|
PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND
|
Professional
|
$1,101.08
|
|
|
Service Code
|
CPT 95810
|
| Hospital Charge Code |
Z13138
|
| Min. Negotiated Rate |
$564.31 |
| Max. Negotiated Rate |
$1,321.30 |
| Rate for Payer: Aetna Medicare |
$564.31
|
| Rate for Payer: Anthem Exchange |
$586.26
|
| Rate for Payer: Anthem Medicare |
$564.31
|
| Rate for Payer: Anthem PPO |
$586.26
|
| Rate for Payer: Anthem Traditional |
$586.26
|
| Rate for Payer: Caresource Just 4 Me |
$648.96
|
| Rate for Payer: Caresource Medicare |
$620.74
|
| Rate for Payer: Centivo/Paragon All Products |
$874.68
|
| Rate for Payer: Coventry/First Health All Products |
$1,321.30
|
| Rate for Payer: Frontpath All Products |
$634.21
|
| Rate for Payer: Humana ChoiceCare |
$1,101.08
|
| Rate for Payer: Humana Medicare |
$564.31
|
| Rate for Payer: Lucent/Coldwater Veneers |
$959.33
|
| Rate for Payer: Lutheran Preferred All Products |
$734.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$825.81
|
| Rate for Payer: PHP All Products |
$908.40
|
| Rate for Payer: Plain Church Group Ministry All Products |
$564.31
|
| Rate for Payer: Signature Care EPO |
$852.55
|
| Rate for Payer: Signature Care PPO |
$852.55
|
| Rate for Payer: Three Rivers Preferred All Products |
$677.00
|
| Rate for Payer: United Healthcare Commercial |
$885.23
|
|
|
PR POLYSOM 6/>YRS SLEEP W/CPAP 4/> ADDL PARAM ATTND
|
Professional
|
$1,151.40
|
|
|
Service Code
|
CPT 95811
|
| Hospital Charge Code |
Z13139
|
| Min. Negotiated Rate |
$590.10 |
| Max. Negotiated Rate |
$1,381.68 |
| Rate for Payer: Aetna Medicare |
$590.10
|
| Rate for Payer: Anthem Exchange |
$616.00
|
| Rate for Payer: Anthem Medicare |
$590.10
|
| Rate for Payer: Anthem PPO |
$616.00
|
| Rate for Payer: Anthem Traditional |
$616.00
|
| Rate for Payer: Caresource Just 4 Me |
$678.62
|
| Rate for Payer: Caresource Medicare |
$649.11
|
| Rate for Payer: Centivo/Paragon All Products |
$914.66
|
| Rate for Payer: Coventry/First Health All Products |
$1,381.68
|
| Rate for Payer: Frontpath All Products |
$662.06
|
| Rate for Payer: Humana ChoiceCare |
$1,151.40
|
| Rate for Payer: Humana Medicare |
$590.10
|
| Rate for Payer: Lucent/Coldwater Veneers |
$1,003.17
|
| Rate for Payer: Lutheran Preferred All Products |
$767.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$863.55
|
| Rate for Payer: PHP All Products |
$949.91
|
| Rate for Payer: Plain Church Group Ministry All Products |
$590.10
|
| Rate for Payer: Signature Care EPO |
$784.24
|
| Rate for Payer: Signature Care PPO |
$784.24
|
| Rate for Payer: Three Rivers Preferred All Products |
$708.00
|
| Rate for Payer: United Healthcare Commercial |
$975.34
|
|
|
PR POST COLPORRHAPHY,RECTUM/VAGINA
|
Professional
|
$1,127.56
|
|
|
Service Code
|
CPT 57250
|
| Hospital Charge Code |
Z12707
|
| Min. Negotiated Rate |
$477.25 |
| Max. Negotiated Rate |
$1,353.07 |
| Rate for Payer: Aetna Medicare |
$577.88
|
| Rate for Payer: Anthem Exchange |
$477.25
|
| Rate for Payer: Anthem Medicare |
$577.88
|
| Rate for Payer: Anthem PPO |
$477.25
|
| Rate for Payer: Anthem Traditional |
$477.25
|
| Rate for Payer: Caresource Just 4 Me |
$664.56
|
| Rate for Payer: Caresource Medicare |
$635.67
|
| Rate for Payer: Centivo/Paragon All Products |
$895.71
|
| Rate for Payer: Coventry/First Health All Products |
$1,353.07
|
