|
PR LAP,LYSIS OF ADHESIONS
|
Professional
|
$1,238.38
|
|
|
Service Code
|
CPT 58660
|
| Hospital Charge Code |
Z12772
|
| Min. Negotiated Rate |
$619.19 |
| Max. Negotiated Rate |
$1,486.06 |
| Rate for Payer: Aetna Medicare |
$634.36
|
| Rate for Payer: Anthem Exchange |
$878.14
|
| Rate for Payer: Anthem Medicare |
$634.36
|
| Rate for Payer: Anthem PPO |
$878.14
|
| Rate for Payer: Anthem Traditional |
$878.14
|
| Rate for Payer: Caresource Just 4 Me |
$729.51
|
| Rate for Payer: Caresource Medicare |
$697.80
|
| Rate for Payer: Centivo/Paragon All Products |
$983.26
|
| Rate for Payer: Coventry/First Health All Products |
$1,486.06
|
| Rate for Payer: Frontpath All Products |
$896.60
|
| Rate for Payer: Humana ChoiceCare |
$1,238.38
|
| Rate for Payer: Humana Medicare |
$634.36
|
| Rate for Payer: Lucent/Coldwater Veneers |
$1,078.41
|
| Rate for Payer: Lutheran Preferred All Products |
$888.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$928.79
|
| Rate for Payer: PHP All Products |
$817.33
|
| Rate for Payer: Plain Church Group Ministry All Products |
$634.36
|
| Rate for Payer: Signature Care EPO |
$885.70
|
| Rate for Payer: Signature Care PPO |
$885.70
|
| Rate for Payer: Three Rivers Preferred All Products |
$825.00
|
| Rate for Payer: United Healthcare Commercial |
$758.38
|
| Rate for Payer: United Healthcare Medicare |
$619.19
|
|
|
PR LAP,MYOMECTOMY 1-4,TOT WT 250 GMS
|
Professional
|
$1,643.28
|
|
|
Service Code
|
CPT 58545
|
| Hospital Charge Code |
Z12751
|
| Min. Negotiated Rate |
$821.64 |
| Max. Negotiated Rate |
$1,971.94 |
| Rate for Payer: Aetna Medicare |
$842.18
|
| Rate for Payer: Anthem Exchange |
$1,152.75
|
| Rate for Payer: Anthem Medicare |
$842.18
|
| Rate for Payer: Anthem PPO |
$1,152.75
|
| Rate for Payer: Anthem Traditional |
$1,152.75
|
| Rate for Payer: Caresource Just 4 Me |
$968.51
|
| Rate for Payer: Caresource Medicare |
$926.40
|
| Rate for Payer: Centivo/Paragon All Products |
$1,305.38
|
| Rate for Payer: Coventry/First Health All Products |
$1,971.94
|
| Rate for Payer: Frontpath All Products |
$1,182.99
|
| Rate for Payer: Humana ChoiceCare |
$1,643.28
|
| Rate for Payer: Humana Medicare |
$842.18
|
| Rate for Payer: Lucent/Coldwater Veneers |
$1,431.71
|
| Rate for Payer: Lutheran Preferred All Products |
$1,179.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$1,232.46
|
| Rate for Payer: PHP All Products |
$1,084.57
|
| Rate for Payer: Plain Church Group Ministry All Products |
$842.18
|
| Rate for Payer: Signature Care EPO |
$1,089.70
|
| Rate for Payer: Signature Care PPO |
$1,089.70
|
| Rate for Payer: Three Rivers Preferred All Products |
$1,095.00
|
| Rate for Payer: United Healthcare Commercial |
$1,009.06
|
| Rate for Payer: United Healthcare Medicare |
$821.64
|
|
|
PR LAP,MYOMECTOMY 5/>,TOTAL WT >250 GMS
|
Professional
|
$2,033.20
|
|
|
Service Code
|
CPT 58546
|
| Hospital Charge Code |
Z12752
|
| Min. Negotiated Rate |
$1,016.60 |
| Max. Negotiated Rate |
$2,439.84 |
| Rate for Payer: Aetna Medicare |
$1,042.01
|
| Rate for Payer: Anthem Exchange |
$1,478.75
|
| Rate for Payer: Anthem Medicare |
$1,042.01
|
| Rate for Payer: Anthem PPO |
$1,478.75
|
| Rate for Payer: Anthem Traditional |
$1,478.75
|
| Rate for Payer: Caresource Just 4 Me |
$1,198.31
|
| Rate for Payer: Caresource Medicare |
$1,146.21
|
| Rate for Payer: Centivo/Paragon All Products |
$1,615.12
|
| Rate for Payer: Coventry/First Health All Products |
$2,439.84
|
| Rate for Payer: Frontpath All Products |
$1,465.05
|
| Rate for Payer: Humana ChoiceCare |
$2,033.20
|
| Rate for Payer: Humana Medicare |
$1,042.01
|
| Rate for Payer: Lucent/Coldwater Veneers |
$1,771.42
|
| Rate for Payer: Lutheran Preferred All Products |
$1,459.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$1,524.90
|
| Rate for Payer: PHP All Products |
$1,341.91
|
| Rate for Payer: Plain Church Group Ministry All Products |
$1,042.01
|
| Rate for Payer: Signature Care EPO |
$1,388.90
|
| Rate for Payer: Signature Care PPO |
$1,388.90
|
| Rate for Payer: Three Rivers Preferred All Products |
