|
PR REMOTE PHYSIOLOGIC MONITORING EA ADDL 20 MIN MO
|
Professional
|
$72.92
|
|
|
Service Code
|
CPT 99458
|
| Hospital Charge Code |
Z13228
|
| Min. Negotiated Rate |
$28.72 |
| Max. Negotiated Rate |
$87.50 |
| Rate for Payer: Aetna Medicare |
$28.72
|
| Rate for Payer: Anthem Medicare |
$28.72
|
| Rate for Payer: Caresource Just 4 Me |
$33.03
|
| Rate for Payer: Caresource Medicare |
$31.59
|
| Rate for Payer: Centivo/Paragon All Products |
$44.52
|
| Rate for Payer: Coventry/First Health All Products |
$87.50
|
| Rate for Payer: Frontpath All Products |
$31.74
|
| Rate for Payer: Humana ChoiceCare |
$72.92
|
| Rate for Payer: Humana Medicare |
$28.72
|
| Rate for Payer: Lucent/Coldwater Veneers |
$48.82
|
| Rate for Payer: PHCS/Multiplan All Products |
$54.69
|
| Rate for Payer: Plain Church Group Ministry All Products |
$28.72
|
| Rate for Payer: United Healthcare Commercial |
$32.93
|
| Rate for Payer: United Healthcare Medicare |
$36.46
|
|
|
PR REMOVAL ADENOIDS,PRIMARY,<12 Y/O
|
Professional
|
$390.44
|
|
|
Service Code
|
CPT 42830
|
| Hospital Charge Code |
Z12583
|
| Min. Negotiated Rate |
$195.22 |
| Max. Negotiated Rate |
$468.53 |
| Rate for Payer: Aetna Medicare |
$200.10
|
| Rate for Payer: Anthem Exchange |
$228.40
|
| Rate for Payer: Anthem Medicare |
$200.10
|
| Rate for Payer: Anthem PPO |
$228.40
|
| Rate for Payer: Anthem Traditional |
$228.40
|
| Rate for Payer: Caresource Just 4 Me |
$230.11
|
| Rate for Payer: Caresource Medicare |
$220.11
|
| Rate for Payer: Centivo/Paragon All Products |
$310.15
|
| Rate for Payer: Coventry/First Health All Products |
$468.53
|
| Rate for Payer: Frontpath All Products |
$271.49
|
| Rate for Payer: Humana ChoiceCare |
$390.44
|
| Rate for Payer: Humana Medicare |
$200.10
|
| Rate for Payer: Lucent/Coldwater Veneers |
$340.17
|
| Rate for Payer: Lutheran Preferred All Products |
$300.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$292.83
|
| Rate for Payer: PHP All Products |
$341.64
|
| Rate for Payer: Plain Church Group Ministry All Products |
$200.10
|
| Rate for Payer: Signature Care EPO |
$290.70
|
| Rate for Payer: Signature Care PPO |
$290.70
|
| Rate for Payer: Three Rivers Preferred All Products |
$280.00
|
| Rate for Payer: United Healthcare Commercial |
$225.25
|
| Rate for Payer: United Healthcare Medicare |
$195.22
|
|
|
PR REMOVAL ANAL FISTULA,INTERSPNINCTERIC
|
Professional
|
$1,028.80
|
|
|
Service Code
|
CPT 46275
|
| Hospital Charge Code |
Z12645
|
| Min. Negotiated Rate |
$393.89 |
| Max. Negotiated Rate |
$1,234.56 |
| Rate for Payer: Aetna Medicare |
$393.89
|
| Rate for Payer: Anthem Exchange |
$470.90
|
| Rate for Payer: Anthem Medicare |
$393.89
|
| Rate for Payer: Anthem PPO |
$470.90
|
| Rate for Payer: Anthem Traditional |
$470.90
|
| Rate for Payer: Caresource Just 4 Me |
$452.97
|
| Rate for Payer: Caresource Medicare |
$433.28
|
| Rate for Payer: Centivo/Paragon All Products |
$610.53
|
| Rate for Payer: Coventry/First Health All Products |
$1,234.56
|
| Rate for Payer: Frontpath All Products |
$546.98
|
| Rate for Payer: Humana ChoiceCare |
$1,028.80
|
| Rate for Payer: Humana Medicare |
$393.89
|
| Rate for Payer: Lucent/Coldwater Veneers |
$669.61
|
| Rate for Payer: Lutheran Preferred All Products |
$591.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$771.60
|
| Rate for Payer: PHP All Products |
$672.50
|
| Rate for Payer: Plain Church Group Ministry All Products |
$393.89
|
| Rate for Payer: Signature Care EPO |
$502.35
|
| Rate for Payer: Signature Care PPO |
$502.35
|
| Rate for Payer: Three Rivers Preferred All Products |
$551.00
|
| Rate for Payer: United Healthcare Commercial |
$408.64
|
| Rate for Payer: United Healthcare Medicare |
$514.40
|
|
|
PR REMOVAL ANAL FISTULA,SUBCUTANEOUS
|
Professional
|
$972.58
|
|
|
Service Code
|
CPT 46270
|
| Hospital Charge Code |
Z12644
|
| Min. Negotiated Rate |
$372.80 |
| Max. Negotiated Rate |
$1,167.10 |
| Rate for Payer: Aetna Medicare |
$372.80
|
| Rate for Payer: Anthem Exchange |
$382.07
|
| Rate for Payer: Anthem Medicare |
$372.80
|
| Rate for Payer: Anthem PPO |
$382.07
|
| Rate for Payer: Anthem Traditional |
$382.07
|
| Rate for Payer: Caresource Just 4 Me |
$428.72
|
| Rate for Payer: Caresource Medicare |
