|
PR KNEE SCOPE,MED OR LAT MENIS REPAIR
|
Professional
|
$1,253.06
|
|
|
Service Code
|
CPT 29882
|
| Hospital Charge Code |
Z12489
|
| Min. Negotiated Rate |
$626.53 |
| Max. Negotiated Rate |
$1,503.67 |
| Rate for Payer: Aetna Medicare |
$642.20
|
| Rate for Payer: Anthem Exchange |
$872.80
|
| Rate for Payer: Anthem Medicare |
$642.20
|
| Rate for Payer: Anthem PPO |
$872.80
|
| Rate for Payer: Anthem Traditional |
$872.80
|
| Rate for Payer: Caresource Just 4 Me |
$738.53
|
| Rate for Payer: Caresource Medicare |
$706.42
|
| Rate for Payer: Centivo/Paragon All Products |
$995.41
|
| Rate for Payer: Coventry/First Health All Products |
$1,503.67
|
| Rate for Payer: Frontpath All Products |
$893.59
|
| Rate for Payer: Humana ChoiceCare |
$1,253.06
|
| Rate for Payer: Humana Medicare |
$642.20
|
| Rate for Payer: Lucent/Coldwater Veneers |
$1,091.74
|
| Rate for Payer: Lutheran Preferred All Products |
$1,028.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$939.79
|
| Rate for Payer: PHP All Products |
$1,090.17
|
| Rate for Payer: Plain Church Group Ministry All Products |
$642.20
|
| Rate for Payer: Signature Care EPO |
$917.15
|
| Rate for Payer: Signature Care PPO |
$917.15
|
| Rate for Payer: Three Rivers Preferred All Products |
$963.00
|
| Rate for Payer: United Healthcare Commercial |
$748.39
|
| Rate for Payer: United Healthcare Medicare |
$626.53
|
|
|
PR KNEE SCOPE,PART SYNOVECT
|
Professional
|
$904.58
|
|
|
Service Code
|
CPT 29875
|
| Hospital Charge Code |
Z12483
|
| Min. Negotiated Rate |
$452.29 |
| Max. Negotiated Rate |
$1,085.50 |
| Rate for Payer: Aetna Medicare |
$463.60
|
| Rate for Payer: Anthem Exchange |
$657.10
|
| Rate for Payer: Anthem Medicare |
$463.60
|
| Rate for Payer: Anthem PPO |
$657.10
|
| Rate for Payer: Anthem Traditional |
$657.10
|
| Rate for Payer: Caresource Just 4 Me |
$533.14
|
| Rate for Payer: Caresource Medicare |
$509.96
|
| Rate for Payer: Centivo/Paragon All Products |
$718.58
|
| Rate for Payer: Coventry/First Health All Products |
$1,085.50
|
| Rate for Payer: Frontpath All Products |
$642.82
|
| Rate for Payer: Humana ChoiceCare |
$904.58
|
| Rate for Payer: Humana Medicare |
$463.60
|
| Rate for Payer: Lucent/Coldwater Veneers |
$788.12
|
| Rate for Payer: Lutheran Preferred All Products |
$742.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$678.44
|
| Rate for Payer: PHP All Products |
$786.98
|
| Rate for Payer: Plain Church Group Ministry All Products |
$463.60
|
| Rate for Payer: Signature Care EPO |
$701.25
|
| Rate for Payer: Signature Care PPO |
$701.25
|
| Rate for Payer: Three Rivers Preferred All Products |
$695.00
|
| Rate for Payer: United Healthcare Commercial |
$532.20
|
| Rate for Payer: United Healthcare Medicare |
$452.29
|
|
|
PR KNEE SCOPE,REMV LOOSE BODY
|
Professional
|
$976.24
|
|
|
Service Code
|
CPT 29874
|
| Hospital Charge Code |
Z12482
|
| Min. Negotiated Rate |
$488.12 |
| Max. Negotiated Rate |
$1,171.49 |
| Rate for Payer: Aetna Medicare |
$500.32
|
| Rate for Payer: Anthem Exchange |
$720.40
|
| Rate for Payer: Anthem Medicare |
$500.32
|
| Rate for Payer: Anthem PPO |
$720.40
|
| Rate for Payer: Anthem Traditional |
$720.40
|
| Rate for Payer: Caresource Just 4 Me |
$575.37
|
| Rate for Payer: Caresource Medicare |
$550.35
|
| Rate for Payer: Centivo/Paragon All Products |
$775.50
|
| Rate for Payer: Coventry/First Health All Products |
$1,171.49
|
| Rate for Payer: Frontpath All Products |
$695.25
|
| Rate for Payer: Humana ChoiceCare |
$976.24
|
| Rate for Payer: Humana Medicare |
$500.32
|
| Rate for Payer: Lucent/Coldwater Veneers |
$850.54
|
| Rate for Payer: Lutheran Preferred All Products |
$801.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$732.18
|
| Rate for Payer: PHP All Products |
$849.33
|
| Rate for Payer: Plain Church Group Ministry All Products |
$500.32
|
| Rate for Payer: Signature Care EPO |
$756.50
|
| Rate for Payer: Signature Care PPO |
$756.50
|
| Rate for Payer: Three Rivers Preferred All Products |
$750.00
|
| Rate for Payer: United Healthcare Commercial |
$577.69
|
| Rate for Payer: United Healthcare Medicare |
$488.12
|
|
|
PR KNEE SCOPE,SHAVE ARTICULAR CART
|