$1,355.00
|
| Rate for Payer: United Healthcare Commercial |
$1,279.65
|
| Rate for Payer: United Healthcare Medicare |
$1,016.60
|
|
|
PR LAP,RMV ADNEXAL STRUCTURE
|
Professional
|
$1,190.24
|
|
|
Service Code
|
CPT 58661
|
| Hospital Charge Code |
Z12773
|
| Min. Negotiated Rate |
$595.12 |
| Max. Negotiated Rate |
$1,428.29 |
| Rate for Payer: Aetna Medicare |
$610.00
|
| Rate for Payer: Anthem Exchange |
$856.61
|
| Rate for Payer: Anthem Medicare |
$610.00
|
| Rate for Payer: Anthem PPO |
$856.61
|
| Rate for Payer: Anthem Traditional |
$856.61
|
| Rate for Payer: Caresource Just 4 Me |
$701.50
|
| Rate for Payer: Caresource Medicare |
$671.00
|
| Rate for Payer: Centivo/Paragon All Products |
$945.50
|
| Rate for Payer: Coventry/First Health All Products |
$1,428.29
|
| Rate for Payer: Frontpath All Products |
$855.58
|
| Rate for Payer: Humana ChoiceCare |
$1,190.24
|
| Rate for Payer: Humana Medicare |
$610.00
|
| Rate for Payer: Lucent/Coldwater Veneers |
$1,037.00
|
| Rate for Payer: Lutheran Preferred All Products |
$854.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$892.68
|
| Rate for Payer: PHP All Products |
$785.56
|
| Rate for Payer: Plain Church Group Ministry All Products |
$610.00
|
| Rate for Payer: Signature Care EPO |
$866.15
|
| Rate for Payer: Signature Care PPO |
$866.15
|
| Rate for Payer: Three Rivers Preferred All Products |
$793.00
|
| Rate for Payer: United Healthcare Commercial |
$729.39
|
| Rate for Payer: United Healthcare Medicare |
$595.12
|
|
|
PR LAP,SALPINGOSTOMY
|
Professional
|
$1,448.76
|
|
|
Service Code
|
CPT 58673
|
| Hospital Charge Code |
Z12776
|
| Min. Negotiated Rate |
$724.38 |
| Max. Negotiated Rate |
$1,738.51 |
| Rate for Payer: Aetna Medicare |
$742.49
|
| Rate for Payer: Anthem Exchange |
$1,076.88
|
| Rate for Payer: Anthem Medicare |
$742.49
|
| Rate for Payer: Anthem PPO |
$1,076.88
|
| Rate for Payer: Anthem Traditional |
$1,076.88
|
| Rate for Payer: Caresource Just 4 Me |
$853.86
|
| Rate for Payer: Caresource Medicare |
$816.74
|
| Rate for Payer: Centivo/Paragon All Products |
$1,150.86
|
| Rate for Payer: Coventry/First Health All Products |
$1,738.51
|
| Rate for Payer: Frontpath All Products |
$1,042.95
|
| Rate for Payer: Humana ChoiceCare |
$1,448.76
|
| Rate for Payer: Humana Medicare |
$742.49
|
| Rate for Payer: Lucent/Coldwater Veneers |
$1,262.23
|
| Rate for Payer: Lutheran Preferred All Products |
$1,039.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$1,086.57
|
| Rate for Payer: PHP All Products |
$956.19
|
| Rate for Payer: Plain Church Group Ministry All Products |
$742.49
|
| Rate for Payer: Signature Care EPO |
$1,020.00
|
| Rate for Payer: Signature Care PPO |
$1,020.00
|
| Rate for Payer: Three Rivers Preferred All Products |
$965.00
|
| Rate for Payer: United Healthcare Commercial |
$912.94
|
| Rate for Payer: United Healthcare Medicare |
$724.38
|
|
|
PR LAP,SPERMATIC CORD PROC,UNLIST
|
Professional
|
$735.00
|
|
|
Service Code
|
CPT 55559
|
| Hospital Charge Code |
Z12684
|
| 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,STOMACH,OTHER,W/O TUBE
|
Professional
|
$1,081.86
|
|
|
Service Code
|
CPT 43659
|
| Hospital Charge Code |
Z12596
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$1,298.23 |
| Rate for Payer: Anthem Exchange |
$0.01
|
| Rate for Payer: Anthem PPO |
$0.01
|
| Rate for Payer: Anthem Traditional |
$0.01
|
| Rate for Payer: Coventry/First Health All Products |
$1,298.23
|
| Rate for Payer: Humana ChoiceCare |
$1,081.86
|
| Rate for Payer: Lutheran Preferred All Products |
$919.58
|
| Rate for Payer: PHCS/Multiplan All Products |
$811.39
|
| Rate for Payer: Signature Care EPO |
$689.69
|
| Rate for Payer: Signature Care PPO |
$689.69
|
| Rate for Payer: Three Rivers Preferred All Products |
$649.12
|
|
|
PR LAP, SUPRACERVIAL HYSTERECTOMY, <250G
|
Professional
|
$1,337.90
|
|
|
Service Code
|
CPT 58541
|
| Hospital Charge Code |
Z12748
|
| Min. Negotiated Rate |
$668.95 |
| Max. Negotiated Rate |
$1,605.48 |
| Rate for Payer: Aetna Medicare |
