|
PR INCISION EARDRUM,ASPIR
|
Professional
|
$701.64
|
|
|
Service Code
|
CPT 69420
|
| Hospital Charge Code |
Z12857
|
| Min. Negotiated Rate |
$113.11 |
| Max. Negotiated Rate |
$841.97 |
| Rate for Payer: Aetna Medicare |
$113.11
|
| Rate for Payer: Anthem Exchange |
$204.41
|
| Rate for Payer: Anthem Medicare |
$113.11
|
| Rate for Payer: Anthem PPO |
$204.41
|
| Rate for Payer: Anthem Traditional |
$204.41
|
| Rate for Payer: Caresource Just 4 Me |
$130.08
|
| Rate for Payer: Caresource Medicare |
$124.42
|
| Rate for Payer: Centivo/Paragon All Products |
$175.32
|
| Rate for Payer: Coventry/First Health All Products |
$841.97
|
| Rate for Payer: Frontpath All Products |
$152.84
|
| Rate for Payer: Humana ChoiceCare |
$701.64
|
| Rate for Payer: Humana Medicare |
$113.11
|
| Rate for Payer: Lucent/Coldwater Veneers |
$192.29
|
| Rate for Payer: Lutheran Preferred All Products |
$181.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$526.23
|
| Rate for Payer: PHP All Products |
$143.46
|
| Rate for Payer: Plain Church Group Ministry All Products |
$113.11
|
| Rate for Payer: Signature Care EPO |
$190.96
|
| Rate for Payer: Signature Care PPO |
$190.96
|
| Rate for Payer: Three Rivers Preferred All Products |
$170.00
|
| Rate for Payer: United Healthcare Commercial |
$128.81
|
| Rate for Payer: United Healthcare Medicare |
$175.41
|
|
|
PR INCISION EARDRUM,ASPIR,GEN ANESTH
|
Professional
|
$558.32
|
|
|
Service Code
|
CPT 69421
|
| Hospital Charge Code |
Z12859
|
| Min. Negotiated Rate |
$139.58 |
| Max. Negotiated Rate |
$669.98 |
| Rate for Payer: Aetna Medicare |
$143.06
|
| Rate for Payer: Anthem Exchange |
$165.60
|
| Rate for Payer: Anthem Medicare |
$143.06
|
| Rate for Payer: Anthem PPO |
$165.60
|
| Rate for Payer: Anthem Traditional |
$165.60
|
| Rate for Payer: Caresource Just 4 Me |
$164.52
|
| Rate for Payer: Caresource Medicare |
$157.37
|
| Rate for Payer: Centivo/Paragon All Products |
$221.74
|
| Rate for Payer: Coventry/First Health All Products |
$669.98
|
| Rate for Payer: Frontpath All Products |
$193.83
|
| Rate for Payer: Humana ChoiceCare |
$558.32
|
| Rate for Payer: Humana Medicare |
$143.06
|
| Rate for Payer: Lucent/Coldwater Veneers |
$243.20
|
| Rate for Payer: Lutheran Preferred All Products |
$229.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$418.74
|
| Rate for Payer: PHP All Products |
$181.45
|
| Rate for Payer: Plain Church Group Ministry All Products |
$143.06
|
| Rate for Payer: Signature Care EPO |
$183.60
|
| Rate for Payer: Signature Care PPO |
$183.60
|
| Rate for Payer: Three Rivers Preferred All Products |
$215.00
|
| Rate for Payer: United Healthcare Commercial |
$163.24
|
| Rate for Payer: United Healthcare Medicare |
$139.58
|
|
|
PR INCISION EARDRUM,ASPIR,GEN ANESTH
|
Professional
|
$279.16
|
|
|
Service Code
|
CPT 69421
|
| Hospital Charge Code |
Z12858
|
| Min. Negotiated Rate |
$139.58 |
| Max. Negotiated Rate |
$334.99 |
| Rate for Payer: Aetna Medicare |
$143.06
|
| Rate for Payer: Anthem Exchange |
$165.60
|
| Rate for Payer: Anthem Medicare |
$143.06
|
| Rate for Payer: Anthem PPO |
$165.60
|
| Rate for Payer: Anthem Traditional |
$165.60
|
| Rate for Payer: Caresource Just 4 Me |
$164.52
|
| Rate for Payer: Caresource Medicare |
$157.37
|
| Rate for Payer: Centivo/Paragon All Products |
$221.74
|
| Rate for Payer: Coventry/First Health All Products |
$334.99
|
| Rate for Payer: Frontpath All Products |
$193.83
|
| Rate for Payer: Humana ChoiceCare |
$279.16
|
| Rate for Payer: Humana Medicare |
$143.06
|
| Rate for Payer: Lucent/Coldwater Veneers |
$243.20
|
| Rate for Payer: Lutheran Preferred All Products |
$229.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$209.37
|
| Rate for Payer: PHP All Products |
$181.45
|
| Rate for Payer: Plain Church Group Ministry All Products |
$143.06
|
| Rate for Payer: Signature Care EPO |
$183.60
|
| Rate for Payer: Signature Care PPO |
$183.60
|
| Rate for Payer: Three Rivers Preferred All Products |
$215.00
|
| Rate for Payer: United Healthcare Commercial |
$163.24
|
| Rate for Payer: United Healthcare Medicare |
$139.58
|
|
|
PR INCISION OF TONGUE FOLD
|
Professional
