|
PR LATERAL RETINACULAR RELEASE OPEN
|
Professional
|
$831.22
|
|
|
Service Code
|
CPT 27425
|
| Hospital Charge Code |
Z12348
|
| Min. Negotiated Rate |
$415.61 |
| Max. Negotiated Rate |
$997.46 |
| Rate for Payer: Aetna Medicare |
$426.00
|
| Rate for Payer: Anthem Medicare |
$426.00
|
| Rate for Payer: Caresource Just 4 Me |
$489.90
|
| Rate for Payer: Caresource Medicare |
$468.60
|
| Rate for Payer: Centivo/Paragon All Products |
$660.30
|
| Rate for Payer: Coventry/First Health All Products |
$997.46
|
| Rate for Payer: Frontpath All Products |
$586.52
|
| Rate for Payer: Humana ChoiceCare |
$831.22
|
| Rate for Payer: Humana Medicare |
$426.00
|
| Rate for Payer: Lucent/Coldwater Veneers |
$724.20
|
| Rate for Payer: PHCS/Multiplan All Products |
$623.41
|
| Rate for Payer: Plain Church Group Ministry All Products |
$426.00
|
| Rate for Payer: United Healthcare Commercial |
$468.04
|
| Rate for Payer: United Healthcare Medicare |
$415.61
|
|
|
PR LAYR CLOS WND FACE,FACIAL 2.5-5 CM
|
Professional
|
$579.04
|
|
|
Service Code
|
CPT 12052
|
| Hospital Charge Code |
Z12056
|
| Min. Negotiated Rate |
$186.55 |
| Max. Negotiated Rate |
$694.85 |
| Rate for Payer: Aetna Medicare |
$186.55
|
| Rate for Payer: Anthem Exchange |
$302.83
|
| Rate for Payer: Anthem Medicare |
$186.55
|
| Rate for Payer: Anthem PPO |
$302.83
|
| Rate for Payer: Anthem Traditional |
$302.83
|
| Rate for Payer: Caresource Just 4 Me |
$214.53
|
| Rate for Payer: Caresource Medicare |
$205.21
|
| Rate for Payer: Centivo/Paragon All Products |
$289.15
|
| Rate for Payer: Coventry/First Health All Products |
$694.85
|
| Rate for Payer: Frontpath All Products |
$252.64
|
| Rate for Payer: Humana ChoiceCare |
$579.04
|
| Rate for Payer: Humana Medicare |
$186.55
|
| Rate for Payer: Lucent/Coldwater Veneers |
$317.13
|
| Rate for Payer: Lutheran Preferred All Products |
$243.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$434.28
|
| Rate for Payer: PHP All Products |
$254.80
|
| Rate for Payer: Plain Church Group Ministry All Products |
$186.55
|
| Rate for Payer: Signature Care EPO |
$253.74
|
| Rate for Payer: Signature Care PPO |
$253.74
|
| Rate for Payer: Three Rivers Preferred All Products |
$224.00
|
| Rate for Payer: United Healthcare Commercial |
$227.29
|
| Rate for Payer: United Healthcare Medicare |
$289.52
|
|
|
PR LAYR CLOS WND FACE,FACIAL <2.5 CM
|
Professional
|
$519.48
|
|
|
Service Code
|
CPT 12051
|
| Hospital Charge Code |
Z12055
|
| Min. Negotiated Rate |
$158.19 |
| Max. Negotiated Rate |
$623.38 |
| Rate for Payer: Aetna Medicare |
$158.19
|
| Rate for Payer: Anthem Exchange |
$267.11
|
| Rate for Payer: Anthem Medicare |
$158.19
|
| Rate for Payer: Anthem PPO |
$267.11
|
| Rate for Payer: Anthem Traditional |
$267.11
|
| Rate for Payer: Caresource Just 4 Me |
$181.92
|
| Rate for Payer: Caresource Medicare |
$174.01
|
| Rate for Payer: Centivo/Paragon All Products |
$245.19
|
| Rate for Payer: Coventry/First Health All Products |
$623.38
|
| Rate for Payer: Frontpath All Products |
$214.38
|
| Rate for Payer: Humana ChoiceCare |
$519.48
|
| Rate for Payer: Humana Medicare |
$158.19
|
| Rate for Payer: Lucent/Coldwater Veneers |
$268.92
|
| Rate for Payer: Lutheran Preferred All Products |
$206.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$389.61
|
| Rate for Payer: PHP All Products |
$216.06
|
| Rate for Payer: Plain Church Group Ministry All Products |
$158.19
|
| Rate for Payer: Signature Care EPO |
$232.05
|
| Rate for Payer: Signature Care PPO |
$232.05
|
| Rate for Payer: Three Rivers Preferred All Products |
$190.00
|
| Rate for Payer: United Healthcare Commercial |
$193.81
|
| Rate for Payer: United Healthcare Medicare |
$259.74
|
|
|