Professional
|
$1,129.48
|
|
|
Service Code
|
CPT 29877
|
| Hospital Charge Code |
Z12485
|
| Min. Negotiated Rate |
$564.74 |
| Max. Negotiated Rate |
$1,355.38 |
| Rate for Payer: Aetna Medicare |
$578.86
|
| Rate for Payer: Anthem Exchange |
$753.70
|
| Rate for Payer: Anthem Medicare |
$578.86
|
| Rate for Payer: Anthem PPO |
$753.70
|
| Rate for Payer: Anthem Traditional |
$753.70
|
| Rate for Payer: Caresource Just 4 Me |
$665.69
|
| Rate for Payer: Caresource Medicare |
$636.75
|
| Rate for Payer: Centivo/Paragon All Products |
$897.23
|
| Rate for Payer: Coventry/First Health All Products |
$1,355.38
|
| Rate for Payer: Frontpath All Products |
$805.62
|
| Rate for Payer: Humana ChoiceCare |
$1,129.48
|
| Rate for Payer: Humana Medicare |
$578.86
|
| Rate for Payer: Lucent/Coldwater Veneers |
$984.06
|
| Rate for Payer: Lutheran Preferred All Products |
$926.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$847.11
|
| Rate for Payer: PHP All Products |
$982.65
|
| Rate for Payer: Plain Church Group Ministry All Products |
$578.86
|
| Rate for Payer: Signature Care EPO |
$812.60
|
| Rate for Payer: Signature Care PPO |
$812.60
|
| Rate for Payer: Three Rivers Preferred All Products |
$868.00
|
| Rate for Payer: United Healthcare Commercial |
$662.73
|
| Rate for Payer: United Healthcare Medicare |
$564.74
|
|
|
PR KNEE SCOPE, W/LATERAL RELEASE
|
Professional
|
$978.28
|
|
|
Service Code
|
CPT 29873
|
| Hospital Charge Code |
Z12481
|
| Min. Negotiated Rate |
$489.14 |
| Max. Negotiated Rate |
$1,294.10 |
| Rate for Payer: Aetna Medicare |
$501.36
|
| Rate for Payer: Anthem Exchange |
$1,294.10
|
| Rate for Payer: Anthem Medicare |
$501.36
|
| Rate for Payer: Anthem PPO |
$1,294.10
|
| Rate for Payer: Anthem Traditional |
$1,294.10
|
| Rate for Payer: Caresource Just 4 Me |
$576.56
|
| Rate for Payer: Caresource Medicare |
$551.50
|
| Rate for Payer: Centivo/Paragon All Products |
$777.11
|
| Rate for Payer: Coventry/First Health All Products |
$1,173.94
|
| Rate for Payer: Frontpath All Products |
$692.77
|
| Rate for Payer: Humana ChoiceCare |
$978.28
|
| Rate for Payer: Humana Medicare |
$501.36
|
| Rate for Payer: Lucent/Coldwater Veneers |
$852.31
|
| Rate for Payer: Lutheran Preferred All Products |
$802.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$733.71
|
| Rate for Payer: PHP All Products |
$851.10
|
| Rate for Payer: Plain Church Group Ministry All Products |
$501.36
|
| Rate for Payer: Signature Care EPO |
$851.82
|
| Rate for Payer: Signature Care PPO |
$851.82
|
| Rate for Payer: Three Rivers Preferred All Products |
$752.00
|
| Rate for Payer: United Healthcare Commercial |
$547.65
|
| Rate for Payer: United Healthcare Medicare |
$489.14
|
|
|
PR LABYRINTHOTOMY W PERFUSION VESTIBULOACTIVE DRUGS,TRANSCRANIAL
|
Professional
|
$418.80
|
|
|
Service Code
|
CPT 69801
|
| Hospital Charge Code |
Z12868
|
| Min. Negotiated Rate |
$116.46 |
| Max. Negotiated Rate |
$804.94 |
| Rate for Payer: Aetna Medicare |
$116.46
|
| Rate for Payer: Anthem Exchange |
$385.80
|
| Rate for Payer: Anthem Medicare |
$116.46
|
| Rate for Payer: Anthem PPO |
$385.80
|
| Rate for Payer: Anthem Traditional |
$385.80
|
| Rate for Payer: Caresource Just 4 Me |
$133.93
|
| Rate for Payer: Caresource Medicare |
$128.11
|
| Rate for Payer: Centivo/Paragon All Products |
$180.51
|
| Rate for Payer: Coventry/First Health All Products |
$502.56
|
| Rate for Payer: Frontpath All Products |
$160.26
|
| Rate for Payer: Humana ChoiceCare |
$418.80
|
| Rate for Payer: Humana Medicare |
$116.46
|
| Rate for Payer: Lucent/Coldwater Veneers |
$197.98
|
| Rate for Payer: Lutheran Preferred All Products |
$186.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$314.10
|
| Rate for Payer: PHP All Products |
$147.71
|
| Rate for Payer: Plain Church Group Ministry All Products |
$116.46
|
| Rate for Payer: Signature Care EPO |
$318.22
|
| Rate for Payer: Signature Care PPO |
$318.22
|
| Rate for Payer: Three Rivers Preferred All Products |
$175.00
|
| Rate for Payer: United Healthcare Commercial |
$804.94
|
| Rate for Payer: United Healthcare Medicare |
$209.40
|
|
|
PR LAP,ABDOMEN,ASPIRATE CYST
|
Professional