| Rate for Payer: Frontpath All Products |
$806.94
|
| Rate for Payer: Humana ChoiceCare |
$1,127.56
|
| Rate for Payer: Humana Medicare |
$577.88
|
| Rate for Payer: Lucent/Coldwater Veneers |
$982.40
|
| Rate for Payer: Lutheran Preferred All Products |
$809.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$845.67
|
| Rate for Payer: PHP All Products |
$744.20
|
| Rate for Payer: Plain Church Group Ministry All Products |
$577.88
|
| Rate for Payer: Signature Care EPO |
$552.76
|
| Rate for Payer: Signature Care PPO |
$552.76
|
| Rate for Payer: Three Rivers Preferred All Products |
$751.00
|
| Rate for Payer: United Healthcare Commercial |
$733.13
|
| Rate for Payer: United Healthcare Medicare |
$563.78
|
|
|
PR PPPS, SUBSEQ VISIT
|
Professional
|
$130.00
|
|
|
Service Code
|
CPT G0439
|
| Hospital Charge Code |
Z13256
|
| Min. Negotiated Rate |
$97.50 |
| Max. Negotiated Rate |
$208.35 |
| Rate for Payer: Aetna Medicare |
$122.56
|
| Rate for Payer: Anthem Exchange |
$145.20
|
| Rate for Payer: Anthem Medicare |
$122.56
|
| Rate for Payer: Anthem PPO |
$145.20
|
| Rate for Payer: Anthem Traditional |
$145.20
|
| Rate for Payer: Caresource Just 4 Me |
$140.94
|
| Rate for Payer: Caresource Medicare |
$134.82
|
| Rate for Payer: Centivo/Paragon All Products |
$189.97
|
| Rate for Payer: Coventry/First Health All Products |
$156.00
|
| Rate for Payer: Humana ChoiceCare |
$130.00
|
| Rate for Payer: Humana Medicare |
$122.56
|
| Rate for Payer: Lucent/Coldwater Veneers |
$208.35
|
| Rate for Payer: PHCS/Multiplan All Products |
$97.50
|
| Rate for Payer: PHP All Products |
$123.16
|
| Rate for Payer: Plain Church Group Ministry All Products |
$122.56
|
| Rate for Payer: Signature Care EPO |
$105.64
|
| Rate for Payer: Signature Care PPO |
$105.64
|
| Rate for Payer: United Healthcare Commercial |
$114.16
|
|
|
PR PRESSURIZED/NONPRESSURIZED INHALATION TREATMENT
|
Professional
|
$15.98
|
|
|
Service Code
|
CPT 94640
|
| Hospital Charge Code |
Z13127
|
| Min. Negotiated Rate |
$7.99 |
| Max. Negotiated Rate |
$25.05 |
| Rate for Payer: Aetna Medicare |
$8.19
|
| Rate for Payer: Anthem Exchange |
$25.05
|
| Rate for Payer: Anthem Medicare |
$8.19
|
| Rate for Payer: Anthem PPO |
$25.05
|
| Rate for Payer: Anthem Traditional |
$25.05
|
| Rate for Payer: Caresource Just 4 Me |
$9.42
|
| Rate for Payer: Caresource Medicare |
$9.01
|
| Rate for Payer: Centivo/Paragon All Products |
$12.69
|
| Rate for Payer: Coventry/First Health All Products |
$19.18
|
| Rate for Payer: Frontpath All Products |
$11.54
|
| Rate for Payer: Humana ChoiceCare |
$15.98
|
| Rate for Payer: Humana Medicare |
$8.19
|
| Rate for Payer: Lucent/Coldwater Veneers |
$13.92
|
| Rate for Payer: Lutheran Preferred All Products |
$11.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$11.98
|
| Rate for Payer: PHP All Products |
$10.78
|
| Rate for Payer: Plain Church Group Ministry All Products |
$8.19
|
| Rate for Payer: Signature Care EPO |
$16.15
|
| Rate for Payer: Signature Care PPO |
$16.15
|
| Rate for Payer: Three Rivers Preferred All Products |
$10.00
|
| Rate for Payer: United Healthcare Commercial |
$15.03
|
| Rate for Payer: United Healthcare Medicare |
$7.99
|
|
|
PR PREVENT COUNSEL,INDIV,15 MIN
|
Professional
|
$70.94
|
|
|
Service Code
|
CPT 99401
|
| Hospital Charge Code |
Z13219
|
| Min. Negotiated Rate |
$22.89 |
