|
PR REMOVE FOREIGN BODY SIMPLE
|
Professional
|
$275.76
|
|
|
Service Code
|
CPT 10120
|
| Hospital Charge Code |
Z11954
|
| Min. Negotiated Rate |
$98.01 |
| Max. Negotiated Rate |
$330.91 |
| Rate for Payer: Aetna Medicare |
$98.10
|
| Rate for Payer: Anthem Exchange |
$172.46
|
| Rate for Payer: Anthem Medicare |
$98.10
|
| Rate for Payer: Anthem PPO |
$172.46
|
| Rate for Payer: Anthem Traditional |
$172.46
|
| Rate for Payer: Caresource Just 4 Me |
$112.81
|
| Rate for Payer: Caresource Medicare |
$107.91
|
| Rate for Payer: Centivo/Paragon All Products |
$152.06
|
| Rate for Payer: Coventry/First Health All Products |
$330.91
|
| Rate for Payer: Frontpath All Products |
$130.61
|
| Rate for Payer: Humana ChoiceCare |
$275.76
|
| Rate for Payer: Humana Medicare |
$98.10
|
| Rate for Payer: Lucent/Coldwater Veneers |
$166.77
|
| Rate for Payer: Lutheran Preferred All Products |
$128.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$206.82
|
| Rate for Payer: PHP All Products |
$134.00
|
| Rate for Payer: Plain Church Group Ministry All Products |
$98.10
|
| Rate for Payer: Signature Care EPO |
$122.46
|
| Rate for Payer: Signature Care PPO |
$122.46
|
| Rate for Payer: Three Rivers Preferred All Products |
$118.00
|
| Rate for Payer: United Healthcare Commercial |
$98.01
|
| Rate for Payer: United Healthcare Medicare |
$137.88
|
|
|
PR REMOVE INTRAUTERINE DEVICE
|
Professional
|
$201.70
|
|
|
Service Code
|
CPT 58301
|
| Hospital Charge Code |
Z12744
|
| Min. Negotiated Rate |
$61.69 |
| Max. Negotiated Rate |
$242.04 |
| Rate for Payer: Aetna Medicare |
$61.69
|
| Rate for Payer: Anthem Exchange |
$134.12
|
| Rate for Payer: Anthem Medicare |
$61.69
|
| Rate for Payer: Anthem PPO |
$134.12
|
| Rate for Payer: Anthem Traditional |
$134.12
|
| Rate for Payer: Caresource Just 4 Me |
$70.94
|
| Rate for Payer: Caresource Medicare |
$67.86
|
| Rate for Payer: Centivo/Paragon All Products |
$95.62
|
| Rate for Payer: Coventry/First Health All Products |
$242.04
|
| Rate for Payer: Frontpath All Products |
$87.10
|
| Rate for Payer: Humana ChoiceCare |
$201.70
|
| Rate for Payer: Humana Medicare |
$61.69
|
| Rate for Payer: Lucent/Coldwater Veneers |
$104.87
|
| Rate for Payer: Lutheran Preferred All Products |
$86.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$151.27
|
| Rate for Payer: PHP All Products |
$79.45
|
| Rate for Payer: Plain Church Group Ministry All Products |
$61.69
|
| Rate for Payer: Signature Care EPO |
$127.50
|
| Rate for Payer: Signature Care PPO |
$127.50
|
| Rate for Payer: Three Rivers Preferred All Products |
$80.00
|
| Rate for Payer: United Healthcare Commercial |
$77.86
|
| Rate for Payer: United Healthcare Medicare |
$100.85
|
|
|
PR REMOVE KNEE CYST/GANGLION
|
Professional
|
$964.14
|
|
|
Service Code
|
CPT 27347
|
| Hospital Charge Code |
Z12338
|
| Min. Negotiated Rate |
$419.80 |
| Max. Negotiated Rate |
$1,156.97 |
| Rate for Payer: Aetna Medicare |
$494.12
|
| Rate for Payer: Anthem Exchange |
$419.80
|
