|
PR HEARING AID EXAM, ONE EAR
|
Professional
|
$250.00
|
|
|
Service Code
|
CPT 92590
|
| Hospital Charge Code |
Z13061
|
| Min. Negotiated Rate |
$54.34 |
| Max. Negotiated Rate |
$300.00 |
| Rate for Payer: Anthem Exchange |
$70.00
|
| Rate for Payer: Anthem PPO |
$70.00
|
| Rate for Payer: Anthem Traditional |
$70.00
|
| Rate for Payer: Coventry/First Health All Products |
$300.00
|
| Rate for Payer: Frontpath All Products |
$57.33
|
| Rate for Payer: Humana ChoiceCare |
$250.00
|
| Rate for Payer: Lutheran Preferred All Products |
$212.50
|
| Rate for Payer: PHCS/Multiplan All Products |
$187.50
|
| Rate for Payer: Signature Care EPO |
$70.55
|
| Rate for Payer: Signature Care PPO |
$70.55
|
| Rate for Payer: Three Rivers Preferred All Products |
$150.00
|
| Rate for Payer: United Healthcare Commercial |
$54.34
|
|
|
PR HEART/LUNG RESUSCITATION (CPR)
|
Professional
|
$599.28
|
|
|
Service Code
|
CPT 92950
|
| Hospital Charge Code |
Z13071
|
| Min. Negotiated Rate |
$172.54 |
| Max. Negotiated Rate |
$719.14 |
| Rate for Payer: Aetna Medicare |
$172.54
|
| Rate for Payer: Anthem Exchange |
$269.50
|
| Rate for Payer: Anthem Medicare |
$172.54
|
| Rate for Payer: Anthem PPO |
$269.50
|
| Rate for Payer: Anthem Traditional |
$269.50
|
| Rate for Payer: Caresource Just 4 Me |
$198.42
|
| Rate for Payer: Caresource Medicare |
$189.79
|
| Rate for Payer: Centivo/Paragon All Products |
$267.44
|
| Rate for Payer: Coventry/First Health All Products |
$719.14
|
| Rate for Payer: Frontpath All Products |
$203.34
|
| Rate for Payer: Humana ChoiceCare |
$599.28
|
| Rate for Payer: Humana Medicare |
$172.54
|
| Rate for Payer: Lucent/Coldwater Veneers |
$293.32
|
| Rate for Payer: Lutheran Preferred All Products |
$276.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$449.46
|
| Rate for Payer: PHP All Products |
$247.44
|
| Rate for Payer: Plain Church Group Ministry All Products |
$172.54
|
| Rate for Payer: Signature Care EPO |
$282.20
|
| Rate for Payer: Signature Care PPO |
$282.20
|
| Rate for Payer: Three Rivers Preferred All Products |
$259.00
|
| Rate for Payer: United Healthcare Commercial |
$213.19
|
| Rate for Payer: United Healthcare Medicare |
$299.64
|
|
|
PR HEMORRHOIDECTOMY,INT/EXT, 2+ COLUMNS/GROUPS
|
Professional
|
$874.36
|
|
|
Service Code
|
CPT 46260
|
| Hospital Charge Code |
Z12643
|
| Min. Negotiated Rate |
$437.18 |
| Max. Negotiated Rate |
$1,049.23 |
| Rate for Payer: Aetna Medicare |
$448.11
|
| Rate for Payer: Anthem Exchange |
$636.90
|
| Rate for Payer: Anthem Medicare |
$448.11
|
| Rate for Payer: Anthem PPO |
$636.90
|
| Rate for Payer: Anthem Traditional |
$636.90
|
| Rate for Payer: Caresource Just 4 Me |
$515.33
|
| Rate for Payer: Caresource Medicare |
$492.92
|
| Rate for Payer: Centivo/Paragon All Products |
$694.57
|
| Rate for Payer: Coventry/First Health All Products |
$1,049.23
|
| Rate for Payer: Frontpath All Products |
$630.20
|
| Rate for Payer: Humana ChoiceCare |
$874.36
|
| Rate for Payer: Humana Medicare |
$448.11
|
| Rate for Payer: Lucent/Coldwater Veneers |
$761.79
|
| Rate for Payer: Lutheran Preferred All Products |
$672.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$655.77
|
| Rate for Payer: PHP All Products |
$765.06
|
| Rate for Payer: Plain Church Group Ministry All Products |
$448.11
|
| Rate for Payer: Signature Care EPO |
$556.75
|
| Rate for Payer: Signature Care PPO |
$556.75
|
| Rate for Payer: Three Rivers Preferred All Products |
$627.00
|
| Rate for Payer: United Healthcare Commercial |
$481.33
|
| Rate for Payer: United Healthcare Medicare |
$437.18
|
|
|
PR HFO WITHOUT JOINTS PRE CST
|
Professional
|
$10.76
|
|
|
Service Code
|
CPT L3923
|
| Hospital Charge Code |
Z13260
|
| Min. Negotiated Rate |
$8.07 |
| Max. Negotiated Rate |
$86.71 |
| Rate for Payer: Coventry/First Health All Products |
$12.91
|
| Rate for Payer: Humana ChoiceCare |
$10.76
|
| Rate for Payer: PHCS/Multiplan All Products |