| Max. Negotiated Rate |
$85.13 |
| Rate for Payer: Anthem Exchange |
$42.75
|
| Rate for Payer: Anthem PPO |
$42.75
|
| Rate for Payer: Anthem Traditional |
$42.75
|
| Rate for Payer: Coventry/First Health All Products |
$85.13
|
| Rate for Payer: Frontpath All Products |
$24.59
|
| Rate for Payer: Humana ChoiceCare |
$70.94
|
| Rate for Payer: Lutheran Preferred All Products |
$24.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$53.20
|
| Rate for Payer: PHP All Products |
$22.89
|
| Rate for Payer: Signature Care EPO |
$37.40
|
| Rate for Payer: Signature Care PPO |
$37.40
|
| Rate for Payer: Three Rivers Preferred All Products |
$23.00
|
| Rate for Payer: United Healthcare Commercial |
$24.32
|
| Rate for Payer: United Healthcare Medicare |
$35.47
|
|
|
PR PREVENT COUNSEL,INDIV,30 MIN
|
Professional
|
$116.08
|
|
|
Service Code
|
CPT 99402
|
| Hospital Charge Code |
Z13220
|
| Min. Negotiated Rate |
$46.13 |
| Max. Negotiated Rate |
$139.30 |
| Rate for Payer: Anthem Exchange |
$82.10
|
| Rate for Payer: Anthem PPO |
$82.10
|
| Rate for Payer: Anthem Traditional |
$82.10
|
| Rate for Payer: Coventry/First Health All Products |
$139.30
|
| Rate for Payer: Frontpath All Products |
$50.27
|
| Rate for Payer: Humana ChoiceCare |
$116.08
|
| Rate for Payer: Lutheran Preferred All Products |
$48.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$87.06
|
| Rate for Payer: PHP All Products |
$46.13
|
| Rate for Payer: Signature Care EPO |
$62.90
|
| Rate for Payer: Signature Care PPO |
$62.90
|
| Rate for Payer: Three Rivers Preferred All Products |
$47.00
|
| Rate for Payer: United Healthcare Commercial |
$49.38
|
| Rate for Payer: United Healthcare Medicare |
$58.04
|
|
|
PR PREVENTIVE VISIT,EST,12-17
|
Professional
|
$210.12
|
|
|
Service Code
|
CPT 99394
|
| Hospital Charge Code |
Z13215
|
| Min. Negotiated Rate |
$68.97 |
| Max. Negotiated Rate |
$252.14 |
| Rate for Payer: Anthem Exchange |
$124.43
|
| Rate for Payer: Anthem PPO |
$124.43
|
| Rate for Payer: Anthem Traditional |
$124.43
|
| Rate for Payer: Coventry/First Health All Products |
$252.14
|
| Rate for Payer: Frontpath All Products |
$85.84
|
| Rate for Payer: Humana ChoiceCare |
$210.12
|
| Rate for Payer: Lutheran Preferred All Products |
$84.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$157.59
|
| Rate for Payer: PHP All Products |
$79.98
|
| Rate for Payer: Signature Care EPO |
$85.00
|
| Rate for Payer: Signature Care PPO |
$85.00
|
| Rate for Payer: Three Rivers Preferred All Products |
$82.00
|
| Rate for Payer: United Healthcare Commercial |
$68.97
|
| Rate for Payer: United Healthcare Medicare |
$105.06
|
|
|
PR PREVENTIVE VISIT,EST,18-39
|
Professional
|
$214.94
|
|
|
Service Code
|
CPT 99395
|
| Hospital Charge Code |
Z13216
|
| Min. Negotiated Rate |
$68.97 |
| Max. Negotiated Rate |
$257.93 |
| Rate for Payer: Anthem Exchange |
$116.76
|
| Rate for Payer: Anthem PPO |
$116.76
|
| Rate for Payer: Anthem Traditional |
$116.76
|
| Rate for Payer: Coventry/First Health All Products |
$257.93
|
| Rate for Payer: Frontpath All Products |
$88.25
|
| Rate for Payer: Humana ChoiceCare |
$214.94
|
| Rate for Payer: Lutheran Preferred All Products |
$86.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$161.20
|
| Rate for Payer: PHP All Products |
$82.47
|
| Rate for Payer: Signature Care EPO |
$86.70
|