PR LAYR CLOS WND FACE,FACIAL 5.1-7.5 CM
|
Professional
|
$667.02
|
|
|
Service Code
|
CPT 12053
|
| Hospital Charge Code |
Z12057
|
| Min. Negotiated Rate |
$201.08 |
| Max. Negotiated Rate |
$800.42 |
| Rate for Payer: Aetna Medicare |
$201.08
|
| Rate for Payer: Anthem Exchange |
$332.96
|
| Rate for Payer: Anthem Medicare |
$201.08
|
| Rate for Payer: Anthem PPO |
$332.96
|
| Rate for Payer: Anthem Traditional |
$332.96
|
| Rate for Payer: Caresource Just 4 Me |
$231.24
|
| Rate for Payer: Caresource Medicare |
$221.19
|
| Rate for Payer: Centivo/Paragon All Products |
$311.67
|
| Rate for Payer: Coventry/First Health All Products |
$800.42
|
| Rate for Payer: Frontpath All Products |
$272.79
|
| Rate for Payer: Humana ChoiceCare |
$667.02
|
| Rate for Payer: Humana Medicare |
$201.08
|
| Rate for Payer: Lucent/Coldwater Veneers |
$341.84
|
| Rate for Payer: Lutheran Preferred All Products |
$261.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$500.26
|
| Rate for Payer: PHP All Products |
$274.64
|
| Rate for Payer: Plain Church Group Ministry All Products |
$201.08
|
| Rate for Payer: Signature Care EPO |
$292.77
|
| Rate for Payer: Signature Care PPO |
$292.77
|
| Rate for Payer: Three Rivers Preferred All Products |
$241.00
|
| Rate for Payer: United Healthcare Commercial |
$231.38
|
| Rate for Payer: United Healthcare Medicare |
$333.51
|
|
|
PR LAYR CLOS WND REST BODY 12.6-20 CM
|
Professional
|
$754.50
|
|
|
Service Code
|
CPT 12045
|
| Hospital Charge Code |
Z12054
|
| Min. Negotiated Rate |
$254.25 |
| Max. Negotiated Rate |
$905.40 |
| Rate for Payer: Aetna Medicare |
$254.25
|
| Rate for Payer: Anthem Medicare |
$254.25
|
| Rate for Payer: Caresource Just 4 Me |
$292.39
|
| Rate for Payer: Caresource Medicare |
$279.68
|
| Rate for Payer: Centivo/Paragon All Products |
$394.09
|
| Rate for Payer: Coventry/First Health All Products |
$905.40
|
| Rate for Payer: Frontpath All Products |
$347.74
|
| Rate for Payer: Humana ChoiceCare |
$754.50
|
| Rate for Payer: Humana Medicare |
$254.25
|
| Rate for Payer: Lucent/Coldwater Veneers |
$432.22
|
| Rate for Payer: PHCS/Multiplan All Products |
$565.88
|
| Rate for Payer: PHP All Products |
$347.26
|
| Rate for Payer: Plain Church Group Ministry All Products |
$254.25
|
| Rate for Payer: Signature Care EPO |
$325.69
|
| Rate for Payer: Signature Care PPO |
$325.69
|
| Rate for Payer: United Healthcare Commercial |
$265.03
|
| Rate for Payer: United Healthcare Medicare |
$377.25
|
|
|
PR LAYR CLOS WND REST BODY <2.5 CM
|
Professional
|
$484.06
|
|
|
Service Code
|
CPT 12041
|
| Hospital Charge Code |
Z12051
|
| Min. Negotiated Rate |
$135.55 |
| Max. Negotiated Rate |
$580.87 |
| Rate for Payer: Aetna Medicare |
$135.55
|
| Rate for Payer: Anthem Exchange |
$248.62
|
| Rate for Payer: Anthem Medicare |
$135.55
|
| Rate for Payer: Anthem PPO |
$248.62
|
| Rate for Payer: Anthem Traditional |
$248.62
|
| Rate for Payer: Caresource Just 4 Me |
$155.88
|
| Rate for Payer: Caresource Medicare |
$149.11
|
| Rate for Payer: Centivo/Paragon All Products |
$210.10
|
| Rate for Payer: Coventry/First Health All Products |
$580.87
|
| Rate for Payer: Frontpath All Products |
$183.18
|
| Rate for Payer: Humana ChoiceCare |
$484.06
|
| Rate for Payer: Humana Medicare |
$135.55
|
| Rate for Payer: Lucent/Coldwater Veneers |
$230.44
|
| Rate for Payer: Lutheran Preferred All Products |
$176.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$363.05
|
| Rate for Payer: PHP All Products |
$185.36
|
| Rate for Payer: Plain Church Group Ministry All Products |
$135.55
|
| Rate for Payer: Signature Care EPO |
$212.92
|
| Rate for Payer: Signature Care PPO |
$212.92
|
| Rate for Payer: Three Rivers Preferred All Products |