$8.07
|
| Rate for Payer: PHP All Products |
$86.71
|
| Rate for Payer: Signature Care EPO |
$10.76
|
| Rate for Payer: Signature Care PPO |
$10.76
|
| Rate for Payer: United Healthcare Commercial |
$67.66
|
|
|
PR HOME/RES VISIT EST PATIENT HIGH MDM 60 MINUTES
|
Professional
|
$345.28
|
|
|
Service Code
|
CPT 99350
|
| Hospital Charge Code |
Z13203
|
| Min. Negotiated Rate |
$163.66 |
| Max. Negotiated Rate |
$414.34 |
| Rate for Payer: Aetna Medicare |
$176.96
|
| Rate for Payer: Anthem Medicare |
$176.96
|
| Rate for Payer: Caresource Just 4 Me |
$203.50
|
| Rate for Payer: Caresource Medicare |
$194.66
|
| Rate for Payer: Centivo/Paragon All Products |
$274.29
|
| Rate for Payer: Coventry/First Health All Products |
$414.34
|
| Rate for Payer: Frontpath All Products |
$180.34
|
| Rate for Payer: Humana ChoiceCare |
$345.28
|
| Rate for Payer: Humana Medicare |
$176.96
|
| Rate for Payer: Lucent/Coldwater Veneers |
$300.83
|
| Rate for Payer: PHCS/Multiplan All Products |
$258.96
|
| Rate for Payer: Plain Church Group Ministry All Products |
$176.96
|
| Rate for Payer: United Healthcare Commercial |
$163.66
|
| Rate for Payer: United Healthcare Medicare |
$172.64
|
|
|
PR HOME/RES VISIT EST PATIENT LOW MDM 30 MINUTES
|
Professional
|
$142.06
|
|
|
Service Code
|
CPT 99348
|
| Hospital Charge Code |
Z13201
|
| Min. Negotiated Rate |
$71.03 |
| Max. Negotiated Rate |
$170.47 |
| Rate for Payer: Aetna Medicare |
$72.80
|
| Rate for Payer: Anthem Medicare |
$72.80
|
| Rate for Payer: Caresource Just 4 Me |
$83.72
|
| Rate for Payer: Caresource Medicare |
$80.08
|
| Rate for Payer: Centivo/Paragon All Products |
$112.84
|
| Rate for Payer: Coventry/First Health All Products |
$170.47
|
| Rate for Payer: Frontpath All Products |
$84.33
|
| Rate for Payer: Humana ChoiceCare |
$142.06
|
| Rate for Payer: Humana Medicare |
$72.80
|
| Rate for Payer: Lucent/Coldwater Veneers |
$123.76
|
| Rate for Payer: PHCS/Multiplan All Products |
$106.55
|
| Rate for Payer: Plain Church Group Ministry All Products |
$72.80
|
| Rate for Payer: United Healthcare Commercial |
$80.60
|
| Rate for Payer: United Healthcare Medicare |
$71.03
|
|
|
PR HOME/RES VISIT EST PATIENT MOD MDM 40 MINUTES
|
Professional
|
$236.54
|
|
|
Service Code
|
CPT 99349
|
| Hospital Charge Code |
Z13202
|
| Min. Negotiated Rate |
$117.39 |
| Max. Negotiated Rate |
$283.85 |
| Rate for Payer: Aetna Medicare |
$121.23
|
| Rate for Payer: Anthem Medicare |
$121.23
|
| Rate for Payer: Caresource Just 4 Me |
$139.41
|
| Rate for Payer: Caresource Medicare |
$133.35
|
| Rate for Payer: Centivo/Paragon All Products |
$187.91
|
| Rate for Payer: Coventry/First Health All Products |
$283.85
|
| Rate for Payer: Frontpath All Products |
$129.79
|
| Rate for Payer: Humana ChoiceCare |
$236.54
|
| Rate for Payer: Humana Medicare |
$121.23
|
| Rate for Payer: Lucent/Coldwater Veneers |
$206.09
|
| Rate for Payer: PHCS/Multiplan All Products |
$177.41
|
| Rate for Payer: Plain Church Group Ministry All Products |
$121.23
|
| Rate for Payer: United Healthcare Commercial |
$117.39
|
| Rate for Payer: United Healthcare Medicare |
$118.27
|
|
|
PR HOME/RES VISIT EST PATIENT SF MDM 20 MINUTES
|
Professional
|
$83.66
|
|
|
Service Code
|
CPT 99347
|
| Hospital Charge Code |
Z13200
|
| Min. Negotiated Rate |
$41.83 |
| Max. Negotiated Rate |
$100.39 |
| Rate for Payer: Aetna Medicare |
$42.87
|
| Rate for Payer: Anthem Medicare |
$42.87
|
| Rate for Payer: Caresource Just 4 Me |
$49.30
|
| Rate for Payer: Caresource Medicare |
$47.16
|
| Rate for Payer: Centivo/Paragon All Products |
$66.45
|
| Rate for Payer: Coventry/First Health All Products |
$100.39
|
| Rate for Payer: Frontpath All Products |
$55.37
|
| Rate for Payer: Humana ChoiceCare |
$83.66
|
| Rate for Payer: Humana Medicare |
$42.87
|
| Rate for Payer: Lucent/Coldwater Veneers |
$72.88
|
| Rate for Payer: PHCS/Multiplan All Products |