| Rate for Payer: Signature Care PPO |
$86.70
|
| Rate for Payer: Three Rivers Preferred All Products |
$85.00
|
| Rate for Payer: United Healthcare Commercial |
$68.97
|
| Rate for Payer: United Healthcare Medicare |
$107.47
|
|
|
PR PREVENTIVE VISIT,EST,40-64
|
Professional
|
$228.48
|
|
|
Service Code
|
CPT 99396
|
| Hospital Charge Code |
Z13217
|
| Min. Negotiated Rate |
$77.73 |
| Max. Negotiated Rate |
$274.18 |
| Rate for Payer: Anthem Exchange |
$131.20
|
| Rate for Payer: Anthem PPO |
$131.20
|
| Rate for Payer: Anthem Traditional |
$131.20
|
| Rate for Payer: Coventry/First Health All Products |
$274.18
|
| Rate for Payer: Frontpath All Products |
$97.08
|
| Rate for Payer: Humana ChoiceCare |
$228.48
|
| Rate for Payer: Lutheran Preferred All Products |
$93.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$171.36
|
| Rate for Payer: PHP All Products |
$89.44
|
| Rate for Payer: Signature Care EPO |
$95.20
|
| Rate for Payer: Signature Care PPO |
$95.20
|
| Rate for Payer: Three Rivers Preferred All Products |
$92.00
|
| Rate for Payer: United Healthcare Commercial |
$77.73
|
| Rate for Payer: United Healthcare Medicare |
$114.24
|
|
|
PR PREVENTIVE VISIT,EST,65 & OVER
|
Professional
|
$246.24
|
|
|
Service Code
|
CPT 99397
|
| Hospital Charge Code |
Z13218
|
| Min. Negotiated Rate |
$86.98 |
| Max. Negotiated Rate |
$295.49 |
| Rate for Payer: Anthem Exchange |
$146.65
|
| Rate for Payer: Anthem PPO |
$146.65
|
| Rate for Payer: Anthem Traditional |
$146.65
|
| Rate for Payer: Coventry/First Health All Products |
$295.49
|
| Rate for Payer: Frontpath All Products |
$102.28
|
| Rate for Payer: Humana ChoiceCare |
$246.24
|
| Rate for Payer: Lutheran Preferred All Products |
$98.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$184.68
|
| Rate for Payer: PHP All Products |
$93.93
|
| Rate for Payer: Signature Care EPO |
$105.40
|
| Rate for Payer: Signature Care PPO |
$105.40
|
| Rate for Payer: Three Rivers Preferred All Products |
$96.00
|
| Rate for Payer: United Healthcare Commercial |
$86.98
|
| Rate for Payer: United Healthcare Medicare |
$123.12
|
|
|
PR PREVENTIVE VISIT,EST,AGE 1-4
|
Professional
|
$192.68
|
|
|
Service Code
|
CPT 99392
|
| Hospital Charge Code |
Z13213
|
| Min. Negotiated Rate |
$60.45 |
| Max. Negotiated Rate |
$231.22 |
| Rate for Payer: Anthem Exchange |
$108.98
|
| Rate for Payer: Anthem PPO |
$108.98
|
| Rate for Payer: Anthem Traditional |
$108.98
|
| Rate for Payer: Coventry/First Health All Products |
$231.22
|
| Rate for Payer: Frontpath All Products |
$75.83
|
| Rate for Payer: Humana ChoiceCare |
$192.68
|
| Rate for Payer: Lutheran Preferred All Products |
$74.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$144.51
|
| Rate for Payer: PHP All Products |
$70.69
|
| Rate for Payer: Signature Care EPO |
$78.20
|
| Rate for Payer: Signature Care PPO |
$78.20
|
| Rate for Payer: Three Rivers Preferred All Products |
$72.00
|
| Rate for Payer: United Healthcare Commercial |
$60.45
|
| Rate for Payer: United Healthcare Medicare |
$96.34
|
|
|
PR PREVENTIVE VISIT,EST,AGE5-11
|
Professional
|
$192.08
|
|
|
Service Code
|
CPT 99393
|
| Hospital Charge Code |
Z13214
|
| Min. Negotiated Rate |
$60.45 |
| Max. Negotiated Rate |
$230.50 |
| Rate for Payer: Anthem Exchange |
$108.98
|
| Rate for Payer: Anthem PPO |
$108.98
|
| Rate for Payer: Anthem Traditional |