$410.08
|
| Rate for Payer: Centivo/Paragon All Products |
$577.84
|
| Rate for Payer: Coventry/First Health All Products |
$1,167.10
|
| Rate for Payer: Frontpath All Products |
$518.73
|
| Rate for Payer: Humana ChoiceCare |
$972.58
|
| Rate for Payer: Humana Medicare |
$372.80
|
| Rate for Payer: Lucent/Coldwater Veneers |
$633.76
|
| Rate for Payer: Lutheran Preferred All Products |
$559.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$729.44
|
| Rate for Payer: PHP All Products |
$636.49
|
| Rate for Payer: Plain Church Group Ministry All Products |
$372.80
|
| Rate for Payer: Signature Care EPO |
$468.35
|
| Rate for Payer: Signature Care PPO |
$468.35
|
| Rate for Payer: Three Rivers Preferred All Products |
$522.00
|
| Rate for Payer: United Healthcare Commercial |
$380.75
|
| Rate for Payer: United Healthcare Medicare |
$486.29
|
|
|
PR REMOVAL ARM/ELBOW F.B.,DEEP
|
Professional
|
$999.02
|
|
|
Service Code
|
CPT 24201
|
| Hospital Charge Code |
Z12192
|
| Min. Negotiated Rate |
$342.21 |
| Max. Negotiated Rate |
$1,198.82 |
| Rate for Payer: Aetna Medicare |
$342.21
|
| Rate for Payer: Anthem Exchange |
$568.71
|
| Rate for Payer: Anthem Medicare |
$342.21
|
| Rate for Payer: Anthem PPO |
$568.71
|
| Rate for Payer: Anthem Traditional |
$568.71
|
| Rate for Payer: Caresource Just 4 Me |
$393.54
|
| Rate for Payer: Caresource Medicare |
$376.43
|
| Rate for Payer: Centivo/Paragon All Products |
$530.43
|
| Rate for Payer: Coventry/First Health All Products |
$1,198.82
|
| Rate for Payer: Frontpath All Products |
$475.23
|
| Rate for Payer: Humana ChoiceCare |
$999.02
|
| Rate for Payer: Humana Medicare |
$342.21
|
| Rate for Payer: Lucent/Coldwater Veneers |
$581.76
|
| Rate for Payer: Lutheran Preferred All Products |
$548.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$749.26
|
| Rate for Payer: PHP All Products |
$580.91
|
| Rate for Payer: Plain Church Group Ministry All Products |
$342.21
|
| Rate for Payer: Signature Care EPO |
$586.50
|
| Rate for Payer: Signature Care PPO |
$586.50
|
| Rate for Payer: Three Rivers Preferred All Products |
$513.00
|
| Rate for Payer: United Healthcare Commercial |
$387.03
|
| Rate for Payer: United Healthcare Medicare |
$499.51
|
|
|
PR REMOVAL DEEP IMPLANT
|
Professional
|
$1,094.14
|
|
|
Service Code
|
CPT 20680
|
| Hospital Charge Code |
Z12139
|
| Min. Negotiated Rate |
$390.65 |
| Max. Negotiated Rate |
$1,312.97 |
| Rate for Payer: Aetna Medicare |
$390.65
|
| Rate for Payer: Anthem Exchange |
$623.38
|
| Rate for Payer: Anthem Medicare |
$390.65
|
| Rate for Payer: Anthem PPO |
$623.38
|
| Rate for Payer: Anthem Traditional |
$623.38
|
| Rate for Payer: Caresource Just 4 Me |
$449.25
|
| Rate for Payer: Caresource Medicare |
$429.72
|
| Rate for Payer: Centivo/Paragon All Products |
$605.51
|
| Rate for Payer: Coventry/First Health All Products |
$1,312.97
|
| Rate for Payer: Frontpath All Products |
$540.71
|
| Rate for Payer: Humana ChoiceCare |
$1,094.14
|
| Rate for Payer: Humana Medicare |
$390.65
|
| Rate for Payer: Lucent/Coldwater Veneers |
$664.10
|
| Rate for Payer: Lutheran Preferred All Products |
$625.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$820.61
|
| Rate for Payer: PHP All Products |
$663.15
|
| Rate for Payer: Plain Church Group Ministry All Products |
$390.65
|
| Rate for Payer: Signature Care EPO |
$499.20
|
| Rate for Payer: Signature Care PPO |
$499.20
|
| Rate for Payer: Three Rivers Preferred All Products |
$586.00
|
| Rate for Payer: United Healthcare Commercial |
$448.31
|
| Rate for Payer: United Healthcare Medicare |
$547.07
|
|
|
PR REMOVAL DRUG IMPLANT DEVICE
|
Professional
|
$203.68
|
|
|
Service Code
|
CPT 11982
|
| Hospital Charge Code |
Z12036
|
| Min. Negotiated Rate |
$68.26 |
| Max. Negotiated Rate |
$244.42 |
| Rate for Payer: Aetna Medicare |
$68.26
|
| Rate for Payer: Anthem Exchange |
$171.20
|
| Rate for Payer: Anthem Medicare |
$68.26
|
| Rate for Payer: Anthem PPO |
$171.20
|
| Rate for Payer: Anthem Traditional |
$171.20
|
| Rate for Payer: Caresource Just 4 Me |
$78.50
|
| Rate for Payer: Caresource Medicare |
$75.09
|
| Rate for Payer: Centivo/Paragon All Products |
$105.80
|
| Rate for Payer: Coventry/First Health All Products |
