|
PR MANIPULATN KNEE JT+ANESTHESIA
|
Professional
|
$279.06
|
|
|
Service Code
|
CPT 27570
|
| Hospital Charge Code |
Z12373
|
| Min. Negotiated Rate |
$139.53 |
| Max. Negotiated Rate |
$334.87 |
| Rate for Payer: Aetna Medicare |
$143.01
|
| Rate for Payer: Anthem Exchange |
$196.00
|
| Rate for Payer: Anthem Medicare |
$143.01
|
| Rate for Payer: Anthem PPO |
$196.00
|
| Rate for Payer: Anthem Traditional |
$196.00
|
| Rate for Payer: Caresource Just 4 Me |
$164.46
|
| Rate for Payer: Caresource Medicare |
$157.31
|
| Rate for Payer: Centivo/Paragon All Products |
$221.67
|
| Rate for Payer: Coventry/First Health All Products |
$334.87
|
| Rate for Payer: Frontpath All Products |
$196.50
|
| Rate for Payer: Humana ChoiceCare |
$279.06
|
| Rate for Payer: Humana Medicare |
$143.01
|
| Rate for Payer: Lucent/Coldwater Veneers |
$243.12
|
| Rate for Payer: Lutheran Preferred All Products |
$229.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$209.30
|
| Rate for Payer: PHP All Products |
$242.77
|
| Rate for Payer: Plain Church Group Ministry All Products |
$143.01
|
| Rate for Payer: Signature Care EPO |
$205.70
|
| Rate for Payer: Signature Care PPO |
$205.70
|
| Rate for Payer: Three Rivers Preferred All Products |
$215.00
|
| Rate for Payer: United Healthcare Commercial |
$156.98
|
| Rate for Payer: United Healthcare Medicare |
$139.53
|
|
|
PR MANIPULATN SHLDR JT W ANESTHESIA
|
Professional
|
$356.70
|
|
|
Service Code
|
CPT 23700
|
| Hospital Charge Code |
Z12184
|
| Min. Negotiated Rate |
$178.35 |
| Max. Negotiated Rate |
$428.04 |
| Rate for Payer: Aetna Medicare |
$182.81
|
| Rate for Payer: Anthem Exchange |
$252.30
|
| Rate for Payer: Anthem Medicare |
$182.81
|
| Rate for Payer: Anthem PPO |
$252.30
|
| Rate for Payer: Anthem Traditional |
$252.30
|
| Rate for Payer: Caresource Just 4 Me |
$210.23
|
| Rate for Payer: Caresource Medicare |
$201.09
|
| Rate for Payer: Centivo/Paragon All Products |
$283.36
|
| Rate for Payer: Coventry/First Health All Products |
$428.04
|
| Rate for Payer: Frontpath All Products |
$253.67
|
| Rate for Payer: Humana ChoiceCare |
$356.70
|
| Rate for Payer: Humana Medicare |
$182.81
|
| Rate for Payer: Lucent/Coldwater Veneers |
$310.78
|
| Rate for Payer: Lutheran Preferred All Products |
$293.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$267.52
|
| Rate for Payer: PHP All Products |
$310.34
|
| Rate for Payer: Plain Church Group Ministry All Products |
$182.81
|
| Rate for Payer: Signature Care EPO |
$280.50
|
| Rate for Payer: Signature Care PPO |
$280.50
|
| Rate for Payer: Three Rivers Preferred All Products |
$274.00
|
| Rate for Payer: United Healthcare Commercial |
$209.16
|
| Rate for Payer: United Healthcare Medicare |
$178.35
|
|
|
PR MANUAL PREP&INSJ I-ARTIC DRUG DELIVERY DEVICE
|
Professional
|
$263.80
|
|
|
Service Code
|
CPT 20704
|
| Hospital Charge Code |
Z12142
|
| Min. Negotiated Rate |
$131.90 |
| Max. Negotiated Rate |
$316.56 |
| Rate for Payer: Aetna Medicare |
$135.20
|
| Rate for Payer: Anthem Exchange |
$135.72
|
| Rate for Payer: Anthem Medicare |
$135.20
|
| Rate for Payer: Anthem PPO |
$135.72
|
| Rate for Payer: Anthem Traditional |
$135.72
|
| Rate for Payer: Caresource Just 4 Me |
$155.48
|
| Rate for Payer: Caresource Medicare |
$148.72
|
| Rate for Payer: Centivo/Paragon All Products |
$209.56
|
| Rate for Payer: Coventry/First Health All Products |
$316.56
|
| Rate for Payer: Frontpath All Products |
$198.17
|
| Rate for Payer: Humana ChoiceCare |
$263.80
|
| Rate for Payer: Humana Medicare |
$135.20
|
| Rate for Payer: Lucent/Coldwater Veneers |
$229.84
|
| Rate for Payer: Lutheran Preferred All Products |
$216.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$197.85
|
| Rate for Payer: PHP All Products |
$184.66
|
| Rate for Payer: Plain Church Group Ministry All Products |
$135.20
|
| Rate for Payer: Signature Care EPO |
$197.12
|
| Rate for Payer: Signature Care PPO |
$197.12
|
| Rate for Payer: Three Rivers Preferred All Products |
$203.00
|
| Rate for Payer: United Healthcare Commercial |
$177.78
|
| Rate for Payer: United Healthcare Medicare |
$131.90
|
|
|
PR MASTECTOMY FOR GYNECOMASTIA
|
Professional
|
$2,105.88
|
|
|
Service Code
|
CPT 19300
|
| Hospital Charge Code |
Z12108
|