| Rate for Payer: Anthem Medicare |
$494.12
|
| Rate for Payer: Anthem PPO |
$419.80
|
| Rate for Payer: Anthem Traditional |
$419.80
|
| Rate for Payer: Caresource Just 4 Me |
$568.24
|
| Rate for Payer: Caresource Medicare |
$543.53
|
| Rate for Payer: Centivo/Paragon All Products |
$765.89
|
| Rate for Payer: Coventry/First Health All Products |
$1,156.97
|
| Rate for Payer: Frontpath All Products |
$682.36
|
| Rate for Payer: Humana ChoiceCare |
$964.14
|
| Rate for Payer: Humana Medicare |
$494.12
|
| Rate for Payer: Lucent/Coldwater Veneers |
$840.00
|
| Rate for Payer: Lutheran Preferred All Products |
$791.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$723.11
|
| Rate for Payer: PHP All Products |
$838.79
|
| Rate for Payer: Plain Church Group Ministry All Products |
$494.12
|
| Rate for Payer: Signature Care EPO |
$650.25
|
| Rate for Payer: Signature Care PPO |
$650.25
|
| Rate for Payer: Three Rivers Preferred All Products |
$741.00
|
| Rate for Payer: United Healthcare Commercial |
$548.25
|
| Rate for Payer: United Healthcare Medicare |
$482.07
|
|
|
PR REMOVE MESH FROM ABD WALL FOR INFECTION
|
Professional
|
$481.54
|
|
|
Service Code
|
CPT 11008
|
| Hospital Charge Code |
Z11962
|
| Min. Negotiated Rate |
$240.77 |
| Max. Negotiated Rate |
$577.85 |
| Rate for Payer: Aetna Medicare |
$246.79
|
| Rate for Payer: Anthem Exchange |
$357.85
|
| Rate for Payer: Anthem Medicare |
$246.79
|
| Rate for Payer: Anthem PPO |
$357.85
|
| Rate for Payer: Anthem Traditional |
$357.85
|
| Rate for Payer: Caresource Just 4 Me |
$283.81
|
| Rate for Payer: Caresource Medicare |
$271.47
|
| Rate for Payer: Centivo/Paragon All Products |
$382.52
|
| Rate for Payer: Coventry/First Health All Products |
$577.85
|
| Rate for Payer: Frontpath All Products |
$361.63
|
| Rate for Payer: Humana ChoiceCare |
$481.54
|
| Rate for Payer: Humana Medicare |
$246.79
|
| Rate for Payer: Lucent/Coldwater Veneers |
$419.54
|
| Rate for Payer: Lutheran Preferred All Products |
$321.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$361.16
|
| Rate for Payer: PHP All Products |
$337.08
|
| Rate for Payer: Plain Church Group Ministry All Products |
$246.79
|
| Rate for Payer: Signature Care EPO |
$302.60
|
| Rate for Payer: Signature Care PPO |
$302.60
|
| Rate for Payer: Three Rivers Preferred All Products |
$296.00
|
| Rate for Payer: United Healthcare Commercial |
$306.45
|
| Rate for Payer: United Healthcare Medicare |
$240.77
|
|
|
PR REMOVE NASAL FOREIGN BODY
|
Professional
|
$385.22
|
|
|
Service Code
|
CPT 30300
|
| Hospital Charge Code |
Z12503
|
| Min. Negotiated Rate |
$114.90 |
| Max. Negotiated Rate |
$462.26 |
| Rate for Payer: Aetna Medicare |
$116.54
|
| Rate for Payer: Anthem Exchange |
$114.90
|
| Rate for Payer: Anthem Medicare |
$116.54
|
| Rate for Payer: Anthem PPO |
$114.90
|
| Rate for Payer: Anthem Traditional |
$114.90
|
| Rate for Payer: Caresource Just 4 Me |
$134.02
|
| Rate for Payer: Caresource Medicare |
$128.19
|
| Rate for Payer: Centivo/Paragon All Products |