$685.68
|
| Rate for Payer: Anthem Exchange |
$1,014.37
|
| Rate for Payer: Anthem Medicare |
$685.68
|
| Rate for Payer: Anthem PPO |
$1,014.37
|
| Rate for Payer: Anthem Traditional |
$1,014.37
|
| Rate for Payer: Caresource Just 4 Me |
$788.53
|
| Rate for Payer: Caresource Medicare |
$754.25
|
| Rate for Payer: Centivo/Paragon All Products |
$1,062.80
|
| Rate for Payer: Coventry/First Health All Products |
$1,605.48
|
| Rate for Payer: Frontpath All Products |
$955.29
|
| Rate for Payer: Humana ChoiceCare |
$1,337.90
|
| Rate for Payer: Humana Medicare |
$685.68
|
| Rate for Payer: Lucent/Coldwater Veneers |
$1,165.66
|
| Rate for Payer: Lutheran Preferred All Products |
$960.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$1,003.43
|
| Rate for Payer: PHP All Products |
$883.02
|
| Rate for Payer: Plain Church Group Ministry All Products |
$685.68
|
| Rate for Payer: Signature Care EPO |
$950.30
|
| Rate for Payer: Signature Care PPO |
$950.30
|
| Rate for Payer: Three Rivers Preferred All Products |
$891.00
|
| Rate for Payer: United Healthcare Commercial |
$965.86
|
| Rate for Payer: United Healthcare Medicare |
$668.95
|
|
|
PR LAP, SUPRACERVIAL HYSTERECTOMY W/ TUBE&OV, <250G
|
Professional
|
$1,519.30
|
|
|
Service Code
|
CPT 58542
|
| Hospital Charge Code |
Z12749
|
| Min. Negotiated Rate |
$759.65 |
| Max. Negotiated Rate |
$1,823.16 |
| Rate for Payer: Aetna Medicare |
$778.64
|
| Rate for Payer: Anthem Exchange |
$1,127.15
|
| Rate for Payer: Anthem Medicare |
$778.64
|
| Rate for Payer: Anthem PPO |
$1,127.15
|
| Rate for Payer: Anthem Traditional |
$1,127.15
|
| Rate for Payer: Caresource Just 4 Me |
$895.44
|
| Rate for Payer: Caresource Medicare |
$856.50
|
| Rate for Payer: Centivo/Paragon All Products |
$1,206.89
|
| Rate for Payer: Coventry/First Health All Products |
$1,823.16
|
| Rate for Payer: Frontpath All Products |
$1,090.32
|
| Rate for Payer: Humana ChoiceCare |
$1,519.30
|
| Rate for Payer: Humana Medicare |
$778.64
|
| Rate for Payer: Lucent/Coldwater Veneers |
$1,323.69
|
| Rate for Payer: Lutheran Preferred All Products |
$1,090.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$1,139.47
|
| Rate for Payer: PHP All Products |
$1,002.74
|
| Rate for Payer: Plain Church Group Ministry All Products |
$778.64
|
| Rate for Payer: Signature Care EPO |
$1,054.85
|
| Rate for Payer: Signature Care PPO |
$1,054.85
|
| Rate for Payer: Three Rivers Preferred All Products |
$1,012.00
|
| Rate for Payer: United Healthcare Commercial |
$1,073.58
|
| Rate for Payer: United Healthcare Medicare |
$759.65
|
|
|
PR LAP, SUPRACERVIAL HYSTERECTOMY W/ TUBE&OV, >250G
|
Professional
|
$1,659.14
|
|
|
Service Code
|
CPT 58544
|
| Hospital Charge Code |
Z12750
|
| Min. Negotiated Rate |
$829.57 |
| Max. Negotiated Rate |
$1,990.97 |
| Rate for Payer: Aetna Medicare |
$850.31
|
| Rate for Payer: Anthem Exchange |
$1,240.63
|
| Rate for Payer: Anthem Medicare |
$850.31
|
| Rate for Payer: Anthem PPO |
$1,240.63
|
| Rate for Payer: Anthem Traditional |
$1,240.63
|
| Rate for Payer: Caresource Just 4 Me |
$977.86
|
| Rate for Payer: Caresource Medicare |
$935.34
|
| Rate for Payer: Centivo/Paragon All Products |
$1,317.98
|
| Rate for Payer: Coventry/First Health All Products |
$1,990.97
|
| Rate for Payer: Frontpath All Products |
$1,189.51
|
| Rate for Payer: Humana ChoiceCare |
$1,659.14
|
| Rate for Payer: Humana Medicare |
$850.31
|
| Rate for Payer: Lucent/Coldwater Veneers |
$1,445.53
|
| Rate for Payer: Lutheran Preferred All Products |
$1,190.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$1,244.36
|
| Rate for Payer: PHP All Products |
$1,095.03
|
| Rate for Payer: Plain Church Group Ministry All Products |
$850.31
|
| Rate for Payer: Signature Care EPO |
$1,161.10
|
| Rate for Payer: Signature Care PPO |
$1,161.10
|
| Rate for Payer: Three Rivers Preferred All Products |
$1,105.00
|
| Rate for Payer: United Healthcare Commercial |
$1,180.03
|
| Rate for Payer: United Healthcare Medicare |
$829.57
|
|
|
PR LAP, SURG CLOSE ENTEROSTOMY RESECT ANAST