| Min. Negotiated Rate |
$400.25 |
| Max. Negotiated Rate |
$2,527.06 |
| Rate for Payer: Aetna Medicare |
$400.25
|
| Rate for Payer: Anthem Exchange |
$582.32
|
| Rate for Payer: Anthem Medicare |
$400.25
|
| Rate for Payer: Anthem PPO |
$582.32
|
| Rate for Payer: Anthem Traditional |
$582.32
|
| Rate for Payer: Caresource Just 4 Me |
$460.29
|
| Rate for Payer: Caresource Medicare |
$440.28
|
| Rate for Payer: Centivo/Paragon All Products |
$620.39
|
| Rate for Payer: Coventry/First Health All Products |
$2,527.06
|
| Rate for Payer: Frontpath All Products |
$561.14
|
| Rate for Payer: Humana ChoiceCare |
$2,105.88
|
| Rate for Payer: Humana Medicare |
$400.25
|
| Rate for Payer: Lucent/Coldwater Veneers |
$680.42
|
| Rate for Payer: Lutheran Preferred All Products |
$520.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$1,579.41
|
| Rate for Payer: PHP All Products |
$546.47
|
| Rate for Payer: Plain Church Group Ministry All Products |
$400.25
|
| Rate for Payer: Signature Care EPO |
$491.30
|
| Rate for Payer: Signature Care PPO |
$491.30
|
| Rate for Payer: Three Rivers Preferred All Products |
$480.00
|
| Rate for Payer: United Healthcare Commercial |
$408.26
|
| Rate for Payer: United Healthcare Medicare |
$526.47
|
|
|
PR MASTECTOMY FOR GYNECOMASTIA
|
Professional
|
$1,052.94
|
|
|
Service Code
|
CPT 19300
|
| Hospital Charge Code |
Z12107
|
| Min. Negotiated Rate |
$400.25 |
| Max. Negotiated Rate |
$1,263.53 |
| Rate for Payer: Aetna Medicare |
$400.25
|
| Rate for Payer: Anthem Exchange |
$582.32
|
| Rate for Payer: Anthem Medicare |
$400.25
|
| Rate for Payer: Anthem PPO |
$582.32
|
| Rate for Payer: Anthem Traditional |
$582.32
|
| Rate for Payer: Caresource Just 4 Me |
$460.29
|
| Rate for Payer: Caresource Medicare |
$440.28
|
| Rate for Payer: Centivo/Paragon All Products |
$620.39
|
| Rate for Payer: Coventry/First Health All Products |
$1,263.53
|
| Rate for Payer: Frontpath All Products |
$561.14
|
| Rate for Payer: Humana ChoiceCare |
$1,052.94
|
| Rate for Payer: Humana Medicare |
$400.25
|
| Rate for Payer: Lucent/Coldwater Veneers |
$680.42
|
| Rate for Payer: Lutheran Preferred All Products |
$520.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$789.71
|
| Rate for Payer: PHP All Products |
$546.47
|
| Rate for Payer: Plain Church Group Ministry All Products |
$400.25
|
| Rate for Payer: Signature Care EPO |
$491.30
|
| Rate for Payer: Signature Care PPO |
$491.30
|
| Rate for Payer: Three Rivers Preferred All Products |
$480.00
|
| Rate for Payer: United Healthcare Commercial |
$408.26
|
| Rate for Payer: United Healthcare Medicare |
$526.47
|
|
|
PR MASTECTOMY, PARTIAL
|
Professional
|
$1,179.88
|
|
|
Service Code
|
CPT 19301
|
| Hospital Charge Code |
Z12109
|
| Min. Negotiated Rate |
$490.65 |
| Max. Negotiated Rate |
$1,415.86 |
| Rate for Payer: Caresource Just 4 Me |
$695.58
|
| Rate for Payer: Caresource Medicare |
$665.34
|
| Rate for Payer: Aetna Medicare |
$604.85
|
| Rate for Payer: Anthem Exchange |
$490.65
|
| Rate for Payer: Anthem Medicare |
$604.85
|
| Rate for Payer: Anthem PPO |
$490.65
|
| Rate for Payer: Anthem Traditional |
$490.65
|
| Rate for Payer: Centivo/Paragon All Products |
$937.52
|
| Rate for Payer: Coventry/First Health All Products |
$1,415.86
|
| Rate for Payer: Frontpath All Products |
$870.80
|
| Rate for Payer: Humana ChoiceCare |
$1,179.88
|
| Rate for Payer: Humana Medicare |
$604.85
|
| Rate for Payer: Lucent/Coldwater Veneers |
$1,028.25
|
| Rate for Payer: Lutheran Preferred All Products |
$786.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$884.91
|
| Rate for Payer: PHP All Products |
$825.92
|
| Rate for Payer: Plain Church Group Ministry All Products |
$604.85
|
| Rate for Payer: Signature Care EPO |
$527.06
|
| Rate for Payer: Signature Care PPO |
$527.06
|
| Rate for Payer: Three Rivers Preferred All Products |
$726.00
|
| Rate for Payer: United Healthcare Commercial |
$655.51
|
| Rate for Payer: United Healthcare Medicare |
$589.94
|
|
|
PR MASTECTOMY,PARTIAL, WITH AXILLARY LYMPHADENECTOMY
|
Professional
|
$1,619.76
|
|
|
Service Code
|
CPT 19302
|
| Hospital Charge Code |
Z12110
|
| Min. Negotiated Rate |
$800.70 |
| Max. Negotiated Rate |
$1,943.71 |
| Rate for Payer: Aetna Medicare |
$830.14