|
$398.60
|
|
|
Service Code
|
CPT 41010
|
| Hospital Charge Code |
Z12567
|
| Min. Negotiated Rate |
$103.33 |
| Max. Negotiated Rate |
$478.32 |
| Rate for Payer: Aetna Medicare |
$103.33
|
| Rate for Payer: Anthem Exchange |
$165.29
|
| Rate for Payer: Anthem Medicare |
$103.33
|
| Rate for Payer: Anthem PPO |
$165.29
|
| Rate for Payer: Anthem Traditional |
$165.29
|
| Rate for Payer: Caresource Just 4 Me |
$118.83
|
| Rate for Payer: Caresource Medicare |
$113.66
|
| Rate for Payer: Centivo/Paragon All Products |
$160.16
|
| Rate for Payer: Coventry/First Health All Products |
$478.32
|
| Rate for Payer: Frontpath All Products |
$139.63
|
| Rate for Payer: Humana ChoiceCare |
$398.60
|
| Rate for Payer: Humana Medicare |
$103.33
|
| Rate for Payer: Lucent/Coldwater Veneers |
$175.66
|
| Rate for Payer: Lutheran Preferred All Products |
$155.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$298.95
|
| Rate for Payer: PHP All Products |
$176.41
|
| Rate for Payer: Plain Church Group Ministry All Products |
$103.33
|
| Rate for Payer: Signature Care EPO |
$244.80
|
| Rate for Payer: Signature Care PPO |
$244.80
|
| Rate for Payer: Three Rivers Preferred All Products |
$145.00
|
| Rate for Payer: United Healthcare Commercial |
$115.98
|
| Rate for Payer: United Healthcare Medicare |
$199.30
|
|
|
PR INCISION SUBCUT TOE TENDON
|
Professional
|
$429.52
|
|
|
Service Code
|
CPT 28010
|
| Hospital Charge Code |
Z12414
|
| Min. Negotiated Rate |
$196.36 |
| Max. Negotiated Rate |
$515.42 |
| Rate for Payer: Aetna Medicare |
$196.36
|
| Rate for Payer: Anthem Medicare |
$196.36
|
| Rate for Payer: Caresource Just 4 Me |
$225.81
|
| Rate for Payer: Caresource Medicare |
$216.00
|
| Rate for Payer: Centivo/Paragon All Products |
$304.36
|
| Rate for Payer: Coventry/First Health All Products |
$515.42
|
| Rate for Payer: Frontpath All Products |
$263.39
|
| Rate for Payer: Humana ChoiceCare |
$429.52
|
| Rate for Payer: Humana Medicare |
$196.36
|
| Rate for Payer: Lucent/Coldwater Veneers |
$333.81
|
| Rate for Payer: PHCS/Multiplan All Products |
$322.14
|
| Rate for Payer: Plain Church Group Ministry All Products |
$196.36
|
| Rate for Payer: United Healthcare Commercial |
$236.03
|
| Rate for Payer: United Healthcare Medicare |
$214.76
|
|
|
PR INCISION SUBCUT TOE TENDON,>1
|
Professional
|
$578.94
|
|
|
Service Code
|
CPT 28011
|
| Hospital Charge Code |
Z12415
|
| Min. Negotiated Rate |
$263.67 |
| Max. Negotiated Rate |
$694.73 |
| Rate for Payer: Aetna Medicare |
$263.67
|
| Rate for Payer: Anthem Medicare |
$263.67
|
| Rate for Payer: Caresource Just 4 Me |
$303.22
|
| Rate for Payer: Caresource Medicare |
$290.04
|
| Rate for Payer: Centivo/Paragon All Products |
$408.69
|
| Rate for Payer: Coventry/First Health All Products |
$694.73
|
| Rate for Payer: Frontpath All Products |
$357.23
|
| Rate for Payer: Humana ChoiceCare |
$578.94
|
| Rate for Payer: Humana Medicare |
$263.67
|
| Rate for Payer: Lucent/Coldwater Veneers |
$448.24
|
| Rate for Payer: PHCS/Multiplan All Products |
$434.21
|
| Rate for Payer: Plain Church Group Ministry All Products |
$263.67
|
| Rate for Payer: United Healthcare Commercial |
$333.13
|
| Rate for Payer: United Healthcare Medicare |
$289.47
|
|
|
PR INCIS TENDON SHEATH,RADIAL STYLOID
|
Professional
|
$636.16
|
|
|
Service Code
|
CPT 25000
|
| Hospital Charge Code |
Z12218
|
| Min. Negotiated Rate |
$318.08 |
| Max. Negotiated Rate |
$763.39 |
| Rate for Payer: Aetna Medicare |
$326.03
|
| Rate for Payer: Anthem Exchange |
$405.70
|
| Rate for Payer: Anthem Medicare |
$326.03
|
| Rate for Payer: Anthem PPO |
$405.70
|
| Rate for Payer: Anthem Traditional |
$405.70
|
| Rate for Payer: Caresource Just 4 Me |
$374.93
|
| Rate for Payer: Caresource Medicare |
$358.63
|
| Rate for Payer: Centivo/Paragon All Products |
$505.35
|
| Rate for Payer: Coventry/First Health All Products |
$763.39
|
| Rate for Payer: Frontpath All Products |
$442.34
|
| Rate for Payer: Humana ChoiceCare |
$636.16
|
| Rate for Payer: Humana Medicare |
$326.03
|
| Rate for Payer: Lucent/Coldwater Veneers |
$554.25
|
| Rate for Payer: Lutheran Preferred All Products |
