payer: Anthem Medicare |
$692.62
|
| Rate for Payer: Anthem PPO |
$750.40
|
| Rate for Payer: Anthem Traditional |
$750.40
|
| Rate for Payer: Caresource Just 4 Me |
$796.51
|
| Rate for Payer: Caresource Medicare |
$761.88
|
| Rate for Payer: Centivo/Paragon All Products |
$1,073.56
|
| Rate for Payer: Coventry/First Health All Products |
$1,621.75
|
| Rate for Payer: Frontpath All Products |
$953.08
|
| Rate for Payer: Humana ChoiceCare |
$1,351.46
|
| Rate for Payer: Humana Medicare |
$692.62
|
| Rate for Payer: Lucent/Coldwater Veneers |
$1,177.45
|
| Rate for Payer: Lutheran Preferred All Products |
$1,108.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$1,013.60
|
| Rate for Payer: PHP All Products |
$1,175.77
|
| Rate for Payer: Plain Church Group Ministry All Products |
$692.62
|
| Rate for Payer: Signature Care EPO |
$1,099.46
|
| Rate for Payer: Signature Care PPO |
$1,099.46
|
| Rate for Payer: Three Rivers Preferred All Products |
$1,039.00
|
| Rate for Payer: United Healthcare Commercial |
$731.29
|
| Rate for Payer: United Healthcare Medicare |
$675.73
|
|
|
PR GASTROSTOMY,OPEN,W/O TUBE CNSTR
|
Professional
|
$1,258.10
|
|
|
Service Code
|
CPT 43830
|
| Hospital Charge Code |
Z12597
|
| Min. Negotiated Rate |
$629.05 |
| Max. Negotiated Rate |
$1,509.72 |
| Rate for Payer: Aetna Medicare |
$644.78
|
| Rate for Payer: Anthem Exchange |
$631.30
|
| Rate for Payer: Anthem Medicare |
$644.78
|
| Rate for Payer: Anthem PPO |
$631.30
|
| Rate for Payer: Anthem Traditional |
$631.30
|
| Rate for Payer: Caresource Just 4 Me |
$741.50
|
| Rate for Payer: Caresource Medicare |
$709.26
|
| Rate for Payer: Centivo/Paragon All Products |
$999.41
|
| Rate for Payer: Coventry/First Health All Products |
$1,509.72
|
| Rate for Payer: Frontpath All Products |
$927.59
|
| Rate for Payer: Humana ChoiceCare |
$1,258.10
|
| Rate for Payer: Humana Medicare |
$644.78
|
| Rate for Payer: Lucent/Coldwater Veneers |
$1,096.13
|
| Rate for Payer: Lutheran Preferred All Products |
$967.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$943.57
|
| Rate for Payer: PHP All Products |
$1,100.84
|
| Rate for Payer: Plain Church Group Ministry All Products |
$644.78
|
| Rate for Payer: Signature Care EPO |
$822.80
|
| Rate for Payer: Signature Care PPO |
$822.80
|
| Rate for Payer: Three Rivers Preferred All Products |
$903.00
|
| Rate for Payer: United Healthcare Commercial |
$734.03
|
| Rate for Payer: United Healthcare Medicare |
$629.05
|
|
|
PR GASTROSTOMY,OPEN,W/TUBE CNSTR
|
Professional
|
$1,859.12
|
|
|
Service Code
|
CPT 43832
|
| Hospital Charge Code |
Z12598
|
| Min. Negotiated Rate |
$929.56 |
| Max. Negotiated Rate |
$2,230.94 |
| Rate for Payer: Aetna Medicare |
$952.79
|
| Rate for Payer: Anthem Exchange |
$963.30
|
| Rate for Payer: Anthem Medicare |
$952.79
|
| Rate for Payer: Anthem PPO |
$963.30
|
| Rate for Payer: Anthem Traditional |
$963.30
|
| Rate for Payer: Caresource Just 4 Me |
$1,095.71
|
| Rate for Payer: Caresource Medicare |
$1,048.07
|
| Rate for Payer: Centivo/Paragon All Products |
$1,476.82
|
| Rate for Payer: Coventry/First Health All Products |
$2,230.94
|
| Rate for Payer: Frontpath All Products |
$1,382.76
|
| Rate for Payer: Humana ChoiceCare |
$1,859.12
|
| Rate for Payer: Humana Medicare |
$952.79
|
| Rate for Payer: Lucent/Coldwater Veneers |
$1,619.74
|
| Rate for Payer: Lutheran Preferred All Products |
$1,429.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$1,394.34
|
| Rate for Payer: PHP All Products |
$1,626.72
|
| Rate for Payer: Plain Church Group Ministry All Products |
$952.79
|
| Rate for Payer: Signature Care EPO |
$1,289.45
|
| Rate for Payer: Signature Care PPO |
$1,289.45
|
| Rate for Payer: Three Rivers Preferred All Products |
$1,334.00
|
| Rate for Payer: United Healthcare Commercial |
$1,131.66
|
| Rate for Payer: United Healthcare Medicare |