|
| Rate for Payer: Anthem Exchange |
$948.64
|
| Rate for Payer: Anthem Medicare |
$830.14
|
| Rate for Payer: Anthem PPO |
$948.64
|
| Rate for Payer: Anthem Traditional |
$948.64
|
| Rate for Payer: Caresource Just 4 Me |
$954.66
|
| Rate for Payer: Caresource Medicare |
$913.15
|
| Rate for Payer: Centivo/Paragon All Products |
$1,286.72
|
| Rate for Payer: Coventry/First Health All Products |
$1,943.71
|
| Rate for Payer: Frontpath All Products |
$1,196.61
|
| Rate for Payer: Humana ChoiceCare |
$1,619.76
|
| Rate for Payer: Humana Medicare |
$830.14
|
| Rate for Payer: Lucent/Coldwater Veneers |
$1,411.24
|
| Rate for Payer: Lutheran Preferred All Products |
$1,079.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$1,214.82
|
| Rate for Payer: PHP All Products |
$1,133.83
|
| Rate for Payer: Plain Church Group Ministry All Products |
$830.14
|
| Rate for Payer: Signature Care EPO |
$800.70
|
| Rate for Payer: Signature Care PPO |
$800.70
|
| Rate for Payer: Three Rivers Preferred All Products |
$996.00
|
| Rate for Payer: United Healthcare Commercial |
$937.16
|
| Rate for Payer: United Healthcare Medicare |
$809.88
|
|
|
PR MASTECTOMY, SIMPLE, COMPLETE
|
Professional
|
$1,710.06
|
|
|
Service Code
|
CPT 19303
|
| Hospital Charge Code |
Z12111
|
| Min. Negotiated Rate |
$827.90 |
| Max. Negotiated Rate |
$2,052.07 |
| Rate for Payer: Aetna Medicare |
$876.40
|
| Rate for Payer: Anthem Exchange |
$980.90
|
| Rate for Payer: Anthem Medicare |
$876.40
|
| Rate for Payer: Anthem PPO |
$980.90
|
| Rate for Payer: Anthem Traditional |
$980.90
|
| Rate for Payer: Caresource Just 4 Me |
$1,007.86
|
| Rate for Payer: Caresource Medicare |
$964.04
|
| Rate for Payer: Centivo/Paragon All Products |
$1,358.42
|
| Rate for Payer: Coventry/First Health All Products |
$2,052.07
|
| Rate for Payer: Frontpath All Products |
$1,264.21
|
| Rate for Payer: Humana ChoiceCare |
$1,710.06
|
| Rate for Payer: Humana Medicare |
$876.40
|
| Rate for Payer: Lucent/Coldwater Veneers |
$1,489.88
|
| Rate for Payer: Lutheran Preferred All Products |
$1,139.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$1,282.55
|
| Rate for Payer: PHP All Products |
$1,197.04
|
| Rate for Payer: Plain Church Group Ministry All Products |
$876.40
|
| Rate for Payer: Signature Care EPO |
$827.90
|
| Rate for Payer: Signature Care PPO |
$827.90
|
| Rate for Payer: Three Rivers Preferred All Products |
$1,052.00
|
| Rate for Payer: United Healthcare Commercial |
$1,014.36
|
| Rate for Payer: United Healthcare Medicare |
$855.03
|
|
|
PR MD SERVICE REQUIRED FOR PMD
|
Professional
|
$60.00
|
|
|
Service Code
|
CPT G0372
|
| Hospital Charge Code |
Z13253
|
| Min. Negotiated Rate |
$8.19 |
| Max. Negotiated Rate |
$72.00 |
| Rate for Payer: Aetna Medicare |
$8.39
|
| Rate for Payer: Anthem Exchange |
$19.09
|
| Rate for Payer: Anthem Medicare |
$8.39
|
| Rate for Payer: Anthem PPO |
$19.09
|
| Rate for Payer: Anthem Traditional |
$19.09
|
| Rate for Payer: Caresource Just 4 Me |
$9.65
|
| Rate for Payer: Caresource Medicare |
$9.23
|
| Rate for Payer: Centivo/Paragon All Products |
$13.00
|
| Rate for Payer: Coventry/First Health All Products |
$72.00
|
| Rate for Payer: Humana ChoiceCare |
$60.00
|
| Rate for Payer: Humana Medicare |
$8.39
|
| Rate for Payer: Lucent/Coldwater Veneers |
$14.26
|
| Rate for Payer: PHCS/Multiplan All Products |
$45.00
|
| Rate for Payer: PHP All Products |
$8.19
|
| Rate for Payer: Plain Church Group Ministry All Products |
$8.39
|
| Rate for Payer: Signature Care EPO |
$38.25
|
| Rate for Payer: Signature Care PPO |
$38.25
|
| Rate for Payer: United Healthcare Commercial |
$10.00
|
|
|
PR MOBILIZE SPLENIC FLEX
|
Professional
|
$213.44
|
|
|
Service Code
|
CPT 44139
|
| Hospital Charge Code |
Z12601
|
| Min. Negotiated Rate |
$106.72 |
| Max. Negotiated Rate |
$256.13 |
| Rate for Payer: Aetna Medicare |
$109.39
|
| Rate for Payer: Anthem Exchange |
$164.60
|
| Rate for Payer: Anthem Medicare |
$109.39
|
| Rate for Payer: Anthem PPO |
$164.60
|
| Rate for Payer: Anthem Traditional |
$164.60
|
| Rate for Payer: Caresource Just 4 Me |
$125.80
|
| Rate for Payer: Caresource Medicare |
$120.33
|
| Rate for Payer: Centivo/Paragon All Products |
$169.55
|
| Rate for Payer: Coventry/First Health All Products |