$244.42
|
| Rate for Payer: Frontpath All Products |
$97.23
|
| Rate for Payer: Humana ChoiceCare |
$203.68
|
| Rate for Payer: Humana Medicare |
$68.26
|
| Rate for Payer: Lucent/Coldwater Veneers |
$116.04
|
| Rate for Payer: Lutheran Preferred All Products |
$89.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$152.76
|
| Rate for Payer: PHP All Products |
$93.24
|
| Rate for Payer: Plain Church Group Ministry All Products |
$68.26
|
| Rate for Payer: Signature Care EPO |
$154.70
|
| Rate for Payer: Signature Care PPO |
$154.70
|
| Rate for Payer: Three Rivers Preferred All Products |
$82.00
|
| Rate for Payer: United Healthcare Commercial |
$117.13
|
| Rate for Payer: United Healthcare Medicare |
$101.84
|
|
|
PR REMOVAL IMPACTED CERUMEN INSTRUMENTATION UNILAT
|
Professional
|
$86.82
|
|
|
Service Code
|
CPT 69210
|
| Hospital Charge Code |
Z12852
|
| Min. Negotiated Rate |
$30.60 |
| Max. Negotiated Rate |
$104.18 |
| Rate for Payer: Aetna Medicare |
$30.60
|
| Rate for Payer: Anthem Exchange |
$62.80
|
| Rate for Payer: Anthem Medicare |
$30.60
|
| Rate for Payer: Anthem PPO |
$62.80
|
| Rate for Payer: Anthem Traditional |
$62.80
|
| Rate for Payer: Caresource Just 4 Me |
$35.19
|
| Rate for Payer: Caresource Medicare |
$33.66
|
| Rate for Payer: Centivo/Paragon All Products |
$47.43
|
| Rate for Payer: Coventry/First Health All Products |
$104.18
|
| Rate for Payer: Frontpath All Products |
$42.96
|
| Rate for Payer: Humana ChoiceCare |
$86.82
|
| Rate for Payer: Humana Medicare |
$30.60
|
| Rate for Payer: Lucent/Coldwater Veneers |
$52.02
|
| Rate for Payer: Lutheran Preferred All Products |
$49.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$65.11
|
| Rate for Payer: PHP All Products |
$38.81
|
| Rate for Payer: Plain Church Group Ministry All Products |
$30.60
|
| Rate for Payer: Signature Care EPO |
$59.50
|
| Rate for Payer: Signature Care PPO |
$59.50
|
| Rate for Payer: Three Rivers Preferred All Products |
$46.00
|
| Rate for Payer: United Healthcare Commercial |
$36.71
|
| Rate for Payer: United Healthcare Medicare |
$43.41
|
|
|
PR REMOVAL IMPACTED CERUMEN INSTRUMENTATION UNILAT
|
Professional
|
$173.64
|
|
|
Service Code
|
CPT 69210
|
| Hospital Charge Code |
Z12853
|
| Min. Negotiated Rate |
$30.60 |
| Max. Negotiated Rate |
$208.37 |
| Rate for Payer: Aetna Medicare |
$30.60
|
| Rate for Payer: Anthem Exchange |
$62.80
|
| Rate for Payer: Anthem Medicare |
$30.60
|
| Rate for Payer: Anthem PPO |
$62.80
|
| Rate for Payer: Anthem Traditional |
$62.80
|
| Rate for Payer: Caresource Just 4 Me |
$35.19
|
| Rate for Payer: Caresource Medicare |
$33.66
|
| Rate for Payer: Centivo/Paragon All Products |
$47.43
|
| Rate for Payer: Coventry/First Health All Products |
$208.37
|
| Rate for Payer: Frontpath All Products |
$42.96
|
| Rate for Payer: Humana ChoiceCare |
$173.64
|
| Rate for Payer: Humana Medicare |
$30.60
|
| Rate for Payer: Lucent/Coldwater Veneers |
$52.02
|
| Rate for Payer: Lutheran Preferred All Products |
$49.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$130.23
|
| Rate for Payer: PHP All Products |
$38.81
|
| Rate for Payer: Plain Church Group Ministry All Products |
$30.60
|
| Rate for Payer: Signature Care EPO |
$59.50
|
| Rate for Payer: Signature Care PPO |
$59.50
|
| Rate for Payer: Three Rivers Preferred All Products |
$46.00
|
| Rate for Payer: United Healthcare Commercial |
$36.71
|
| Rate for Payer: United Healthcare Medicare |
$43.41
|
|
|
PR REMOVAL IMPACTED CERUMEN IRRIGATION/LVG UNILAT
|
Professional
|
$27.42
|
|
|
Service Code
|
CPT 69209
|
| Hospital Charge Code |
Z12850
|
| Min. Negotiated Rate |
$12.51 |
| Max. Negotiated Rate |
$32.90 |
| Rate for Payer: Aetna Medicare |
$14.05
|
| Rate for Payer: Anthem Exchange |
$23.07
|
| Rate for Payer: Anthem Medicare |
$14.05
|
| Rate for Payer: Anthem PPO |
$23.07
|
| Rate for Payer: Anthem Traditional |
$23.07
|
| Rate for Payer: Caresource Just 4 Me |
$16.16
|
| Rate for Payer: Caresource Medicare |
$15.46
|
| Rate for Payer: Centivo/Paragon All Products |
$21.78
|
| Rate for Payer: Coventry/First Health All Products |
$32.90
|
| Rate for Payer: Frontpath All Products |
$18.56
|
| Rate for Payer: Humana ChoiceCare |
$27.42
|
| Rate for Payer: Humana Medicare |