$180.64
|
| Rate for Payer: Coventry/First Health All Products |
$462.26
|
| Rate for Payer: Frontpath All Products |
$157.38
|
| Rate for Payer: Humana ChoiceCare |
$385.22
|
| Rate for Payer: Humana Medicare |
$116.54
|
| Rate for Payer: Lucent/Coldwater Veneers |
$198.12
|
| Rate for Payer: Lutheran Preferred All Products |
$186.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$288.92
|
| Rate for Payer: PHP All Products |
$159.18
|
| Rate for Payer: Plain Church Group Ministry All Products |
$116.54
|
| Rate for Payer: Signature Care EPO |
$297.50
|
| Rate for Payer: Signature Care PPO |
$297.50
|
| Rate for Payer: Three Rivers Preferred All Products |
$175.00
|
| Rate for Payer: United Healthcare Commercial |
$127.34
|
| Rate for Payer: United Healthcare Medicare |
$192.61
|
|
|
PR REMOVE TONSILS/ADENOIDS,<12 Y/O
|
Professional
|
$535.50
|
|
|
Service Code
|
CPT 42820
|
| Hospital Charge Code |
Z12579
|
| Min. Negotiated Rate |
$267.75 |
| Max. Negotiated Rate |
$642.60 |
| Rate for Payer: Aetna Medicare |
$274.44
|
| Rate for Payer: Anthem Exchange |
$358.30
|
| Rate for Payer: Anthem Medicare |
$274.44
|
| Rate for Payer: Anthem PPO |
$358.30
|
| Rate for Payer: Anthem Traditional |
$358.30
|
| Rate for Payer: Caresource Just 4 Me |
$315.61
|
| Rate for Payer: Caresource Medicare |
$301.88
|
| Rate for Payer: Centivo/Paragon All Products |
$425.38
|
| Rate for Payer: Coventry/First Health All Products |
$642.60
|
| Rate for Payer: Frontpath All Products |
$375.05
|
| Rate for Payer: Humana ChoiceCare |
$535.50
|
| Rate for Payer: Humana Medicare |
$274.44
|
| Rate for Payer: Lucent/Coldwater Veneers |
$466.55
|
| Rate for Payer: Lutheran Preferred All Products |
$412.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$401.62
|
| Rate for Payer: PHP All Products |
$468.56
|
| Rate for Payer: Plain Church Group Ministry All Products |
$274.44
|
| Rate for Payer: Signature Care EPO |
$414.80
|
| Rate for Payer: Signature Care PPO |
$414.80
|
| Rate for Payer: Three Rivers Preferred All Products |
$384.00
|
| Rate for Payer: United Healthcare Commercial |
$320.94
|
| Rate for Payer: United Healthcare Medicare |
$267.75
|
|
|
PR REMOVE TONSILS/ADENOIDS,12+ Y/O
|
Professional
|
$560.18
|
|
|
Service Code
|
CPT 42821
|
| Hospital Charge Code |
Z12580
|
| Min. Negotiated Rate |
$280.09 |
| Max. Negotiated Rate |
$672.22 |
| Rate for Payer: Aetna Medicare |
$287.09
|
| Rate for Payer: Anthem Exchange |
$403.30
|
| Rate for Payer: Anthem Medicare |
$287.09
|
| Rate for Payer: Anthem PPO |
$403.30
|
| Rate for Payer: Anthem Traditional |
$403.30
|
| Rate for Payer: Caresource Just 4 Me |
$330.15
|
| Rate for Payer: Caresource Medicare |
$315.80
|
| Rate for Payer: Centivo/Paragon All Products |
$444.99
|
| Rate for Payer: Coventry/First Health All Products |
$672.22
|
| Rate for Payer: Frontpath All Products |
$391.29
|
| Rate for Payer: Humana ChoiceCare |
$560.18
|
| Rate for Payer: Humana Medicare |
$287.09
|
| Rate for Payer: Lucent/Coldwater Veneers |
$488.05
|