$256.13
|
| Rate for Payer: Frontpath All Products |
$159.43
|
| Rate for Payer: Humana ChoiceCare |
$213.44
|
| Rate for Payer: Humana Medicare |
$109.39
|
| Rate for Payer: Lucent/Coldwater Veneers |
$185.96
|
| Rate for Payer: Lutheran Preferred All Products |
$164.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$160.08
|
| Rate for Payer: PHP All Products |
$186.76
|
| Rate for Payer: Plain Church Group Ministry All Products |
$109.39
|
| Rate for Payer: Signature Care EPO |
$174.25
|
| Rate for Payer: Signature Care PPO |
$174.25
|
| Rate for Payer: Three Rivers Preferred All Products |
$153.00
|
| Rate for Payer: United Healthcare Commercial |
$134.59
|
| Rate for Payer: United Healthcare Medicare |
$106.72
|
|
|
PR MOD SED OTHER PHYS/QHP INITIAL 15 MINS 5/> YRS
|
Professional
|
$139.46
|
|
|
Service Code
|
CPT 99156
|
| Hospital Charge Code |
Z13153
|
| Min. Negotiated Rate |
$69.73 |
| Max. Negotiated Rate |
$167.35 |
| Rate for Payer: Aetna Medicare |
$71.47
|
| Rate for Payer: Anthem Exchange |
$73.45
|
| Rate for Payer: Anthem Medicare |
$71.47
|
| Rate for Payer: Anthem PPO |
$73.45
|
| Rate for Payer: Anthem Traditional |
$73.45
|
| Rate for Payer: Caresource Just 4 Me |
$82.19
|
| Rate for Payer: Caresource Medicare |
$78.62
|
| Rate for Payer: Centivo/Paragon All Products |
$110.78
|
| Rate for Payer: Coventry/First Health All Products |
$167.35
|
| Rate for Payer: Frontpath All Products |
$79.61
|
| Rate for Payer: Humana ChoiceCare |
$139.46
|
| Rate for Payer: Humana Medicare |
$71.47
|
| Rate for Payer: Lucent/Coldwater Veneers |
$121.50
|
| Rate for Payer: Lutheran Preferred All Products |
$93.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$104.59
|
| Rate for Payer: PHP All Products |
$83.67
|
| Rate for Payer: Plain Church Group Ministry All Products |
$71.47
|
| Rate for Payer: Signature Care EPO |
$96.14
|
| Rate for Payer: Signature Care PPO |
$96.14
|
| Rate for Payer: Three Rivers Preferred All Products |
$86.00
|
| Rate for Payer: United Healthcare Commercial |
$92.93
|
| Rate for Payer: United Healthcare Medicare |
$69.73
|
|
|
PR MOD SED SAME PHYS/QHP EACH ADDL 15 MINS
|
Professional
|
$19.30
|
|
|
Service Code
|
CPT 99153
|
| Hospital Charge Code |
Z13152
|
| Min. Negotiated Rate |
$9.65 |
| Max. Negotiated Rate |
$23.16 |
| Rate for Payer: Aetna Medicare |
$9.89
|
| Rate for Payer: Anthem Exchange |
$10.08
|
| Rate for Payer: Anthem Medicare |
$9.89
|
| Rate for Payer: Anthem PPO |
$10.08
|
| Rate for Payer: Anthem Traditional |
$10.08
|
| Rate for Payer: Caresource Just 4 Me |
$11.37
|
| Rate for Payer: Caresource Medicare |
$10.88
|
| Rate for Payer: Centivo/Paragon All Products |
$15.33
|
| Rate for Payer: Coventry/First Health All Products |
$23.16
|
| Rate for Payer: Frontpath All Products |
$10.65
|
| Rate for Payer: Humana ChoiceCare |
$19.30
|
| Rate for Payer: Humana Medicare |
$9.89
|
| Rate for Payer: Lucent/Coldwater Veneers |
$16.81
|
| Rate for Payer: Lutheran Preferred All Products |
$13.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$14.48
|
| Rate for Payer: PHP All Products |
$11.58
|
| Rate for Payer: Plain Church Group Ministry All Products |
$9.89
|
| Rate for Payer: Signature Care EPO |
$13.28
|
| Rate for Payer: Signature Care PPO |
$13.28
|
| Rate for Payer: Three Rivers Preferred All Products |
$12.00
|
| Rate for Payer: United Healthcare Commercial |
$12.69
|
| Rate for Payer: United Healthcare Medicare |
$9.65
|
|
|
PR MOD SED SAME PHYS/QHP INITIAL 15 MINS 5/> YRS
|
Professional
|
$90.68
|
|
|
Service Code
|
CPT 99152
|
| Hospital Charge Code |
Z13151
|
| Min. Negotiated Rate |
$11.59 |
| Max. Negotiated Rate |
$108.82 |
| Rate for Payer: Aetna Medicare |
$11.59
|
| Rate for Payer: Anthem Exchange |
$48.29
|
| Rate for Payer: Anthem Medicare |
$11.59
|
| Rate for Payer: Anthem PPO |
$48.29
|
| Rate for Payer: Anthem Traditional |
$48.29
|
| Rate for Payer: Caresource Just 4 Me |
$13.33
|
| Rate for Payer: Caresource Medicare |
$12.75
|
| Rate for Payer: Centivo/Paragon All Products |
$17.96
|
| Rate for Payer: Coventry/First Health All Products |
$108.82
|
| Rate for Payer: Frontpath All Products |
$13.20
|
| Rate for Payer: Humana ChoiceCare |
$90.68
|
| Rate for Payer: Humana Medicare |