$14.05
|
| Rate for Payer: Lucent/Coldwater Veneers |
$23.89
|
| Rate for Payer: Lutheran Preferred All Products |
$22.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$20.57
|
| Rate for Payer: PHP All Products |
$17.82
|
| Rate for Payer: Plain Church Group Ministry All Products |
$14.05
|
| Rate for Payer: Signature Care EPO |
$12.51
|
| Rate for Payer: Signature Care PPO |
$12.51
|
| Rate for Payer: Three Rivers Preferred All Products |
$21.00
|
| Rate for Payer: United Healthcare Commercial |
$14.75
|
| Rate for Payer: United Healthcare Medicare |
$13.71
|
|
|
PR REMOVAL IMPACTED CERUMEN IRRIGATION/LVG UNILAT
|
Professional
|
$109.60
|
|
|
Service Code
|
CPT 69209
|
| Hospital Charge Code |
Z12851
|
| Min. Negotiated Rate |
$12.51 |
| Max. Negotiated Rate |
$131.52 |
| Rate for Payer: Aetna Medicare |
$14.05
|
| Rate for Payer: Anthem Exchange |
$23.07
|
| Rate for Payer: Anthem Medicare |
$14.05
|
| Rate for Payer: Anthem PPO |
$23.07
|
| Rate for Payer: Anthem Traditional |
$23.07
|
| Rate for Payer: Caresource Just 4 Me |
$16.16
|
| Rate for Payer: Caresource Medicare |
$15.46
|
| Rate for Payer: Centivo/Paragon All Products |
$21.78
|
| Rate for Payer: Coventry/First Health All Products |
$131.52
|
| Rate for Payer: Frontpath All Products |
$18.56
|
| Rate for Payer: Humana ChoiceCare |
$109.60
|
| Rate for Payer: Humana Medicare |
$14.05
|
| Rate for Payer: Lucent/Coldwater Veneers |
$23.89
|
| Rate for Payer: Lutheran Preferred All Products |
$22.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$82.20
|
| Rate for Payer: PHP All Products |
$17.82
|
| Rate for Payer: Plain Church Group Ministry All Products |
$14.05
|
| Rate for Payer: Signature Care EPO |
$12.51
|
| Rate for Payer: Signature Care PPO |
$12.51
|
| Rate for Payer: Three Rivers Preferred All Products |
$21.00
|
| Rate for Payer: United Healthcare Commercial |
$14.75
|
| Rate for Payer: United Healthcare Medicare |
$13.71
|
|
|
PR REMOVAL IMPLANTABLE DEFIB PULSE GENERATOR ONLY
|
Professional
|
$382.28
|
|
|
Service Code
|
CPT 33241
|
| Hospital Charge Code |
Z12536
|
| Min. Negotiated Rate |
$191.14 |
| Max. Negotiated Rate |
$458.74 |
| Rate for Payer: Aetna Medicare |
$195.92
|
| Rate for Payer: Anthem Exchange |
$320.30
|
| Rate for Payer: Anthem Medicare |
$195.92
|
| Rate for Payer: Anthem PPO |
$320.30
|
| Rate for Payer: Anthem Traditional |
$320.30
|
| Rate for Payer: Caresource Just 4 Me |
$225.31
|
| Rate for Payer: Caresource Medicare |
$215.51
|
| Rate for Payer: Centivo/Paragon All Products |
$303.68
|
| Rate for Payer: Coventry/First Health All Products |
$458.74
|
| Rate for Payer: Frontpath All Products |
$280.23
|
| Rate for Payer: Humana ChoiceCare |
$382.28
|
| Rate for Payer: Humana Medicare |
$195.92
|
| Rate for Payer: Lucent/Coldwater Veneers |
$333.06
|
| Rate for Payer: Lutheran Preferred All Products |
$313.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$286.71
|
| Rate for Payer: PHP All Products |
$267.60
|
| Rate for Payer: Plain Church Group Ministry All Products |
$195.92
|
| Rate for Payer: Signature Care EPO |
$337.79
|
| Rate for Payer: Signature Care PPO |
$337.79
|
| Rate for Payer: Three Rivers Preferred All Products |
$294.00
|
| Rate for Payer: United Healthcare Commercial |
$274.34
|
| Rate for Payer: United Healthcare Medicare |
$191.14
|
|
|
PR REMOVAL INTACT BREAST IMPLANT
|
Professional
|
$1,005.14
|
|
|
Service Code
|
CPT 19328
|
| Hospital Charge Code |
Z12112
|
| Min. Negotiated Rate |
$447.95 |
| Max. Negotiated Rate |
$1,206.17 |
| Rate for Payer: Aetna Medicare |
$515.13
|
| Rate for Payer: Anthem Exchange |
$487.30
|
| Rate for Payer: Anthem Medicare |
$515.13
|
| Rate for Payer: Anthem PPO |
$487.30
|
| Rate for Payer: Anthem Traditional |
$487.30
|
| Rate for Payer: Caresource Just 4 Me |
$592.40
|
| Rate for Payer: Caresource Medicare |
$566.64
|
| Rate for Payer: Centivo/Paragon All Products |
$798.45
|
| Rate for Payer: Coventry/First Health All Products |
$1,206.17
|
| Rate for Payer: Frontpath All Products |
$714.13
|
| Rate for Payer: Humana ChoiceCare |
$1,005.14
|
| Rate for Payer: Humana Medicare |
$515.13
|
| Rate for Payer: Lucent/Coldwater Veneers |
$875.72
|
| Rate for Payer: Lutheran Preferred All Products |