$163.00
|
| Rate for Payer: United Healthcare Commercial |
$181.16
|
| Rate for Payer: United Healthcare Medicare |
$242.03
|
|
|
PR LAYR CLOS WND REST BODY 2.6-7.5 CM
|
Professional
|
$568.28
|
|
|
Service Code
|
CPT 12042
|
| Hospital Charge Code |
Z12052
|
| Min. Negotiated Rate |
$182.89 |
| Max. Negotiated Rate |
$681.94 |
| Rate for Payer: Aetna Medicare |
$182.89
|
| Rate for Payer: Anthem Exchange |
$289.93
|
| Rate for Payer: Anthem Medicare |
$182.89
|
| Rate for Payer: Anthem PPO |
$289.93
|
| Rate for Payer: Anthem Traditional |
$289.93
|
| Rate for Payer: Caresource Just 4 Me |
$210.32
|
| Rate for Payer: Caresource Medicare |
$201.18
|
| Rate for Payer: Centivo/Paragon All Products |
$283.48
|
| Rate for Payer: Coventry/First Health All Products |
$681.94
|
| Rate for Payer: Frontpath All Products |
$248.05
|
| Rate for Payer: Humana ChoiceCare |
$568.28
|
| Rate for Payer: Humana Medicare |
$182.89
|
| Rate for Payer: Lucent/Coldwater Veneers |
$310.91
|
| Rate for Payer: Lutheran Preferred All Products |
$238.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$426.21
|
| Rate for Payer: PHP All Products |
$249.80
|
| Rate for Payer: Plain Church Group Ministry All Products |
$182.89
|
| Rate for Payer: Signature Care EPO |
$249.53
|
| Rate for Payer: Signature Care PPO |
$249.53
|
| Rate for Payer: Three Rivers Preferred All Products |
$219.00
|
| Rate for Payer: United Healthcare Commercial |
$211.79
|
| Rate for Payer: United Healthcare Medicare |
$284.14
|
|
|
PR LAYR CLOS WND REST BODY 7.6-12.5 CMS
|
Professional
|
$697.60
|
|
|
Service Code
|
CPT 12044
|
| Hospital Charge Code |
Z12053
|
| Min. Negotiated Rate |
$199.15 |
| Max. Negotiated Rate |
$837.12 |
| Rate for Payer: Aetna Medicare |
$199.15
|
| Rate for Payer: Anthem Exchange |
$334.48
|
| Rate for Payer: Anthem Medicare |
$199.15
|
| Rate for Payer: Anthem PPO |
$334.48
|
| Rate for Payer: Anthem Traditional |
$334.48
|
| Rate for Payer: Caresource Just 4 Me |
$229.02
|
| Rate for Payer: Caresource Medicare |
$219.07
|
| Rate for Payer: Centivo/Paragon All Products |
$308.68
|
| Rate for Payer: Coventry/First Health All Products |
$837.12
|
| Rate for Payer: Frontpath All Products |
$272.28
|
| Rate for Payer: Humana ChoiceCare |
$697.60
|
| Rate for Payer: Humana Medicare |
$199.15
|
| Rate for Payer: Lucent/Coldwater Veneers |
$338.56
|
| Rate for Payer: Lutheran Preferred All Products |
$259.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$523.20
|
| Rate for Payer: PHP All Products |
$272.01
|
| Rate for Payer: Plain Church Group Ministry All Products |
$199.15
|
| Rate for Payer: Signature Care EPO |
$305.41
|
| Rate for Payer: Signature Care PPO |
$305.41
|
| Rate for Payer: Three Rivers Preferred All Products |
$239.00
|
| Rate for Payer: United Healthcare Commercial |
$228.39
|
| Rate for Payer: United Healthcare Medicare |
$348.80
|
|
|
PR LAYR CLOS WND TRUNK,ARM,LEG <2.5 CM
|
Professional
|
$482.24
|
|
|
Service Code
|
CPT 12031
|
| Hospital Charge Code |
Z12048
|
| Min. Negotiated Rate |
$141.57 |
| Max. Negotiated Rate |
$578.69 |
| Rate for Payer: Aetna Medicare |
$141.57
|
| Rate for Payer: Anthem Exchange |
$247.82
|
| Rate for Payer: Anthem Medicare |
$141.57
|
| Rate for Payer: Anthem PPO |
$247.82
|
| Rate for Payer: Anthem Traditional |
$247.82
|
| Rate for Payer: Caresource Just 4 Me |
$162.81
|
| Rate for Payer: Caresource Medicare |
$155.73
|
| Rate for Payer: Centivo/Paragon All Products |
$219.43
|
| Rate for Payer: Coventry/First Health All Products |
$578.69
|
| Rate for Payer: Frontpath All Products |
$191.41
|
| Rate for Payer: Humana ChoiceCare |
$482.24
|
| Rate for Payer: Humana Medicare |
$141.57
|
