|
PR INS NEW/RPLC PRM PACEMAKER W/TRANSV ELTRD VENTR
|
Professional
|
$847.78
|
|
|
Service Code
|
CPT 33207
|
| Hospital Charge Code |
Z12523
|
| Min. Negotiated Rate |
$423.89 |
| Max. Negotiated Rate |
$1,017.34 |
| Rate for Payer: Aetna Medicare |
$434.48
|
| Rate for Payer: Anthem Exchange |
$802.90
|
| Rate for Payer: Anthem Medicare |
$434.48
|
| Rate for Payer: Anthem PPO |
$802.90
|
| Rate for Payer: Anthem Traditional |
$802.90
|
| Rate for Payer: Caresource Just 4 Me |
$499.65
|
| Rate for Payer: Caresource Medicare |
$477.93
|
| Rate for Payer: Centivo/Paragon All Products |
$673.44
|
| Rate for Payer: Coventry/First Health All Products |
$1,017.34
|
| Rate for Payer: Frontpath All Products |
$627.21
|
| Rate for Payer: Humana ChoiceCare |
$847.78
|
| Rate for Payer: Humana Medicare |
$434.48
|
| Rate for Payer: Lucent/Coldwater Veneers |
$738.62
|
| Rate for Payer: Lutheran Preferred All Products |
$695.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$635.84
|
| Rate for Payer: PHP All Products |
$593.44
|
| Rate for Payer: Plain Church Group Ministry All Products |
$434.48
|
| Rate for Payer: Signature Care EPO |
$719.10
|
| Rate for Payer: Signature Care PPO |
$719.10
|
| Rate for Payer: Three Rivers Preferred All Products |
$652.00
|
| Rate for Payer: United Healthcare Commercial |
$588.50
|
| Rate for Payer: United Healthcare Medicare |
$423.89
|
|
|
PR INTER DEVC REMOTE 30D
|
Professional
|
$246.00
|
|
|
Service Code
|
CPT G2066
|
| Hospital Charge Code |
Z13259
|
| Min. Negotiated Rate |
$45.25 |
| Max. Negotiated Rate |
$295.20 |
| Rate for Payer: Coventry/First Health All Products |
$295.20
|
| Rate for Payer: Humana ChoiceCare |
$246.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$184.50
|
| Rate for Payer: Signature Care EPO |
$45.25
|
| Rate for Payer: Signature Care PPO |
$45.25
|
| Rate for Payer: United Healthcare Commercial |
$61.11
|
|
|
PR INTERROGATION EVAL F2F IMPLANT SUBQ LEAD DEFIB
|
Professional
|
$129.98
|
|
|
Service Code
|
CPT 93261
|
| Hospital Charge Code |
Z13087
|
| Min. Negotiated Rate |
$66.62 |
| Max. Negotiated Rate |
$155.98 |
| Rate for Payer: Aetna Medicare |
$66.62
|
| Rate for Payer: Anthem Exchange |
$83.83
|
| Rate for Payer: Anthem Medicare |
$66.62
|
| Rate for Payer: Anthem PPO |
$83.83
|
| Rate for Payer: Anthem Traditional |
$83.83
|
| Rate for Payer: Caresource Just 4 Me |
$76.61
|
| Rate for Payer: Caresource Medicare |
$73.28
|
| Rate for Payer: Centivo/Paragon All Products |
$103.26
|
| Rate for Payer: Coventry/First Health All Products |
$155.98
|
| Rate for Payer: Frontpath All Products |
$76.82
|
| Rate for Payer: Humana ChoiceCare |
$129.98
|
| Rate for Payer: Humana Medicare |
$66.62
|
| Rate for Payer: Lucent/Coldwater Veneers |
$113.25
|
| Rate for Payer: Lutheran Preferred All Products |
$107.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$97.48
|
| Rate for Payer: PHP All Products |
$95.54
|
| Rate for Payer: Plain Church Group Ministry All Products |
$66.62
|
| Rate for Payer: Signature Care EPO |
$91.99
|
| Rate for Payer: Signature Care PPO |
$91.99
|
| Rate for Payer: Three Rivers Preferred All Products |
$100.00
|
| Rate for Payer: United Healthcare Commercial |
$73.76
|
|
|
PR INTERROGATION EVAL IN PERSON WR DEFIBRILLATOR
|
Professional
|
$93.82
|
|
|
Service Code
|
CPT 93292
|
| Hospital Charge Code |
Z13104
|
| Min. Negotiated Rate |
$43.91 |
| Max. Negotiated Rate |
$112.58 |
| Rate for Payer: Aetna Medicare |
$48.09
|
| Rate for Payer: Anthem Exchange |
$52.34
|
| Rate for Payer: Anthem Medicare |
$48.09
|
| Rate for Payer: Anthem PPO |
$52.34
|
| Rate for Payer: Anthem Traditional |
$52.34
|
| Rate for Payer: Caresource Just 4 Me |
$55.30
|
| Rate for Payer: Caresource Medicare |
$52.90
|
| Rate for Payer: Centivo/Paragon All Products |
$74.54
|
| Rate for Payer: Coventry/First Health All Products |
$112.58
|
| Rate for Payer: Frontpath All Products |