|
$672.62
|
|
|
Service Code
|
CPT 49322
|
| Hospital Charge Code |
Z12665
|
| Min. Negotiated Rate |
$336.31 |
| Max. Negotiated Rate |
$807.14 |
| Rate for Payer: Aetna Medicare |
$344.72
|
| Rate for Payer: Anthem Exchange |
$490.10
|
| Rate for Payer: Anthem Medicare |
$344.72
|
| Rate for Payer: Anthem PPO |
$490.10
|
| Rate for Payer: Anthem Traditional |
$490.10
|
| Rate for Payer: Caresource Just 4 Me |
$396.43
|
| Rate for Payer: Caresource Medicare |
$379.19
|
| Rate for Payer: Centivo/Paragon All Products |
$534.32
|
| Rate for Payer: Coventry/First Health All Products |
$807.14
|
| Rate for Payer: Frontpath All Products |
$493.88
|
| Rate for Payer: Humana ChoiceCare |
$672.62
|
| Rate for Payer: Humana Medicare |
$344.72
|
| Rate for Payer: Lucent/Coldwater Veneers |
$586.02
|
| Rate for Payer: Lutheran Preferred All Products |
$517.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$504.47
|
| Rate for Payer: PHP All Products |
$588.54
|
| Rate for Payer: Plain Church Group Ministry All Products |
$344.72
|
| Rate for Payer: Signature Care EPO |
$500.65
|
| Rate for Payer: Signature Care PPO |
$500.65
|
| Rate for Payer: Three Rivers Preferred All Products |
$483.00
|
| Rate for Payer: United Healthcare Commercial |
$403.75
|
| Rate for Payer: United Healthcare Medicare |
$336.31
|
|
|
PR LAP,ABD/PERIT/OMENTUM,UNLIST
|
Professional
|
$735.00
|
|
|
Service Code
|
CPT 49329
|
| Hospital Charge Code |
Z12667
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$882.00 |
| Rate for Payer: Anthem Exchange |
$0.01
|
| Rate for Payer: Anthem PPO |
$0.01
|
| Rate for Payer: Anthem Traditional |
$0.01
|
| Rate for Payer: Coventry/First Health All Products |
$882.00
|
| Rate for Payer: Humana ChoiceCare |
$735.00
|
| Rate for Payer: Lutheran Preferred All Products |
$624.75
|
| Rate for Payer: PHCS/Multiplan All Products |
$551.25
|
| Rate for Payer: Signature Care EPO |
$468.56
|
| Rate for Payer: Signature Care PPO |
$468.56
|
| Rate for Payer: Three Rivers Preferred All Products |
$441.00
|
|
|
PR LAP,APPENDECTOMY
|
Professional
|
$1,077.46
|
|
|
Service Code
|
CPT 44970
|
| Hospital Charge Code |
Z12625
|
| Min. Negotiated Rate |
$538.73 |
| Max. Negotiated Rate |
$1,292.95 |
| Rate for Payer: Aetna Medicare |
$552.20
|
| Rate for Payer: Anthem Exchange |
$673.00
|
| Rate for Payer: Anthem Medicare |
$552.20
|
| Rate for Payer: Anthem PPO |
$673.00
|
| Rate for Payer: Anthem Traditional |
$673.00
|
| Rate for Payer: Caresource Just 4 Me |
$635.03
|
| Rate for Payer: Caresource Medicare |
$607.42
|
| Rate for Payer: Centivo/Paragon All Products |
$855.91
|
| Rate for Payer: Coventry/First Health All Products |
$1,292.95
|
| Rate for Payer: Frontpath All Products |
$795.54
|
| Rate for Payer: Humana ChoiceCare |
$1,077.46
|
| Rate for Payer: Humana Medicare |
$552.20
|
| Rate for Payer: Lucent/Coldwater Veneers |
$938.74
|
| Rate for Payer: Lutheran Preferred All Products |
$828.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$808.10
|
| Rate for Payer: PHP All Products |
$942.78
|
| Rate for Payer: Plain Church Group Ministry All Products |
$552.20
|
| Rate for Payer: Signature Care EPO |
$747.15
|
| Rate for Payer: Signature Care PPO |
$747.15
|
| Rate for Payer: Three Rivers Preferred All Products |
$773.00
|
| Rate for Payer: United Healthcare Commercial |
$629.04
|
| Rate for Payer: United Healthcare Medicare |
$538.73
|
|
|
PR LAPAROSCOPY TOTAL HYSTERECTOMY UTERUS > 250 GRAM
|
Professional
|
$1,892.82
|
|
|
Service Code
|
CPT 58572
|
| Hospital Charge Code |
Z12766
|
| Min. Negotiated Rate |
$946.41 |
| Max. Negotiated Rate |
$2,271.38 |
| Rate for Payer: Aetna Medicare |
$970.07
|
| Rate for Payer: Anthem Exchange |
$1,506.18
|
| Rate for Payer: Anthem Medicare |
$970.07
|
| Rate for Payer: Anthem PPO |
$1,506.18
|
| Rate for Payer: Anthem Traditional |
$1,506.18
|
| Rate for Payer: Caresource Just 4 Me |
$1,115.58
|
| Rate for Payer: Caresource Medicare |
$1,067.08
|
| Rate for Payer: Centivo/Paragon All Products |
$1,503.61
|
| Rate for Payer: Coventry/First Health All Products |
$2,271.38
|
| Rate for Payer: Frontpath All Products |
$1,357.60
|
| Rate for Payer: Humana ChoiceCare |