| Rate for Payer: Lutheran Preferred All Products |
$431.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$420.13
|
| Rate for Payer: PHP All Products |
$490.16
|
| Rate for Payer: Plain Church Group Ministry All Products |
$287.09
|
| Rate for Payer: Signature Care EPO |
$447.95
|
| Rate for Payer: Signature Care PPO |
$447.95
|
| Rate for Payer: Three Rivers Preferred All Products |
$402.00
|
| Rate for Payer: United Healthcare Commercial |
$334.95
|
| Rate for Payer: United Healthcare Medicare |
$280.09
|
|
|
PR REMOVE UTERUS AFTER CESAREAN
|
Professional
|
$842.28
|
|
|
Service Code
|
CPT 59525
|
| Hospital Charge Code |
Z12807
|
| Min. Negotiated Rate |
$421.14 |
| Max. Negotiated Rate |
$1,010.74 |
| Rate for Payer: Aetna Medicare |
$431.67
|
| Rate for Payer: Anthem Exchange |
$552.79
|
| Rate for Payer: Anthem Medicare |
$431.67
|
| Rate for Payer: Anthem PPO |
$552.79
|
| Rate for Payer: Anthem Traditional |
$552.79
|
| Rate for Payer: Caresource Just 4 Me |
$496.42
|
| Rate for Payer: Caresource Medicare |
$474.84
|
| Rate for Payer: Centivo/Paragon All Products |
$669.09
|
| Rate for Payer: Coventry/First Health All Products |
$1,010.74
|
| Rate for Payer: Frontpath All Products |
$627.69
|
| Rate for Payer: Humana ChoiceCare |
$842.28
|
| Rate for Payer: Humana Medicare |
$431.67
|
| Rate for Payer: Lucent/Coldwater Veneers |
$733.84
|
| Rate for Payer: Lutheran Preferred All Products |
$604.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$631.71
|
| Rate for Payer: PHP All Products |
$555.91
|
| Rate for Payer: Plain Church Group Ministry All Products |
$431.67
|
| Rate for Payer: Signature Care EPO |
$604.35
|
| Rate for Payer: Signature Care PPO |
$604.35
|
| Rate for Payer: Three Rivers Preferred All Products |
$561.00
|
| Rate for Payer: United Healthcare Commercial |
$549.79
|
| Rate for Payer: United Healthcare Medicare |
$421.14
|
|
|
PR REMV BENIGN FEMUR LESION
|
Professional
|
$1,108.70
|
|
|
Service Code
|
CPT 27355
|
| Hospital Charge Code |
Z12340
|
| Min. Negotiated Rate |
$554.35 |
| Max. Negotiated Rate |
$1,330.44 |
| Rate for Payer: Aetna Medicare |
$568.21
|
| Rate for Payer: Anthem Exchange |
$813.20
|
| Rate for Payer: Anthem Medicare |
$568.21
|
| Rate for Payer: Anthem PPO |
$813.20
|
| Rate for Payer: Anthem Traditional |
$813.20
|
| Rate for Payer: Caresource Just 4 Me |
$653.44
|
| Rate for Payer: Caresource Medicare |
$625.03
|
| Rate for Payer: Centivo/Paragon All Products |
$880.73
|
| Rate for Payer: Coventry/First Health All Products |
$1,330.44
|
| Rate for Payer: Frontpath All Products |
$790.57
|
| Rate for Payer: Humana ChoiceCare |
$1,108.70
|
| Rate for Payer: Humana Medicare |
$568.21
|
| Rate for Payer: Lucent/Coldwater Veneers |
$965.96
|
| Rate for Payer: Lutheran Preferred All Products |
$909.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$831.53
|
| Rate for Payer: PHP All Products |
$964.57
|
| Rate for Payer: Plain Church Group Ministry All Products |
$568.21
|
| Rate for Payer: Signature Care EPO |