$55.15
|
| Rate for Payer: Humana ChoiceCare |
$93.82
|
| Rate for Payer: Humana Medicare |
$48.09
|
| Rate for Payer: Lucent/Coldwater Veneers |
$81.75
|
| Rate for Payer: Lutheran Preferred All Products |
$77.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$70.36
|
| Rate for Payer: PHP All Products |
$68.96
|
| Rate for Payer: Plain Church Group Ministry All Products |
$48.09
|
| Rate for Payer: Signature Care EPO |
$52.63
|
| Rate for Payer: Signature Care PPO |
$52.63
|
| Rate for Payer: Three Rivers Preferred All Products |
$72.00
|
| Rate for Payer: United Healthcare Commercial |
$43.91
|
|
|
PR INTERROGATION EVAL REMOTE </90 D 1/2/MLT LD DFB
|
Professional
|
$68.26
|
|
|
Service Code
|
CPT 93295
|
| Hospital Charge Code |
Z13106
|
| Min. Negotiated Rate |
$34.13 |
| Max. Negotiated Rate |
$95.24 |
| Rate for Payer: Aetna Medicare |
$34.98
|
| Rate for Payer: Anthem Exchange |
$95.24
|
| Rate for Payer: Anthem Medicare |
$34.98
|
| Rate for Payer: Anthem PPO |
$95.24
|
| Rate for Payer: Anthem Traditional |
$95.24
|
| Rate for Payer: Caresource Just 4 Me |
$40.23
|
| Rate for Payer: Caresource Medicare |
$38.48
|
| Rate for Payer: Centivo/Paragon All Products |
$54.22
|
| Rate for Payer: Coventry/First Health All Products |
$81.91
|
| Rate for Payer: Frontpath All Products |
$40.68
|
| Rate for Payer: Humana ChoiceCare |
$68.26
|
| Rate for Payer: Humana Medicare |
$34.98
|
| Rate for Payer: Lucent/Coldwater Veneers |
$59.47
|
| Rate for Payer: Lutheran Preferred All Products |
$56.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$51.20
|
| Rate for Payer: PHP All Products |
$50.17
|
| Rate for Payer: Plain Church Group Ministry All Products |
$34.98
|
| Rate for Payer: Signature Care EPO |
$60.79
|
| Rate for Payer: Signature Care PPO |
$60.79
|
| Rate for Payer: Three Rivers Preferred All Products |
$52.00
|
| Rate for Payer: United Healthcare Commercial |
$79.90
|
| Rate for Payer: United Healthcare Medicare |
$34.13
|
|
|
PR INTERROG DEV EVAL PM/LDLS PM PHYS/QHP IN PERSON
|
Professional
|
$103.76
|
|
|
Service Code
|
CPT 93288
|
| Hospital Charge Code |
Z13101
|
| Min. Negotiated Rate |
$50.54 |
| Max. Negotiated Rate |
$124.51 |
| Rate for Payer: Aetna Medicare |
$53.17
|
| Rate for Payer: Anthem Exchange |
$60.24
|
| Rate for Payer: Anthem Medicare |
$53.17
|
| Rate for Payer: Anthem PPO |
$60.24
|
| Rate for Payer: Anthem Traditional |
$60.24
|
| Rate for Payer: Caresource Just 4 Me |
$61.15
|
| Rate for Payer: Caresource Medicare |
$58.49
|
| Rate for Payer: Centivo/Paragon All Products |
$82.41
|
| Rate for Payer: Coventry/First Health All Products |
$124.51
|
| Rate for Payer: Frontpath All Products |
$61.75
|
| Rate for Payer: Humana ChoiceCare |
$103.76
|
| Rate for Payer: Humana Medicare |
$53.17
|
| Rate for Payer: Lucent/Coldwater Veneers |
$90.39
|
| Rate for Payer: Lutheran Preferred All Products |
$85.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$77.82
|
| Rate for Payer: PHP All Products |
$76.26
|
| Rate for Payer: Plain Church Group Ministry All Products |
$53.17
|
| Rate for Payer: Signature Care EPO |
$60.84
|
| Rate for Payer: Signature Care PPO |
$60.84
|
| Rate for Payer: Three Rivers Preferred All Products |
$80.00
|
| Rate for Payer: United Healthcare Commercial |
$50.54
|
|
|
PR INTERROG DEV EVAL SCRMS PHYS/QHP IN PERSON
|
Professional
|
$91.36
|
|
|
Service Code
|
CPT 93291
|
| Hospital Charge Code |
Z13103
|
| Min. Negotiated Rate |
$46.82 |
| Max. Negotiated Rate |
$109.63 |
| Rate for Payer: Aetna Medicare |
$46.82
|
| Rate for Payer: Anthem Exchange |
$57.77
|
| Rate for Payer: Anthem Medicare |
$46.82
|
| Rate for Payer: Anthem PPO |
$57.77
|
| Rate for Payer: Anthem Traditional |
$57.77
|
| Rate for Payer: Caresource Just 4 Me |
$53.84
|
| Rate for Payer: Caresource Medicare |
$51.50
|
| Rate for Payer: Centivo/Paragon All Products |
$72.57
|
| Rate for Payer: Coventry/First Health All Products |