$929.56
|
|
|
PR GROUP PSYCHOTHERAPY
|
Professional
|
$50.48
|
|
|
Service Code
|
CPT 90853
|
| Hospital Charge Code |
Z13031
|
| Min. Negotiated Rate |
$22.79 |
| Max. Negotiated Rate |
$60.58 |
| Rate for Payer: Aetna Medicare |
$22.79
|
| Rate for Payer: Anthem Exchange |
$31.64
|
| Rate for Payer: Anthem Medicare |
$22.79
|
| Rate for Payer: Anthem PPO |
$31.64
|
| Rate for Payer: Anthem Traditional |
$31.64
|
| Rate for Payer: Caresource Just 4 Me |
$26.21
|
| Rate for Payer: Caresource Medicare |
$25.07
|
| Rate for Payer: Centivo/Paragon All Products |
$35.32
|
| Rate for Payer: Coventry/First Health All Products |
$60.58
|
| Rate for Payer: Frontpath All Products |
$26.07
|
| Rate for Payer: Humana ChoiceCare |
$50.48
|
| Rate for Payer: Humana Medicare |
$22.79
|
| Rate for Payer: Lucent/Coldwater Veneers |
$38.74
|
| Rate for Payer: Lutheran Preferred All Products |
$30.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$37.86
|
| Rate for Payer: PHP All Products |
$24.23
|
| Rate for Payer: Plain Church Group Ministry All Products |
$22.79
|
| Rate for Payer: Signature Care EPO |
$34.85
|
| Rate for Payer: Signature Care PPO |
$34.85
|
| Rate for Payer: Three Rivers Preferred All Products |
$27.00
|
| Rate for Payer: United Healthcare Commercial |
$35.56
|
| Rate for Payer: United Healthcare Medicare |
$25.24
|
|
|
PR HEARING AID CHECK, BOTH EARS
|
Professional
|
$100.00
|
|
|
Service Code
|
CPT 92593
|
| Hospital Charge Code |
Z13064
|
| Min. Negotiated Rate |
$30.00 |
| Max. Negotiated Rate |
$120.00 |
| Rate for Payer: Anthem Exchange |
$30.00
|
| Rate for Payer: Anthem PPO |
$30.00
|
| Rate for Payer: Anthem Traditional |
$30.00
|
| Rate for Payer: Coventry/First Health All Products |
$120.00
|
| Rate for Payer: Frontpath All Products |
$37.76
|
| Rate for Payer: Humana ChoiceCare |
$100.00
|
| Rate for Payer: Lutheran Preferred All Products |
$85.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$75.00
|
| Rate for Payer: Signature Care EPO |
$46.75
|
| Rate for Payer: Signature Care PPO |
$46.75
|
| Rate for Payer: Three Rivers Preferred All Products |
$60.00
|
| Rate for Payer: United Healthcare Commercial |
$35.85
|
|
|
PR HEARING AID CHECK, ONE EAR
|
Professional
|
$50.00
|
|
|
Service Code
|
CPT 92592
|
| Hospital Charge Code |
Z13063
|
| Min. Negotiated Rate |
$20.00 |
| Max. Negotiated Rate |
$60.00 |
| Rate for Payer: Anthem Exchange |
$20.00
|
| Rate for Payer: Anthem PPO |
$20.00
|
| Rate for Payer: Anthem Traditional |
$20.00
|
| Rate for Payer: Coventry/First Health All Products |
$60.00
|
| Rate for Payer: Frontpath All Products |
$22.70
|
| Rate for Payer: Humana ChoiceCare |
$50.00
|
| Rate for Payer: Lutheran Preferred All Products |
$42.50
|
| Rate for Payer: PHCS/Multiplan All Products |
$37.50
|
| Rate for Payer: Signature Care EPO |
$31.45
|
| Rate for Payer: Signature Care PPO |
$31.45
|
| Rate for Payer: Three Rivers Preferred All Products |
$30.00
|
| Rate for Payer: United Healthcare Commercial |
$21.90
|
|
|
PR HEARING AID EXAM, BOTH EARS
|
Professional
|
$350.00
|
|
|
Service Code
|
CPT 92591
|
| Hospital Charge Code |
Z13062
|
| Min. Negotiated Rate |
$69.58 |
| Max. Negotiated Rate |
$420.00 |
| Rate for Payer: Anthem Exchange |
$110.00
|
| Rate for Payer: Anthem PPO |
$110.00
|
| Rate for Payer: Anthem Traditional |
$110.00
|
| Rate for Payer: Coventry/First Health All Products |
$420.00
|
| Rate for Payer: Frontpath All Products |
$73.10
|
| Rate for Payer: Humana ChoiceCare |
$350.00
|
| Rate for Payer: Lutheran Preferred All Products |
$297.50
|
| Rate for Payer: PHCS/Multiplan All Products |
$262.50
|
| Rate for Payer: Signature Care EPO |
$106.25
|
| Rate for Payer: Signature Care PPO |
$106.25
|
| Rate for Payer: Three Rivers Preferred All Products |
$210.00
|
| Rate for Payer: United Healthcare Commercial |
$69.58
|
|