$522.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$477.12
|
| Rate for Payer: PHP All Products |
$553.46
|
| Rate for Payer: Plain Church Group Ministry All Products |
$326.03
|
| Rate for Payer: Signature Care EPO |
$542.45
|
| Rate for Payer: Signature Care PPO |
$542.45
|
| Rate for Payer: Three Rivers Preferred All Products |
$489.00
|
| Rate for Payer: United Healthcare Commercial |
$366.11
|
| Rate for Payer: United Healthcare Medicare |
$318.08
|
|
|
PR INDUCED AB BY VAG SUPPOS
|
Professional
|
$755.64
|
|
|
Service Code
|
CPT 59855
|
| Hospital Charge Code |
Z12818
|
| Min. Negotiated Rate |
$377.82 |
| Max. Negotiated Rate |
$906.77 |
| Rate for Payer: Aetna Medicare |
$387.26
|
| Rate for Payer: Anthem Exchange |
$543.82
|
| Rate for Payer: Anthem Medicare |
$387.26
|
| Rate for Payer: Anthem PPO |
$543.82
|
| Rate for Payer: Anthem Traditional |
$543.82
|
| Rate for Payer: Caresource Just 4 Me |
$445.35
|
| Rate for Payer: Caresource Medicare |
$425.99
|
| Rate for Payer: Centivo/Paragon All Products |
$600.25
|
| Rate for Payer: Coventry/First Health All Products |
$906.77
|
| Rate for Payer: Frontpath All Products |
$551.13
|
| Rate for Payer: Humana ChoiceCare |
$755.64
|
| Rate for Payer: Humana Medicare |
$387.26
|
| Rate for Payer: Lucent/Coldwater Veneers |
$658.34
|
| Rate for Payer: Lutheran Preferred All Products |
$542.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$566.73
|
| Rate for Payer: PHP All Products |
$498.72
|
| Rate for Payer: Plain Church Group Ministry All Products |
$387.26
|
| Rate for Payer: Signature Care EPO |
$485.35
|
| Rate for Payer: Signature Care PPO |
$485.35
|
| Rate for Payer: Three Rivers Preferred All Products |
$503.00
|
| Rate for Payer: United Healthcare Commercial |
$462.13
|
| Rate for Payer: United Healthcare Medicare |
$377.82
|
|
|
PR INDUCED ABORTN BY DIL/EVAC
|
Professional
|
$762.16
|
|
|
Service Code
|
CPT 59841
|
| Hospital Charge Code |
Z12817
|
| Min. Negotiated Rate |
$339.05 |
| Max. Negotiated Rate |
$914.59 |
| Rate for Payer: Aetna Medicare |
$339.05
|
| Rate for Payer: Anthem Exchange |
$500.90
|
| Rate for Payer: Anthem Medicare |
$339.05
|
| Rate for Payer: Anthem PPO |
$500.90
|
| Rate for Payer: Anthem Traditional |
$500.90
|
| Rate for Payer: Caresource Just 4 Me |
$389.91
|
| Rate for Payer: Caresource Medicare |
$372.96
|
| Rate for Payer: Centivo/Paragon All Products |
$525.53
|
| Rate for Payer: Coventry/First Health All Products |
$914.59
|
| Rate for Payer: Frontpath All Products |
$484.16
|
| Rate for Payer: Humana ChoiceCare |
$762.16
|
| Rate for Payer: Humana Medicare |
$339.05
|
| Rate for Payer: Lucent/Coldwater Veneers |
$576.38
|
| Rate for Payer: Lutheran Preferred All Products |
$475.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$571.62
|
| Rate for Payer: PHP All Products |
$436.63
|
| Rate for Payer: Plain Church Group Ministry All Products |
$339.05
|
| Rate for Payer: Signature Care EPO |
$394.40
|
| Rate for Payer: Signature Care PPO |
$394.40
|
| Rate for Payer: Three Rivers Preferred All Products |
$441.00
|
| Rate for Payer: United Healthcare Commercial |
$397.18
|
| Rate for Payer: United Healthcare Medicare |
$381.08
|
|
|
PR INGESTION CHALLENGE TEST INITIAL 120 MINUTES
|
Professional
|
$223.94
|
|
|
Service Code
|
CPT 95076
|
| Hospital Charge Code |
Z13133
|
| Min. Negotiated Rate |
$70.63 |
| Max. Negotiated Rate |
$268.73 |
| Rate for Payer: Aetna Medicare |
$70.63
|
| Rate for Payer: Anthem Exchange |
$121.18
|
| Rate for Payer: Anthem Medicare |
$70.63
|
| Rate for Payer: Anthem PPO |
$121.18
|
| Rate for Payer: Anthem Traditional |
$121.18
|
| Rate for Payer: Caresource Just 4 Me |
$81.22
|
| Rate for Payer: Caresource Medicare |
$77.69
|
| Rate for Payer: Centivo/Paragon All Products |
$109.48
|
| Rate for Payer: Coventry/First Health All Products |
$268.73
|
| Rate for Payer: Frontpath All Products |
$76.13
|
| Rate for Payer: Humana ChoiceCare |
$223.94
|
| Rate for Payer: Humana Medicare |
$70.63
|
| Rate for Payer: Lucent/Coldwater Veneers |
$120.07
|
| Rate for Payer: Lutheran Preferred All Products |
$92.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$167.95