$109.63
|
| Rate for Payer: Frontpath All Products |
$54.19
|
| Rate for Payer: Humana ChoiceCare |
$91.36
|
| Rate for Payer: Humana Medicare |
$46.82
|
| Rate for Payer: Lucent/Coldwater Veneers |
$79.59
|
| Rate for Payer: Lutheran Preferred All Products |
$75.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$68.52
|
| Rate for Payer: PHP All Products |
$67.14
|
| Rate for Payer: Plain Church Group Ministry All Products |
$46.82
|
| Rate for Payer: Signature Care EPO |
$58.24
|
| Rate for Payer: Signature Care PPO |
$58.24
|
| Rate for Payer: Three Rivers Preferred All Products |
$70.00
|
| Rate for Payer: United Healthcare Commercial |
$48.46
|
|
|
PR INTERROG EVAL F2F 1/DUAL/MLT LEADS IMPLTBL DFB
|
Professional
|
$134.28
|
|
|
Service Code
|
CPT 93289
|
| Hospital Charge Code |
Z13102
|
| Min. Negotiated Rate |
$68.82 |
| Max. Negotiated Rate |
$161.14 |
| Rate for Payer: Aetna Medicare |
$68.82
|
| Rate for Payer: Anthem Exchange |
$93.35
|
| Rate for Payer: Anthem Medicare |
$68.82
|
| Rate for Payer: Anthem PPO |
$93.35
|
| Rate for Payer: Anthem Traditional |
$93.35
|
| Rate for Payer: Caresource Just 4 Me |
$79.14
|
| Rate for Payer: Caresource Medicare |
$75.70
|
| Rate for Payer: Centivo/Paragon All Products |
$106.67
|
| Rate for Payer: Coventry/First Health All Products |
$161.14
|
| Rate for Payer: Frontpath All Products |
$79.64
|
| Rate for Payer: Humana ChoiceCare |
$134.28
|
| Rate for Payer: Humana Medicare |
$68.82
|
| Rate for Payer: Lucent/Coldwater Veneers |
$116.99
|
| Rate for Payer: Lutheran Preferred All Products |
$110.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$100.71
|
| Rate for Payer: PHP All Products |
$98.70
|
| Rate for Payer: Plain Church Group Ministry All Products |
$68.82
|
| Rate for Payer: Signature Care EPO |
$95.85
|
| Rate for Payer: Signature Care PPO |
$95.85
|
| Rate for Payer: Three Rivers Preferred All Products |
$103.00
|
| Rate for Payer: United Healthcare Commercial |
$78.31
|
|
|
PR INTRACUTANEOUS TESTS W/ALLERGENIC EXTRACTS
|
Professional
|
$14.22
|
|
|
Service Code
|
CPT 95024
|
| Hospital Charge Code |
Z13132
|
| Min. Negotiated Rate |
$0.81 |
| Max. Negotiated Rate |
$17.06 |
| Rate for Payer: Aetna Medicare |
$0.81
|
| Rate for Payer: Anthem Exchange |
$5.74
|
| Rate for Payer: Anthem Medicare |
$0.81
|
| Rate for Payer: Anthem PPO |
$5.74
|
| Rate for Payer: Anthem Traditional |
$5.74
|
| Rate for Payer: Caresource Just 4 Me |
$0.93
|
| Rate for Payer: Caresource Medicare |
$0.89
|
| Rate for Payer: Centivo/Paragon All Products |
$1.26
|
| Rate for Payer: Coventry/First Health All Products |
$17.06
|
| Rate for Payer: Frontpath All Products |
$1.08
|
| Rate for Payer: Humana ChoiceCare |
$14.22
|
| Rate for Payer: Humana Medicare |
$0.81
|
| Rate for Payer: Lucent/Coldwater Veneers |
$1.38
|
| Rate for Payer: Lutheran Preferred All Products |
$1.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$10.67
|
| Rate for Payer: PHP All Products |
$0.91
|
| Rate for Payer: Plain Church Group Ministry All Products |
$0.81
|
| Rate for Payer: Signature Care EPO |
$6.52
|
| Rate for Payer: Signature Care PPO |
$6.52
|
| Rate for Payer: Three Rivers Preferred All Products |
$1.00
|
| Rate for Payer: United Healthcare Commercial |
$7.76
|
| Rate for Payer: United Healthcare Medicare |
$7.11
|
|
|
PR INTRANASAL BIOPSY
|
Professional
|
$259.28
|
|
|
Service Code
|
CPT 30100
|
| Hospital Charge Code |
Z12499
|
| Min. Negotiated Rate |
$63.42 |
| Max. Negotiated Rate |
$311.14 |
| Rate for Payer: Aetna Medicare |
$63.42
|
| Rate for Payer: Anthem Exchange |
$91.50
|
| Rate for Payer: Anthem Medicare |
$63.42
|
| Rate for Payer: Anthem PPO |
$91.50
|
| Rate for Payer: Anthem Traditional |
$91.50
|
| Rate for Payer: Caresource Just 4 Me |
$72.93
|
| Rate for Payer: Caresource Medicare |
$69.76
|
| Rate for Payer: Centivo/Paragon All Products |
$98.30
|