$1,892.82
|
| Rate for Payer: Humana Medicare |
$970.07
|
| Rate for Payer: Lucent/Coldwater Veneers |
$1,649.12
|
| Rate for Payer: Lutheran Preferred All Products |
$1,358.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$1,419.62
|
| Rate for Payer: PHP All Products |
$1,249.26
|
| Rate for Payer: Plain Church Group Ministry All Products |
$970.07
|
| Rate for Payer: Signature Care EPO |
$1,264.59
|
| Rate for Payer: Signature Care PPO |
$1,264.59
|
| Rate for Payer: Three Rivers Preferred All Products |
$1,261.00
|
| Rate for Payer: United Healthcare Commercial |
$1,290.85
|
| Rate for Payer: United Healthcare Medicare |
$946.41
|
|
|
PR LAPAROSCOPY TOT HYSTERECTOMY UTERUS >250 GRAM W TUBE/OVARY
|
Professional
|
$2,217.26
|
|
|
Service Code
|
CPT 58573
|
| Hospital Charge Code |
Z12767
|
| Min. Negotiated Rate |
$1,108.63 |
| Max. Negotiated Rate |
$2,660.71 |
| Rate for Payer: Aetna Medicare |
$1,136.34
|
| Rate for Payer: Anthem Exchange |
$1,695.20
|
| Rate for Payer: Anthem Medicare |
$1,136.34
|
| Rate for Payer: Anthem PPO |
$1,695.20
|
| Rate for Payer: Anthem Traditional |
$1,695.20
|
| Rate for Payer: Caresource Just 4 Me |
$1,306.79
|
| Rate for Payer: Caresource Medicare |
$1,249.97
|
| Rate for Payer: Centivo/Paragon All Products |
$1,761.33
|
| Rate for Payer: Coventry/First Health All Products |
$2,660.71
|
| Rate for Payer: Frontpath All Products |
$1,593.80
|
| Rate for Payer: Humana ChoiceCare |
$2,217.26
|
| Rate for Payer: Humana Medicare |
$1,136.34
|
| Rate for Payer: Lucent/Coldwater Veneers |
$1,931.78
|
| Rate for Payer: Lutheran Preferred All Products |
$1,591.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$1,662.95
|
| Rate for Payer: PHP All Products |
$1,463.39
|
| Rate for Payer: Plain Church Group Ministry All Products |
$1,136.34
|
| Rate for Payer: Signature Care EPO |
$1,431.52
|
| Rate for Payer: Signature Care PPO |
$1,431.52
|
| Rate for Payer: Three Rivers Preferred All Products |
$1,477.00
|
| Rate for Payer: United Healthcare Commercial |
$1,462.61
|
| Rate for Payer: United Healthcare Medicare |
$1,108.63
|
|
|
PR LAPAROSCOPY W TOT HYSTERECT UTERUS 250 GRAM OR LESS
|
Professional
|
$1,473.56
|
|
|
Service Code
|
CPT 58570
|
| Hospital Charge Code |
Z12764
|
| Min. Negotiated Rate |
$736.78 |
| Max. Negotiated Rate |
$1,768.27 |
| Rate for Payer: Aetna Medicare |
$755.36
|
| Rate for Payer: Anthem Exchange |
$1,213.60
|
| Rate for Payer: Anthem Medicare |
$755.36
|
| Rate for Payer: Anthem PPO |
$1,213.60
|
| Rate for Payer: Anthem Traditional |
$1,213.60
|
| Rate for Payer: Caresource Just 4 Me |
$868.66
|
| Rate for Payer: Caresource Medicare |
$830.90
|
| Rate for Payer: Centivo/Paragon All Products |
$1,170.81
|
| Rate for Payer: Coventry/First Health All Products |
$1,768.27
|
| Rate for Payer: Frontpath All Products |
$1,054.09
|
| Rate for Payer: Humana ChoiceCare |
$1,473.56
|
| Rate for Payer: Humana Medicare |
$755.36
|
| Rate for Payer: Lucent/Coldwater Veneers |
$1,284.11
|
| Rate for Payer: Lutheran Preferred All Products |
$1,057.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$1,105.17
|
| Rate for Payer: PHP All Products |
$972.54
|
| Rate for Payer: Plain Church Group Ministry All Products |
$755.36
|
| Rate for Payer: Signature Care EPO |
$1,018.47
|
| Rate for Payer: Signature Care PPO |
$1,018.47
|
| Rate for Payer: Three Rivers Preferred All Products |
$982.00
|
| Rate for Payer: United Healthcare Commercial |
$1,037.33
|
| Rate for Payer: United Healthcare Medicare |
$736.78
|
|
|
PR LAPAROSCOPY W TOT HYSTERECTUTERUS <=250 GRAM W TUBE/OVARY
|
Professional
|
$1,655.50
|
|
|
Service Code
|
CPT 58571
|
| Hospital Charge Code |
Z12765
|
| Min. Negotiated Rate |
$827.75 |
| Max. Negotiated Rate |
$1,986.60 |
| Rate for Payer: Aetna Medicare |
$848.44
|
| Rate for Payer: Anthem Exchange |
$1,327.01
|
| Rate for Payer: Anthem Medicare |
$848.44
|
| Rate for Payer: Anthem PPO |
$1,327.01
|
| Rate for Payer: Anthem Traditional |
$1,327.01
|
| Rate for Payer: Caresource Just 4 Me |
$975.71
|
| Rate for Payer: Caresource Medicare |
$933.28
|
| Rate for Payer: Centivo/Paragon All Products |
$1,315.08
|