$11.59
|
| Rate for Payer: Lucent/Coldwater Veneers |
$19.70
|
| Rate for Payer: Lutheran Preferred All Products |
$15.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$68.01
|
| Rate for Payer: PHP All Products |
$13.56
|
| Rate for Payer: Plain Church Group Ministry All Products |
$11.59
|
| Rate for Payer: Signature Care EPO |
$63.62
|
| Rate for Payer: Signature Care PPO |
$63.62
|
| Rate for Payer: Three Rivers Preferred All Products |
$14.00
|
| Rate for Payer: United Healthcare Commercial |
$15.13
|
| Rate for Payer: United Healthcare Medicare |
$45.34
|
|
|
PR MULTIP FAMILY-GROUP PSYCHOTHERAPY
|
Professional
|
$69.16
|
|
|
Service Code
|
CPT 90849
|
| Hospital Charge Code |
Z13030
|
| Min. Negotiated Rate |
$27.72 |
| Max. Negotiated Rate |
$82.99 |
| Rate for Payer: Aetna Medicare |
$27.72
|
| Rate for Payer: Anthem Exchange |
$33.35
|
| Rate for Payer: Anthem Medicare |
$27.72
|
| Rate for Payer: Anthem PPO |
$33.35
|
| Rate for Payer: Anthem Traditional |
$33.35
|
| Rate for Payer: Caresource Just 4 Me |
$31.88
|
| Rate for Payer: Caresource Medicare |
$30.49
|
| Rate for Payer: Centivo/Paragon All Products |
$42.97
|
| Rate for Payer: Coventry/First Health All Products |
$82.99
|
| Rate for Payer: Frontpath All Products |
$30.59
|
| Rate for Payer: Humana ChoiceCare |
$69.16
|
| Rate for Payer: Humana Medicare |
$27.72
|
| Rate for Payer: Lucent/Coldwater Veneers |
$47.12
|
| Rate for Payer: Lutheran Preferred All Products |
$36.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$51.87
|
| Rate for Payer: PHP All Products |
$29.48
|
| Rate for Payer: Plain Church Group Ministry All Products |
$27.72
|
| Rate for Payer: Signature Care EPO |
$35.70
|
| Rate for Payer: Signature Care PPO |
$35.70
|
| Rate for Payer: Three Rivers Preferred All Products |
$33.00
|
| Rate for Payer: United Healthcare Commercial |
$36.25
|
| Rate for Payer: United Healthcare Medicare |
$34.58
|
|
|
PR MULTIPLE SLEEP LATENCY TEST
|
Professional
|
$755.10
|
|
|
Service Code
|
CPT 95805
|
| Hospital Charge Code |
Z13137
|
| Min. Negotiated Rate |
$386.98 |
| Max. Negotiated Rate |
$906.12 |
| Rate for Payer: Aetna Medicare |
$386.98
|
| Rate for Payer: Anthem Exchange |
$393.58
|
| Rate for Payer: Anthem Medicare |
$386.98
|
| Rate for Payer: Anthem PPO |
$393.58
|
| Rate for Payer: Anthem Traditional |
$393.58
|
| Rate for Payer: Caresource Just 4 Me |
$445.03
|
| Rate for Payer: Caresource Medicare |
$425.68
|
| Rate for Payer: Centivo/Paragon All Products |
$599.82
|
| Rate for Payer: Coventry/First Health All Products |
$906.12
|
| Rate for Payer: Frontpath All Products |
$433.82
|
| Rate for Payer: Humana ChoiceCare |
$755.10
|
| Rate for Payer: Humana Medicare |
$386.98
|
| Rate for Payer: Lucent/Coldwater Veneers |
$657.87
|
| Rate for Payer: Lutheran Preferred All Products |
$503.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$566.33
|
| Rate for Payer: PHP All Products |
$622.95
|
| Rate for Payer: Plain Church Group Ministry All Products |
$386.98
|
| Rate for Payer: Signature Care EPO |
$656.85
|
| Rate for Payer: Signature Care PPO |
$656.85
|
| Rate for Payer: Three Rivers Preferred All Products |
$464.00
|
| Rate for Payer: United Healthcare Commercial |
$484.58
|
|
|
PR MUSCLE-SKIN FLAP,TRUNK
|
Professional
|
$2,693.22
|
|
|
Service Code
|
CPT 15734
|
| Hospital Charge Code |
Z12083
|
| Min. Negotiated Rate |
$1,346.61 |
| Max. Negotiated Rate |
$3,231.86 |
| Rate for Payer: Aetna Medicare |
$1,380.12
|
| Rate for Payer: Anthem Exchange |
$1,659.30
|
| Rate for Payer: Anthem Medicare |
$1,380.12
|
| Rate for Payer: Anthem PPO |
$1,659.30
|
| Rate for Payer: Anthem Traditional |
$1,659.30
|
| Rate for Payer: Caresource Just 4 Me |
$1,587.14
|
| Rate for Payer: Caresource Medicare |
$1,518.13
|
| Rate for Payer: Centivo/Paragon All Products |
$2,139.19
|
| Rate for Payer: Coventry/First Health All Products |
$3,231.86
|
| Rate for Payer: Frontpath All Products |
$1,958.12
|
| Rate for Payer: Humana ChoiceCare |
$2,693.22
|
| Rate for Payer: Humana Medicare |
$1,380.12
|
| Rate for Payer: Lucent/Coldwater Veneers |
$2,346.20
|
| Rate for Payer: Lutheran Preferred All Products |
$1,794.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$2,019.91
|
| Rate for Payer: PHP All Products |