| Rate for Payer: Coventry/First Health All Products |
$311.14
|
| Rate for Payer: Frontpath All Products |
$85.98
|
| Rate for Payer: Humana ChoiceCare |
$259.28
|
| Rate for Payer: Humana Medicare |
$63.42
|
| Rate for Payer: Lucent/Coldwater Veneers |
$107.81
|
| Rate for Payer: Lutheran Preferred All Products |
$101.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$194.46
|
| Rate for Payer: PHP All Products |
$86.63
|
| Rate for Payer: Plain Church Group Ministry All Products |
$63.42
|
| Rate for Payer: Signature Care EPO |
$153.85
|
| Rate for Payer: Signature Care PPO |
$153.85
|
| Rate for Payer: Three Rivers Preferred All Products |
$95.00
|
| Rate for Payer: United Healthcare Commercial |
$76.55
|
| Rate for Payer: United Healthcare Medicare |
$129.64
|
|
|
PR INTRAOPERATIVE SENTINEL LYMPH NODE ID W DYE INJECTION
|
Professional
|
$242.56
|
|
|
Service Code
|
CPT 38900
|
| Hospital Charge Code |
Z12559
|
| Min. Negotiated Rate |
$121.28 |
| Max. Negotiated Rate |
$291.07 |
| Rate for Payer: Aetna Medicare |
$124.31
|
| Rate for Payer: Anthem Exchange |
$165.04
|
| Rate for Payer: Anthem Medicare |
$124.31
|
| Rate for Payer: Anthem PPO |
$165.04
|
| Rate for Payer: Anthem Traditional |
$165.04
|
| Rate for Payer: Caresource Just 4 Me |
$142.96
|
| Rate for Payer: Caresource Medicare |
$136.74
|
| Rate for Payer: Centivo/Paragon All Products |
$192.68
|
| Rate for Payer: Coventry/First Health All Products |
$291.07
|
| Rate for Payer: Frontpath All Products |
$182.25
|
| Rate for Payer: Humana ChoiceCare |
$242.56
|
| Rate for Payer: Humana Medicare |
$124.31
|
| Rate for Payer: Lucent/Coldwater Veneers |
$211.33
|
| Rate for Payer: Lutheran Preferred All Products |
$199.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$181.92
|
| Rate for Payer: PHP All Products |
$169.79
|
| Rate for Payer: Plain Church Group Ministry All Products |
$124.31
|
| Rate for Payer: Signature Care EPO |
$142.15
|
| Rate for Payer: Signature Care PPO |
$142.15
|
| Rate for Payer: Three Rivers Preferred All Products |
$186.00
|
| Rate for Payer: United Healthcare Commercial |
$168.83
|
| Rate for Payer: United Healthcare Medicare |
$121.28
|
|
|
PR IP/OBS CONSLTJ NEW/EST PT HIGH MDM 80 MINUTES
|
Professional
|
$348.88
|
|
|
Service Code
|
CPT 99255
|
| Hospital Charge Code |
Z13183
|
| Min. Negotiated Rate |
$174.44 |
| Max. Negotiated Rate |
$418.66 |
| Rate for Payer: Anthem Exchange |
$208.20
|
| Rate for Payer: Anthem PPO |
$208.20
|
| Rate for Payer: Anthem Traditional |
$208.20
|
| Rate for Payer: Coventry/First Health All Products |
$418.66
|
| Rate for Payer: Frontpath All Products |
$198.27
|
| Rate for Payer: Humana ChoiceCare |
$348.88
|
| Rate for Payer: Lutheran Preferred All Products |
$188.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$261.66
|
| Rate for Payer: PHP All Products |
$179.67
|
| Rate for Payer: Signature Care EPO |
$204.85
|
| Rate for Payer: Signature Care PPO |
$204.85
|
| Rate for Payer: Three Rivers Preferred All Products |
$184.00
|
| Rate for Payer: United Healthcare Commercial |
$204.93
|
| Rate for Payer: United Healthcare Medicare |
$174.44
|
|
|
PR IP/OBS CONSLTJ NEW/EST PT LOW MDM 45 MINUTES
|
Professional
|
$186.62
|
|
|
Service Code
|
CPT 99253
|
| Hospital Charge Code |
Z13181
|
| Min. Negotiated Rate |
$93.31 |
| Max. Negotiated Rate |
$223.94 |
| Rate for Payer: Anthem Exchange |
$116.27
|
| Rate for Payer: Anthem PPO |
$116.27
|
| Rate for Payer: Anthem Traditional |
$116.27
|
| Rate for Payer: Coventry/First Health All Products |
$223.94
|
| Rate for Payer: Frontpath All Products |
$113.73
|
| Rate for Payer: Humana ChoiceCare |
$186.62
|
| Rate for Payer: Lutheran Preferred All Products |
$100.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$139.97
|
| Rate for Payer: PHP All Products |
$96.10
|
| Rate for Payer: Signature Care EPO |
$102.85
|
| Rate for Payer: Signature Care PPO |
$102.85
|