| Rate for Payer: Coventry/First Health All Products |
$1,986.60
|
| Rate for Payer: Frontpath All Products |
$1,187.33
|
| Rate for Payer: Humana ChoiceCare |
$1,655.50
|
| Rate for Payer: Humana Medicare |
$848.44
|
| Rate for Payer: Lucent/Coldwater Veneers |
$1,442.35
|
| Rate for Payer: Lutheran Preferred All Products |
$1,188.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$1,241.62
|
| Rate for Payer: PHP All Products |
$1,092.63
|
| Rate for Payer: Plain Church Group Ministry All Products |
$848.44
|
| Rate for Payer: Signature Care EPO |
$1,118.45
|
| Rate for Payer: Signature Care PPO |
$1,118.45
|
| Rate for Payer: Three Rivers Preferred All Products |
$1,103.00
|
| Rate for Payer: United Healthcare Commercial |
$1,140.59
|
| Rate for Payer: United Healthcare Medicare |
$827.75
|
|
|
PR LAP,CHOLECYSTECTOMY
|
Professional
|
$1,178.08
|
|
|
Service Code
|
CPT 47562
|
| Hospital Charge Code |
Z12655
|
| Min. Negotiated Rate |
$589.04 |
| Max. Negotiated Rate |
$1,413.70 |
| Rate for Payer: Aetna Medicare |
$603.77
|
| Rate for Payer: Anthem Exchange |
$892.00
|
| Rate for Payer: Anthem Medicare |
$603.77
|
| Rate for Payer: Anthem PPO |
$892.00
|
| Rate for Payer: Anthem Traditional |
$892.00
|
| Rate for Payer: Caresource Just 4 Me |
$694.34
|
| Rate for Payer: Caresource Medicare |
$664.15
|
| Rate for Payer: Centivo/Paragon All Products |
$935.84
|
| Rate for Payer: Coventry/First Health All Products |
$1,413.70
|
| Rate for Payer: Frontpath All Products |
$873.86
|
| Rate for Payer: Humana ChoiceCare |
$1,178.08
|
| Rate for Payer: Humana Medicare |
$603.77
|
| Rate for Payer: Lucent/Coldwater Veneers |
$1,026.41
|
| Rate for Payer: Lutheran Preferred All Products |
$906.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$883.56
|
| Rate for Payer: PHP All Products |
$1,030.83
|
| Rate for Payer: Plain Church Group Ministry All Products |
$603.77
|
| Rate for Payer: Signature Care EPO |
$931.60
|
| Rate for Payer: Signature Care PPO |
$931.60
|
| Rate for Payer: Three Rivers Preferred All Products |
$845.00
|
| Rate for Payer: United Healthcare Commercial |
$783.93
|
| Rate for Payer: United Healthcare Medicare |
$589.04
|
|
|
PR LAP,CHOLECYSTECTOMY/EXPLORE
|
Professional
|
$1,991.60
|
|
|
Service Code
|
CPT 47564
|
| Hospital Charge Code |
Z12657
|
| Min. Negotiated Rate |
$928.40 |
| Max. Negotiated Rate |
$2,389.92 |
| Rate for Payer: Aetna Medicare |
$1,020.86
|
| Rate for Payer: Anthem Exchange |
$1,139.20
|
| Rate for Payer: Anthem Medicare |
$1,020.86
|
| Rate for Payer: Anthem PPO |
$1,139.20
|
| Rate for Payer: Anthem Traditional |
$1,139.20
|
| Rate for Payer: Caresource Just 4 Me |
$1,173.99
|
| Rate for Payer: Caresource Medicare |
$1,122.95
|
| Rate for Payer: Centivo/Paragon All Products |
$1,582.33
|
| Rate for Payer: Coventry/First Health All Products |
$2,389.92
|
| Rate for Payer: Frontpath All Products |
$1,476.92
|
| Rate for Payer: Humana ChoiceCare |
$1,991.60
|
| Rate for Payer: Humana Medicare |
$1,020.86
|
| Rate for Payer: Lucent/Coldwater Veneers |
$1,735.46
|
| Rate for Payer: Lutheran Preferred All Products |
$1,531.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$1,493.70
|
| Rate for Payer: PHP All Products |
$1,742.66
|
| Rate for Payer: Plain Church Group Ministry All Products |
$1,020.86
|
| Rate for Payer: Signature Care EPO |
$1,172.15
|
| Rate for Payer: Signature Care PPO |
$1,172.15
|
| Rate for Payer: Three Rivers Preferred All Products |
$1,429.00
|
| Rate for Payer: United Healthcare Commercial |
$928.40
|
| Rate for Payer: United Healthcare Medicare |
$995.80
|
|
|
PR LAP,CHOLECYSTECTOMY/GRAPH
|
Professional
|
$1,283.40
|
|
|
Service Code
|
CPT 47563
|
| Hospital Charge Code |
Z12656
|
| Min. Negotiated Rate |
$641.70 |
| Max. Negotiated Rate |
$1,540.08 |
| Rate for Payer: Aetna Medicare |
$657.75
|
| Rate for Payer: Anthem Exchange |
$965.28
|
| Rate for Payer: Anthem Medicare |
$657.75
|
| Rate for Payer: Anthem PPO |
$965.28
|
| Rate for Payer: Anthem Traditional |
$965.28
|
| Rate for Payer: Caresource Just 4 Me |
$756.41
|
| Rate for Payer: Caresource Medicare |
$723.53
|
| Rate for Payer: Centivo/Paragon All Products |
$1,019.51
|