$62.74
|
| Rate for Payer: Plain Church Group Ministry All Products |
$42.87
|
| Rate for Payer: United Healthcare Commercial |
$53.38
|
| Rate for Payer: United Healthcare Medicare |
$41.83
|
|
|
PR HOME/RES VISIT NEW PATIENT LOW MDM 30 MINUTES
|
Professional
|
$145.94
|
|
|
Service Code
|
CPT 99342
|
| Hospital Charge Code |
Z13199
|
| Min. Negotiated Rate |
$72.97 |
| Max. Negotiated Rate |
$175.13 |
| Rate for Payer: Aetna Medicare |
$74.80
|
| Rate for Payer: Anthem Exchange |
$95.50
|
| Rate for Payer: Anthem Medicare |
$74.80
|
| Rate for Payer: Anthem PPO |
$95.50
|
| Rate for Payer: Anthem Traditional |
$95.50
|
| Rate for Payer: Caresource Just 4 Me |
$86.02
|
| Rate for Payer: Caresource Medicare |
$82.28
|
| Rate for Payer: Centivo/Paragon All Products |
$115.94
|
| Rate for Payer: Coventry/First Health All Products |
$175.13
|
| Rate for Payer: Frontpath All Products |
$78.23
|
| Rate for Payer: Humana ChoiceCare |
$145.94
|
| Rate for Payer: Humana Medicare |
$74.80
|
| Rate for Payer: Lucent/Coldwater Veneers |
$127.16
|
| Rate for Payer: Lutheran Preferred All Products |
$79.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$109.45
|
| Rate for Payer: PHP All Products |
$75.16
|
| Rate for Payer: Plain Church Group Ministry All Products |
$74.80
|
| Rate for Payer: Signature Care EPO |
$73.95
|
| Rate for Payer: Signature Care PPO |
$73.95
|
| Rate for Payer: Three Rivers Preferred All Products |
$77.00
|
| Rate for Payer: United Healthcare Commercial |
$79.66
|
| Rate for Payer: United Healthcare Medicare |
$72.97
|
|
|
PR HOSPITAL IP/OBS CARE SAME DATE HIGH MDM 85 MIN
|
Professional
|
$388.92
|
|
|
Service Code
|
CPT 99236
|
| Hospital Charge Code |
Z13173
|
| Min. Negotiated Rate |
$194.46 |
| Max. Negotiated Rate |
$466.70 |
| Rate for Payer: Aetna Medicare |
$199.01
|
| Rate for Payer: Anthem Exchange |
$226.90
|
| Rate for Payer: Anthem Medicare |
$199.01
|
| Rate for Payer: Anthem PPO |
$226.90
|
| Rate for Payer: Anthem Traditional |
$226.90
|
| Rate for Payer: Caresource Just 4 Me |
$228.86
|
| Rate for Payer: Caresource Medicare |
$218.91
|
| Rate for Payer: Centivo/Paragon All Products |
$308.47
|
| Rate for Payer: Coventry/First Health All Products |
$466.70
|
| Rate for Payer: Frontpath All Products |
$216.27
|
| Rate for Payer: Humana ChoiceCare |
$388.92
|
| Rate for Payer: Humana Medicare |
$199.01
|
| Rate for Payer: Lucent/Coldwater Veneers |
$338.32
|
| Rate for Payer: Lutheran Preferred All Products |
$209.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$291.69
|
| Rate for Payer: PHP All Products |
$200.29
|
| Rate for Payer: Plain Church Group Ministry All Products |
$199.01
|
| Rate for Payer: Signature Care EPO |
$240.55
|
| Rate for Payer: Signature Care PPO |
$240.55
|
| Rate for Payer: Three Rivers Preferred All Products |
$205.00
|
| Rate for Payer: United Healthcare Commercial |
$210.83
|
| Rate for Payer: United Healthcare Medicare |
$194.46
|
|
|
PR HOSPITAL IP/OBS CARE SAME DATE MOD MDM 70 MIN
|
Professional
|
$296.16
|
|
|
Service Code
|
CPT 99235
|
| Hospital Charge Code |
Z13172
|
| Min. Negotiated Rate |
$148.08 |
| Max. Negotiated Rate |
$355.39 |
| Rate for Payer: Aetna Medicare |
$151.78
|
| Rate for Payer: Anthem Exchange |
$182.00
|
| Rate for Payer: Anthem Medicare |
$151.78
|
| Rate for Payer: Anthem PPO |
$182.00
|
| Rate for Payer: Anthem Traditional |
$182.00
|
| Rate for Payer: Caresource Just 4 Me |
$174.55
|
| Rate for Payer: Caresource Medicare |
$166.96
|
| Rate for Payer: Centivo/Paragon All Products |
$235.26
|
| Rate for Payer: Coventry/First Health All Products |
$355.39
|
| Rate for Payer: Frontpath All Products |
$168.77
|
| Rate for Payer: Humana ChoiceCare |
$296.16
|
| Rate for Payer: Humana Medicare |
$151.78
|
| Rate for Payer: Lucent/Coldwater Veneers |
$258.03
|
| Rate for Payer: Lutheran Preferred All Products |
$159.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$222.12