$1,885.25
|
| Rate for Payer: Plain Church Group Ministry All Products |
$1,380.12
|
| Rate for Payer: Signature Care EPO |
$1,477.30
|
| Rate for Payer: Signature Care PPO |
$1,477.30
|
| Rate for Payer: Three Rivers Preferred All Products |
$1,656.00
|
| Rate for Payer: United Healthcare Commercial |
$1,458.96
|
| Rate for Payer: United Healthcare Medicare |
$1,346.61
|
|
|
PR MYOMECTOMY 1-4,W/TOT 250GMS/<,ABD APPRCH
|
Professional
|
$1,703.26
|
|
|
Service Code
|
CPT 58140
|
| Hospital Charge Code |
Z12732
|
| Min. Negotiated Rate |
$851.63 |
| Max. Negotiated Rate |
$2,043.91 |
| Rate for Payer: Aetna Medicare |
$872.92
|
| Rate for Payer: Anthem Exchange |
$1,150.79
|
| Rate for Payer: Anthem Medicare |
$872.92
|
| Rate for Payer: Anthem PPO |
$1,150.79
|
| Rate for Payer: Anthem Traditional |
$1,150.79
|
| Rate for Payer: Caresource Just 4 Me |
$1,003.86
|
| Rate for Payer: Caresource Medicare |
$960.21
|
| Rate for Payer: Centivo/Paragon All Products |
$1,353.03
|
| Rate for Payer: Coventry/First Health All Products |
$2,043.91
|
| Rate for Payer: Frontpath All Products |
$1,227.04
|
| Rate for Payer: Humana ChoiceCare |
$1,703.26
|
| Rate for Payer: Humana Medicare |
$872.92
|
| Rate for Payer: Lucent/Coldwater Veneers |
$1,483.96
|
| Rate for Payer: Lutheran Preferred All Products |
$1,222.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$1,277.44
|
| Rate for Payer: PHP All Products |
$1,124.15
|
| Rate for Payer: Plain Church Group Ministry All Products |
$872.92
|
| Rate for Payer: Signature Care EPO |
$1,087.15
|
| Rate for Payer: Signature Care PPO |
$1,087.15
|
| Rate for Payer: Three Rivers Preferred All Products |
$1,135.00
|
| Rate for Payer: United Healthcare Commercial |
$1,029.24
|
| Rate for Payer: United Healthcare Medicare |
$851.63
|
|
|
PR MYOMECTOMY 5/>,TOT>250 GMS,ABD APPRCH
|
Professional
|
$2,109.42
|
|
|
Service Code
|
CPT 58146
|
| Hospital Charge Code |
Z12734
|
| Min. Negotiated Rate |
$1,054.71 |
| Max. Negotiated Rate |
$2,531.30 |
| Rate for Payer: Aetna Medicare |
$1,081.08
|
| Rate for Payer: Anthem Exchange |
$1,484.13
|
| Rate for Payer: Anthem Medicare |
$1,081.08
|
| Rate for Payer: Anthem PPO |
$1,484.13
|
| Rate for Payer: Anthem Traditional |
$1,484.13
|
| Rate for Payer: Caresource Just 4 Me |
$1,243.24
|
| Rate for Payer: Caresource Medicare |
$1,189.19
|
| Rate for Payer: Centivo/Paragon All Products |
$1,675.67
|
| Rate for Payer: Coventry/First Health All Products |
$2,531.30
|
| Rate for Payer: Frontpath All Products |
$1,519.75
|
| Rate for Payer: Humana ChoiceCare |
$2,109.42
|
| Rate for Payer: Humana Medicare |
$1,081.08
|
| Rate for Payer: Lucent/Coldwater Veneers |
$1,837.84
|
| Rate for Payer: Lutheran Preferred All Products |
$1,514.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$1,582.07
|
| Rate for Payer: PHP All Products |
$1,392.22
|
| Rate for Payer: Plain Church Group Ministry All Products |
$1,081.08
|
| Rate for Payer: Signature Care EPO |
$1,380.40
|
| Rate for Payer: Signature Care PPO |
$1,380.40
|
| Rate for Payer: Three Rivers Preferred All Products |
$1,405.00
|
| Rate for Payer: United Healthcare Commercial |
$1,311.88
|
| Rate for Payer: United Healthcare Medicare |
$1,054.71
|
|
|
PR MYRINGOPLASTY
|
Professional
|
$1,365.42
|
|
|
Service Code
|
CPT 69620
|
| Hospital Charge Code |
Z12867
|
| Min. Negotiated Rate |
$466.08 |
| Max. Negotiated Rate |
$1,638.50 |
| Rate for Payer: Humana Medicare |
$466.08
|
| Rate for Payer: Aetna Medicare |
$466.08
|
| Rate for Payer: Anthem Exchange |
$666.56
|
| Rate for Payer: Anthem Medicare |
$466.08
|
| Rate for Payer: Anthem PPO |
$666.56
|
| Rate for Payer: Anthem Traditional |
$666.56
|
| Rate for Payer: Caresource Just 4 Me |
$535.99
|
| Rate for Payer: Caresource Medicare |
$512.69
|
| Rate for Payer: Centivo/Paragon All Products |
$722.42
|
| Rate for Payer: Coventry/First Health All Products |
$1,638.50
|
| Rate for Payer: Frontpath All Products |
$636.12
|
| Rate for Payer: Humana ChoiceCare |
$1,365.42
|
| Rate for Payer: Lucent/Coldwater Veneers |
$792.34
|
| Rate for Payer: Lutheran Preferred All Products |
$746.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$1,024.07
|
| Rate for Payer: PHP All Products |
$591.12
|