|
| Rate for Payer: PHP All Products |
$79.24
|
| Rate for Payer: Plain Church Group Ministry All Products |
$70.63
|
| Rate for Payer: Signature Care EPO |
$127.87
|
| Rate for Payer: Signature Care PPO |
$127.87
|
| Rate for Payer: Three Rivers Preferred All Products |
$85.00
|
| Rate for Payer: United Healthcare Commercial |
$92.15
|
| Rate for Payer: United Healthcare Medicare |
$111.97
|
|
|
PR INITIAL HOSP NEONATE 28 DAY OR LESS, CRITICALLY ILL
|
Professional
|
$1,663.42
|
|
|
Service Code
|
CPT 99468
|
| Hospital Charge Code |
Z13233
|
| Min. Negotiated Rate |
$831.71 |
| Max. Negotiated Rate |
$3,140.00 |
| Rate for Payer: Aetna Medicare |
$852.66
|
| Rate for Payer: Anthem Exchange |
$974.10
|
| Rate for Payer: Anthem Medicare |
$852.66
|
| Rate for Payer: Anthem PPO |
$974.10
|
| Rate for Payer: Anthem Traditional |
$974.10
|
| Rate for Payer: Caresource Just 4 Me |
$980.56
|
| Rate for Payer: Caresource Medicare |
$937.93
|
| Rate for Payer: Centivo/Paragon All Products |
$1,321.62
|
| Rate for Payer: Coventry/First Health All Products |
$1,996.10
|
| Rate for Payer: Frontpath All Products |
$936.64
|
| Rate for Payer: Humana ChoiceCare |
$1,663.42
|
| Rate for Payer: Humana Medicare |
$852.66
|
| Rate for Payer: Lucent/Coldwater Veneers |
$1,449.52
|
| Rate for Payer: Lutheran Preferred All Products |
$3,140.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$1,247.57
|
| Rate for Payer: PHP All Products |
$856.66
|
| Rate for Payer: Plain Church Group Ministry All Products |
$852.66
|
| Rate for Payer: Signature Care EPO |
$914.46
|
| Rate for Payer: Signature Care PPO |
$914.46
|
| Rate for Payer: Three Rivers Preferred All Products |
$3,140.00
|
| Rate for Payer: United Healthcare Commercial |
$882.53
|
| Rate for Payer: United Healthcare Medicare |
$831.71
|
|
|
PR INITIAL HOSP NEONATE 28 DAY OR LESS, NOT CRITICALLY ILL
|
Professional
|
$630.90
|
|
|
Service Code
|
CPT 99477
|
| Hospital Charge Code |
Z13234
|
| Min. Negotiated Rate |
$296.95 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Medicare |
$323.34
|
| Rate for Payer: Anthem Exchange |
$442.71
|
| Rate for Payer: Anthem Medicare |
$323.34
|
| Rate for Payer: Anthem PPO |
$442.71
|
| Rate for Payer: Anthem Traditional |
$442.71
|
| Rate for Payer: Caresource Just 4 Me |
$371.84
|
| Rate for Payer: Caresource Medicare |
$355.67
|
| Rate for Payer: Centivo/Paragon All Products |
$501.18
|
| Rate for Payer: Coventry/First Health All Products |
$757.08
|
| Rate for Payer: Frontpath All Products |
$354.43
|
| Rate for Payer: Humana ChoiceCare |
$630.90
|
| Rate for Payer: Humana Medicare |
$323.34
|
| Rate for Payer: Lucent/Coldwater Veneers |
$549.68
|
| Rate for Payer: Lutheran Preferred All Products |
$1,200.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$473.17
|
| Rate for Payer: PHP All Products |
$324.91
|
| Rate for Payer: Plain Church Group Ministry All Products |
$323.34
|
| Rate for Payer: Signature Care EPO |
$296.95
|
| Rate for Payer: Signature Care PPO |
$296.95
|
| Rate for Payer: Three Rivers Preferred All Products |
$1,200.00
|
| Rate for Payer: United Healthcare Commercial |
$343.61
|
| Rate for Payer: United Healthcare Medicare |
$315.45
|
|
|
PR INITIAL NORMAL NEWBORN CARE, HOSPITAL OR BIRTH CENTER
|
Professional
|
$172.88
|
|
|
Service Code
|
CPT 99460
|
| Hospital Charge Code |
Z13229
|
| Min. Negotiated Rate |
$57.27 |
| Max. Negotiated Rate |
$325.00 |
| Rate for Payer: Aetna Medicare |
$88.60
|
| Rate for Payer: Anthem Exchange |
$106.00
|
| Rate for Payer: Anthem Medicare |
$88.60
|
| Rate for Payer: Anthem PPO |
$106.00
|
| Rate for Payer: Anthem Traditional |
$106.00
|
| Rate for Payer: Caresource Just 4 Me |
$101.89
|
| Rate for Payer: Caresource Medicare |
$97.46
|
| Rate for Payer: Centivo/Paragon All Products |
$137.33
|
| Rate for Payer: Coventry/First Health All Products |
$207.46
|
| Rate for Payer: Frontpath All Products |
$97.16
|
| Rate for Payer: Humana ChoiceCare |
$172.88
|
| Rate for Payer: Humana Medicare |
$88.60
|
| Rate for Payer: Lucent/Coldwater Veneers |
$150.62
|
| Rate for Payer: Lutheran Preferred All Products |