|
| Rate for Payer: PHP All Products |
$152.52
|
| Rate for Payer: Plain Church Group Ministry All Products |
$151.78
|
| Rate for Payer: Signature Care EPO |
$192.95
|
| Rate for Payer: Signature Care PPO |
$192.95
|
| Rate for Payer: Three Rivers Preferred All Products |
$156.00
|
| Rate for Payer: United Healthcare Commercial |
$169.62
|
| Rate for Payer: United Healthcare Medicare |
$148.08
|
|
|
PR HOSPITAL IP/OBS CARE SAME DATE SF/LOW MDM 45 MIN
|
Professional
|
$182.48
|
|
|
Service Code
|
CPT 99234
|
| Hospital Charge Code |
Z13171
|
| Min. Negotiated Rate |
$91.24 |
| Max. Negotiated Rate |
$218.98 |
| Rate for Payer: Aetna Medicare |
$93.52
|
| Rate for Payer: Anthem Exchange |
$136.97
|
| Rate for Payer: Anthem Medicare |
$93.52
|
| Rate for Payer: Anthem PPO |
$136.97
|
| Rate for Payer: Anthem Traditional |
$136.97
|
| Rate for Payer: Caresource Just 4 Me |
$107.55
|
| Rate for Payer: Caresource Medicare |
$102.87
|
| Rate for Payer: Centivo/Paragon All Products |
$144.96
|
| Rate for Payer: Coventry/First Health All Products |
$218.98
|
| Rate for Payer: Frontpath All Products |
$133.33
|
| Rate for Payer: Humana ChoiceCare |
$182.48
|
| Rate for Payer: Humana Medicare |
$93.52
|
| Rate for Payer: Lucent/Coldwater Veneers |
$158.98
|
| Rate for Payer: Lutheran Preferred All Products |
$98.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$136.86
|
| Rate for Payer: PHP All Products |
$93.97
|
| Rate for Payer: Plain Church Group Ministry All Products |
$93.52
|
| Rate for Payer: Signature Care EPO |
$146.20
|
| Rate for Payer: Signature Care PPO |
$146.20
|
| Rate for Payer: Three Rivers Preferred All Products |
$96.00
|
| Rate for Payer: United Healthcare Commercial |
$129.10
|
| Rate for Payer: United Healthcare Medicare |
$91.24
|
|
|
PR HOSPITAL IP/OBS DISCHARGE DAY MGMT > 30 MIN
|
Professional
|
$211.96
|
|
|
Service Code
|
CPT 99239
|
| Hospital Charge Code |
Z13175
|
| Min. Negotiated Rate |
$97.88 |
| Max. Negotiated Rate |
$254.35 |
| Rate for Payer: Aetna Medicare |
$108.63
|
| Rate for Payer: Anthem Exchange |
$108.35
|
| Rate for Payer: Anthem Medicare |
$108.63
|
| Rate for Payer: Anthem PPO |
$108.35
|
| Rate for Payer: Anthem Traditional |
$108.35
|
| Rate for Payer: Caresource Just 4 Me |
$124.92
|
| Rate for Payer: Caresource Medicare |
$119.49
|
| Rate for Payer: Centivo/Paragon All Products |
$168.38
|
| Rate for Payer: Coventry/First Health All Products |
$254.35
|
| Rate for Payer: Frontpath All Products |
$106.62
|
| Rate for Payer: Humana ChoiceCare |
$211.96
|
| Rate for Payer: Humana Medicare |
$108.63
|
| Rate for Payer: Lucent/Coldwater Veneers |
$184.67
|
| Rate for Payer: Lutheran Preferred All Products |
$114.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$158.97
|
| Rate for Payer: PHP All Products |
$109.16
|
| Rate for Payer: Plain Church Group Ministry All Products |
$108.63
|
| Rate for Payer: Signature Care EPO |
$101.15
|
| Rate for Payer: Signature Care PPO |
$101.15
|
| Rate for Payer: Three Rivers Preferred All Products |
$112.00
|
| Rate for Payer: United Healthcare Commercial |
$97.88
|
| Rate for Payer: United Healthcare Medicare |
$105.98
|
|
|
PR HOSPITAL IP/OBS DISCHARGE DAY MGMT 30 MIN/<
|
Professional
|
$149.62
|
|
|
Service Code
|
CPT 99238
|
| Hospital Charge Code |
Z13174
|
| Min. Negotiated Rate |
$67.34 |
| Max. Negotiated Rate |
$179.54 |
| Rate for Payer: Aetna Medicare |
$76.68
|
| Rate for Payer: Anthem Exchange |
$76.10
|
| Rate for Payer: Anthem Medicare |
$76.68
|
| Rate for Payer: Anthem PPO |
$76.10
|
| Rate for Payer: Anthem Traditional |
$76.10
|
| Rate for Payer: Caresource Just 4 Me |
$88.18
|
| Rate for Payer: Caresource Medicare |
$84.35
|
| Rate for Payer: Centivo/Paragon All Products |
$118.85
|
| Rate for Payer: Coventry/First Health All Products |
$179.54
|
| Rate for Payer: Frontpath All Products |
$72.95
|
| Rate for Payer: Humana ChoiceCare |