$670.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$753.86
|
| Rate for Payer: PHP All Products |
$703.59
|
| Rate for Payer: Plain Church Group Ministry All Products |
$515.13
|
| Rate for Payer: Signature Care EPO |
$447.95
|
| Rate for Payer: Signature Care PPO |
$447.95
|
| Rate for Payer: Three Rivers Preferred All Products |
$618.00
|
| Rate for Payer: United Healthcare Commercial |
$520.26
|
| Rate for Payer: United Healthcare Medicare |
$502.57
|
|
|
PR REMOVAL OF COCCYX
|
Professional
|
$923.00
|
|
|
Service Code
|
CPT 27080
|
| Hospital Charge Code |
Z12308
|
| Min. Negotiated Rate |
$461.50 |
| Max. Negotiated Rate |
$1,107.60 |
| Rate for Payer: Caresource Just 4 Me |
$544.00
|
| Rate for Payer: Caresource Medicare |
$520.34
|
| Rate for Payer: Aetna Medicare |
$473.04
|
| Rate for Payer: Anthem Exchange |
$605.50
|
| Rate for Payer: Anthem Medicare |
$473.04
|
| Rate for Payer: Anthem PPO |
$605.50
|
| Rate for Payer: Anthem Traditional |
$605.50
|
| Rate for Payer: Centivo/Paragon All Products |
$733.21
|
| Rate for Payer: Coventry/First Health All Products |
$1,107.60
|
| Rate for Payer: Frontpath All Products |
$667.11
|
| Rate for Payer: Humana ChoiceCare |
$923.00
|
| Rate for Payer: Humana Medicare |
$473.04
|
| Rate for Payer: Lucent/Coldwater Veneers |
$804.17
|
| Rate for Payer: Lutheran Preferred All Products |
$757.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$692.25
|
| Rate for Payer: PHP All Products |
$803.02
|
| Rate for Payer: Plain Church Group Ministry All Products |
$473.04
|
| Rate for Payer: Signature Care EPO |
$668.10
|
| Rate for Payer: Signature Care PPO |
$668.10
|
| Rate for Payer: Three Rivers Preferred All Products |
$710.00
|
| Rate for Payer: United Healthcare Commercial |
$530.34
|
| Rate for Payer: United Healthcare Medicare |
$461.50
|
|
|
PR REMOVAL OF CONTRACEPTIVE CAPSUL
|
Professional
|
$263.54
|
|
|
Service Code
|
CPT 11976
|
| Hospital Charge Code |
Z12033
|
| Min. Negotiated Rate |
$86.29 |
| Max. Negotiated Rate |
$316.25 |
| Rate for Payer: Aetna Medicare |
$86.29
|
| Rate for Payer: Anthem Exchange |
$168.27
|
| Rate for Payer: Anthem Medicare |
$86.29
|
| Rate for Payer: Anthem PPO |
$168.27
|
| Rate for Payer: Anthem Traditional |
$168.27
|
| Rate for Payer: Caresource Just 4 Me |
$99.23
|
| Rate for Payer: Caresource Medicare |
$94.92
|
| Rate for Payer: Centivo/Paragon All Products |
$133.75
|
| Rate for Payer: Coventry/First Health All Products |
$316.25
|
| Rate for Payer: Frontpath All Products |
$121.78
|
| Rate for Payer: Humana ChoiceCare |
$263.54
|
| Rate for Payer: Humana Medicare |
$86.29
|
| Rate for Payer: Lucent/Coldwater Veneers |
$146.69
|
| Rate for Payer: Lutheran Preferred All Products |
$112.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$197.66
|
| Rate for Payer: PHP All Products |
$117.86
|
| Rate for Payer: Plain Church Group Ministry All Products |
$86.29
|
| Rate for Payer: Signature Care EPO |
$144.50
|
| Rate for Payer: Signature Care PPO |
$144.50
|
| Rate for Payer: Three Rivers Preferred All Products |
$104.00
|
| Rate for Payer: United Healthcare Commercial |
$108.69
|
| Rate for Payer: United Healthcare Medicare |
$131.77
|
|
|
PR REMOVAL OF ELBOW BURSA
|
Professional
|
$661.10
|
|
|
Service Code
|
CPT 24105
|
| Hospital Charge Code |
Z12190
|
| Min. Negotiated Rate |
$330.55 |
| Max. Negotiated Rate |
$793.32 |
| Rate for Payer: Aetna Medicare |
$338.82
|
| Rate for Payer: Anthem Exchange |
$383.60
|
| Rate for Payer: Anthem Medicare |
$338.82
|
| Rate for Payer: Anthem PPO |
$383.60
|
| Rate for Payer: Anthem Traditional |
$383.60
|
| Rate for Payer: Caresource Just 4 Me |
$389.64
|
| Rate for Payer: Caresource Medicare |
$372.70
|
| Rate for Payer: Centivo/Paragon All Products |
$525.17
|
| Rate for Payer: Coventry/First Health All Products |
$793.32
|
| Rate for Payer: Frontpath All Products |
$462.45
|
| Rate for Payer: Humana ChoiceCare |
$661.10
|
| Rate for Payer: Humana Medicare |
$338.82
|
| Rate for Payer: Lucent/Coldwater Veneers |
$575.99
|
| Rate for Payer: Lutheran Preferred All Products |
$542.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$495.83
|
| Rate for Payer: PHP All Products |
$575.16
|