|
Professional
|
$2,956.26
|
|
|
Service Code
|
CPT 44227
|
| Hospital Charge Code |
Z12613
|
| Min. Negotiated Rate |
$1,478.13 |
| Max. Negotiated Rate |
$3,547.51 |
| Rate for Payer: Aetna Medicare |
$1,515.08
|
| Rate for Payer: Anthem Exchange |
$1,701.14
|
| Rate for Payer: Anthem Medicare |
$1,515.08
|
| Rate for Payer: Anthem PPO |
$1,701.14
|
| Rate for Payer: Anthem Traditional |
$1,701.14
|
| Rate for Payer: Caresource Just 4 Me |
$1,742.34
|
| Rate for Payer: Caresource Medicare |
$1,666.59
|
| Rate for Payer: Centivo/Paragon All Products |
$2,348.37
|
| Rate for Payer: Coventry/First Health All Products |
$3,547.51
|
| Rate for Payer: Frontpath All Products |
$2,185.07
|
| Rate for Payer: Humana ChoiceCare |
$2,956.26
|
| Rate for Payer: Humana Medicare |
$1,515.08
|
| Rate for Payer: Lucent/Coldwater Veneers |
$2,575.64
|
| Rate for Payer: Lutheran Preferred All Products |
$2,273.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$2,217.20
|
| Rate for Payer: PHP All Products |
$2,586.73
|
| Rate for Payer: Plain Church Group Ministry All Products |
$1,515.08
|
| Rate for Payer: Signature Care EPO |
$2,144.55
|
| Rate for Payer: Signature Care PPO |
$2,144.55
|
| Rate for Payer: Three Rivers Preferred All Products |
$2,121.00
|
| Rate for Payer: United Healthcare Commercial |
$1,799.50
|
| Rate for Payer: United Healthcare Medicare |
$1,478.13
|
|
|
PR LAP,SURG,COLECTOMY, PARTIAL, W/ANAST
|
Professional
|
$2,741.42
|
|
|
Service Code
|
CPT 44204
|
| Hospital Charge Code |
Z12609
|
| Min. Negotiated Rate |
$1,370.71 |
| Max. Negotiated Rate |
$3,289.70 |
| Rate for Payer: Aetna Medicare |
$1,405.14
|
| Rate for Payer: Anthem Exchange |
$1,752.70
|
| Rate for Payer: Anthem Medicare |
$1,405.14
|
| Rate for Payer: Anthem PPO |
$1,752.70
|
| Rate for Payer: Anthem Traditional |
$1,752.70
|
| Rate for Payer: Caresource Just 4 Me |
$1,615.91
|
| Rate for Payer: Caresource Medicare |
$1,545.65
|
| Rate for Payer: Centivo/Paragon All Products |
$2,177.97
|
| Rate for Payer: Coventry/First Health All Products |
$3,289.70
|
| Rate for Payer: Frontpath All Products |
$2,020.67
|
| Rate for Payer: Humana ChoiceCare |
$2,741.42
|
| Rate for Payer: Humana Medicare |
$1,405.14
|
| Rate for Payer: Lucent/Coldwater Veneers |
$2,388.74
|
| Rate for Payer: Lutheran Preferred All Products |
$2,108.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$2,056.07
|
| Rate for Payer: PHP All Products |
$2,398.75
|
| Rate for Payer: Plain Church Group Ministry All Products |
$1,405.14
|
| Rate for Payer: Signature Care EPO |
$2,038.30
|
| Rate for Payer: Signature Care PPO |
$2,038.30
|
| Rate for Payer: Three Rivers Preferred All Products |
$1,967.00
|
| Rate for Payer: United Healthcare Commercial |
$1,661.98
|
| Rate for Payer: United Healthcare Medicare |
$1,370.71
|
|
|
PR LAP,SURG,COLECTOMY,W/ANAST
|
Professional
|
$3,239.94
|
|
|
Service Code
|
CPT 44207
|
| Hospital Charge Code |
Z12611
|
| Min. Negotiated Rate |
$1,619.97 |
| Max. Negotiated Rate |
$3,887.93 |
| Rate for Payer: Aetna Medicare |
$1,660.46
|
| Rate for Payer: Anthem Exchange |
$1,915.30
|
| Rate for Payer: Anthem Medicare |
$1,660.46
|
| Rate for Payer: Anthem PPO |
$1,915.30
|
| Rate for Payer: Anthem Traditional |
$1,915.30
|
| Rate for Payer: Caresource Just 4 Me |
$1,909.53
|
| Rate for Payer: Caresource Medicare |
$1,826.51
|
| Rate for Payer: Centivo/Paragon All Products |
$2,573.71
|
| Rate for Payer: Coventry/First Health All Products |
$3,887.93
|
| Rate for Payer: Frontpath All Products |
$2,376.08
|
| Rate for Payer: Humana ChoiceCare |
$3,239.94
|
| Rate for Payer: Humana Medicare |
$1,660.46
|
| Rate for Payer: Lucent/Coldwater Veneers |
$2,822.78
|
| Rate for Payer: Lutheran Preferred All Products |
$2,491.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$2,429.95
|
| Rate for Payer: PHP All Products |
$2,834.94
|
| Rate for Payer: Plain Church Group Ministry All Products |
$1,660.46
|
| Rate for Payer: Signature Care EPO |
$2,391.90
|
| Rate for Payer: Signature Care PPO |