| Rate for Payer: Three Rivers Preferred All Products |
$99.00
|
| Rate for Payer: United Healthcare Commercial |
$116.27
|
| Rate for Payer: United Healthcare Medicare |
$93.31
|
|
|
PR IP/OBS CONSLTJ NEW/EST PT MOD MDM 60 MINUTES
|
Professional
|
$259.28
|
|
|
Service Code
|
CPT 99254
|
| Hospital Charge Code |
Z13182
|
| Min. Negotiated Rate |
$129.64 |
| Max. Negotiated Rate |
$311.14 |
| Rate for Payer: Anthem Exchange |
$168.22
|
| Rate for Payer: Anthem PPO |
$168.22
|
| Rate for Payer: Anthem Traditional |
$168.22
|
| Rate for Payer: Coventry/First Health All Products |
$311.14
|
| Rate for Payer: Frontpath All Products |
$163.72
|
| Rate for Payer: Humana ChoiceCare |
$259.28
|
| Rate for Payer: Lutheran Preferred All Products |
$140.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$194.46
|
| Rate for Payer: PHP All Products |
$133.53
|
| Rate for Payer: Signature Care EPO |
$148.75
|
| Rate for Payer: Signature Care PPO |
$148.75
|
| Rate for Payer: Three Rivers Preferred All Products |
$137.00
|
| Rate for Payer: United Healthcare Commercial |
$168.22
|
| Rate for Payer: United Healthcare Medicare |
$129.64
|
|
|
PR IP/OBS CONSLTJ NEW/EST PT SF MDM 35 MINUTES
|
Professional
|
$133.64
|
|
|
Service Code
|
CPT 99252
|
| Hospital Charge Code |
Z13180
|
| Min. Negotiated Rate |
$66.82 |
| Max. Negotiated Rate |
$160.37 |
| Rate for Payer: Anthem Exchange |
$85.00
|
| Rate for Payer: Anthem PPO |
$85.00
|
| Rate for Payer: Anthem Traditional |
$85.00
|
| Rate for Payer: Coventry/First Health All Products |
$160.37
|
| Rate for Payer: Frontpath All Products |
$73.19
|
| Rate for Payer: Humana ChoiceCare |
$133.64
|
| Rate for Payer: Lutheran Preferred All Products |
$72.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$100.23
|
| Rate for Payer: PHP All Products |
$68.83
|
| Rate for Payer: Signature Care EPO |
$75.65
|
| Rate for Payer: Signature Care PPO |
$75.65
|
| Rate for Payer: Three Rivers Preferred All Products |
$71.00
|
| Rate for Payer: United Healthcare Commercial |
$76.58
|
| Rate for Payer: United Healthcare Medicare |
$66.82
|
|
|
PR IRRIGATION MAXILLARY SINUS
|
Professional
|
$339.80
|
|
|
Service Code
|
CPT 31000
|
| Hospital Charge Code |
Z12511
|
| Min. Negotiated Rate |
$103.45 |
| Max. Negotiated Rate |
$407.76 |
| Rate for Payer: Aetna Medicare |
$103.45
|
| Rate for Payer: Anthem Exchange |
$115.40
|
| Rate for Payer: Anthem Medicare |
$103.45
|
| Rate for Payer: Anthem PPO |
$115.40
|
| Rate for Payer: Anthem Traditional |
$115.40
|
| Rate for Payer: Caresource Just 4 Me |
$118.97
|
| Rate for Payer: Caresource Medicare |
$113.80
|
| Rate for Payer: Centivo/Paragon All Products |
$160.35
|
| Rate for Payer: Coventry/First Health All Products |
$407.76
|
| Rate for Payer: Frontpath All Products |
$138.83
|
| Rate for Payer: Humana ChoiceCare |
$339.80
|
| Rate for Payer: Humana Medicare |
$103.45
|
| Rate for Payer: Lucent/Coldwater Veneers |
$175.87
|
| Rate for Payer: Lutheran Preferred All Products |
$166.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$254.85
|
| Rate for Payer: PHP All Products |
$141.30
|
| Rate for Payer: Plain Church Group Ministry All Products |
$103.45
|
| Rate for Payer: Signature Care EPO |
$208.25
|
| Rate for Payer: Signature Care PPO |
$208.25
|
| Rate for Payer: Three Rivers Preferred All Products |
$155.00
|
| Rate for Payer: United Healthcare Commercial |
$111.46
|
| Rate for Payer: United Healthcare Medicare |
$169.90
|
|
|
PR KNEE ARTHROSCOPY/SURGERY MED AND LAT
|
Professional
|
$1,023.30
|
|
|
Service Code
|
CPT 29880
|
| Hospital Charge Code |
Z12487
|
| Min. Negotiated Rate |
$511.65 |
| Max. Negotiated Rate |
$1,227.96 |
| Rate for Payer: Aetna Medicare |
$524.44
|
| Rate for Payer: Anthem Exchange |
$860.60
|
| Rate for Payer: Anthem Medicare |
$524.44
|
| Rate for Payer: Anthem PPO |
$860.60
|
| Rate for Payer: Anthem Traditional |
$860.60
|
| Rate for Payer: Caresource Just 4 Me |