$108.98
|
| Rate for Payer: Coventry/First Health All Products |
$230.50
|
| Rate for Payer: Frontpath All Products |
$75.83
|
| Rate for Payer: Humana ChoiceCare |
$192.08
|
| Rate for Payer: Lutheran Preferred All Products |
$74.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$144.06
|
| Rate for Payer: PHP All Products |
$70.69
|
| Rate for Payer: Signature Care EPO |
$77.35
|
| Rate for Payer: Signature Care PPO |
$77.35
|
| Rate for Payer: Three Rivers Preferred All Products |
$72.00
|
| Rate for Payer: United Healthcare Commercial |
$60.45
|
| Rate for Payer: United Healthcare Medicare |
$96.04
|
|
|
PR PREVENTIVE VISIT,EST, INFANT < 1 YR
|
Professional
|
$180.44
|
|
|
Service Code
|
CPT 99391
|
| Hospital Charge Code |
Z13212
|
| Min. Negotiated Rate |
$51.70 |
| Max. Negotiated Rate |
$216.53 |
| Rate for Payer: Anthem Exchange |
$100.71
|
| Rate for Payer: Anthem PPO |
$100.71
|
| Rate for Payer: Anthem Traditional |
$100.71
|
| Rate for Payer: Coventry/First Health All Products |
$216.53
|
| Rate for Payer: Frontpath All Products |
$69.63
|
| Rate for Payer: Humana ChoiceCare |
$180.44
|
| Rate for Payer: Lutheran Preferred All Products |
$67.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$135.33
|
| Rate for Payer: PHP All Products |
$64.39
|
| Rate for Payer: Signature Care EPO |
$69.70
|
| Rate for Payer: Signature Care PPO |
$69.70
|
| Rate for Payer: Three Rivers Preferred All Products |
$66.00
|
| Rate for Payer: United Healthcare Commercial |
$51.70
|
| Rate for Payer: United Healthcare Medicare |
$90.22
|
|
|
PR PREVENTIVE VISIT,NEW,12-17
|
Professional
|
$245.64
|
|
|
Service Code
|
CPT 99384
|
| Hospital Charge Code |
Z13208
|
| Min. Negotiated Rate |
$77.73 |
| Max. Negotiated Rate |
$294.77 |
| Rate for Payer: Anthem Exchange |
$139.89
|
| Rate for Payer: Anthem PPO |
$139.89
|
| Rate for Payer: Anthem Traditional |
$139.89
|
| Rate for Payer: Coventry/First Health All Products |
$294.77
|
| Rate for Payer: Frontpath All Products |
$102.28
|
| Rate for Payer: Humana ChoiceCare |
$245.64
|
| Rate for Payer: Lutheran Preferred All Products |
$98.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$184.23
|
| Rate for Payer: PHP All Products |
$93.93
|
| Rate for Payer: Signature Care EPO |
$105.40
|
| Rate for Payer: Signature Care PPO |
$105.40
|
| Rate for Payer: Three Rivers Preferred All Products |
$96.00
|
| Rate for Payer: United Healthcare Commercial |
$77.73
|
| Rate for Payer: United Healthcare Medicare |
$122.82
|
|
|
PR PREVENTIVE VISIT,NEW,18-39
|
Professional
|
$238.54
|
|
|
Service Code
|
CPT 99385
|
| Hospital Charge Code |
Z13209
|
| Min. Negotiated Rate |
$77.73 |
| Max. Negotiated Rate |
$286.25 |
| Rate for Payer: Anthem Exchange |
$131.20
|
| Rate for Payer: Anthem PPO |
$131.20
|
| Rate for Payer: Anthem Traditional |
$131.20
|
| Rate for Payer: Coventry/First Health All Products |
$286.25
|
| Rate for Payer: Frontpath All Products |
$98.11
|
| Rate for Payer: Humana ChoiceCare |
$238.54
|
| Rate for Payer: Lutheran Preferred All Products |
$94.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$178.91
|
| Rate for Payer: PHP All Products |
$90.28
|
| Rate for Payer: Signature Care EPO |
$105.40
|
| Rate for Payer: Signature Care PPO |
$105.40
|
| Rate for Payer: Three Rivers Preferred All Products |
$93.00
|
| Rate for Payer: United Healthcare Commercial |