$2,391.90
|
| Rate for Payer: Three Rivers Preferred All Products |
$2,325.00
|
| Rate for Payer: United Healthcare Commercial |
$1,982.18
|
| Rate for Payer: United Healthcare Medicare |
$1,619.97
|
|
|
PR LAP,SURG,COLECTOMY,W/REMVL TERM ILEUM
|
Professional
|
$2,385.84
|
|
|
Service Code
|
CPT 44205
|
| Hospital Charge Code |
Z12610
|
| Min. Negotiated Rate |
$1,192.92 |
| Max. Negotiated Rate |
$2,863.01 |
| Rate for Payer: Aetna Medicare |
$1,222.75
|
| Rate for Payer: Anthem Exchange |
$1,551.90
|
| Rate for Payer: Anthem Medicare |
$1,222.75
|
| Rate for Payer: Anthem PPO |
$1,551.90
|
| Rate for Payer: Anthem Traditional |
$1,551.90
|
| Rate for Payer: Caresource Just 4 Me |
$1,406.16
|
| Rate for Payer: Caresource Medicare |
$1,345.03
|
| Rate for Payer: Centivo/Paragon All Products |
$1,895.26
|
| Rate for Payer: Coventry/First Health All Products |
$2,863.01
|
| Rate for Payer: Frontpath All Products |
$1,753.31
|
| Rate for Payer: Humana ChoiceCare |
$2,385.84
|
| Rate for Payer: Humana Medicare |
$1,222.75
|
| Rate for Payer: Lucent/Coldwater Veneers |
$2,078.67
|
| Rate for Payer: Lutheran Preferred All Products |
$1,834.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$1,789.38
|
| Rate for Payer: PHP All Products |
$2,087.62
|
| Rate for Payer: Plain Church Group Ministry All Products |
$1,222.75
|
| Rate for Payer: Signature Care EPO |
$1,806.25
|
| Rate for Payer: Signature Care PPO |
$1,806.25
|
| Rate for Payer: Three Rivers Preferred All Products |
$1,712.00
|
| Rate for Payer: United Healthcare Commercial |
$1,450.86
|
| Rate for Payer: United Healthcare Medicare |
$1,192.92
|
|
|
PR LAP,SURG,ENTERECTOMY,RESECT & ANAST
|
Professional
|
$2,470.68
|
|
|
Service Code
|
CPT 44202
|
| Hospital Charge Code |
Z12608
|
| Min. Negotiated Rate |
$1,235.34 |
| Max. Negotiated Rate |
$2,964.82 |
| Rate for Payer: Aetna Medicare |
$1,266.22
|
| Rate for Payer: Anthem Exchange |
$1,709.00
|
| Rate for Payer: Anthem Medicare |
$1,266.22
|
| Rate for Payer: Anthem PPO |
$1,709.00
|
| Rate for Payer: Anthem Traditional |
$1,709.00
|
| Rate for Payer: Caresource Just 4 Me |
$1,456.15
|
| Rate for Payer: Caresource Medicare |
$1,392.84
|
| Rate for Payer: Centivo/Paragon All Products |
$1,962.64
|
| Rate for Payer: Coventry/First Health All Products |
$2,964.82
|
| Rate for Payer: Frontpath All Products |
$1,830.63
|
| Rate for Payer: Humana ChoiceCare |
$2,470.68
|
| Rate for Payer: Humana Medicare |
$1,266.22
|
| Rate for Payer: Lucent/Coldwater Veneers |
$2,152.57
|
| Rate for Payer: Lutheran Preferred All Products |
$1,899.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$1,853.01
|
| Rate for Payer: PHP All Products |
$2,161.85
|
| Rate for Payer: Plain Church Group Ministry All Products |
$1,266.22
|
| Rate for Payer: Signature Care EPO |
$1,798.60
|
| Rate for Payer: Signature Care PPO |
$1,798.60
|
| Rate for Payer: Three Rivers Preferred All Products |
$1,773.00
|
| Rate for Payer: United Healthcare Commercial |
$1,487.74
|
| Rate for Payer: United Healthcare Medicare |
$1,235.34
|
|
|
PR LAP, SURG ENTEROLYSIS
|
Professional
|
$1,638.74
|
|
|
Service Code
|
CPT 44180
|
| Hospital Charge Code |
Z12607
|
| Min. Negotiated Rate |
$819.37 |
| Max. Negotiated Rate |
$1,966.49 |
| Rate for Payer: Aetna Medicare |
$839.85
|
| Rate for Payer: Anthem Exchange |
$944.63
|
| Rate for Payer: Anthem Medicare |
$839.85
|
| Rate for Payer: Anthem PPO |
$944.63
|
| Rate for Payer: Anthem Traditional |
$944.63
|
| Rate for Payer: Caresource Just 4 Me |
$965.83
|
| Rate for Payer: Caresource Medicare |
$923.84
|
| Rate for Payer: Centivo/Paragon All Products |
$1,301.77
|
| Rate for Payer: Coventry/First Health All Products |
$1,966.49
|
| Rate for Payer: Frontpath All Products |
$1,216.40
|
| Rate for Payer: Humana ChoiceCare |
$1,638.74
|
| Rate for Payer: Humana Medicare |
$839.85
|
| Rate for Payer: Lucent/Coldwater Veneers |
$1,427.74
|
| Rate for Payer: Lutheran Preferred All Products |
$1,260.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$1,229.06
|