$842.35
|
| Rate for Payer: Signature Care PPO |
$842.35
|
| Rate for Payer: Three Rivers Preferred All Products |
$852.00
|
| Rate for Payer: United Healthcare Commercial |
$646.71
|
| Rate for Payer: United Healthcare Medicare |
$554.35
|
|
|
PR REMV BONE FOR GRAFT MINOR
|
Professional
|
$710.74
|
|
|
Service Code
|
CPT 20900
|
| Hospital Charge Code |
Z12143
|
| Min. Negotiated Rate |
$168.22 |
| Max. Negotiated Rate |
$852.89 |
| Rate for Payer: Aetna Medicare |
$168.22
|
| Rate for Payer: Anthem Medicare |
$168.22
|
| Rate for Payer: Caresource Just 4 Me |
$193.45
|
| Rate for Payer: Caresource Medicare |
$185.04
|
| Rate for Payer: Centivo/Paragon All Products |
$260.74
|
| Rate for Payer: Coventry/First Health All Products |
$852.89
|
| Rate for Payer: Frontpath All Products |
$235.73
|
| Rate for Payer: Humana ChoiceCare |
$710.74
|
| Rate for Payer: Humana Medicare |
$168.22
|
| Rate for Payer: Lucent/Coldwater Veneers |
$285.97
|
| Rate for Payer: PHCS/Multiplan All Products |
$533.06
|
| Rate for Payer: PHP All Products |
$285.56
|
| Rate for Payer: Plain Church Group Ministry All Products |
$168.22
|
| Rate for Payer: Signature Care EPO |
$628.59
|
| Rate for Payer: Signature Care PPO |
$628.59
|
| Rate for Payer: United Healthcare Commercial |
$286.45
|
| Rate for Payer: United Healthcare Medicare |
$355.37
|
|
|
PR REMV EXT CANAL F.B.,GEN ANESTH
|
Professional
|
$175.42
|
|
|
Service Code
|
CPT 69205
|
| Hospital Charge Code |
Z12848
|
| Min. Negotiated Rate |
$87.71 |
| Max. Negotiated Rate |
$210.50 |
| Rate for Payer: Aetna Medicare |
$89.90
|
| Rate for Payer: Anthem Exchange |
$117.30
|
| Rate for Payer: Anthem Medicare |
$89.90
|
| Rate for Payer: Anthem PPO |
$117.30
|
| Rate for Payer: Anthem Traditional |
$117.30
|
| Rate for Payer: Caresource Just 4 Me |
$103.39
|
| Rate for Payer: Caresource Medicare |
$98.89
|
| Rate for Payer: Centivo/Paragon All Products |
$139.34
|
| Rate for Payer: Coventry/First Health All Products |
$210.50
|
| Rate for Payer: Frontpath All Products |
$121.13
|
| Rate for Payer: Humana ChoiceCare |
$175.42
|
| Rate for Payer: Humana Medicare |
$89.90
|
| Rate for Payer: Lucent/Coldwater Veneers |
$152.83
|
| Rate for Payer: Lutheran Preferred All Products |
$144.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$131.56
|
| Rate for Payer: PHP All Products |
$114.02
|
| Rate for Payer: Plain Church Group Ministry All Products |
$89.90
|
| Rate for Payer: Signature Care EPO |
$122.40
|
| Rate for Payer: Signature Care PPO |
$122.40
|
| Rate for Payer: Three Rivers Preferred All Products |
$135.00
|
| Rate for Payer: United Healthcare Commercial |
$109.36
|
| Rate for Payer: United Healthcare Medicare |
$87.71
|
|
|
PR REMV EXT CANAL F.B.,GEN ANESTH
|
Professional
|
$350.84
|
|
|
Service Code
|
CPT 69205
|
| Hospital Charge Code |
Z12849
|
| Min. Negotiated Rate |
$87.71 |
| Max. Negotiated Rate |
$421.01 |
| Rate for Payer: Aetna Medicare |
$89.90
|
| Rate for Payer: Anthem Exchange |
$117.30
|
| Rate for Payer: Anthem Medicare |