$325.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$129.66
|
| Rate for Payer: PHP All Products |
$89.04
|
| Rate for Payer: Plain Church Group Ministry All Products |
$88.60
|
| Rate for Payer: Signature Care EPO |
$81.97
|
| Rate for Payer: Signature Care PPO |
$81.97
|
| Rate for Payer: Three Rivers Preferred All Products |
$325.00
|
| Rate for Payer: United Healthcare Commercial |
$57.27
|
| Rate for Payer: United Healthcare Medicare |
$86.44
|
|
|
PR INITIAL NORMAL NEWBORN CARE, SAME DAY DISCHARGE
|
Professional
|
$201.60
|
|
|
Service Code
|
CPT 99463
|
| Hospital Charge Code |
Z13231
|
| Min. Negotiated Rate |
$76.59 |
| Max. Negotiated Rate |
$380.00 |
| Rate for Payer: Aetna Medicare |
$103.32
|
| Rate for Payer: Anthem Exchange |
$135.60
|
| Rate for Payer: Anthem Medicare |
$103.32
|
| Rate for Payer: Anthem PPO |
$135.60
|
| Rate for Payer: Anthem Traditional |
$135.60
|
| Rate for Payer: Caresource Just 4 Me |
$118.82
|
| Rate for Payer: Caresource Medicare |
$113.65
|
| Rate for Payer: Centivo/Paragon All Products |
$160.15
|
| Rate for Payer: Coventry/First Health All Products |
$241.92
|
| Rate for Payer: Frontpath All Products |
$111.61
|
| Rate for Payer: Humana ChoiceCare |
$201.60
|
| Rate for Payer: Humana Medicare |
$103.32
|
| Rate for Payer: Lucent/Coldwater Veneers |
$175.64
|
| Rate for Payer: Lutheran Preferred All Products |
$380.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$151.20
|
| Rate for Payer: PHP All Products |
$103.82
|
| Rate for Payer: Plain Church Group Ministry All Products |
$103.32
|
| Rate for Payer: Signature Care EPO |
$98.34
|
| Rate for Payer: Signature Care PPO |
$98.34
|
| Rate for Payer: Three Rivers Preferred All Products |
$380.00
|
| Rate for Payer: United Healthcare Commercial |
$76.59
|
| Rate for Payer: United Healthcare Medicare |
$100.80
|
|
|
PR INITIAL NURSING FACILITY CARE HI MDM 45 MINUTES
|
Professional
|
$338.32
|
|
|
Service Code
|
CPT 99306
|
| Hospital Charge Code |
Z13193
|
| Min. Negotiated Rate |
$108.59 |
| Max. Negotiated Rate |
$405.98 |
| Rate for Payer: Aetna Medicare |
$173.39
|
| Rate for Payer: Anthem Exchange |
$108.59
|
| Rate for Payer: Anthem Medicare |
$173.39
|
| Rate for Payer: Anthem PPO |
$108.59
|
| Rate for Payer: Anthem Traditional |
$108.59
|
| Rate for Payer: Caresource Just 4 Me |
$199.40
|
| Rate for Payer: Caresource Medicare |
$190.73
|
| Rate for Payer: Centivo/Paragon All Products |
$268.75
|
| Rate for Payer: Coventry/First Health All Products |
$405.98
|
| Rate for Payer: Frontpath All Products |
$167.29
|
| Rate for Payer: Humana ChoiceCare |
$338.32
|
| Rate for Payer: Humana Medicare |
$173.39
|
| Rate for Payer: Lucent/Coldwater Veneers |
$294.76
|
| Rate for Payer: Lutheran Preferred All Products |
$182.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$253.74
|
| Rate for Payer: PHP All Products |
$174.24
|
| Rate for Payer: Plain Church Group Ministry All Products |
$173.39
|
| Rate for Payer: Signature Care EPO |
$136.87
|
| Rate for Payer: Signature Care PPO |
$136.87
|
| Rate for Payer: Three Rivers Preferred All Products |
$179.00
|
| Rate for Payer: United Healthcare Commercial |
$146.59
|
| Rate for Payer: United Healthcare Medicare |
$169.16
|
|
|
PR INITIAL NURSING FACILITY CARE MOD MDM 35 MINUTES
|
Professional
|
$246.86
|
|
|
Service Code
|
CPT 99305
|
| Hospital Charge Code |
Z13192
|
| Min. Negotiated Rate |
$88.00 |
| Max. Negotiated Rate |
$296.23 |
| Rate for Payer: Aetna Medicare |
$126.51
|
| Rate for Payer: Anthem Exchange |
$88.00
|
| Rate for Payer: Anthem Medicare |
$126.51
|
| Rate for Payer: Anthem PPO |
$88.00
|
| Rate for Payer: Anthem Traditional |
$88.00
|
| Rate for Payer: Caresource Just 4 Me |
$145.49
|
| Rate for Payer: Caresource Medicare |
$139.16
|
| Rate for Payer: Centivo/Paragon All Products |
$196.09
|
| Rate for Payer: Coventry/First Health All Products |
$296.23
|
| Rate for Payer: Frontpath All Products |
$130.18
|
| Rate for Payer: Humana ChoiceCare |
$246.86
|
| Rate for Payer: Humana Medicare |
$126.51
|
| Rate for Payer: Lucent/Coldwater Veneers |
$215.07
|
| Rate for Payer: Lutheran Preferred All Products |