$149.62
|
| Rate for Payer: Humana Medicare |
$76.68
|
| Rate for Payer: Lucent/Coldwater Veneers |
$130.36
|
| Rate for Payer: Lutheran Preferred All Products |
$81.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$112.22
|
| Rate for Payer: PHP All Products |
$77.06
|
| Rate for Payer: Plain Church Group Ministry All Products |
$76.68
|
| Rate for Payer: Signature Care EPO |
$73.95
|
| Rate for Payer: Signature Care PPO |
$73.95
|
| Rate for Payer: Three Rivers Preferred All Products |
$79.00
|
| Rate for Payer: United Healthcare Commercial |
$67.34
|
| Rate for Payer: United Healthcare Medicare |
$74.81
|
|
|
PR HYMENOTOMY, SIMPLE INCISION
|
Professional
|
$86.08
|
|
|
Service Code
|
CPT 56442
|
| Hospital Charge Code |
Z12688
|
| Min. Negotiated Rate |
$43.04 |
| Max. Negotiated Rate |
$103.30 |
| Rate for Payer: Aetna Medicare |
$44.12
|
| Rate for Payer: Anthem Exchange |
$62.17
|
| Rate for Payer: Anthem Medicare |
$44.12
|
| Rate for Payer: Anthem PPO |
$62.17
|
| Rate for Payer: Anthem Traditional |
$62.17
|
| Rate for Payer: Caresource Just 4 Me |
$50.74
|
| Rate for Payer: Caresource Medicare |
$48.53
|
| Rate for Payer: Centivo/Paragon All Products |
$68.39
|
| Rate for Payer: Coventry/First Health All Products |
$103.30
|
| Rate for Payer: Frontpath All Products |
$60.24
|
| Rate for Payer: Humana ChoiceCare |
$86.08
|
| Rate for Payer: Humana Medicare |
$44.12
|
| Rate for Payer: Lucent/Coldwater Veneers |
$75.00
|
| Rate for Payer: Lutheran Preferred All Products |
$62.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$64.56
|
| Rate for Payer: PHP All Products |
$56.81
|
| Rate for Payer: Plain Church Group Ministry All Products |
$44.12
|
| Rate for Payer: Signature Care EPO |
$54.40
|
| Rate for Payer: Signature Care PPO |
$54.40
|
| Rate for Payer: Three Rivers Preferred All Products |
$57.00
|
| Rate for Payer: United Healthcare Commercial |
$54.75
|
| Rate for Payer: United Healthcare Medicare |
$43.04
|
|
|
PR HYPNOTHERAPY
|
Professional
|
$196.68
|
|
|
Service Code
|
CPT 90880
|
| Hospital Charge Code |
Z13034
|
| Min. Negotiated Rate |
$85.37 |
| Max. Negotiated Rate |
$236.02 |
| Rate for Payer: Aetna Medicare |
$85.37
|
| Rate for Payer: Anthem Exchange |
$105.19
|
| Rate for Payer: Anthem Medicare |
$85.37
|
| Rate for Payer: Anthem PPO |
$105.19
|
| Rate for Payer: Anthem Traditional |
$105.19
|
| Rate for Payer: Caresource Just 4 Me |
$98.18
|
| Rate for Payer: Caresource Medicare |
$93.91
|
| Rate for Payer: Centivo/Paragon All Products |
$132.32
|
| Rate for Payer: Coventry/First Health All Products |
$236.02
|
| Rate for Payer: Frontpath All Products |
$98.93
|
| Rate for Payer: Humana ChoiceCare |
$196.68
|
| Rate for Payer: Humana Medicare |
$85.37
|
| Rate for Payer: Lucent/Coldwater Veneers |
$145.13
|
| Rate for Payer: Lutheran Preferred All Products |
$111.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$147.51
|
| Rate for Payer: PHP All Products |
$90.78
|
| Rate for Payer: Plain Church Group Ministry All Products |
$85.37
|
| Rate for Payer: Signature Care EPO |
$133.45
|
| Rate for Payer: Signature Care PPO |
$133.45
|
| Rate for Payer: Three Rivers Preferred All Products |
$102.00
|
| Rate for Payer: United Healthcare Commercial |
$119.95
|
| Rate for Payer: United Healthcare Medicare |
$98.34
|
|
|
PR HYSTEROSCOPY,DX,SEP PROC
|
Professional
|
$663.70
|
|
|
Service Code
|
CPT 58555
|
| Hospital Charge Code |
Z12757
|
| Min. Negotiated Rate |
$140.72 |
| Max. Negotiated Rate |
$796.44 |
| Rate for Payer: Aetna Medicare |
$140.72
|
| Rate for Payer: Anthem Exchange |
$317.01
|
| Rate for Payer: Anthem Medicare |
$140.72
|
| Rate for Payer: Anthem PPO |
$317.01
|
| Rate for Payer: Anthem Traditional |
$317.01
|
| Rate for Payer: Caresource Just 4 Me |
$161.83
|
| Rate for Payer: Caresource Medicare |
$154.79
|
| Rate for Payer: Centivo/Paragon All Products |
$218.12
|