| Rate for Payer: PHP All Products |
$1,433.89
|
| Rate for Payer: Plain Church Group Ministry All Products |
$839.85
|
| Rate for Payer: Signature Care EPO |
$1,190.85
|
| Rate for Payer: Signature Care PPO |
$1,190.85
|
| Rate for Payer: Three Rivers Preferred All Products |
$1,176.00
|
| Rate for Payer: United Healthcare Commercial |
$987.09
|
| Rate for Payer: United Healthcare Medicare |
$819.37
|
|
|
PR LAP, SURG MOBIL SPLENIC FL DUR PTL COLECTOMY
|
Professional
|
$331.40
|
|
|
Service Code
|
CPT 44213
|
| Hospital Charge Code |
Z12612
|
| Min. Negotiated Rate |
$165.70 |
| Max. Negotiated Rate |
$397.68 |
| Rate for Payer: Aetna Medicare |
$169.84
|
| Rate for Payer: Anthem Exchange |
$216.93
|
| Rate for Payer: Anthem Medicare |
$169.84
|
| Rate for Payer: Anthem PPO |
$216.93
|
| Rate for Payer: Anthem Traditional |
$216.93
|
| Rate for Payer: Caresource Just 4 Me |
$195.32
|
| Rate for Payer: Caresource Medicare |
$186.82
|
| Rate for Payer: Centivo/Paragon All Products |
$263.25
|
| Rate for Payer: Coventry/First Health All Products |
$397.68
|
| Rate for Payer: Frontpath All Products |
$246.28
|
| Rate for Payer: Humana ChoiceCare |
$331.40
|
| Rate for Payer: Humana Medicare |
$169.84
|
| Rate for Payer: Lucent/Coldwater Veneers |
$288.73
|
| Rate for Payer: Lutheran Preferred All Products |
$255.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$248.55
|
| Rate for Payer: PHP All Products |
$289.98
|
| Rate for Payer: Plain Church Group Ministry All Products |
$169.84
|
| Rate for Payer: Signature Care EPO |
$273.70
|
| Rate for Payer: Signature Care PPO |
$273.70
|
| Rate for Payer: Three Rivers Preferred All Products |
$238.00
|
| Rate for Payer: United Healthcare Commercial |
$211.06
|
| Rate for Payer: United Healthcare Medicare |
$165.70
|
|
|
PR LAP,TUBAL CAUTERY
|
Professional
|
$680.26
|
|
|
Service Code
|
CPT 58670
|
| Hospital Charge Code |
Z12775
|
| Min. Negotiated Rate |
$340.13 |
| Max. Negotiated Rate |
$816.31 |
| Rate for Payer: Aetna Medicare |
$348.63
|
| Rate for Payer: Anthem Exchange |
$466.97
|
| Rate for Payer: Anthem Medicare |
$348.63
|
| Rate for Payer: Anthem PPO |
$466.97
|
| Rate for Payer: Anthem Traditional |
$466.97
|
| Rate for Payer: Caresource Just 4 Me |
$400.92
|
| Rate for Payer: Caresource Medicare |
$383.49
|
| Rate for Payer: Centivo/Paragon All Products |
$540.38
|
| Rate for Payer: Coventry/First Health All Products |
$816.31
|
| Rate for Payer: Frontpath All Products |
$486.46
|
| Rate for Payer: Humana ChoiceCare |
$680.26
|
| Rate for Payer: Humana Medicare |
$348.63
|
| Rate for Payer: Lucent/Coldwater Veneers |
$592.67
|
| Rate for Payer: Lutheran Preferred All Products |
$488.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$510.19
|
| Rate for Payer: PHP All Products |
$448.97
|
| Rate for Payer: Plain Church Group Ministry All Products |
$348.63
|
| Rate for Payer: Signature Care EPO |
$471.75
|
| Rate for Payer: Signature Care PPO |
$471.75
|
| Rate for Payer: Three Rivers Preferred All Products |
$453.00
|
| Rate for Payer: United Healthcare Commercial |
$410.58
|
| Rate for Payer: United Healthcare Medicare |
$340.13
|
|
|
PR LAP,UTERUS,UNLISTED PROCEDURE
|
Professional
|
$2,157.53
|
|
|
Service Code
|
CPT 58578
|
| Hospital Charge Code |
Z12768
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$2,589.04 |
| 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 |
$2,589.04
|
| Rate for Payer: Humana ChoiceCare |
$2,157.53
|
| Rate for Payer: Lutheran Preferred All Products |
$1,833.90
|
| Rate for Payer: PHCS/Multiplan All Products |
$1,618.15
|
| Rate for Payer: Signature Care EPO |
$1,375.43
|
| Rate for Payer: Signature Care PPO |
$1,375.43
|
| Rate for Payer: Three Rivers Preferred All Products |
$1,294.52
|
|
|
PR LAP,VAG HYST,UTERUS >250GMS
|
Professional
|
$2,044.16
|
|
|
Service Code
|
CPT 58553
|
| Hospital Charge Code |
Z12755
|
| Min. Negotiated Rate |
$1,022.08 |
| Max. Negotiated Rate |
$2,452.99 |
| Rate for Payer: Aetna Medicare |
$1,047.63
|
| Rate for Payer: Anthem Exchange |
$1,478.75
|