$603.11
|
| Rate for Payer: Caresource Medicare |
$576.88
|
| Rate for Payer: Centivo/Paragon All Products |
$812.88
|
| Rate for Payer: Coventry/First Health All Products |
$1,227.96
|
| Rate for Payer: Frontpath All Products |
$728.14
|
| Rate for Payer: Humana ChoiceCare |
$1,023.30
|
| Rate for Payer: Humana Medicare |
$524.44
|
| Rate for Payer: Lucent/Coldwater Veneers |
$891.55
|
| Rate for Payer: Lutheran Preferred All Products |
$839.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$767.47
|
| Rate for Payer: PHP All Products |
$890.27
|
| Rate for Payer: Plain Church Group Ministry All Products |
$524.44
|
| Rate for Payer: Signature Care EPO |
$891.41
|
| Rate for Payer: Signature Care PPO |
$891.41
|
| Rate for Payer: Three Rivers Preferred All Products |
$787.00
|
| Rate for Payer: United Healthcare Commercial |
$741.23
|
| Rate for Payer: United Healthcare Medicare |
$511.65
|
|
|
PR KNEE ARTHROSCOPY/SURGERY MED OR LAT
|
Professional
|
$985.82
|
|
|
Service Code
|
CPT 29881
|
| Hospital Charge Code |
Z12488
|
| Min. Negotiated Rate |
$492.91 |
| Max. Negotiated Rate |
$1,182.98 |
| Rate for Payer: Aetna Medicare |
$505.24
|
| Rate for Payer: Anthem Exchange |
$791.70
|
| Rate for Payer: Anthem Medicare |
$505.24
|
| Rate for Payer: Anthem PPO |
$791.70
|
| Rate for Payer: Anthem Traditional |
$791.70
|
| Rate for Payer: Caresource Just 4 Me |
$581.03
|
| Rate for Payer: Caresource Medicare |
$555.76
|
| Rate for Payer: Centivo/Paragon All Products |
$783.12
|
| Rate for Payer: Coventry/First Health All Products |
$1,182.98
|
| Rate for Payer: Frontpath All Products |
$701.12
|
| Rate for Payer: Humana ChoiceCare |
$985.82
|
| Rate for Payer: Humana Medicare |
$505.24
|
| Rate for Payer: Lucent/Coldwater Veneers |
$858.91
|
| Rate for Payer: Lutheran Preferred All Products |
$808.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$739.37
|
| Rate for Payer: PHP All Products |
$857.67
|
| Rate for Payer: Plain Church Group Ministry All Products |
$505.24
|
| Rate for Payer: Signature Care EPO |
$850.00
|
| Rate for Payer: Signature Care PPO |
$850.00
|
| Rate for Payer: Three Rivers Preferred All Products |
$758.00
|
| Rate for Payer: United Healthcare Commercial |
$690.29
|
| Rate for Payer: United Healthcare Medicare |
$492.91
|
|
|
PR KNEE SCOPE,ABRASN ARTHROPLASTY
|
Professional
|
$1,201.80
|
|
|
Service Code
|
CPT 29879
|
| Hospital Charge Code |
Z12486
|
| Min. Negotiated Rate |
$600.90 |
| Max. Negotiated Rate |
$1,442.16 |
| Rate for Payer: Aetna Medicare |
$615.92
|
| Rate for Payer: Anthem Exchange |
$817.00
|
| Rate for Payer: Anthem Medicare |
$615.92
|
| Rate for Payer: Anthem PPO |
$817.00
|
| Rate for Payer: Anthem Traditional |
$817.00
|
| Rate for Payer: Caresource Just 4 Me |
$708.31
|
| Rate for Payer: Caresource Medicare |
$677.51
|
| Rate for Payer: Centivo/Paragon All Products |
$954.68
|
| Rate for Payer: Coventry/First Health All Products |
$1,442.16
|
| Rate for Payer: Frontpath All Products |
$857.94
|
| Rate for Payer: Humana ChoiceCare |
$1,201.80
|
| Rate for Payer: Humana Medicare |
$615.92
|
| Rate for Payer: Lucent/Coldwater Veneers |
$1,047.06
|
| Rate for Payer: Lutheran Preferred All Products |
$985.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$901.35
|
| Rate for Payer: PHP All Products |
$1,045.56
|
| Rate for Payer: Plain Church Group Ministry All Products |
$615.92
|
| Rate for Payer: Signature Care EPO |
$875.50
|
| Rate for Payer: Signature Care PPO |
$875.50
|
| Rate for Payer: Three Rivers Preferred All Products |
$924.00
|
| Rate for Payer: United Healthcare Commercial |
$709.64
|
| Rate for Payer: United Healthcare Medicare |
$600.90
|
|
|
PR KNEE SCOPE,AID ANT CRUCIATE REPAIR
|
Professional
|
$1,767.34
|
|
|
Service Code
|
CPT 29888
|
| Hospital Charge Code |
Z12492
|
| Min. Negotiated Rate |
$883.67 |
| Max. Negotiated Rate |
$2,120.81 |
| Rate for Payer: Aetna Medicare |
$905.76