| Rate for Payer: Coventry/First Health All Products |
$796.44
|
| Rate for Payer: Frontpath All Products |
$196.16
|
| Rate for Payer: Humana ChoiceCare |
$663.70
|
| Rate for Payer: Humana Medicare |
$140.72
|
| Rate for Payer: Lucent/Coldwater Veneers |
$239.22
|
| Rate for Payer: Lutheran Preferred All Products |
$197.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$497.78
|
| Rate for Payer: PHP All Products |
$181.22
|
| Rate for Payer: Plain Church Group Ministry All Products |
$140.72
|
| Rate for Payer: Signature Care EPO |
$296.28
|
| Rate for Payer: Signature Care PPO |
$296.28
|
| Rate for Payer: Three Rivers Preferred All Products |
$183.00
|
| Rate for Payer: United Healthcare Commercial |
$216.80
|
| Rate for Payer: United Healthcare Medicare |
$331.85
|
|
|
PR HYSTEROSCOPY,LYSIS ADHESIONS
|
Professional
|
$515.38
|
|
|
Service Code
|
CPT 58559
|
| Hospital Charge Code |
Z12759
|
| Min. Negotiated Rate |
$257.69 |
| Max. Negotiated Rate |
$618.46 |
| Rate for Payer: Aetna Medicare |
$264.13
|
| Rate for Payer: Anthem Exchange |
$471.87
|
| Rate for Payer: Anthem Medicare |
$264.13
|
| Rate for Payer: Anthem PPO |
$471.87
|
| Rate for Payer: Anthem Traditional |
$471.87
|
| Rate for Payer: Caresource Just 4 Me |
$303.75
|
| Rate for Payer: Caresource Medicare |
$290.54
|
| Rate for Payer: Centivo/Paragon All Products |
$409.40
|
| Rate for Payer: Coventry/First Health All Products |
$618.46
|
| Rate for Payer: Frontpath All Products |
$372.37
|
| Rate for Payer: Humana ChoiceCare |
$515.38
|
| Rate for Payer: Humana Medicare |
$264.13
|
| Rate for Payer: Lucent/Coldwater Veneers |
$449.02
|
| Rate for Payer: Lutheran Preferred All Products |
$370.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$386.53
|
| Rate for Payer: PHP All Products |
$340.15
|
| Rate for Payer: Plain Church Group Ministry All Products |
$264.13
|
| Rate for Payer: Signature Care EPO |
$442.00
|
| Rate for Payer: Signature Care PPO |
$442.00
|
| Rate for Payer: Three Rivers Preferred All Products |
$343.00
|
| Rate for Payer: United Healthcare Commercial |
$393.30
|
| Rate for Payer: United Healthcare Medicare |
$257.69
|
|
|
PR HYSTEROSCOPY,RMV FB
|
Professional
|
$792.40
|
|
|
Service Code
|
CPT 58562
|
| Hospital Charge Code |
Z12761
|
| Min. Negotiated Rate |
$206.06 |
| Max. Negotiated Rate |
$950.88 |
| Rate for Payer: Aetna Medicare |
$206.06
|
| Rate for Payer: Anthem Exchange |
$457.94
|
| Rate for Payer: Anthem Medicare |
$206.06
|
| Rate for Payer: Anthem PPO |
$457.94
|
| Rate for Payer: Anthem Traditional |
$457.94
|
| Rate for Payer: Caresource Just 4 Me |
$236.97
|
| Rate for Payer: Caresource Medicare |
$226.67
|
| Rate for Payer: Centivo/Paragon All Products |
$319.39
|
| Rate for Payer: Coventry/First Health All Products |
$950.88
|
| Rate for Payer: Frontpath All Products |
$289.16
|
| Rate for Payer: Humana ChoiceCare |
$792.40
|
| Rate for Payer: Humana Medicare |
$206.06
|
| Rate for Payer: Lucent/Coldwater Veneers |
$350.30
|
| Rate for Payer: Lutheran Preferred All Products |
$288.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$594.30
|
| Rate for Payer: PHP All Products |
$265.37
|
| Rate for Payer: Plain Church Group Ministry All Products |
$206.06
|
| Rate for Payer: Signature Care EPO |
$372.30
|
| Rate for Payer: Signature Care PPO |
$372.30
|
| Rate for Payer: Three Rivers Preferred All Products |
$268.00
|
| Rate for Payer: United Healthcare Commercial |
$333.39
|
| Rate for Payer: United Healthcare Medicare |
$396.20
|
|
|
PR HYSTEROSCOPY,RMV MYOMA
|
Professional
|
$648.64
|
|
|
Service Code
|
CPT 58561
|
| Hospital Charge Code |
Z12760
|
| Min. Negotiated Rate |
$324.32 |
| Max. Negotiated Rate |
$1,077.60 |
| Rate for Payer: Aetna Medicare |
$332.43
|
| Rate for Payer: Anthem Exchange |
$1,077.60
|
| Rate for Payer: Anthem Medicare |
$332.43
|
| Rate for Payer: Anthem PPO |
$1,077.60
|
| Rate for Payer: Anthem Traditional |
$1,077.60
|