| Rate for Payer: Lucent/Coldwater Veneers |
$240.67
|
| Rate for Payer: Lutheran Preferred All Products |
$184.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$361.68
|
| Rate for Payer: PHP All Products |
$193.36
|
| Rate for Payer: Plain Church Group Ministry All Products |
$141.57
|
| Rate for Payer: Signature Care EPO |
$211.83
|
| Rate for Payer: Signature Care PPO |
$211.83
|
| Rate for Payer: Three Rivers Preferred All Products |
$170.00
|
| Rate for Payer: United Healthcare Commercial |
$169.05
|
| Rate for Payer: United Healthcare Medicare |
$241.12
|
|
|
PR LAYR CLOS WND TRUNK,ARM,LEG 2.6-7.5 CM
|
Professional
|
$556.42
|
|
|
Service Code
|
CPT 12032
|
| Hospital Charge Code |
Z12049
|
| Min. Negotiated Rate |
$177.43 |
| Max. Negotiated Rate |
$667.70 |
| Rate for Payer: Aetna Medicare |
$177.43
|
| Rate for Payer: Anthem Exchange |
$289.36
|
| Rate for Payer: Anthem Medicare |
$177.43
|
| Rate for Payer: Anthem PPO |
$289.36
|
| Rate for Payer: Anthem Traditional |
$289.36
|
| Rate for Payer: Caresource Just 4 Me |
$204.04
|
| Rate for Payer: Caresource Medicare |
$195.17
|
| Rate for Payer: Centivo/Paragon All Products |
$275.02
|
| Rate for Payer: Coventry/First Health All Products |
$667.70
|
| Rate for Payer: Frontpath All Products |
$238.80
|
| Rate for Payer: Humana ChoiceCare |
$556.42
|
| Rate for Payer: Humana Medicare |
$177.43
|
| Rate for Payer: Lucent/Coldwater Veneers |
$301.63
|
| Rate for Payer: Lutheran Preferred All Products |
$231.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$417.31
|
| Rate for Payer: PHP All Products |
$242.34
|
| Rate for Payer: Plain Church Group Ministry All Products |
$177.43
|
| Rate for Payer: Signature Care EPO |
$256.70
|
| Rate for Payer: Signature Care PPO |
$256.70
|
| Rate for Payer: Three Rivers Preferred All Products |
$213.00
|
| Rate for Payer: United Healthcare Commercial |
$207.63
|
| Rate for Payer: United Healthcare Medicare |
$278.21
|
|
|
PR LAYR CLOS WND TRUNK,ARM,LEG 7.6-12.5 CM
|
Professional
|
$611.32
|
|
|
Service Code
|
CPT 12034
|
| Hospital Charge Code |
Z12050
|
| Min. Negotiated Rate |
$191.36 |
| Max. Negotiated Rate |
$733.58 |
| Rate for Payer: Aetna Medicare |
$191.36
|
| Rate for Payer: Anthem Exchange |
$301.39
|
| Rate for Payer: Anthem Medicare |
$191.36
|
| Rate for Payer: Anthem PPO |
$301.39
|
| Rate for Payer: Anthem Traditional |
$301.39
|
| Rate for Payer: Caresource Just 4 Me |
$220.06
|
| Rate for Payer: Caresource Medicare |
$210.50
|
| Rate for Payer: Centivo/Paragon All Products |
$296.61
|
| Rate for Payer: Coventry/First Health All Products |
$733.58
|
| Rate for Payer: Frontpath All Products |
$261.33
|
| Rate for Payer: Humana ChoiceCare |
$611.32
|
| Rate for Payer: Humana Medicare |
$191.36
|
| Rate for Payer: Lucent/Coldwater Veneers |
$325.31
|
| Rate for Payer: Lutheran Preferred All Products |
$249.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$458.49
|
| Rate for Payer: PHP All Products |
$261.37
|
| Rate for Payer: Plain Church Group Ministry All Products |
$191.36
|
| Rate for Payer: Signature Care EPO |
$268.35
|
| Rate for Payer: Signature Care PPO |
$268.35
|
| Rate for Payer: Three Rivers Preferred All Products |
$230.00
|
| Rate for Payer: United Healthcare Commercial |
$217.51
|
| Rate for Payer: United Healthcare Medicare |
$305.66
|
|
|
PR LENGTH/SHORT LEG/ANKL TENDON,SINGLE
|
Professional
|
$1,200.08
|
|
|
Service Code
|
CPT 27685
|
| Hospital Charge Code |
Z12382
|
| Min. Negotiated Rate |
$438.46 |
| Max. Negotiated Rate |
$1,440.10 |
| Rate for Payer: Caresource Medicare |
$482.31
|
| Rate for Payer: Aetna Medicare |
$438.46
|
| Rate for Payer: Anthem Medicare |
$438.46
|
| Rate for Payer: Caresource Just 4 Me |
$504.23
|