| Rate for Payer: Plain Church Group Ministry All Products |
$338.82
|
| Rate for Payer: Signature Care EPO |
$458.15
|
| Rate for Payer: Signature Care PPO |
$458.15
|
| Rate for Payer: Three Rivers Preferred All Products |
$508.00
|
| Rate for Payer: United Healthcare Commercial |
$353.69
|
| Rate for Payer: United Healthcare Medicare |
$330.55
|
|
|
PR REMOVAL OF FALLOPIAN TUBE
|
Professional
|
$1,455.66
|
|
|
Service Code
|
CPT 58700
|
| Hospital Charge Code |
Z12777
|
| Min. Negotiated Rate |
$727.83 |
| Max. Negotiated Rate |
$1,746.79 |
| Rate for Payer: Aetna Medicare |
$746.02
|
| Rate for Payer: Anthem Exchange |
$956.46
|
| Rate for Payer: Anthem Medicare |
$746.02
|
| Rate for Payer: Anthem PPO |
$956.46
|
| Rate for Payer: Anthem Traditional |
$956.46
|
| Rate for Payer: Caresource Just 4 Me |
$857.92
|
| Rate for Payer: Caresource Medicare |
$820.62
|
| Rate for Payer: Centivo/Paragon All Products |
$1,156.33
|
| Rate for Payer: Coventry/First Health All Products |
$1,746.79
|
| Rate for Payer: Frontpath All Products |
$1,050.10
|
| Rate for Payer: Humana ChoiceCare |
$1,455.66
|
| Rate for Payer: Humana Medicare |
$746.02
|
| Rate for Payer: Lucent/Coldwater Veneers |
$1,268.23
|
| Rate for Payer: Lutheran Preferred All Products |
$1,044.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$1,091.75
|
| Rate for Payer: PHP All Products |
$960.73
|
| Rate for Payer: Plain Church Group Ministry All Products |
$746.02
|
| Rate for Payer: Signature Care EPO |
$887.40
|
| Rate for Payer: Signature Care PPO |
$887.40
|
| Rate for Payer: Three Rivers Preferred All Products |
$970.00
|
| Rate for Payer: United Healthcare Commercial |
$858.04
|
| Rate for Payer: United Healthcare Medicare |
$727.83
|
|
|
PR REMOVAL OF FOREIGN BODY
|
Professional
|
$395.54
|
|
|
Service Code
|
CPT 20520
|
| Hospital Charge Code |
Z12116
|
| Min. Negotiated Rate |
$137.57 |
| Max. Negotiated Rate |
$474.65 |
| Rate for Payer: Aetna Medicare |
$137.57
|
| Rate for Payer: Anthem Exchange |
$240.08
|
| Rate for Payer: Anthem Medicare |
$137.57
|
| Rate for Payer: Anthem PPO |
$240.08
|
| Rate for Payer: Anthem Traditional |
$240.08
|
| Rate for Payer: Caresource Just 4 Me |
$158.21
|
| Rate for Payer: Caresource Medicare |
$151.33
|
| Rate for Payer: Centivo/Paragon All Products |
$213.23
|
| Rate for Payer: Coventry/First Health All Products |
$474.65
|
| Rate for Payer: Frontpath All Products |
$188.30
|
| Rate for Payer: Humana ChoiceCare |
$395.54
|
| Rate for Payer: Humana Medicare |
$137.57
|
| Rate for Payer: Lucent/Coldwater Veneers |
$233.87
|
| Rate for Payer: Lutheran Preferred All Products |
$220.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$296.66
|
| Rate for Payer: PHP All Products |
$233.54
|
| Rate for Payer: Plain Church Group Ministry All Products |
$137.57
|
| Rate for Payer: Signature Care EPO |
$233.75
|
| Rate for Payer: Signature Care PPO |
$233.75
|
| Rate for Payer: Three Rivers Preferred All Products |
$206.00
|
| Rate for Payer: United Healthcare Commercial |
$153.30
|
| Rate for Payer: United Healthcare Medicare |
$197.77
|
|
|
PR REMOVAL OF FOREIGN BODY DEEP/COMPLIC
|
Professional
|
$846.00
|
|
|
Service Code
|
CPT 20525
|
| Hospital Charge Code |
Z12117
|
| Min. Negotiated Rate |
$229.21 |
| Max. Negotiated Rate |
$1,015.20 |
| Rate for Payer: Aetna Medicare |
$229.21
|
| Rate for Payer: Anthem Exchange |
$485.31
|
| Rate for Payer: Anthem Medicare |
$229.21
|
| Rate for Payer: Anthem PPO |
$485.31
|
| Rate for Payer: Anthem Traditional |
$485.31
|
| Rate for Payer: Caresource Just 4 Me |
$263.59
|
| Rate for Payer: Caresource Medicare |
$252.13
|
| Rate for Payer: Centivo/Paragon All Products |
$355.28
|
| Rate for Payer: Coventry/First Health All Products |
$1,015.20
|
| Rate for Payer: Frontpath All Products |
$318.90
|
| Rate for Payer: Humana ChoiceCare |
$846.00
|
| Rate for Payer: Humana Medicare |
$229.21
|
| Rate for Payer: Lucent/Coldwater Veneers |
$389.66
|
| Rate for Payer: Lutheran Preferred All Products |
$367.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$634.50
|
| Rate for Payer: PHP All Products |
$389.10
|
| Rate for Payer: Plain Church Group Ministry All Products |
$229.21
|
| Rate for Payer: Signature Care EPO |
$399.50
|