| Rate for Payer: Caresource Just 4 Me |
$382.29
|
| Rate for Payer: Caresource Medicare |
$365.67
|
| Rate for Payer: Centivo/Paragon All Products |
$515.27
|
| Rate for Payer: Coventry/First Health All Products |
$778.37
|
| Rate for Payer: Frontpath All Products |
$467.88
|
| Rate for Payer: Humana ChoiceCare |
$648.64
|
| Rate for Payer: Humana Medicare |
$332.43
|
| Rate for Payer: Lucent/Coldwater Veneers |
$565.13
|
| Rate for Payer: Lutheran Preferred All Products |
$465.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$486.48
|
| Rate for Payer: PHP All Products |
$428.11
|
| Rate for Payer: Plain Church Group Ministry All Products |
$332.43
|
| Rate for Payer: Signature Care EPO |
$570.04
|
| Rate for Payer: Signature Care PPO |
$570.04
|
| Rate for Payer: Three Rivers Preferred All Products |
$432.00
|
| Rate for Payer: United Healthcare Commercial |
$629.56
|
| Rate for Payer: United Healthcare Medicare |
$324.32
|
|
|
PR HYSTEROSCOPY, STERILIZE W IMPLANTS
|
Professional
|
$3,064.88
|
|
|
Service Code
|
CPT 58565
|
| Hospital Charge Code |
Z12763
|
| Min. Negotiated Rate |
$429.45 |
| Max. Negotiated Rate |
$3,677.86 |
| Rate for Payer: Caresource Medicare |
$472.40
|
| Rate for Payer: Aetna Medicare |
$429.45
|
| Rate for Payer: Anthem Exchange |
$2,834.63
|
| Rate for Payer: Anthem Medicare |
$429.45
|
| Rate for Payer: Anthem PPO |
$2,834.63
|
| Rate for Payer: Anthem Traditional |
$2,834.63
|
| Rate for Payer: Caresource Just 4 Me |
$493.87
|
| Rate for Payer: Centivo/Paragon All Products |
$665.65
|
| Rate for Payer: Coventry/First Health All Products |
$3,677.86
|
| Rate for Payer: Frontpath All Products |
$598.87
|
| Rate for Payer: Humana ChoiceCare |
$3,064.88
|
| Rate for Payer: Humana Medicare |
$429.45
|
| Rate for Payer: Lucent/Coldwater Veneers |
$730.06
|
| Rate for Payer: Lutheran Preferred All Products |
$601.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$2,298.66
|
| Rate for Payer: PHP All Products |
$553.04
|
| Rate for Payer: Plain Church Group Ministry All Products |
$429.45
|
| Rate for Payer: Signature Care EPO |
$2,655.40
|
| Rate for Payer: Signature Care PPO |
$2,655.40
|
| Rate for Payer: Three Rivers Preferred All Products |
$558.00
|
| Rate for Payer: United Healthcare Commercial |
$499.00
|
| Rate for Payer: United Healthcare Medicare |
$1,532.44
|
|
|
PR HYSTEROSCOPY,W/ENDO BX
|
Professional
|
$2,444.22
|
|
|
Service Code
|
CPT 58558
|
| Hospital Charge Code |
Z12758
|
| Min. Negotiated Rate |
$215.08 |
| Max. Negotiated Rate |
$2,933.06 |
| Rate for Payer: Aetna Medicare |
$215.08
|
| Rate for Payer: Anthem Exchange |
$1,934.43
|
| Rate for Payer: Anthem Medicare |
$215.08
|
| Rate for Payer: Anthem PPO |
$1,934.43
|
| Rate for Payer: Anthem Traditional |
$1,934.43
|
| Rate for Payer: Caresource Just 4 Me |
$247.34
|
| Rate for Payer: Caresource Medicare |
$236.59
|
| Rate for Payer: Centivo/Paragon All Products |
$333.37
|
| Rate for Payer: Coventry/First Health All Products |
$2,933.06
|
| Rate for Payer: Frontpath All Products |
$301.08
|
| Rate for Payer: Humana ChoiceCare |
$2,444.22
|
| Rate for Payer: Humana Medicare |
$215.08
|
| Rate for Payer: Lucent/Coldwater Veneers |
$365.64
|
| Rate for Payer: Lutheran Preferred All Products |
$301.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$1,833.16
|
| Rate for Payer: PHP All Products |
$276.99
|
| Rate for Payer: Plain Church Group Ministry All Products |
$215.08
|
| Rate for Payer: Signature Care EPO |
$1,638.55
|
| Rate for Payer: Signature Care PPO |
$1,638.55
|
| Rate for Payer: Three Rivers Preferred All Products |
$280.00
|
| Rate for Payer: United Healthcare Commercial |
$305.65
|
| Rate for Payer: United Healthcare Medicare |
$1,222.11
|
|
|
PR HYSTEROSCOPY,W/ENDOMETRIAL ABLATION
|
Professional
|
$3,887.22
|
|
|
Service Code
|
CPT 58563
|
| Hospital Charge Code |
Z12762
|
| Min. Negotiated Rate |
$228.83 |
| Max. Negotiated Rate |