| Rate for Payer: Centivo/Paragon All Products |
$679.61
|
| Rate for Payer: Coventry/First Health All Products |
$1,440.10
|
| Rate for Payer: Frontpath All Products |
$598.52
|
| Rate for Payer: Humana ChoiceCare |
$1,200.08
|
| Rate for Payer: Humana Medicare |
$438.46
|
| Rate for Payer: Lucent/Coldwater Veneers |
$745.38
|
| Rate for Payer: PHCS/Multiplan All Products |
$900.06
|
| Rate for Payer: PHP All Products |
$744.31
|
| Rate for Payer: Plain Church Group Ministry All Products |
$438.46
|
| Rate for Payer: Signature Care EPO |
$840.65
|
| Rate for Payer: Signature Care PPO |
$840.65
|
| Rate for Payer: United Healthcare Commercial |
$521.46
|
| Rate for Payer: United Healthcare Medicare |
$600.04
|
|
|
PR LIGATE FALLOPIAN TUBE
|
Professional
|
$679.06
|
|
|
Service Code
|
CPT 58600
|
| Hospital Charge Code |
Z12769
|
| Min. Negotiated Rate |
$339.53 |
| Max. Negotiated Rate |
$814.87 |
| Rate for Payer: Aetna Medicare |
$348.02
|
| Rate for Payer: Anthem Exchange |
$469.42
|
| Rate for Payer: Anthem Medicare |
$348.02
|
| Rate for Payer: Anthem PPO |
$469.42
|
| Rate for Payer: Anthem Traditional |
$469.42
|
| Rate for Payer: Caresource Just 4 Me |
$400.22
|
| Rate for Payer: Caresource Medicare |
$382.82
|
| Rate for Payer: Centivo/Paragon All Products |
$539.43
|
| Rate for Payer: Coventry/First Health All Products |
$814.87
|
| Rate for Payer: Frontpath All Products |
$484.82
|
| Rate for Payer: Humana ChoiceCare |
$679.06
|
| Rate for Payer: Humana Medicare |
$348.02
|
| Rate for Payer: Lucent/Coldwater Veneers |
$591.63
|
| Rate for Payer: Lutheran Preferred All Products |
$487.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$509.29
|
| Rate for Payer: PHP All Products |
$448.18
|
| Rate for Payer: Plain Church Group Ministry All Products |
$348.02
|
| Rate for Payer: Signature Care EPO |
$441.15
|
| Rate for Payer: Signature Care PPO |
$441.15
|
| Rate for Payer: Three Rivers Preferred All Products |
$452.00
|
| Rate for Payer: United Healthcare Commercial |
$407.83
|
| Rate for Payer: United Healthcare Medicare |
$339.53
|
|
|
PR LIGATE FALLOPIAN TUBE,POSTPARTUM
|
Professional
|
$617.10
|
|
|
Service Code
|
CPT 58605
|
| Hospital Charge Code |
Z12770
|
| Min. Negotiated Rate |
$308.55 |
| Max. Negotiated Rate |
$740.52 |
| Rate for Payer: Aetna Medicare |
$316.27
|
| Rate for Payer: Anthem Exchange |
$425.86
|
| Rate for Payer: Anthem Medicare |
$316.27
|
| Rate for Payer: Anthem PPO |
$425.86
|
| Rate for Payer: Anthem Traditional |
$425.86
|
| Rate for Payer: Caresource Just 4 Me |
$363.71
|
| Rate for Payer: Caresource Medicare |
$347.90
|
| Rate for Payer: Centivo/Paragon All Products |
$490.22
|
| Rate for Payer: Coventry/First Health All Products |
$740.52
|
| Rate for Payer: Frontpath All Products |
$441.94
|
| Rate for Payer: Humana ChoiceCare |
$617.10
|
| Rate for Payer: Humana Medicare |
$316.27
|
| Rate for Payer: Lucent/Coldwater Veneers |
$537.66
|
| Rate for Payer: Lutheran Preferred All Products |
$443.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$462.83
|
| Rate for Payer: PHP All Products |
$407.29
|
| Rate for Payer: Plain Church Group Ministry All Products |
$316.27
|
| Rate for Payer: Signature Care EPO |
$400.35
|
| Rate for Payer: Signature Care PPO |
$400.35
|
| Rate for Payer: Three Rivers Preferred All Products |
$411.00
|
| Rate for Payer: United Healthcare Commercial |
$370.58
|
| Rate for Payer: United Healthcare Medicare |
$308.55
|
|
|
PR LIGATION,FALLOPIAN TUBE W/C-SECTION
|
Professional
|
$137.46
|
|
|
Service Code
|
CPT 58611
|
| Hospital Charge Code |
Z12771
|
| Min. Negotiated Rate |
$68.73 |
| Max. Negotiated Rate |
$164.95 |
| Rate for Payer: Aetna Medicare |
$70.45
|