| Rate for Payer: Coventry/First Health All Products |
$1,540.08
|
| Rate for Payer: Frontpath All Products |
$951.20
|
| Rate for Payer: Humana ChoiceCare |
$1,283.40
|
| Rate for Payer: Humana Medicare |
$657.75
|
| Rate for Payer: Lucent/Coldwater Veneers |
$1,118.17
|
| Rate for Payer: Lutheran Preferred All Products |
$987.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$962.55
|
| Rate for Payer: PHP All Products |
$1,122.98
|
| Rate for Payer: Plain Church Group Ministry All Products |
$657.75
|
| Rate for Payer: Signature Care EPO |
$999.60
|
| Rate for Payer: Signature Care PPO |
$999.60
|
| Rate for Payer: Three Rivers Preferred All Products |
$921.00
|
| Rate for Payer: United Healthcare Commercial |
$802.71
|
| Rate for Payer: United Healthcare Medicare |
$641.70
|
|
|
PR LAP,DIAGNOSTIC ABDOMEN
|
Professional
|
$588.96
|
|
|
Service Code
|
CPT 49320
|
| Hospital Charge Code |
Z12663
|
| Min. Negotiated Rate |
$294.48 |
| Max. Negotiated Rate |
$706.75 |
| Rate for Payer: Aetna Medicare |
$301.84
|
| Rate for Payer: Anthem Exchange |
$442.70
|
| Rate for Payer: Anthem Medicare |
$301.84
|
| Rate for Payer: Anthem PPO |
$442.70
|
| Rate for Payer: Anthem Traditional |
$442.70
|
| Rate for Payer: Caresource Just 4 Me |
$347.12
|
| Rate for Payer: Caresource Medicare |
$332.02
|
| Rate for Payer: Centivo/Paragon All Products |
$467.85
|
| Rate for Payer: Coventry/First Health All Products |
$706.75
|
| Rate for Payer: Frontpath All Products |
$431.85
|
| Rate for Payer: Humana ChoiceCare |
$588.96
|
| Rate for Payer: Humana Medicare |
$301.84
|
| Rate for Payer: Lucent/Coldwater Veneers |
$513.13
|
| Rate for Payer: Lutheran Preferred All Products |
$453.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$441.72
|
| Rate for Payer: PHP All Products |
$515.34
|
| Rate for Payer: Plain Church Group Ministry All Products |
$301.84
|
| Rate for Payer: Signature Care EPO |
$445.40
|
| Rate for Payer: Signature Care PPO |
$445.40
|
| Rate for Payer: Three Rivers Preferred All Products |
$423.00
|
| Rate for Payer: United Healthcare Commercial |
$352.56
|
| Rate for Payer: United Healthcare Medicare |
$294.48
|
|
|
PR LAP,DX SURGICAL ABD W/BIOPSY
|
Professional
|
$618.46
|
|
|
Service Code
|
CPT 49321
|
| Hospital Charge Code |
Z12664
|
| Min. Negotiated Rate |
$309.23 |
| Max. Negotiated Rate |
$742.15 |
| Rate for Payer: Aetna Medicare |
$316.96
|
| Rate for Payer: Anthem Exchange |
$471.80
|
| Rate for Payer: Anthem Medicare |
$316.96
|
| Rate for Payer: Anthem PPO |
$471.80
|
| Rate for Payer: Anthem Traditional |
$471.80
|
| Rate for Payer: Caresource Just 4 Me |
$364.50
|
| Rate for Payer: Caresource Medicare |
$348.66
|
| Rate for Payer: Centivo/Paragon All Products |
$491.29
|
| Rate for Payer: Coventry/First Health All Products |
$742.15
|
| Rate for Payer: Frontpath All Products |
$452.48
|
| Rate for Payer: Humana ChoiceCare |
$618.46
|
| Rate for Payer: Humana Medicare |
$316.96
|
| Rate for Payer: Lucent/Coldwater Veneers |
$538.83
|
| Rate for Payer: Lutheran Preferred All Products |
$475.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$463.85
|
| Rate for Payer: PHP All Products |
$541.15
|
| Rate for Payer: Plain Church Group Ministry All Products |
$316.96
|
| Rate for Payer: Signature Care EPO |
$464.10
|
| Rate for Payer: Signature Care PPO |
$464.10
|
| Rate for Payer: Three Rivers Preferred All Products |
$444.00
|
| Rate for Payer: United Healthcare Commercial |
$371.16
|
| Rate for Payer: United Healthcare Medicare |
$309.23
|
|
|
PR LAP,FULGURATE/EXCISE LESIONS
|
Professional
|
$1,299.02
|
|
|
Service Code
|
CPT 58662
|
| Hospital Charge Code |
Z12774
|
| Min. Negotiated Rate |
$649.51 |
| Max. Negotiated Rate |
$1,558.82 |
| Rate for Payer: Aetna Medicare |
$665.75
|
| Rate for Payer: Anthem Exchange |
$930.03
|
| Rate for Payer: Anthem Medicare |
$665.75
|
| Rate for Payer: Anthem PPO |
$930.03
|
| Rate for Payer: Anthem Traditional |
$930.03
|
| Rate for Payer: Caresource Just 4 Me |
$765.61
|
| Rate for Payer: Caresource Medicare |
$732.33
|
| Rate for Payer: Centivo/Paragon All Products |
$1,031.91
|
| Rate for Payer: Coventry/First Health All Products |