$77.73
|
| Rate for Payer: United Healthcare Medicare |
$119.27
|
|
|
PR PREVENTIVE VISIT,NEW,40-64
|
Professional
|
$275.32
|
|
|
Service Code
|
CPT 99386
|
| Hospital Charge Code |
Z13210
|
| Min. Negotiated Rate |
$95.38 |
| Max. Negotiated Rate |
$330.38 |
| Rate for Payer: Anthem Exchange |
$161.10
|
| Rate for Payer: Anthem PPO |
$161.10
|
| Rate for Payer: Anthem Traditional |
$161.10
|
| Rate for Payer: Coventry/First Health All Products |
$330.38
|
| Rate for Payer: Frontpath All Products |
$118.88
|
| Rate for Payer: Humana ChoiceCare |
$275.32
|
| Rate for Payer: Lutheran Preferred All Products |
$114.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$206.49
|
| Rate for Payer: PHP All Products |
$109.53
|
| Rate for Payer: Signature Care EPO |
$124.10
|
| Rate for Payer: Signature Care PPO |
$124.10
|
| Rate for Payer: Three Rivers Preferred All Products |
$112.00
|
| Rate for Payer: United Healthcare Commercial |
$95.38
|
| Rate for Payer: United Healthcare Medicare |
$137.66
|
|
|
PR PREVENTIVE VISIT,NEW,65 & OVER
|
Professional
|
$298.94
|
|
|
Service Code
|
CPT 99387
|
| Hospital Charge Code |
Z13211
|
| Min. Negotiated Rate |
$104.63 |
| Max. Negotiated Rate |
$358.73 |
| Rate for Payer: Anthem Exchange |
$175.54
|
| Rate for Payer: Anthem PPO |
$175.54
|
| Rate for Payer: Anthem Traditional |
$175.54
|
| Rate for Payer: Coventry/First Health All Products |
$358.73
|
| Rate for Payer: Frontpath All Products |
$127.51
|
| Rate for Payer: Humana ChoiceCare |
$298.94
|
| Rate for Payer: Lutheran Preferred All Products |
$123.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$224.20
|
| Rate for Payer: PHP All Products |
$117.66
|
| Rate for Payer: Signature Care EPO |
$134.30
|
| Rate for Payer: Signature Care PPO |
$134.30
|
| Rate for Payer: Three Rivers Preferred All Products |
$121.00
|
| Rate for Payer: United Healthcare Commercial |
$104.63
|
| Rate for Payer: United Healthcare Medicare |
$149.47
|
|
|
PR PREVENTIVE VISIT,NEW,AGE 1-4
|
Professional
|
$216.00
|
|
|
Service Code
|
CPT 99382
|
| Hospital Charge Code |
Z13206
|
| Min. Negotiated Rate |
$68.97 |
| Max. Negotiated Rate |
$259.20 |
| Rate for Payer: Anthem Exchange |
$124.43
|
| Rate for Payer: Anthem PPO |
$124.43
|
| Rate for Payer: Anthem Traditional |
$124.43
|
| Rate for Payer: Coventry/First Health All Products |
$259.20
|
| Rate for Payer: Frontpath All Products |
$81.03
|
| Rate for Payer: Humana ChoiceCare |
$216.00
|
| Rate for Payer: Lutheran Preferred All Products |
$79.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$162.00
|
| Rate for Payer: PHP All Products |
$75.34
|
| Rate for Payer: Signature Care EPO |
$98.60
|
| Rate for Payer: Signature Care PPO |
$98.60
|
| Rate for Payer: Three Rivers Preferred All Products |
$77.00
|
| Rate for Payer: United Healthcare Commercial |
$68.97
|
| Rate for Payer: United Healthcare Medicare |
$104.77
|
|
|
PR PREVENTIVE VISIT,NEW,AGE5-11
|
Professional
|
$217.94
|
|
|
Service Code
|
CPT 99383
|
| Hospital Charge Code |
Z13207
|
| Min. Negotiated Rate |
$68.97 |
| Max. Negotiated Rate |
$261.53 |
| Rate for Payer: Anthem Exchange |
$124.43
|
| Rate for Payer: Anthem PPO |
$124.43
|
| Rate for Payer: Anthem Traditional |
$124.43
|
| Rate for Payer: Coventry/First Health All Products |
$261.53
|
| Rate for Payer: Frontpath All Products |
$85.84