| Rate for Payer: Anthem Exchange |
$107.69
|
| Rate for Payer: Anthem Medicare |
$70.45
|
| Rate for Payer: Anthem PPO |
$107.69
|
| Rate for Payer: Anthem Traditional |
$107.69
|
| Rate for Payer: Caresource Just 4 Me |
$81.02
|
| Rate for Payer: Caresource Medicare |
$77.50
|
| Rate for Payer: Centivo/Paragon All Products |
$109.20
|
| Rate for Payer: Coventry/First Health All Products |
$164.95
|
| Rate for Payer: Frontpath All Products |
$99.63
|
| Rate for Payer: Humana ChoiceCare |
$137.46
|
| Rate for Payer: Humana Medicare |
$70.45
|
| Rate for Payer: Lucent/Coldwater Veneers |
$119.77
|
| Rate for Payer: Lutheran Preferred All Products |
$99.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$103.09
|
| Rate for Payer: PHP All Products |
$90.72
|
| Rate for Payer: Plain Church Group Ministry All Products |
$70.45
|
| Rate for Payer: Signature Care EPO |
$99.45
|
| Rate for Payer: Signature Care PPO |
$99.45
|
| Rate for Payer: Three Rivers Preferred All Products |
$92.00
|
| Rate for Payer: United Healthcare Commercial |
$89.28
|
| Rate for Payer: United Healthcare Medicare |
$68.73
|
|
|
PR LIGMT REVISION,KNEE,EXTRA-ARTIC
|
Professional
|
$1,293.36
|
|
|
Service Code
|
CPT 27427
|
| Hospital Charge Code |
Z12349
|
| Min. Negotiated Rate |
$646.68 |
| Max. Negotiated Rate |
$1,552.03 |
| Rate for Payer: Aetna Medicare |
$662.85
|
| Rate for Payer: Anthem Exchange |
$950.20
|
| Rate for Payer: Anthem Medicare |
$662.85
|
| Rate for Payer: Anthem PPO |
$950.20
|
| Rate for Payer: Anthem Traditional |
$950.20
|
| Rate for Payer: Caresource Just 4 Me |
$762.28
|
| Rate for Payer: Caresource Medicare |
$729.14
|
| Rate for Payer: Centivo/Paragon All Products |
$1,027.42
|
| Rate for Payer: Coventry/First Health All Products |
$1,552.03
|
| Rate for Payer: Frontpath All Products |
$923.65
|
| Rate for Payer: Humana ChoiceCare |
$1,293.36
|
| Rate for Payer: Humana Medicare |
$662.85
|
| Rate for Payer: Lucent/Coldwater Veneers |
$1,126.85
|
| Rate for Payer: Lutheran Preferred All Products |
$1,061.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$970.02
|
| Rate for Payer: PHP All Products |
$1,125.23
|
| Rate for Payer: Plain Church Group Ministry All Products |
$662.85
|
| Rate for Payer: Signature Care EPO |
$998.75
|
| Rate for Payer: Signature Care PPO |
$998.75
|
| Rate for Payer: Three Rivers Preferred All Products |
$994.00
|
| Rate for Payer: United Healthcare Commercial |
$775.06
|
| Rate for Payer: United Healthcare Medicare |
$646.68
|
|
|
PR LONG ARM CAST, ADULT
|
Professional
|
$38.92
|
|
|
Service Code
|
CPT Q4050
|
| Hospital Charge Code |
Z13289
|
| Min. Negotiated Rate |
$26.47 |
| Max. Negotiated Rate |
$46.70 |
| Rate for Payer: Coventry/First Health All Products |
$46.70
|
| Rate for Payer: Humana ChoiceCare |
$38.92
|
| Rate for Payer: PHCS/Multiplan All Products |
$29.19
|
| Rate for Payer: Signature Care EPO |
$26.47
|
| Rate for Payer: Signature Care PPO |
$26.47
|
|
|
PR LONG ARM CAST, PEDIATRIC
|
Professional
|
$33.41
|
|
|
Service Code
|
CPT Q4050
|
| Hospital Charge Code |
Z13290
|
| Min. Negotiated Rate |
$22.72 |
| Max. Negotiated Rate |
$40.09 |
| Rate for Payer: Coventry/First Health All Products |
$40.09
|
| Rate for Payer: Humana ChoiceCare |
$33.41
|
| Rate for Payer: PHCS/Multiplan All Products |
$25.06
|
| Rate for Payer: Signature Care EPO |
$22.72
|
| Rate for Payer: Signature Care PPO |
$22.72
|
|
|
PR LONG LEG CAST, ADULT
|
Professional
|
$81.84
|
|
|
Service Code
|
CPT Q4050
|
| Hospital Charge Code |
Z13293
|
| Min. Negotiated Rate |
$55.65 |
| Max. Negotiated Rate |
$98.21 |
| Rate for Payer: Coventry/First Health All Products |
$98.21
|
| Rate for Payer: Humana ChoiceCare |
$81.84
|
| Rate for Payer: PHCS/Multiplan All Products |