$133.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$185.15
|
| Rate for Payer: PHP All Products |
$127.13
|
| Rate for Payer: Plain Church Group Ministry All Products |
$126.51
|
| Rate for Payer: Signature Care EPO |
$107.26
|
| Rate for Payer: Signature Care PPO |
$107.26
|
| Rate for Payer: Three Rivers Preferred All Products |
$130.00
|
| Rate for Payer: United Healthcare Commercial |
$114.07
|
| Rate for Payer: United Healthcare Medicare |
$123.43
|
|
|
PR INITIAL NURSING FACILITY CARE SF/LOW MDM 25 MIN
|
Professional
|
$149.02
|
|
|
Service Code
|
CPT 99304
|
| Hospital Charge Code |
Z13191
|
| Min. Negotiated Rate |
$66.29 |
| Max. Negotiated Rate |
$178.82 |
| Rate for Payer: Aetna Medicare |
$76.37
|
| Rate for Payer: Anthem Exchange |
$66.29
|
| Rate for Payer: Anthem Medicare |
$76.37
|
| Rate for Payer: Anthem PPO |
$66.29
|
| Rate for Payer: Anthem Traditional |
$66.29
|
| Rate for Payer: Caresource Just 4 Me |
$87.83
|
| Rate for Payer: Caresource Medicare |
$84.01
|
| Rate for Payer: Centivo/Paragon All Products |
$118.37
|
| Rate for Payer: Coventry/First Health All Products |
$178.82
|
| Rate for Payer: Frontpath All Products |
$90.30
|
| Rate for Payer: Humana ChoiceCare |
$149.02
|
| Rate for Payer: Humana Medicare |
$76.37
|
| Rate for Payer: Lucent/Coldwater Veneers |
$129.83
|
| Rate for Payer: Lutheran Preferred All Products |
$80.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$111.77
|
| Rate for Payer: PHP All Products |
$76.74
|
| Rate for Payer: Plain Church Group Ministry All Products |
$76.37
|
| Rate for Payer: Signature Care EPO |
$75.14
|
| Rate for Payer: Signature Care PPO |
$75.14
|
| Rate for Payer: Three Rivers Preferred All Products |
$79.00
|
| Rate for Payer: United Healthcare Commercial |
$81.57
|
| Rate for Payer: United Healthcare Medicare |
$74.51
|
|
|
PR INITIAL PREVENTIVE EXAM
|
Professional
|
$359.00
|
|
|
Service Code
|
CPT G0402
|
| Hospital Charge Code |
Z13254
|
| Min. Negotiated Rate |
$87.90 |
| Max. Negotiated Rate |
$430.80 |
| Rate for Payer: Aetna Medicare |
$124.96
|
| Rate for Payer: Anthem Exchange |
$87.90
|
| Rate for Payer: Anthem Medicare |
$124.96
|
| Rate for Payer: Anthem PPO |
$87.90
|
| Rate for Payer: Anthem Traditional |
$87.90
|
| Rate for Payer: Caresource Just 4 Me |
$143.70
|
| Rate for Payer: Caresource Medicare |
$137.46
|
| Rate for Payer: Centivo/Paragon All Products |
$193.69
|
| Rate for Payer: Coventry/First Health All Products |
$430.80
|
| Rate for Payer: Humana ChoiceCare |
$359.00
|
| Rate for Payer: Humana Medicare |
$124.96
|
| Rate for Payer: Lucent/Coldwater Veneers |
$212.43
|
| Rate for Payer: PHCS/Multiplan All Products |
$269.25
|
| Rate for Payer: PHP All Products |
$125.57
|
| Rate for Payer: Plain Church Group Ministry All Products |
$124.96
|
| Rate for Payer: Signature Care EPO |
$135.19
|
| Rate for Payer: Signature Care PPO |
$135.19
|
| Rate for Payer: United Healthcare Commercial |
$92.30
|
|
|
PR INITIAL RX BURN(S) 1ST DEGREE
|
Professional
|
$142.76
|
|
|
Service Code
|
CPT 16000
|
| Hospital Charge Code |
Z12086
|
| Min. Negotiated Rate |
$42.60 |
| Max. Negotiated Rate |
$171.31 |
| Rate for Payer: Aetna Medicare |
$42.60
|
| Rate for Payer: Anthem Exchange |
$83.00
|
| Rate for Payer: Anthem Medicare |
$42.60
|
| Rate for Payer: Anthem PPO |
$83.00
|
| Rate for Payer: Anthem Traditional |
$83.00
|
| Rate for Payer: Caresource Just 4 Me |
$48.99
|
| Rate for Payer: Caresource Medicare |
$46.86
|
| Rate for Payer: Centivo/Paragon All Products |
$66.03
|
| Rate for Payer: Coventry/First Health All Products |
$171.31
|
| Rate for Payer: Frontpath All Products |
$58.68
|
| Rate for Payer: Humana ChoiceCare |
$142.76
|
| Rate for Payer: Humana Medicare |
$42.60
|
| Rate for Payer: Lucent/Coldwater Veneers |
$72.42
|
| Rate for Payer: Lutheran Preferred All Products |
$55.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$107.07
|
| Rate for Payer: PHP All Products |
$58.19
|
| Rate for Payer: Plain Church Group Ministry All Products |
$42.60
|
| Rate for Payer: Signature Care EPO |
$72.25
|
| Rate for Payer: Signature Care PPO |
$72.25
|
| Rate for Payer: Three Rivers Preferred All Products |