|
| Rate for Payer: Humana ChoiceCare |
$217.94
|
| Rate for Payer: Lutheran Preferred All Products |
$84.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$163.45
|
| Rate for Payer: PHP All Products |
$79.98
|
| Rate for Payer: Signature Care EPO |
$96.90
|
| Rate for Payer: Signature Care PPO |
$96.90
|
| Rate for Payer: Three Rivers Preferred All Products |
$82.00
|
| Rate for Payer: United Healthcare Commercial |
$68.97
|
| Rate for Payer: United Healthcare Medicare |
$108.97
|
|
|
PR PREVENTIVE VISIT,NEW,INFANT < 1 YR
|
Professional
|
$216.00
|
|
|
Service Code
|
CPT 99381
|
| Hospital Charge Code |
Z13205
|
| Min. Negotiated Rate |
$60.45 |
| Max. Negotiated Rate |
$259.20 |
| Rate for Payer: Anthem Exchange |
$112.99
|
| Rate for Payer: Anthem PPO |
$112.99
|
| Rate for Payer: Anthem Traditional |
$112.99
|
| Rate for Payer: Coventry/First Health All Products |
$259.20
|
| Rate for Payer: Frontpath All Products |
$75.83
|
| Rate for Payer: Humana ChoiceCare |
$216.00
|
| Rate for Payer: Lutheran Preferred All Products |
$74.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$162.00
|
| Rate for Payer: PHP All Products |
$70.69
|
| Rate for Payer: Signature Care EPO |
$91.80
|
| Rate for Payer: Signature Care PPO |
$91.80
|
| Rate for Payer: Three Rivers Preferred All Products |
$72.00
|
| Rate for Payer: United Healthcare Commercial |
$60.45
|
| Rate for Payer: United Healthcare Medicare |
$100.25
|
|
|
PR PRGRMG DEV EVAL 1 LEAD PM/LDLS PM 1 CAR CHMBR IP
|
Professional
|
$125.24
|
|
|
Service Code
|
CPT 93279
|
| Hospital Charge Code |
Z13092
|
| Min. Negotiated Rate |
$64.19 |
| Max. Negotiated Rate |
$150.29 |
| Rate for Payer: Aetna Medicare |
$64.19
|
| Rate for Payer: Anthem Exchange |
$78.30
|
| Rate for Payer: Anthem Medicare |
$64.19
|
| Rate for Payer: Anthem PPO |
$78.30
|
| Rate for Payer: Anthem Traditional |
$78.30
|
| Rate for Payer: Caresource Just 4 Me |
$73.82
|
| Rate for Payer: Caresource Medicare |
$70.61
|
| Rate for Payer: Centivo/Paragon All Products |
$99.49
|
| Rate for Payer: Coventry/First Health All Products |
$150.29
|
| Rate for Payer: Frontpath All Products |
$73.61
|
| Rate for Payer: Humana ChoiceCare |
$125.24
|
| Rate for Payer: Humana Medicare |
$64.19
|
| Rate for Payer: Lucent/Coldwater Veneers |
$109.12
|
| Rate for Payer: Lutheran Preferred All Products |
$103.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$93.93
|
| Rate for Payer: PHP All Products |
$92.05
|
| Rate for Payer: Plain Church Group Ministry All Products |
$64.19
|
| Rate for Payer: Signature Care EPO |
$80.40
|
| Rate for Payer: Signature Care PPO |
$80.40
|
| Rate for Payer: Three Rivers Preferred All Products |
$96.00
|
| Rate for Payer: United Healthcare Commercial |
$65.69
|
|
|
PR PRGRMG DEV EVAL IMPLANTABLE SUBQ LEAD DFB SYSTEM
|
Professional
|
$141.50
|
|
|
Service Code
|
CPT 93260
|
| Hospital Charge Code |
Z13086
|
| Min. Negotiated Rate |
$72.52 |
| Max. Negotiated Rate |
$169.80 |
| Rate for Payer: Aetna Medicare |
$72.52
|
| Rate for Payer: Anthem Exchange |
$91.81
|
| Rate for Payer: Anthem Medicare |
$72.52
|
| Rate for Payer: Anthem PPO |
$91.81
|
| Rate for Payer: Anthem Traditional |
$91.81
|
| Rate for Payer: Caresource Just 4 Me |
$83.40
|
| Rate for Payer: Caresource Medicare |
$79.77
|
| Rate for Payer: Centivo/Paragon All Products |
$112.41
|