$61.38
|
| Rate for Payer: Signature Care EPO |
$55.65
|
| Rate for Payer: Signature Care PPO |
$55.65
|
|
|
PR LONG LEG CAST, PEDIATRIC
|
Professional
|
$55.38
|
|
|
Service Code
|
CPT Q4050
|
| Hospital Charge Code |
Z13294
|
| Min. Negotiated Rate |
$37.66 |
| Max. Negotiated Rate |
$66.46 |
| Rate for Payer: Coventry/First Health All Products |
$66.46
|
| Rate for Payer: Humana ChoiceCare |
$55.38
|
| Rate for Payer: PHCS/Multiplan All Products |
$41.54
|
| Rate for Payer: Signature Care EPO |
$37.66
|
| Rate for Payer: Signature Care PPO |
$37.66
|
|
|
PR LOUDNESS BALANCE TEST
|
Professional
|
$85.86
|
|
|
Service Code
|
CPT 92562
|
| Hospital Charge Code |
Z13046
|
| Min. Negotiated Rate |
$16.10 |
| Max. Negotiated Rate |
$103.03 |
| Rate for Payer: Aetna Medicare |
$44.00
|
| Rate for Payer: Anthem Exchange |
$16.10
|
| Rate for Payer: Anthem Medicare |
$44.00
|
| Rate for Payer: Anthem PPO |
$16.10
|
| Rate for Payer: Anthem Traditional |
$16.10
|
| Rate for Payer: Caresource Just 4 Me |
$50.60
|
| Rate for Payer: Caresource Medicare |
$48.40
|
| Rate for Payer: Centivo/Paragon All Products |
$68.20
|
| Rate for Payer: Coventry/First Health All Products |
$103.03
|
| Rate for Payer: Frontpath All Products |
$47.33
|
| Rate for Payer: Humana ChoiceCare |
$85.86
|
| Rate for Payer: Humana Medicare |
$44.00
|
| Rate for Payer: Lucent/Coldwater Veneers |
$74.80
|
| Rate for Payer: Lutheran Preferred All Products |
$57.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$64.39
|
| Rate for Payer: PHP All Products |
$62.24
|
| Rate for Payer: Plain Church Group Ministry All Products |
$44.00
|
| Rate for Payer: Signature Care EPO |
$36.30
|
| Rate for Payer: Signature Care PPO |
$36.30
|
| Rate for Payer: Three Rivers Preferred All Products |
$53.00
|
| Rate for Payer: United Healthcare Commercial |
$25.09
|
| Rate for Payer: United Healthcare Medicare |
$42.93
|
|
|
PR LYSIS ADNEXAL ADHESIONS
|
Professional
|
$1,641.28
|
|
|
Service Code
|
CPT 58740
|
| Hospital Charge Code |
Z12779
|
| Min. Negotiated Rate |
$820.64 |
| Max. Negotiated Rate |
$1,969.54 |
| Rate for Payer: Aetna Medicare |
$841.48
|
| Rate for Payer: Anthem Exchange |
$1,117.99
|
| Rate for Payer: Anthem Medicare |
$841.48
|
| Rate for Payer: Anthem PPO |
$1,117.99
|
| Rate for Payer: Anthem Traditional |
$1,117.99
|
| Rate for Payer: Caresource Just 4 Me |
$967.70
|
| Rate for Payer: Caresource Medicare |
$925.63
|
| Rate for Payer: Centivo/Paragon All Products |
$1,304.29
|
| Rate for Payer: Coventry/First Health All Products |
$1,969.54
|
| Rate for Payer: Frontpath All Products |
$1,182.57
|
| Rate for Payer: Humana ChoiceCare |
$1,641.28
|
| Rate for Payer: Humana Medicare |
$841.48
|
| Rate for Payer: Lucent/Coldwater Veneers |
$1,430.52
|
| Rate for Payer: Lutheran Preferred All Products |
$1,178.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$1,230.96
|
| Rate for Payer: PHP All Products |
$1,083.25
|
| Rate for Payer: Plain Church Group Ministry All Products |
$841.48
|
| Rate for Payer: Signature Care EPO |
$1,035.30
|
| Rate for Payer: Signature Care PPO |
$1,035.30
|
| Rate for Payer: Three Rivers Preferred All Products |
$1,094.00
|
| Rate for Payer: United Healthcare Commercial |
$983.49
|
| Rate for Payer: United Healthcare Medicare |
$820.64
|
|
|
PR LYSIS OF LABIAL LESION(S)
|
Professional
|
$336.34
|
|
|
Service Code
|
CPT 56441
|
| Hospital Charge Code |
Z12687
|
| Min. Negotiated Rate |
$145.21 |
| Max. Negotiated Rate |
$403.61 |
| Rate for Payer: Aetna Medicare |
$145.21
|
| Rate for Payer: Anthem Exchange |
$195.31
|
| Rate for Payer: Anthem Medicare |
$145.21
|
| Rate for Payer: Anthem PPO |
$195.31
|
| Rate for Payer: Anthem Traditional |