|
| Rate for Payer: Anthem Exchange |
$1,381.20
|
| Rate for Payer: Anthem Medicare |
$905.76
|
| Rate for Payer: Anthem PPO |
$1,381.20
|
| Rate for Payer: Anthem Traditional |
$1,381.20
|
| Rate for Payer: Caresource Just 4 Me |
$1,041.62
|
| Rate for Payer: Caresource Medicare |
$996.34
|
| Rate for Payer: Centivo/Paragon All Products |
$1,403.93
|
| Rate for Payer: Coventry/First Health All Products |
$2,120.81
|
| Rate for Payer: Frontpath All Products |
$1,269.50
|
| Rate for Payer: Humana ChoiceCare |
$1,767.34
|
| Rate for Payer: Humana Medicare |
$905.76
|
| Rate for Payer: Lucent/Coldwater Veneers |
$1,539.79
|
| Rate for Payer: Lutheran Preferred All Products |
$1,449.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$1,325.50
|
| Rate for Payer: PHP All Products |
$1,537.59
|
| Rate for Payer: Plain Church Group Ministry All Products |
$905.76
|
| Rate for Payer: Signature Care EPO |
$1,409.30
|
| Rate for Payer: Signature Care PPO |
$1,409.30
|
| Rate for Payer: Three Rivers Preferred All Products |
$1,359.00
|
| Rate for Payer: United Healthcare Commercial |
$1,084.83
|
| Rate for Payer: United Healthcare Medicare |
$883.67
|
|
|
PR KNEE SCOPE,AID POST CRUC REPAIR
|
Professional
|
$2,213.12
|
|
|
Service Code
|
CPT 29889
|
| Hospital Charge Code |
Z12493
|
| Min. Negotiated Rate |
$1,106.56 |
| Max. Negotiated Rate |
$2,655.74 |
| Rate for Payer: Aetna Medicare |
$1,134.23
|
| Rate for Payer: Anthem Medicare |
$1,134.23
|
| Rate for Payer: Caresource Just 4 Me |
$1,304.36
|
| Rate for Payer: Caresource Medicare |
$1,247.65
|
| Rate for Payer: Centivo/Paragon All Products |
$1,758.06
|
| Rate for Payer: Coventry/First Health All Products |
$2,655.74
|
| Rate for Payer: Frontpath All Products |
$1,588.86
|
| Rate for Payer: Humana ChoiceCare |
$2,213.12
|
| Rate for Payer: Humana Medicare |
$1,134.23
|
| Rate for Payer: Lucent/Coldwater Veneers |
$1,928.19
|
| Rate for Payer: PHCS/Multiplan All Products |
$1,659.84
|
| Rate for Payer: PHP All Products |
$1,925.42
|
| Rate for Payer: Plain Church Group Ministry All Products |
$1,134.23
|
| Rate for Payer: Signature Care EPO |
$1,650.70
|
| Rate for Payer: Signature Care PPO |
$1,650.70
|
| Rate for Payer: United Healthcare Commercial |
$1,324.88
|
| Rate for Payer: United Healthcare Medicare |
$1,106.56
|
|
|
PR KNEE SCOPE,CLEAN/DRAIN
|
Professional
|
$939.20
|
|
|
Service Code
|
CPT 29871
|
| Hospital Charge Code |
Z12480
|
| Min. Negotiated Rate |
$469.60 |
| Max. Negotiated Rate |
$1,127.04 |
| Rate for Payer: Aetna Medicare |
$481.34
|
| Rate for Payer: Anthem Exchange |
$672.10
|
| Rate for Payer: Anthem Medicare |
$481.34
|
| Rate for Payer: Anthem PPO |
$672.10
|
| Rate for Payer: Anthem Traditional |
$672.10
|
| Rate for Payer: Caresource Just 4 Me |
$553.54
|
| Rate for Payer: Caresource Medicare |
$529.47
|
| Rate for Payer: Centivo/Paragon All Products |
$746.08
|
| Rate for Payer: Coventry/First Health All Products |
$1,127.04
|
| Rate for Payer: Frontpath All Products |
$666.35
|
| Rate for Payer: Humana ChoiceCare |
$939.20
|
| Rate for Payer: Humana Medicare |
$481.34
|
| Rate for Payer: Lucent/Coldwater Veneers |
$818.28
|
| Rate for Payer: Lutheran Preferred All Products |
$770.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$704.40
|
| Rate for Payer: PHP All Products |
$817.10
|
| Rate for Payer: Plain Church Group Ministry All Products |
$481.34
|
| Rate for Payer: Signature Care EPO |
$716.55
|
| Rate for Payer: Signature Care PPO |
$716.55
|
| Rate for Payer: Three Rivers Preferred All Products |
$722.00
|
| Rate for Payer: United Healthcare Commercial |
$550.16
|
| Rate for Payer: United Healthcare Medicare |
$469.60
|
|
|
PR KNEE SCOPE,FULL SYNOVECT
|
Professional
|
$1,185.98
|
|
|
Service Code
|
CPT 29876
|
| Hospital Charge Code |
Z12484
|
| Min. Negotiated Rate |
$592.99 |
| Max. Negotiated Rate |
$1,423.18 |
| Rate for Payer: Aetna Medicare |
$607.81