| Rate for Payer: Coventry/First Health All Products |
$169.80
|
| Rate for Payer: Frontpath All Products |
$83.09
|
| Rate for Payer: Humana ChoiceCare |
$141.50
|
| Rate for Payer: Humana Medicare |
$72.52
|
| Rate for Payer: Lucent/Coldwater Veneers |
$123.28
|
| Rate for Payer: Lutheran Preferred All Products |
$116.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$106.12
|
| Rate for Payer: PHP All Products |
$104.00
|
| Rate for Payer: Plain Church Group Ministry All Products |
$72.52
|
| Rate for Payer: Signature Care EPO |
$101.60
|
| Rate for Payer: Signature Care PPO |
$101.60
|
| Rate for Payer: Three Rivers Preferred All Products |
$109.00
|
| Rate for Payer: United Healthcare Commercial |
$80.79
|
|
|
PR PRGRMG DEV EVAL SCRMS PHYS/QHP IN PERSON
|
Professional
|
$111.82
|
|
|
Service Code
|
CPT 93285
|
| Hospital Charge Code |
Z13098
|
| Min. Negotiated Rate |
$56.51 |
| Max. Negotiated Rate |
$134.18 |
| Rate for Payer: Aetna Medicare |
$57.31
|
| Rate for Payer: Anthem Exchange |
$67.36
|
| Rate for Payer: Anthem Medicare |
$57.31
|
| Rate for Payer: Anthem PPO |
$67.36
|
| Rate for Payer: Anthem Traditional |
$67.36
|
| Rate for Payer: Caresource Just 4 Me |
$65.91
|
| Rate for Payer: Caresource Medicare |
$63.04
|
| Rate for Payer: Centivo/Paragon All Products |
$88.83
|
| Rate for Payer: Coventry/First Health All Products |
$134.18
|
| Rate for Payer: Frontpath All Products |
$66.23
|
| Rate for Payer: Humana ChoiceCare |
$111.82
|
| Rate for Payer: Humana Medicare |
$57.31
|
| Rate for Payer: Lucent/Coldwater Veneers |
$97.43
|
| Rate for Payer: Lutheran Preferred All Products |
$92.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$83.86
|
| Rate for Payer: PHP All Products |
$82.19
|
| Rate for Payer: Plain Church Group Ministry All Products |
$57.31
|
| Rate for Payer: Signature Care EPO |
$68.56
|
| Rate for Payer: Signature Care PPO |
$68.56
|
| Rate for Payer: Three Rivers Preferred All Products |
$86.00
|
| Rate for Payer: United Healthcare Commercial |
$56.51
|
|
|
PR PRGRMG EVAL IMPLANTABLE IN PERSON MULTI LEAD DFB
|
Professional
|
$197.46
|
|
|
Service Code
|
CPT 93284
|
| Hospital Charge Code |
Z13097
|
| Min. Negotiated Rate |
$101.20 |
| Max. Negotiated Rate |
$236.95 |
| Rate for Payer: Aetna Medicare |
$101.20
|
| Rate for Payer: Anthem Exchange |
$143.25
|
| Rate for Payer: Anthem Medicare |
$101.20
|
| Rate for Payer: Anthem PPO |
$143.25
|
| Rate for Payer: Anthem Traditional |
$143.25
|
| Rate for Payer: Caresource Just 4 Me |
$116.38
|
| Rate for Payer: Caresource Medicare |
$111.32
|
| Rate for Payer: Centivo/Paragon All Products |
$156.86
|
| Rate for Payer: Coventry/First Health All Products |
$236.95
|
| Rate for Payer: Frontpath All Products |
$116.05
|
| Rate for Payer: Humana ChoiceCare |
$197.46
|
| Rate for Payer: Humana Medicare |
$101.20
|
| Rate for Payer: Lucent/Coldwater Veneers |
$172.04
|
| Rate for Payer: Lutheran Preferred All Products |
$162.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$148.09
|
| Rate for Payer: PHP All Products |
$145.14
|
| Rate for Payer: Plain Church Group Ministry All Products |
$101.20
|
| Rate for Payer: Signature Care EPO |
$146.71
|
| Rate for Payer: Signature Care PPO |
$146.71
|
| Rate for Payer: Three Rivers Preferred All Products |
$152.00
|
| Rate for Payer: United Healthcare Commercial |
$120.18
|
|