| Rate for Payer: Plain Church Group Ministry All Products |
$466.08
|
| Rate for Payer: Signature Care EPO |
$598.83
|
| Rate for Payer: Signature Care PPO |
$598.83
|
| Rate for Payer: Three Rivers Preferred All Products |
$699.00
|
| Rate for Payer: United Healthcare Commercial |
$528.66
|
| Rate for Payer: United Healthcare Medicare |
$682.71
|
|
|
PR NARCOSYNTHESIS
|
Professional
|
$304.20
|
|
|
Service Code
|
CPT 90865
|
| Hospital Charge Code |
Z13032
|
| Min. Negotiated Rate |
$118.85 |
| Max. Negotiated Rate |
$365.04 |
| Rate for Payer: Aetna Medicare |
$118.85
|
| Rate for Payer: Anthem Exchange |
$160.65
|
| Rate for Payer: Anthem Medicare |
$118.85
|
| Rate for Payer: Anthem PPO |
$160.65
|
| Rate for Payer: Anthem Traditional |
$160.65
|
| Rate for Payer: Caresource Just 4 Me |
$136.68
|
| Rate for Payer: Caresource Medicare |
$130.74
|
| Rate for Payer: Centivo/Paragon All Products |
$184.22
|
| Rate for Payer: Coventry/First Health All Products |
$365.04
|
| Rate for Payer: Frontpath All Products |
$137.02
|
| Rate for Payer: Humana ChoiceCare |
$304.20
|
| Rate for Payer: Humana Medicare |
$118.85
|
| Rate for Payer: Lucent/Coldwater Veneers |
$202.04
|
| Rate for Payer: Lutheran Preferred All Products |
$155.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$228.15
|
| Rate for Payer: PHP All Products |
$126.39
|
| Rate for Payer: Plain Church Group Ministry All Products |
$118.85
|
| Rate for Payer: Signature Care EPO |
$181.90
|
| Rate for Payer: Signature Care PPO |
$181.90
|
| Rate for Payer: Three Rivers Preferred All Products |
$143.00
|
| Rate for Payer: United Healthcare Commercial |
$161.49
|
| Rate for Payer: United Healthcare Medicare |
$152.10
|
|
|
PR NASAL ENDOSCOPY,DX
|
Professional
|
$344.92
|
|
|
Service Code
|
CPT 31231
|
| Hospital Charge Code |
Z12512
|
| Min. Negotiated Rate |
$60.39 |
| Max. Negotiated Rate |
$413.90 |
| Rate for Payer: Aetna Medicare |
$60.39
|
| Rate for Payer: Anthem Exchange |
$224.03
|
| Rate for Payer: Anthem Medicare |
$60.39
|
| Rate for Payer: Anthem PPO |
$224.03
|
| Rate for Payer: Anthem Traditional |
$224.03
|
| Rate for Payer: Caresource Just 4 Me |
$69.45
|
| Rate for Payer: Caresource Medicare |
$66.43
|
| Rate for Payer: Centivo/Paragon All Products |
$93.60
|
| Rate for Payer: Coventry/First Health All Products |
$413.90
|
| Rate for Payer: Frontpath All Products |
$82.25
|
| Rate for Payer: Humana ChoiceCare |
$344.92
|
| Rate for Payer: Humana Medicare |
$60.39
|
| Rate for Payer: Lucent/Coldwater Veneers |
$102.66
|
| Rate for Payer: Lutheran Preferred All Products |
$97.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$258.69
|
| Rate for Payer: PHP All Products |
$82.48
|
| Rate for Payer: Plain Church Group Ministry All Products |
$60.39
|
| Rate for Payer: Signature Care EPO |
$237.15
|
| Rate for Payer: Signature Care PPO |
$237.15
|
| Rate for Payer: Three Rivers Preferred All Products |
$91.00
|
| Rate for Payer: United Healthcare Commercial |
$85.55
|
| Rate for Payer: United Healthcare Medicare |
$172.46
|
|
|
PR NASAL/SINUS ENDOSCOPY,BX/RMV POLYP/DEBRID
|
Professional
|
$469.66
|
|
|
Service Code
|
CPT 31237
|
| Hospital Charge Code |
Z12513
|
| Min. Negotiated Rate |
$149.32 |
| Max. Negotiated Rate |
$563.59 |
| Rate for Payer: Aetna Medicare |
$149.32
|
| Rate for Payer: Anthem Exchange |
$300.60
|
| Rate for Payer: Anthem Medicare |
$149.32
|
| Rate for Payer: Anthem PPO |
$300.60
|
| Rate for Payer: Anthem Traditional |
$300.60
|
| Rate for Payer: Caresource Just 4 Me |
$171.72
|
| Rate for Payer: Caresource Medicare |
$164.25
|
| Rate for Payer: Centivo/Paragon All Products |
$231.45
|
| Rate for Payer: Coventry/First Health All Products |
$563.59
|
| Rate for Payer: Frontpath All Products |
$205.41
|
| Rate for Payer: Humana ChoiceCare |
$469.66
|
| Rate for Payer: Humana Medicare |
$149.32
|
| Rate for Payer: Lucent/Coldwater Veneers |
$253.84
|
| Rate for Payer: Lutheran Preferred All Products |
$239.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$352.25
|
| Rate for Payer: PHP All Products |
$203.95
|
| Rate for Payer: Plain Church Group Ministry All Products |
$149.32
|
| Rate for Payer: Signature Care EPO |
$409.82
|
| Rate for Payer: Signature Care PPO |
$409.82
|