| Rate for Payer: Signature Care PPO |
$399.50
|
| Rate for Payer: Three Rivers Preferred All Products |
$344.00
|
| Rate for Payer: United Healthcare Commercial |
$269.28
|
| Rate for Payer: United Healthcare Medicare |
$423.00
|
|
|
PR REMOVAL OF HEEL SPUR
|
Professional
|
$955.66
|
|
|
Service Code
|
CPT 28119
|
| Hospital Charge Code |
Z12421
|
| Min. Negotiated Rate |
$343.14 |
| Max. Negotiated Rate |
$1,146.79 |
| Rate for Payer: Aetna Medicare |
$343.14
|
| Rate for Payer: Anthem Exchange |
$499.70
|
| Rate for Payer: Anthem Medicare |
$343.14
|
| Rate for Payer: Anthem PPO |
$499.70
|
| Rate for Payer: Anthem Traditional |
$499.70
|
| Rate for Payer: Caresource Just 4 Me |
$394.61
|
| Rate for Payer: Caresource Medicare |
$377.45
|
| Rate for Payer: Centivo/Paragon All Products |
$531.87
|
| Rate for Payer: Coventry/First Health All Products |
$1,146.79
|
| Rate for Payer: Frontpath All Products |
$465.89
|
| Rate for Payer: Humana ChoiceCare |
$955.66
|
| Rate for Payer: Humana Medicare |
$343.14
|
| Rate for Payer: Lucent/Coldwater Veneers |
$583.34
|
| Rate for Payer: Lutheran Preferred All Products |
$549.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$716.75
|
| Rate for Payer: PHP All Products |
$582.50
|
| Rate for Payer: Plain Church Group Ministry All Products |
$343.14
|
| Rate for Payer: Signature Care EPO |
$668.95
|
| Rate for Payer: Signature Care PPO |
$668.95
|
| Rate for Payer: Three Rivers Preferred All Products |
$515.00
|
| Rate for Payer: United Healthcare Commercial |
$412.36
|
| Rate for Payer: United Healthcare Medicare |
$477.83
|
|
|
PR REMOVAL OF HIP PROSTHESIS,COMPLEX
|
Professional
|
$2,867.78
|
|
|
Service Code
|
CPT 27091
|
| Hospital Charge Code |
Z12309
|
| Min. Negotiated Rate |
$1,433.89 |
| Max. Negotiated Rate |
$3,441.34 |
| Rate for Payer: Aetna Medicare |
$1,469.73
|
| Rate for Payer: Anthem Exchange |
$2,023.30
|
| Rate for Payer: Anthem Medicare |
$1,469.73
|
| Rate for Payer: Anthem PPO |
$2,023.30
|
| Rate for Payer: Anthem Traditional |
$2,023.30
|
| Rate for Payer: Caresource Just 4 Me |
$1,690.19
|
| Rate for Payer: Caresource Medicare |
$1,616.70
|
| Rate for Payer: Centivo/Paragon All Products |
$2,278.08
|
| Rate for Payer: Coventry/First Health All Products |
$3,441.34
|
| Rate for Payer: Frontpath All Products |
$2,072.75
|
| Rate for Payer: Humana ChoiceCare |
$2,867.78
|
| Rate for Payer: Humana Medicare |
$1,469.73
|
| Rate for Payer: Lucent/Coldwater Veneers |
$2,498.54
|
| Rate for Payer: Lutheran Preferred All Products |
$2,352.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$2,150.84
|
| Rate for Payer: PHP All Products |
$2,494.97
|
| Rate for Payer: Plain Church Group Ministry All Products |
$1,469.73
|
| Rate for Payer: Signature Care EPO |
$2,125.85
|
| Rate for Payer: Signature Care PPO |
$2,125.85
|
| Rate for Payer: Three Rivers Preferred All Products |
$2,205.00
|
| Rate for Payer: United Healthcare Commercial |
$1,757.24
|
| Rate for Payer: United Healthcare Medicare |
$1,433.89
|
|
|
PR REMOVAL OF HYDROCELE,TUNICA,UNILAT
|
Professional
|
$616.92
|
|
|
Service Code
|
CPT 55040
|
| Hospital Charge Code |
Z12682
|
| Min. Negotiated Rate |
$308.46 |
| Max. Negotiated Rate |
$740.30 |
| Rate for Payer: Aetna Medicare |
$316.18
|
| Rate for Payer: Anthem Exchange |
$424.88
|
| Rate for Payer: Anthem Medicare |
$316.18
|
| Rate for Payer: Anthem PPO |
$424.88
|
| Rate for Payer: Anthem Traditional |
$424.88
|
| Rate for Payer: Caresource Just 4 Me |
$363.61
|
| Rate for Payer: Caresource Medicare |
$347.80
|
| Rate for Payer: Centivo/Paragon All Products |
$490.08
|
| Rate for Payer: Coventry/First Health All Products |
$740.30
|
| Rate for Payer: Frontpath All Products |
$435.55
|
| Rate for Payer: Humana ChoiceCare |
$616.92
|
| Rate for Payer: Humana Medicare |
$316.18
|
| Rate for Payer: Lucent/Coldwater Veneers |
$537.51
|
| Rate for Payer: Lutheran Preferred All Products |
$443.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$462.69
|
| Rate for Payer: PHP All Products |
$407.17
|
| Rate for Payer: Plain Church Group Ministry All Products |
$316.18
|
| Rate for Payer: Signature Care EPO |
$378.25
|
| Rate for Payer: Signature Care PPO |
$378.25
|
| Rate for Payer: Three Rivers Preferred All Products |