$1,558.82
|
| Rate for Payer: Frontpath All Products |
$932.63
|
| Rate for Payer: Humana ChoiceCare |
$1,299.02
|
| Rate for Payer: Humana Medicare |
$665.75
|
| Rate for Payer: Lucent/Coldwater Veneers |
$1,131.77
|
| Rate for Payer: Lutheran Preferred All Products |
$932.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$974.26
|
| Rate for Payer: PHP All Products |
$857.36
|
| Rate for Payer: Plain Church Group Ministry All Products |
$665.75
|
| Rate for Payer: Signature Care EPO |
$879.75
|
| Rate for Payer: Signature Care PPO |
$879.75
|
| Rate for Payer: Three Rivers Preferred All Products |
$865.00
|
| Rate for Payer: United Healthcare Commercial |
$797.19
|
| Rate for Payer: United Healthcare Medicare |
$649.51
|
|
|
PR LAP,HERNIA REPAIR PROC,UNLIST
|
Professional
|
$735.00
|
|
|
Service Code
|
CPT 49659
|
| Hospital Charge Code |
Z12674
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$882.00 |
| Rate for Payer: Anthem Exchange |
$0.01
|
| Rate for Payer: Anthem PPO |
$0.01
|
| Rate for Payer: Anthem Traditional |
$0.01
|
| Rate for Payer: Coventry/First Health All Products |
$882.00
|
| Rate for Payer: Humana ChoiceCare |
$735.00
|
| Rate for Payer: Lutheran Preferred All Products |
$624.75
|
| Rate for Payer: PHCS/Multiplan All Products |
$551.25
|
| Rate for Payer: Signature Care EPO |
$468.56
|
| Rate for Payer: Signature Care PPO |
$468.56
|
| Rate for Payer: Three Rivers Preferred All Products |
$441.00
|
|
|
PR LAP,INGUINAL HERNIA REPR,INITIAL
|
Professional
|
$1,551.04
|
|
|
Service Code
|
CPT 49650
|
| Hospital Charge Code |
Z12672
|
| Min. Negotiated Rate |
$387.76 |
| Max. Negotiated Rate |
$1,861.25 |
| Rate for Payer: Aetna Medicare |
$397.46
|
| Rate for Payer: Anthem Exchange |
$516.40
|
| Rate for Payer: Anthem Medicare |
$397.46
|
| Rate for Payer: Anthem PPO |
$516.40
|
| Rate for Payer: Anthem Traditional |
$516.40
|
| Rate for Payer: Caresource Just 4 Me |
$457.08
|
| Rate for Payer: Caresource Medicare |
$437.21
|
| Rate for Payer: Centivo/Paragon All Products |
$616.06
|
| Rate for Payer: Coventry/First Health All Products |
$1,861.25
|
| Rate for Payer: Frontpath All Products |
$569.58
|
| Rate for Payer: Humana ChoiceCare |
$1,551.04
|
| Rate for Payer: Humana Medicare |
$397.46
|
| Rate for Payer: Lucent/Coldwater Veneers |
$675.68
|
| Rate for Payer: Lutheran Preferred All Products |
$596.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$1,163.28
|
| Rate for Payer: PHP All Products |
$678.59
|
| Rate for Payer: Plain Church Group Ministry All Products |
$397.46
|
| Rate for Payer: Signature Care EPO |
$548.25
|
| Rate for Payer: Signature Care PPO |
$548.25
|
| Rate for Payer: Three Rivers Preferred All Products |
$556.00
|
| Rate for Payer: United Healthcare Commercial |
$448.61
|
| Rate for Payer: United Healthcare Medicare |
$387.76
|
|
|
PR LAP,INGUINAL HERNIA REPR,INITIAL
|
Professional
|
$775.52
|
|
|
Service Code
|
CPT 49650
|
| Hospital Charge Code |
Z12671
|
| Min. Negotiated Rate |
$387.76 |
| Max. Negotiated Rate |
$930.62 |
| Rate for Payer: Aetna Medicare |
$397.46
|
| Rate for Payer: Anthem Exchange |
$516.40
|
| Rate for Payer: Anthem Medicare |
$397.46
|
| Rate for Payer: Anthem PPO |
$516.40
|
| Rate for Payer: Anthem Traditional |
$516.40
|
| Rate for Payer: Caresource Just 4 Me |
$457.08
|
| Rate for Payer: Caresource Medicare |
$437.21
|
| Rate for Payer: Centivo/Paragon All Products |
$616.06
|
| Rate for Payer: Coventry/First Health All Products |
$930.62
|
| Rate for Payer: Frontpath All Products |
$569.58
|
| Rate for Payer: Humana ChoiceCare |
$775.52
|
| Rate for Payer: Humana Medicare |
$397.46
|
| Rate for Payer: Lucent/Coldwater Veneers |
$675.68
|
| Rate for Payer: Lutheran Preferred All Products |
$596.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$581.64
|
| Rate for Payer: PHP All Products |
$678.59
|
| Rate for Payer: Plain Church Group Ministry All Products |
$397.46
|
| Rate for Payer: Signature Care EPO |
$548.25
|
| Rate for Payer: Signature Care PPO |
$548.25
|
| Rate for Payer: Three Rivers Preferred All Products |
$556.00
|
| Rate for Payer: United Healthcare Commercial |
$448.61
|