$4,664.66 |
| Rate for Payer: Aetna Medicare |
$228.83
|
| Rate for Payer: Anthem Exchange |
$3,197.32
|
| Rate for Payer: Anthem Medicare |
$228.83
|
| Rate for Payer: Anthem PPO |
$3,197.32
|
| Rate for Payer: Anthem Traditional |
$3,197.32
|
| Rate for Payer: Caresource Just 4 Me |
$263.15
|
| Rate for Payer: Caresource Medicare |
$251.71
|
| Rate for Payer: Centivo/Paragon All Products |
$354.69
|
| Rate for Payer: Coventry/First Health All Products |
$4,664.66
|
| Rate for Payer: Frontpath All Products |
$321.23
|
| Rate for Payer: Humana ChoiceCare |
$3,887.22
|
| Rate for Payer: Humana Medicare |
$228.83
|
| Rate for Payer: Lucent/Coldwater Veneers |
$389.01
|
| Rate for Payer: Lutheran Preferred All Products |
$320.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$2,915.41
|
| Rate for Payer: PHP All Products |
$294.69
|
| Rate for Payer: Plain Church Group Ministry All Products |
$228.83
|
| Rate for Payer: Signature Care EPO |
$2,404.65
|
| Rate for Payer: Signature Care PPO |
$2,404.65
|
| Rate for Payer: Three Rivers Preferred All Products |
$297.00
|
| Rate for Payer: United Healthcare Commercial |
$393.30
|
| Rate for Payer: United Healthcare Medicare |
$1,943.61
|
|
|
PR I&D BARTHOLIN GLAND ABSCESS
|
Professional
|
$340.40
|
|
|
Service Code
|
CPT 56420
|
| Hospital Charge Code |
Z12686
|
| Min. Negotiated Rate |
$103.06 |
| Max. Negotiated Rate |
$408.48 |
| Rate for Payer: Aetna Medicare |
$104.07
|
| Rate for Payer: Anthem Exchange |
$187.47
|
| Rate for Payer: Anthem Medicare |
$104.07
|
| Rate for Payer: Anthem PPO |
$187.47
|
| Rate for Payer: Anthem Traditional |
$187.47
|
| Rate for Payer: Caresource Just 4 Me |
$119.68
|
| Rate for Payer: Caresource Medicare |
$114.48
|
| Rate for Payer: Centivo/Paragon All Products |
$161.31
|
| Rate for Payer: Coventry/First Health All Products |
$408.48
|
| Rate for Payer: Frontpath All Products |
$144.44
|
| Rate for Payer: Humana ChoiceCare |
$340.40
|
| Rate for Payer: Humana Medicare |
$104.07
|
| Rate for Payer: Lucent/Coldwater Veneers |
$176.92
|
| Rate for Payer: Lutheran Preferred All Products |
$146.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$255.30
|
| Rate for Payer: PHP All Products |
$134.02
|
| Rate for Payer: Plain Church Group Ministry All Products |
$104.07
|
| Rate for Payer: Signature Care EPO |
$176.80
|
| Rate for Payer: Signature Care PPO |
$176.80
|
| Rate for Payer: Three Rivers Preferred All Products |
$135.00
|
| Rate for Payer: United Healthcare Commercial |
$103.06
|
| Rate for Payer: United Healthcare Medicare |
$170.20
|
|
|
PR IDENTIFY SENTINEL NODE
|
Professional
|
$150.30
|
|
|
Service Code
|
CPT 38792
|
| Hospital Charge Code |
Z12558
|
| Min. Negotiated Rate |
$30.41 |
| Max. Negotiated Rate |
$180.36 |
| Rate for Payer: Aetna Medicare |
$30.41
|
| Rate for Payer: Anthem Exchange |
$76.98
|
| Rate for Payer: Anthem Medicare |
$30.41
|
| Rate for Payer: Anthem PPO |
$76.98
|
| Rate for Payer: Anthem Traditional |
$76.98
|
| Rate for Payer: Caresource Just 4 Me |
$34.97
|
| Rate for Payer: Caresource Medicare |
$33.45
|
| Rate for Payer: Centivo/Paragon All Products |
$47.14
|
| Rate for Payer: Coventry/First Health All Products |
$180.36
|
| Rate for Payer: Frontpath All Products |
$43.12
|
| Rate for Payer: Humana ChoiceCare |
$150.30
|
| Rate for Payer: Humana Medicare |
$30.41
|
| Rate for Payer: Lucent/Coldwater Veneers |
$51.70
|
| Rate for Payer: Lutheran Preferred All Products |
$49.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$112.73
|
| Rate for Payer: PHP All Products |
$41.54
|
| Rate for Payer: Plain Church Group Ministry All Products |
$30.41
|
| Rate for Payer: Signature Care EPO |
$65.88
|
| Rate for Payer: Signature Care PPO |
$65.88
|
| Rate for Payer: Three Rivers Preferred All Products |
$46.00
|
| Rate for Payer: United Healthcare Commercial |
$44.93
|
| Rate for Payer: United Healthcare Medicare |
$75.15
|
|