| Rate for Payer: Anthem Medicare |
$1,047.63
|
| Rate for Payer: Anthem PPO |
$1,478.75
|
| Rate for Payer: Anthem Traditional |
$1,478.75
|
| Rate for Payer: Caresource Just 4 Me |
$1,204.77
|
| Rate for Payer: Caresource Medicare |
$1,152.39
|
| Rate for Payer: Centivo/Paragon All Products |
$1,623.83
|
| Rate for Payer: Coventry/First Health All Products |
$2,452.99
|
| Rate for Payer: Frontpath All Products |
$1,473.07
|
| Rate for Payer: Humana ChoiceCare |
$2,044.16
|
| Rate for Payer: Humana Medicare |
$1,047.63
|
| Rate for Payer: Lucent/Coldwater Veneers |
$1,780.97
|
| Rate for Payer: Lutheran Preferred All Products |
$1,467.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$1,533.12
|
| Rate for Payer: PHP All Products |
$1,349.15
|
| Rate for Payer: Plain Church Group Ministry All Products |
$1,047.63
|
| Rate for Payer: Signature Care EPO |
$1,382.10
|
| Rate for Payer: Signature Care PPO |
$1,382.10
|
| Rate for Payer: Three Rivers Preferred All Products |
$1,362.00
|
| Rate for Payer: United Healthcare Commercial |
$1,286.30
|
| Rate for Payer: United Healthcare Medicare |
$1,022.08
|
|
|
PR LAP,VAG HYST,UTERUS 250GMS/<
|
Professional
|
$1,610.30
|
|
|
Service Code
|
CPT 58550
|
| Hospital Charge Code |
Z12753
|
| Min. Negotiated Rate |
$805.15 |
| Max. Negotiated Rate |
$1,932.36 |
| Rate for Payer: Aetna Medicare |
$825.44
|
| Rate for Payer: Anthem Exchange |
$1,213.60
|
| Rate for Payer: Anthem Medicare |
$825.44
|
| Rate for Payer: Anthem PPO |
$1,213.60
|
| Rate for Payer: Anthem Traditional |
$1,213.60
|
| Rate for Payer: Caresource Just 4 Me |
$949.26
|
| Rate for Payer: Caresource Medicare |
$907.98
|
| Rate for Payer: Centivo/Paragon All Products |
$1,279.43
|
| Rate for Payer: Coventry/First Health All Products |
$1,932.36
|
| Rate for Payer: Frontpath All Products |
$1,156.18
|
| Rate for Payer: Humana ChoiceCare |
$1,610.30
|
| Rate for Payer: Humana Medicare |
$825.44
|
| Rate for Payer: Lucent/Coldwater Veneers |
$1,403.25
|
| Rate for Payer: Lutheran Preferred All Products |
$1,156.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$1,207.72
|
| Rate for Payer: PHP All Products |
$1,062.80
|
| Rate for Payer: Plain Church Group Ministry All Products |
$825.44
|
| Rate for Payer: Signature Care EPO |
$1,074.40
|
| Rate for Payer: Signature Care PPO |
$1,074.40
|
| Rate for Payer: Three Rivers Preferred All Products |
$1,073.00
|
| Rate for Payer: United Healthcare Commercial |
$995.59
|
| Rate for Payer: United Healthcare Medicare |
$805.15
|
|
|
PR LAP,VAG HYST,UTERUS >250GMS,SALP-OOPH
|
Professional
|
$2,377.46
|
|
|
Service Code
|
CPT 58554
|
| Hospital Charge Code |
Z12756
|
| Min. Negotiated Rate |
$1,188.73 |
| Max. Negotiated Rate |
$2,852.95 |
| Rate for Payer: Aetna Medicare |
$1,218.45
|
| Rate for Payer: Anthem Exchange |
$1,696.57
|
| Rate for Payer: Anthem Medicare |
$1,218.45
|
| Rate for Payer: Anthem PPO |
$1,696.57
|
| Rate for Payer: Anthem Traditional |
$1,696.57
|
| Rate for Payer: Caresource Just 4 Me |
$1,401.22
|
| Rate for Payer: Caresource Medicare |
$1,340.30
|
| Rate for Payer: Centivo/Paragon All Products |
$1,888.60
|
| Rate for Payer: Coventry/First Health All Products |
$2,852.95
|
| Rate for Payer: Frontpath All Products |
$1,712.85
|
| Rate for Payer: Humana ChoiceCare |
$2,377.46
|
| Rate for Payer: Humana Medicare |
$1,218.45
|
| Rate for Payer: Lucent/Coldwater Veneers |
$2,071.37
|
| Rate for Payer: Lutheran Preferred All Products |
$1,706.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$1,783.10
|
| Rate for Payer: PHP All Products |
$1,569.12
|
| Rate for Payer: Plain Church Group Ministry All Products |
$1,218.45
|
| Rate for Payer: Signature Care EPO |
$1,598.85
|
| Rate for Payer: Signature Care PPO |
$1,598.85
|
| Rate for Payer: Three Rivers Preferred All Products |
$1,584.00
|
| Rate for Payer: United Healthcare Commercial |
$1,474.61
|
| Rate for Payer: United Healthcare Medicare |
$1,188.73
|
|
|
PR LAP,VAG HYST,UTERUS 250GMS/<,SALP-OOPH
|
Professional
|
$1,791.24
|
|
|
Service Code
|
CPT 58552
|