$411.00
|
| Rate for Payer: United Healthcare Commercial |
$411.88
|
| Rate for Payer: United Healthcare Medicare |
$308.46
|
|
|
PR REMOVAL OF NAIL BED
|
Professional
|
$293.16
|
|
|
Service Code
|
CPT 11750
|
| Hospital Charge Code |
Z12026
|
| Min. Negotiated Rate |
$95.30 |
| Max. Negotiated Rate |
$351.79 |
| Rate for Payer: Aetna Medicare |
$95.30
|
| Rate for Payer: Anthem Exchange |
$190.62
|
| Rate for Payer: Anthem Medicare |
$95.30
|
| Rate for Payer: Anthem PPO |
$190.62
|
| Rate for Payer: Anthem Traditional |
$190.62
|
| Rate for Payer: Caresource Just 4 Me |
$109.59
|
| Rate for Payer: Caresource Medicare |
$104.83
|
| Rate for Payer: Centivo/Paragon All Products |
$147.72
|
| Rate for Payer: Coventry/First Health All Products |
$351.79
|
| Rate for Payer: Frontpath All Products |
$129.16
|
| Rate for Payer: Humana ChoiceCare |
$293.16
|
| Rate for Payer: Humana Medicare |
$95.30
|
| Rate for Payer: Lucent/Coldwater Veneers |
$162.01
|
| Rate for Payer: Lutheran Preferred All Products |
$124.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$219.87
|
| Rate for Payer: PHP All Products |
$130.16
|
| Rate for Payer: Plain Church Group Ministry All Products |
$95.30
|
| Rate for Payer: Signature Care EPO |
$180.87
|
| Rate for Payer: Signature Care PPO |
$180.87
|
| Rate for Payer: Three Rivers Preferred All Products |
$114.00
|
| Rate for Payer: United Healthcare Commercial |
$189.46
|
| Rate for Payer: United Healthcare Medicare |
$146.58
|
|
|
PR REMOVAL OF NAIL PLATE
|
Professional
|
$211.12
|
|
|
Service Code
|
CPT 11730
|
| Hospital Charge Code |
Z12023
|
| Min. Negotiated Rate |
$50.77 |
| Max. Negotiated Rate |
$253.34 |
| Rate for Payer: Aetna Medicare |
$50.77
|
| Rate for Payer: Anthem Exchange |
$103.06
|
| Rate for Payer: Anthem Medicare |
$50.77
|
| Rate for Payer: Anthem PPO |
$103.06
|
| Rate for Payer: Anthem Traditional |
$103.06
|
| Rate for Payer: Caresource Just 4 Me |
$58.39
|
| Rate for Payer: Caresource Medicare |
$55.85
|
| Rate for Payer: Centivo/Paragon All Products |
$78.69
|
| Rate for Payer: Coventry/First Health All Products |
$253.34
|
| Rate for Payer: Frontpath All Products |
$69.33
|
| Rate for Payer: Humana ChoiceCare |
$211.12
|
| Rate for Payer: Humana Medicare |
$50.77
|
| Rate for Payer: Lucent/Coldwater Veneers |
$86.31
|
| Rate for Payer: Lutheran Preferred All Products |
$66.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$158.34
|
| Rate for Payer: PHP All Products |
$69.35
|
| Rate for Payer: Plain Church Group Ministry All Products |
$50.77
|
| Rate for Payer: Signature Care EPO |
$92.74
|
| Rate for Payer: Signature Care PPO |
$92.74
|
| Rate for Payer: Three Rivers Preferred All Products |
$61.00
|
| Rate for Payer: United Healthcare Commercial |
$66.61
|
| Rate for Payer: United Healthcare Medicare |
$105.56
|
|
|
PR REMOVAL OF OMENTUM
|
Professional
|
$1,423.66
|
|
|
Service Code
|
CPT 49255
|
| Hospital Charge Code |
Z12662
|
| Min. Negotiated Rate |
$711.83 |
| Max. Negotiated Rate |
$1,708.39 |
| Rate for Payer: Aetna Medicare |
$729.62
|
| Rate for Payer: Anthem Exchange |
$850.30
|
| Rate for Payer: Anthem Medicare |
$729.62
|
| Rate for Payer: Anthem PPO |
$850.30
|
| Rate for Payer: Anthem Traditional |
$850.30
|
| Rate for Payer: Caresource Just 4 Me |
$839.06
|
| Rate for Payer: Caresource Medicare |
$802.58
|
| Rate for Payer: Centivo/Paragon All Products |
$1,130.91
|
| Rate for Payer: Coventry/First Health All Products |
$1,708.39
|
| Rate for Payer: Frontpath All Products |
$1,037.45
|
| Rate for Payer: Humana ChoiceCare |
$1,423.66
|
| Rate for Payer: Humana Medicare |
$729.62
|
| Rate for Payer: Lucent/Coldwater Veneers |
$1,240.35
|
| Rate for Payer: Lutheran Preferred All Products |
$1,094.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$1,067.75
|
| Rate for Payer: PHP All Products |
$1,245.70
|
| Rate for Payer: Plain Church Group Ministry All Products |
$729.62
|
| Rate for Payer: Signature Care EPO |
$969.00
|
| Rate for Payer: Signature Care PPO |
$969.00
|
| Rate for Payer: Three Rivers Preferred All Products |
$1,021.00
|
| Rate for Payer: United Healthcare Commercial |
$836.49
|
| Rate for Payer: United Healthcare Medicare |
$711.83
|
|