$195.31
|
| Rate for Payer: Caresource Just 4 Me |
$166.99
|
| Rate for Payer: Caresource Medicare |
$159.73
|
| Rate for Payer: Centivo/Paragon All Products |
$225.08
|
| Rate for Payer: Coventry/First Health All Products |
$403.61
|
| Rate for Payer: Frontpath All Products |
$199.78
|
| Rate for Payer: Humana ChoiceCare |
$336.34
|
| Rate for Payer: Humana Medicare |
$145.21
|
| Rate for Payer: Lucent/Coldwater Veneers |
$246.86
|
| Rate for Payer: Lutheran Preferred All Products |
$203.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$252.25
|
| Rate for Payer: PHP All Products |
$187.00
|
| Rate for Payer: Plain Church Group Ministry All Products |
$145.21
|
| Rate for Payer: Signature Care EPO |
$186.15
|
| Rate for Payer: Signature Care PPO |
$186.15
|
| Rate for Payer: Three Rivers Preferred All Products |
$189.00
|
| Rate for Payer: United Healthcare Commercial |
$158.85
|
| Rate for Payer: United Healthcare Medicare |
$168.17
|
|
|
PR MANIPULATE FINGER JT W/ ANESTH,EACH
|
Professional
|
$652.94
|
|
|
Service Code
|
CPT 26340
|
| Hospital Charge Code |
Z12271
|
| Min. Negotiated Rate |
$321.10 |
| Max. Negotiated Rate |
$783.53 |
| Rate for Payer: Caresource Just 4 Me |
$384.82
|
| Rate for Payer: Caresource Medicare |
$368.09
|
| Rate for Payer: Aetna Medicare |
$334.63
|
| Rate for Payer: Anthem Exchange |
$344.70
|
| Rate for Payer: Anthem Medicare |
$334.63
|
| Rate for Payer: Anthem PPO |
$344.70
|
| Rate for Payer: Anthem Traditional |
$344.70
|
| Rate for Payer: Centivo/Paragon All Products |
$518.68
|
| Rate for Payer: Coventry/First Health All Products |
$783.53
|
| Rate for Payer: Frontpath All Products |
$447.71
|
| Rate for Payer: Humana ChoiceCare |
$652.94
|
| Rate for Payer: Humana Medicare |
$334.63
|
| Rate for Payer: Lucent/Coldwater Veneers |
$568.87
|
| Rate for Payer: Lutheran Preferred All Products |
$535.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$489.71
|
| Rate for Payer: PHP All Products |
$568.05
|
| Rate for Payer: Plain Church Group Ministry All Products |
$334.63
|
| Rate for Payer: Signature Care EPO |
$408.85
|
| Rate for Payer: Signature Care PPO |
$408.85
|
| Rate for Payer: Three Rivers Preferred All Products |
$502.00
|
| Rate for Payer: United Healthcare Commercial |
$321.10
|
| Rate for Payer: United Healthcare Medicare |
$326.47
|
|
|
PR MANIPULATE WRIST W/ANESTHES
|
Professional
|
$794.86
|
|
|
Service Code
|
CPT 25259
|
| Hospital Charge Code |
Z12227
|
| Min. Negotiated Rate |
$397.43 |
| Max. Negotiated Rate |
$953.83 |
| Rate for Payer: Aetna Medicare |
$407.37
|
| Rate for Payer: Anthem Exchange |
$451.20
|
| Rate for Payer: Anthem Medicare |
$407.37
|
| Rate for Payer: Anthem PPO |
$451.20
|
| Rate for Payer: Anthem Traditional |
$451.20
|
| Rate for Payer: Caresource Just 4 Me |
$468.48
|
| Rate for Payer: Caresource Medicare |
$448.11
|
| Rate for Payer: Centivo/Paragon All Products |
$631.42
|
| Rate for Payer: Coventry/First Health All Products |
$953.83
|
| Rate for Payer: Frontpath All Products |
$550.54
|
| Rate for Payer: Humana ChoiceCare |
$794.86
|
| Rate for Payer: Humana Medicare |
$407.37
|
| Rate for Payer: Lucent/Coldwater Veneers |
$692.53
|
| Rate for Payer: Lutheran Preferred All Products |
$652.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$596.14
|
| Rate for Payer: PHP All Products |
$691.53
|
| Rate for Payer: Plain Church Group Ministry All Products |
$407.37
|
| Rate for Payer: Signature Care EPO |
$527.00
|
| Rate for Payer: Signature Care PPO |
$527.00
|
| Rate for Payer: Three Rivers Preferred All Products |
$611.00
|
| Rate for Payer: United Healthcare Commercial |
$411.35
|
| Rate for Payer: United Healthcare Medicare |
$397.43
|
|