| Hospital Charge Code |
Z12754
|
| Min. Negotiated Rate |
$895.62 |
| Max. Negotiated Rate |
$2,149.49 |
| Rate for Payer: Aetna Medicare |
$918.01
|
| Rate for Payer: Anthem Exchange |
$1,327.01
|
| Rate for Payer: Anthem Medicare |
$918.01
|
| Rate for Payer: Anthem PPO |
$1,327.01
|
| Rate for Payer: Anthem Traditional |
$1,327.01
|
| Rate for Payer: Caresource Just 4 Me |
$1,055.71
|
| Rate for Payer: Caresource Medicare |
$1,009.81
|
| Rate for Payer: Centivo/Paragon All Products |
$1,422.92
|
| Rate for Payer: Coventry/First Health All Products |
$2,149.49
|
| Rate for Payer: Frontpath All Products |
$1,285.15
|
| Rate for Payer: Humana ChoiceCare |
$1,791.24
|
| Rate for Payer: Humana Medicare |
$918.01
|
| Rate for Payer: Lucent/Coldwater Veneers |
$1,560.62
|
| Rate for Payer: Lutheran Preferred All Products |
$1,285.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$1,343.43
|
| Rate for Payer: PHP All Products |
$1,182.22
|
| Rate for Payer: Plain Church Group Ministry All Products |
$918.01
|
| Rate for Payer: Signature Care EPO |
$1,277.55
|
| Rate for Payer: Signature Care PPO |
$1,277.55
|
| Rate for Payer: Three Rivers Preferred All Products |
$1,193.00
|
| Rate for Payer: United Healthcare Commercial |
$1,099.54
|
| Rate for Payer: United Healthcare Medicare |
$895.62
|
|
|
PR LARYNGOSCOPY FLEXIBLE DIAGNOSTIC
|
Professional
|
$236.42
|
|
|
Service Code
|
CPT 31575
|
| Hospital Charge Code |
Z12517
|
| Min. Negotiated Rate |
$63.44 |
| Max. Negotiated Rate |
$283.70 |
| Rate for Payer: Aetna Medicare |
$63.44
|
| Rate for Payer: Anthem Exchange |
$145.26
|
| Rate for Payer: Anthem Medicare |
$63.44
|
| Rate for Payer: Anthem PPO |
$145.26
|
| Rate for Payer: Anthem Traditional |
$145.26
|
| Rate for Payer: Caresource Just 4 Me |
$72.96
|
| Rate for Payer: Caresource Medicare |
$69.78
|
| Rate for Payer: Centivo/Paragon All Products |
$98.33
|
| Rate for Payer: Coventry/First Health All Products |
$283.70
|
| Rate for Payer: Frontpath All Products |
$85.57
|
| Rate for Payer: Humana ChoiceCare |
$236.42
|
| Rate for Payer: Humana Medicare |
$63.44
|
| Rate for Payer: Lucent/Coldwater Veneers |
$107.85
|
| Rate for Payer: Lutheran Preferred All Products |
$101.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$177.31
|
| Rate for Payer: PHP All Products |
$86.64
|
| Rate for Payer: Plain Church Group Ministry All Products |
$63.44
|
| Rate for Payer: Signature Care EPO |
$154.70
|
| Rate for Payer: Signature Care PPO |
$154.70
|
| Rate for Payer: Three Rivers Preferred All Products |
$95.00
|
| Rate for Payer: United Healthcare Commercial |
$85.55
|
| Rate for Payer: United Healthcare Medicare |
$118.21
|
|
|
PR LARYNGOSCOPY,INDIRECT+INJECT CORD
|
Professional
|
$238.32
|
|
|
Service Code
|
CPT 31513
|
| Hospital Charge Code |
Z12516
|
| Min. Negotiated Rate |
$119.16 |
| Max. Negotiated Rate |
$285.98 |
| Rate for Payer: Aetna Medicare |
$122.14
|
| Rate for Payer: Anthem Exchange |
$193.70
|
| Rate for Payer: Anthem Medicare |
$122.14
|
| Rate for Payer: Anthem PPO |
$193.70
|
| Rate for Payer: Anthem Traditional |
$193.70
|
| Rate for Payer: Caresource Just 4 Me |
$140.46
|
| Rate for Payer: Caresource Medicare |
$134.35
|
| Rate for Payer: Centivo/Paragon All Products |
$189.32
|
| Rate for Payer: Coventry/First Health All Products |
$285.98
|
| Rate for Payer: Frontpath All Products |
$167.48
|
| Rate for Payer: Humana ChoiceCare |
$238.32
|
| Rate for Payer: Humana Medicare |
$122.14
|
| Rate for Payer: Lucent/Coldwater Veneers |
$207.64
|
| Rate for Payer: Lutheran Preferred All Products |
$195.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$178.74
|
| Rate for Payer: PHP All Products |
$166.82
|
| Rate for Payer: Plain Church Group Ministry All Products |
$122.14
|
| Rate for Payer: Signature Care EPO |
$190.40
|
| Rate for Payer: Signature Care PPO |
$190.40
|
| Rate for Payer: Three Rivers Preferred All Products |
$183.00
|
| Rate for Payer: United Healthcare Commercial |
$149.76
|
| Rate for Payer: United Healthcare Medicare |
$119.16
|
|