| Rate for Payer: United Healthcare Medicare |
$387.76
|
|
|
PR LAP,INGUINAL HERNIA REPR,RECUR
|
Professional
|
$1,012.16
|
|
|
Service Code
|
CPT 49651
|
| Hospital Charge Code |
Z12673
|
| Min. Negotiated Rate |
$506.08 |
| Max. Negotiated Rate |
$1,214.59 |
| Rate for Payer: Aetna Medicare |
$518.74
|
| Rate for Payer: Anthem Exchange |
$662.20
|
| Rate for Payer: Anthem Medicare |
$518.74
|
| Rate for Payer: Anthem PPO |
$662.20
|
| Rate for Payer: Anthem Traditional |
$662.20
|
| Rate for Payer: Caresource Just 4 Me |
$596.55
|
| Rate for Payer: Caresource Medicare |
$570.61
|
| Rate for Payer: Centivo/Paragon All Products |
$804.05
|
| Rate for Payer: Coventry/First Health All Products |
$1,214.59
|
| Rate for Payer: Frontpath All Products |
$744.30
|
| Rate for Payer: Humana ChoiceCare |
$1,012.16
|
| Rate for Payer: Humana Medicare |
$518.74
|
| Rate for Payer: Lucent/Coldwater Veneers |
$881.86
|
| Rate for Payer: Lutheran Preferred All Products |
$778.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$759.12
|
| Rate for Payer: PHP All Products |
$885.65
|
| Rate for Payer: Plain Church Group Ministry All Products |
$518.74
|
| Rate for Payer: Signature Care EPO |
$712.30
|
| Rate for Payer: Signature Care PPO |
$712.30
|
| Rate for Payer: Three Rivers Preferred All Products |
$726.00
|
| Rate for Payer: United Healthcare Commercial |
$580.41
|
| Rate for Payer: United Healthcare Medicare |
$506.08
|
|
|
PR LAP INSERTION TUNNELED INTRAPERITONEAL CATHETER
|
Professional
|
$689.76
|
|
|
Service Code
|
CPT 49324
|
| Hospital Charge Code |
Z12666
|
| Min. Negotiated Rate |
$344.88 |
| Max. Negotiated Rate |
$827.71 |
| Rate for Payer: Aetna Medicare |
$353.50
|
| Rate for Payer: Anthem Exchange |
$528.02
|
| Rate for Payer: Anthem Medicare |
$353.50
|
| Rate for Payer: Anthem PPO |
$528.02
|
| Rate for Payer: Anthem Traditional |
$528.02
|
| Rate for Payer: Caresource Just 4 Me |
$406.52
|
| Rate for Payer: Caresource Medicare |
$388.85
|
| Rate for Payer: Centivo/Paragon All Products |
$547.93
|
| Rate for Payer: Coventry/First Health All Products |
$827.71
|
| Rate for Payer: Frontpath All Products |
$512.59
|
| Rate for Payer: Humana ChoiceCare |
$689.76
|
| Rate for Payer: Humana Medicare |
$353.50
|
| Rate for Payer: Lucent/Coldwater Veneers |
$600.95
|
| Rate for Payer: Lutheran Preferred All Products |
$530.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$517.32
|
| Rate for Payer: PHP All Products |
$603.54
|
| Rate for Payer: Plain Church Group Ministry All Products |
$353.50
|
| Rate for Payer: Signature Care EPO |
$484.50
|
| Rate for Payer: Signature Care PPO |
$484.50
|
| Rate for Payer: Three Rivers Preferred All Products |
$495.00
|
| Rate for Payer: United Healthcare Commercial |
$420.34
|
| Rate for Payer: United Healthcare Medicare |
$344.88
|
|
|
PR LAP,LYMPH NODE BX
|
Professional
|
$932.80
|
|
|
Service Code
|
CPT 38570
|
| Hospital Charge Code |
Z12554
|
| Min. Negotiated Rate |
$466.40 |
| Max. Negotiated Rate |
$1,119.36 |
| Rate for Payer: Aetna Medicare |
$478.06
|
| Rate for Payer: Anthem Exchange |
$741.00
|
| Rate for Payer: Anthem Medicare |
$478.06
|
| Rate for Payer: Anthem PPO |
$741.00
|
| Rate for Payer: Anthem Traditional |
$741.00
|
| Rate for Payer: Caresource Just 4 Me |
$549.77
|
| Rate for Payer: Caresource Medicare |
$525.87
|
| Rate for Payer: Centivo/Paragon All Products |
$740.99
|
| Rate for Payer: Coventry/First Health All Products |
$1,119.36
|
| Rate for Payer: Frontpath All Products |
$671.16
|
| Rate for Payer: Humana ChoiceCare |
$932.80
|
| Rate for Payer: Humana Medicare |
$478.06
|
| Rate for Payer: Lucent/Coldwater Veneers |
$812.70
|
| Rate for Payer: Lutheran Preferred All Products |
$765.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$699.60
|
| Rate for Payer: PHP All Products |
$652.95
|
| Rate for Payer: Plain Church Group Ministry All Products |
$478.06
|
| Rate for Payer: Signature Care EPO |
$708.05
|
| Rate for Payer: Signature Care PPO |
$708.05
|
| Rate for Payer: Three Rivers Preferred All Products |
$717.00
|
| Rate for Payer: United Healthcare Commercial |
$623.95
|
| Rate for Payer: United Healthcare Medicare |
$466.40
|
|