| Rate for Payer: Three Rivers Preferred All Products |
$224.00
|
| Rate for Payer: United Healthcare Commercial |
$206.48
|
| Rate for Payer: United Healthcare Medicare |
$234.83
|
|
|
PR NASAL/SINUS ENDOSCOPY,W/CONTROL NASAL HEM
|
Professional
|
$458.76
|
|
|
Service Code
|
CPT 31238
|
| Hospital Charge Code |
Z12514
|
| Min. Negotiated Rate |
$156.08 |
| Max. Negotiated Rate |
$550.51 |
| Rate for Payer: Aetna Medicare |
$156.08
|
| Rate for Payer: Anthem Exchange |
$331.60
|
| Rate for Payer: Anthem Medicare |
$156.08
|
| Rate for Payer: Anthem PPO |
$331.60
|
| Rate for Payer: Anthem Traditional |
$331.60
|
| Rate for Payer: Caresource Just 4 Me |
$179.49
|
| Rate for Payer: Caresource Medicare |
$171.69
|
| Rate for Payer: Centivo/Paragon All Products |
$241.92
|
| Rate for Payer: Coventry/First Health All Products |
$550.51
|
| Rate for Payer: Frontpath All Products |
$215.16
|
| Rate for Payer: Humana ChoiceCare |
$458.76
|
| Rate for Payer: Humana Medicare |
$156.08
|
| Rate for Payer: Lucent/Coldwater Veneers |
$265.34
|
| Rate for Payer: Lutheran Preferred All Products |
$250.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$344.07
|
| Rate for Payer: PHP All Products |
$213.18
|
| Rate for Payer: Plain Church Group Ministry All Products |
$156.08
|
| Rate for Payer: Signature Care EPO |
$400.61
|
| Rate for Payer: Signature Care PPO |
$400.61
|
| Rate for Payer: Three Rivers Preferred All Products |
$234.00
|
| Rate for Payer: United Healthcare Commercial |
$224.20
|
| Rate for Payer: United Healthcare Medicare |
$229.38
|
|
|
PR NASOPHARYNGOSCOPY
|
Professional
|
$215.68
|
|
|
Service Code
|
CPT 92511
|
| Hospital Charge Code |
Z13037
|
| Min. Negotiated Rate |
$35.82 |
| Max. Negotiated Rate |
$258.82 |
| Rate for Payer: Humana Medicare |
$35.82
|
| Rate for Payer: Aetna Medicare |
$35.82
|
| Rate for Payer: Anthem Exchange |
$115.91
|
| Rate for Payer: Anthem Medicare |
$35.82
|
| Rate for Payer: Anthem PPO |
$115.91
|
| Rate for Payer: Anthem Traditional |
$115.91
|
| Rate for Payer: Caresource Just 4 Me |
$41.19
|
| Rate for Payer: Caresource Medicare |
$39.40
|
| Rate for Payer: Centivo/Paragon All Products |
$55.52
|
| Rate for Payer: Coventry/First Health All Products |
$258.82
|
| Rate for Payer: Frontpath All Products |
$40.52
|
| Rate for Payer: Humana ChoiceCare |
$215.68
|
| Rate for Payer: Lucent/Coldwater Veneers |
$60.89
|
| Rate for Payer: Lutheran Preferred All Products |
$47.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$161.76
|
| Rate for Payer: PHP All Products |
$50.68
|
| Rate for Payer: Plain Church Group Ministry All Products |
$35.82
|
| Rate for Payer: Signature Care EPO |
$165.75
|
| Rate for Payer: Signature Care PPO |
$165.75
|
| Rate for Payer: Three Rivers Preferred All Products |
$43.00
|
| Rate for Payer: United Healthcare Commercial |
$67.65
|
| Rate for Payer: United Healthcare Medicare |
$107.84
|
|
|
PR NEEDLE BIOPSY LIVER,W OTHR PROC
|
Professional
|
$182.84
|
|
|
Service Code
|
CPT 47001
|
| Hospital Charge Code |
Z12652
|
| Min. Negotiated Rate |
$91.42 |
| Max. Negotiated Rate |
$219.41 |
| Rate for Payer: Aetna Medicare |
$93.71
|
| Rate for Payer: Anthem Exchange |
$150.10
|
| Rate for Payer: Anthem Medicare |
$93.71
|
| Rate for Payer: Anthem PPO |
$150.10
|
| Rate for Payer: Anthem Traditional |
$150.10
|
| Rate for Payer: Caresource Just 4 Me |
$107.77
|
| Rate for Payer: Caresource Medicare |
$103.08
|
| Rate for Payer: Centivo/Paragon All Products |
$145.25
|
| Rate for Payer: Coventry/First Health All Products |
$219.41
|
| Rate for Payer: Frontpath All Products |
$136.79
|
| Rate for Payer: Humana ChoiceCare |
$182.84
|
| Rate for Payer: Humana Medicare |
$93.71
|
| Rate for Payer: Lucent/Coldwater Veneers |
$159.31
|
| Rate for Payer: Lutheran Preferred All Products |
$141.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$137.13
|
| Rate for Payer: PHP All Products |
$159.99
|
| Rate for Payer: Plain Church Group Ministry All Products |
$93.71
|
| Rate for Payer: Signature Care EPO |
$148.75
|
| Rate for Payer: Signature Care PPO |
$148.75
|
| Rate for Payer: Three Rivers Preferred All Products |
$131.00
|
| Rate for Payer: United Healthcare Commercial |
$115.18
|
| Rate for Payer: United Healthcare Medicare |
$91.42
|
|