|
| Rate for Payer: Anthem Exchange |
$815.10
|
| Rate for Payer: Anthem Medicare |
$607.81
|
| Rate for Payer: Anthem PPO |
$815.10
|
| Rate for Payer: Anthem Traditional |
$815.10
|
| Rate for Payer: Caresource Just 4 Me |
$698.98
|
| Rate for Payer: Caresource Medicare |
$668.59
|
| Rate for Payer: Centivo/Paragon All Products |
$942.11
|
| Rate for Payer: Coventry/First Health All Products |
$1,423.18
|
| Rate for Payer: Frontpath All Products |
$847.28
|
| Rate for Payer: Humana ChoiceCare |
$1,185.98
|
| Rate for Payer: Humana Medicare |
$607.81
|
| Rate for Payer: Lucent/Coldwater Veneers |
$1,033.28
|
| Rate for Payer: Lutheran Preferred All Products |
$972.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$889.49
|
| Rate for Payer: PHP All Products |
$1,031.80
|
| Rate for Payer: Plain Church Group Ministry All Products |
$607.81
|
| Rate for Payer: Signature Care EPO |
$863.60
|
| Rate for Payer: Signature Care PPO |
$863.60
|
| Rate for Payer: Three Rivers Preferred All Products |
$912.00
|
| Rate for Payer: United Healthcare Commercial |
$700.79
|
| Rate for Payer: United Healthcare Medicare |
$592.99
|
|
|
PR KNEE SCOPE,LYSIS OF ADHESNS
|
Professional
|
$1,126.64
|
|
|
Service Code
|
CPT 29884
|
| Hospital Charge Code |
Z12491
|
| Min. Negotiated Rate |
$563.32 |
| Max. Negotiated Rate |
$1,351.97 |
| Rate for Payer: Aetna Medicare |
$577.40
|
| Rate for Payer: Anthem Exchange |
$768.70
|
| Rate for Payer: Anthem Medicare |
$577.40
|
| Rate for Payer: Anthem PPO |
$768.70
|
| Rate for Payer: Anthem Traditional |
$768.70
|
| Rate for Payer: Caresource Just 4 Me |
$664.01
|
| Rate for Payer: Caresource Medicare |
$635.14
|
| Rate for Payer: Centivo/Paragon All Products |
$894.97
|
| Rate for Payer: Coventry/First Health All Products |
$1,351.97
|
| Rate for Payer: Frontpath All Products |
$801.19
|
| Rate for Payer: Humana ChoiceCare |
$1,126.64
|
| Rate for Payer: Humana Medicare |
$577.40
|
| Rate for Payer: Lucent/Coldwater Veneers |
$981.58
|
| Rate for Payer: Lutheran Preferred All Products |
$924.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$844.98
|
| Rate for Payer: PHP All Products |
$980.18
|
| Rate for Payer: Plain Church Group Ministry All Products |
$577.40
|
| Rate for Payer: Signature Care EPO |
$809.20
|
| Rate for Payer: Signature Care PPO |
$809.20
|
| Rate for Payer: Three Rivers Preferred All Products |
$866.00
|
| Rate for Payer: United Healthcare Commercial |
$660.73
|
| Rate for Payer: United Healthcare Medicare |
$563.32
|
|
|
PR KNEE SCOPE,MED+LAT MENIS REPAIR
|
Professional
|
$1,529.12
|
|
|
Service Code
|
CPT 29883
|
| Hospital Charge Code |
Z12490
|
| Min. Negotiated Rate |
$764.56 |
| Max. Negotiated Rate |
$1,834.94 |
| Rate for Payer: Aetna Medicare |
$783.67
|
| Rate for Payer: Anthem Exchange |
$948.30
|
| Rate for Payer: Anthem Medicare |
$783.67
|
| Rate for Payer: Anthem PPO |
$948.30
|
| Rate for Payer: Anthem Traditional |
$948.30
|
| Rate for Payer: Caresource Just 4 Me |
$901.22
|
| Rate for Payer: Caresource Medicare |
$862.04
|
| Rate for Payer: Centivo/Paragon All Products |
$1,214.69
|
| Rate for Payer: Coventry/First Health All Products |
$1,834.94
|
| Rate for Payer: Frontpath All Products |
$1,091.06
|
| Rate for Payer: Humana ChoiceCare |
$1,529.12
|
| Rate for Payer: Humana Medicare |
$783.67
|
| Rate for Payer: Lucent/Coldwater Veneers |
$1,332.24
|
| Rate for Payer: Lutheran Preferred All Products |
$1,254.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$1,146.84
|
| Rate for Payer: PHP All Products |
$1,330.33
|
| Rate for Payer: Plain Church Group Ministry All Products |
$783.67
|
| Rate for Payer: Signature Care EPO |
$1,160.25
|
| Rate for Payer: Signature Care PPO |
$1,160.25
|
| Rate for Payer: Three Rivers Preferred All Products |
$1,176.00
|
| Rate for Payer: United Healthcare Commercial |
$914.08
|
| Rate for Payer: United Healthcare Medicare |
$764.56
|
|