$51.00
|
| Rate for Payer: United Healthcare Commercial |
$52.21
|
| Rate for Payer: United Healthcare Medicare |
$71.38
|
|
|
PR INJECT CARPAL TUNNEL
|
Professional
|
$148.52
|
|
|
Service Code
|
CPT 20526
|
| Hospital Charge Code |
Z12118
|
| Min. Negotiated Rate |
$52.66 |
| Max. Negotiated Rate |
$178.22 |
| Rate for Payer: Aetna Medicare |
$52.66
|
| Rate for Payer: Anthem Exchange |
$79.70
|
| Rate for Payer: Anthem Medicare |
$52.66
|
| Rate for Payer: Anthem PPO |
$79.70
|
| Rate for Payer: Anthem Traditional |
$79.70
|
| Rate for Payer: Caresource Just 4 Me |
$60.56
|
| Rate for Payer: Caresource Medicare |
$57.93
|
| Rate for Payer: Centivo/Paragon All Products |
$81.62
|
| Rate for Payer: Coventry/First Health All Products |
$178.22
|
| Rate for Payer: Frontpath All Products |
$74.56
|
| Rate for Payer: Humana ChoiceCare |
$148.52
|
| Rate for Payer: Humana Medicare |
$52.66
|
| Rate for Payer: Lucent/Coldwater Veneers |
$89.52
|
| Rate for Payer: Lutheran Preferred All Products |
$84.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$111.39
|
| Rate for Payer: PHP All Products |
$89.39
|
| Rate for Payer: Plain Church Group Ministry All Products |
$52.66
|
| Rate for Payer: Signature Care EPO |
$108.80
|
| Rate for Payer: Signature Care PPO |
$108.80
|
| Rate for Payer: Three Rivers Preferred All Products |
$79.00
|
| Rate for Payer: United Healthcare Commercial |
$64.51
|
| Rate for Payer: United Healthcare Medicare |
$74.26
|
|
|
PR INJECT CARPAL TUNNEL
|
Professional
|
$297.04
|
|
|
Service Code
|
CPT 20526
|
| Hospital Charge Code |
Z12119
|
| Min. Negotiated Rate |
$52.66 |
| Max. Negotiated Rate |
$356.45 |
| Rate for Payer: Aetna Medicare |
$52.66
|
| Rate for Payer: Anthem Exchange |
$79.70
|
| Rate for Payer: Anthem Medicare |
$52.66
|
| Rate for Payer: Anthem PPO |
$79.70
|
| Rate for Payer: Anthem Traditional |
$79.70
|
| Rate for Payer: Caresource Just 4 Me |
$60.56
|
| Rate for Payer: Caresource Medicare |
$57.93
|
| Rate for Payer: Centivo/Paragon All Products |
$81.62
|
| Rate for Payer: Coventry/First Health All Products |
$356.45
|
| Rate for Payer: Frontpath All Products |
$74.56
|
| Rate for Payer: Humana ChoiceCare |
$297.04
|
| Rate for Payer: Humana Medicare |
$52.66
|
| Rate for Payer: Lucent/Coldwater Veneers |
$89.52
|
| Rate for Payer: Lutheran Preferred All Products |
$84.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$222.78
|
| Rate for Payer: PHP All Products |
$89.39
|
| Rate for Payer: Plain Church Group Ministry All Products |
$52.66
|
| Rate for Payer: Signature Care EPO |
$108.80
|
| Rate for Payer: Signature Care PPO |
$108.80
|
| Rate for Payer: Three Rivers Preferred All Products |
$79.00
|
| Rate for Payer: United Healthcare Commercial |
$64.51
|
| Rate for Payer: United Healthcare Medicare |
$74.26
|
|
|
PR INJECTION AA&/STRD OTHER PERIPHERAL NERVE/BRANCH
|
Professional
|
$137.04
|
|
|
Service Code
|
CPT 64450
|
| Hospital Charge Code |
Z12827
|
| Min. Negotiated Rate |
$39.36 |
| Max. Negotiated Rate |
$164.45 |
| Rate for Payer: Aetna Medicare |
$39.36
|
| Rate for Payer: Anthem Exchange |
$113.50
|
| Rate for Payer: Anthem Medicare |
$39.36
|
| Rate for Payer: Anthem PPO |
$113.50
|
| Rate for Payer: Anthem Traditional |
$113.50
|
| Rate for Payer: Caresource Just 4 Me |
$45.26
|
| Rate for Payer: Caresource Medicare |
$43.30
|
| Rate for Payer: Centivo/Paragon All Products |
$61.01
|
| Rate for Payer: Coventry/First Health All Products |
$164.45
|
| Rate for Payer: Frontpath All Products |
$54.60
|
| Rate for Payer: Humana ChoiceCare |
$137.04
|
| Rate for Payer: Humana Medicare |
$39.36
|
| Rate for Payer: Lucent/Coldwater Veneers |
$66.91
|
| Rate for Payer: Lutheran Preferred All Products |
$63.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$102.78
|
| Rate for Payer: PHP All Products |
$61.44
|
| Rate for Payer: Plain Church Group Ministry All Products |
$39.36
|
| Rate for Payer: Signature Care EPO |
$121.77
|
| Rate for Payer: Signature Care PPO |
$121.77
|
| Rate for Payer: Three Rivers Preferred All Products |
$59.00
|
| Rate for Payer: United Healthcare Commercial |
$81.05
|
| Rate for Payer: United Healthcare Medicare |
$68.52
|
|
|
PR INJECTION AA&/STRD PARACERVICAL NERVE
|
Professional
|
$147.32
|
|
|
Service Code
|
CPT 64435
|
| Hospital Charge Code |
Z12826
|
| Min. Negotiated Rate |
$40.31 |
| Max. Negotiated Rate |
$176.78 |
| Rate for Payer: Aetna Medicare |
$40.31
|
| Rate for Payer: Anthem Exchange |
$148.20
|
| Rate for Payer: Anthem Medicare |
$40.31
|
| Rate for Payer: Anthem PPO |
$148.20
|
| Rate for Payer: Anthem Traditional |
$148.20
|
| Rate for Payer: Caresource Just 4 Me |
$46.36
|
| Rate for Payer: Caresource Medicare |
$44.34
|
| Rate for Payer: Centivo/Paragon All Products |
$62.48
|
| Rate for Payer: Coventry/First Health All Products |
$176.78
|
| Rate for Payer: Frontpath All Products |
$55.99
|
| Rate for Payer: Humana ChoiceCare |
$147.32
|
| Rate for Payer: Humana Medicare |
$40.31
|
| Rate for Payer: Lucent/Coldwater Veneers |
$68.53
|
| Rate for Payer: Lutheran Preferred All Products |
$65.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$110.49
|
| Rate for Payer: PHP All Products |
$62.93
|
| Rate for Payer: Plain Church Group Ministry All Products |
$40.31
|
| Rate for Payer: Signature Care EPO |
$105.62
|
| Rate for Payer: Signature Care PPO |
$105.62
|
| Rate for Payer: Three Rivers Preferred All Products |
$60.00
|
| Rate for Payer: United Healthcare Commercial |
$94.94
|
| Rate for Payer: United Healthcare Medicare |
$73.66
|
|
|
PR INJECTION AA&/STRD PUDENDAL NERVE
|
Professional
|
$180.12
|
|
|
Service Code
|
CPT 64430
|
| Hospital Charge Code |
Z12825
|
| Min. Negotiated Rate |
$51.25 |
| Max. Negotiated Rate |
$216.14 |
| Rate for Payer: Aetna Medicare |
$51.25
|
| Rate for Payer: Anthem Exchange |
$150.10
|
| Rate for Payer: Anthem Medicare |
$51.25
|
| Rate for Payer: Anthem PPO |
$150.10
|
| Rate for Payer: Anthem Traditional |
$150.10
|
| Rate for Payer: Caresource Just 4 Me |
$58.94
|
| Rate for Payer: Caresource Medicare |
$56.38
|
| Rate for Payer: Centivo/Paragon All Products |
$79.44
|
| Rate for Payer: Coventry/First Health All Products |
$216.14
|
| Rate for Payer: Frontpath All Products |
$70.12
|
| Rate for Payer: Humana ChoiceCare |
$180.12
|
| Rate for Payer: Humana Medicare |
$51.25
|
| Rate for Payer: Lucent/Coldwater Veneers |
$87.12
|
| Rate for Payer: Lutheran Preferred All Products |
$82.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$135.09
|
| Rate for Payer: PHP All Products |
$80.01
|
| Rate for Payer: Plain Church Group Ministry All Products |
$51.25
|
| Rate for Payer: Signature Care EPO |
$158.73
|
| Rate for Payer: Signature Care PPO |
$158.73
|
| Rate for Payer: Three Rivers Preferred All Products |
$77.00
|
| Rate for Payer: United Healthcare Commercial |
$99.15
|
| Rate for Payer: United Healthcare Medicare |
$90.06
|
|
|
PR INJECTION AA&/STRD TRIGEMINAL NERVE EACH BRANCH
|
Professional
|
$201.34
|
|
|
Service Code
|
CPT 64400
|
| Hospital Charge Code |
Z12824
|
| Min. Negotiated Rate |
$45.76 |
| Max. Negotiated Rate |
$241.61 |
| Rate for Payer: Aetna Medicare |
$45.76
|
| Rate for Payer: Anthem Exchange |
$117.70
|
| Rate for Payer: Anthem Medicare |
$45.76
|
| Rate for Payer: Anthem PPO |
$117.70
|
| Rate for Payer: Anthem Traditional |
$117.70
|
| Rate for Payer: Caresource Just 4 Me |
$52.62
|
| Rate for Payer: Caresource Medicare |
$50.34
|
| Rate for Payer: Centivo/Paragon All Products |
$70.93
|
| Rate for Payer: Coventry/First Health All Products |
$241.61
|
| Rate for Payer: Frontpath All Products |
$65.77
|
| Rate for Payer: Humana ChoiceCare |
$201.34
|
| Rate for Payer: Humana Medicare |
$45.76
|
| Rate for Payer: Lucent/Coldwater Veneers |
$77.79
|
| Rate for Payer: Lutheran Preferred All Products |
$73.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$151.00
|
| Rate for Payer: PHP All Products |
$71.43
|
| Rate for Payer: Plain Church Group Ministry All Products |
$45.76
|
| Rate for Payer: Signature Care EPO |
$174.25
|
| Rate for Payer: Signature Care PPO |
$174.25
|
| Rate for Payer: Three Rivers Preferred All Products |
$69.00
|
| Rate for Payer: United Healthcare Commercial |
$70.56
|
| Rate for Payer: United Healthcare Medicare |
$100.67
|
|