$89.90
|
| Rate for Payer: Anthem PPO |
$117.30
|
| Rate for Payer: Anthem Traditional |
$117.30
|
| Rate for Payer: Caresource Just 4 Me |
$103.39
|
| Rate for Payer: Caresource Medicare |
$98.89
|
| Rate for Payer: Centivo/Paragon All Products |
$139.34
|
| Rate for Payer: Coventry/First Health All Products |
$421.01
|
| Rate for Payer: Frontpath All Products |
$121.13
|
| Rate for Payer: Humana ChoiceCare |
$350.84
|
| Rate for Payer: Humana Medicare |
$89.90
|
| Rate for Payer: Lucent/Coldwater Veneers |
$152.83
|
| Rate for Payer: Lutheran Preferred All Products |
$144.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$263.13
|
| Rate for Payer: PHP All Products |
$114.02
|
| Rate for Payer: Plain Church Group Ministry All Products |
$89.90
|
| Rate for Payer: Signature Care EPO |
$122.40
|
| Rate for Payer: Signature Care PPO |
$122.40
|
| Rate for Payer: Three Rivers Preferred All Products |
$135.00
|
| Rate for Payer: United Healthcare Commercial |
$109.36
|
| Rate for Payer: United Healthcare Medicare |
$87.71
|
|
|
PR REMV EXT CANAL FOREIGN BODY
|
Professional
|
$293.08
|
|
|
Service Code
|
CPT 69200
|
| Hospital Charge Code |
Z12847
|
| Min. Negotiated Rate |
$44.23 |
| Max. Negotiated Rate |
$351.70 |
| Rate for Payer: Aetna Medicare |
$44.23
|
| Rate for Payer: Anthem Exchange |
$142.59
|
| Rate for Payer: Anthem Medicare |
$44.23
|
| Rate for Payer: Anthem PPO |
$142.59
|
| Rate for Payer: Anthem Traditional |
$142.59
|
| Rate for Payer: Caresource Just 4 Me |
$50.86
|
| Rate for Payer: Caresource Medicare |
$48.65
|
| Rate for Payer: Centivo/Paragon All Products |
$68.56
|
| Rate for Payer: Coventry/First Health All Products |
$351.70
|
| Rate for Payer: Frontpath All Products |
$61.00
|
| Rate for Payer: Humana ChoiceCare |
$293.08
|
| Rate for Payer: Humana Medicare |
$44.23
|
| Rate for Payer: Lucent/Coldwater Veneers |
$75.19
|
| Rate for Payer: Lutheran Preferred All Products |
$71.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$219.81
|
| Rate for Payer: PHP All Products |
$56.09
|
| Rate for Payer: Plain Church Group Ministry All Products |
$44.23
|
| Rate for Payer: Signature Care EPO |
$127.74
|
| Rate for Payer: Signature Care PPO |
$127.74
|
| Rate for Payer: Three Rivers Preferred All Products |
$66.00
|
| Rate for Payer: United Healthcare Commercial |
$61.16
|
| Rate for Payer: United Healthcare Medicare |
$73.27
|
|
|
PR REMV EXT CANAL FOREIGN BODY
|
Professional
|
$146.54
|
|
|
Service Code
|
CPT 69200
|
| Hospital Charge Code |
Z12846
|
| Min. Negotiated Rate |
$44.23 |
| Max. Negotiated Rate |
$175.85 |
| Rate for Payer: Aetna Medicare |
$44.23
|
| Rate for Payer: Anthem Exchange |
$142.59
|
| Rate for Payer: Anthem Medicare |
$44.23
|
| Rate for Payer: Anthem PPO |
$142.59
|
| Rate for Payer: Anthem Traditional |
$142.59
|
| Rate for Payer: Caresource Just 4 Me |
$50.86
|
| Rate for Payer: Caresource Medicare |
$48.65
|
| Rate for Payer: Centivo/Paragon All Products |
$68.56
|
| Rate for Payer: Coventry/First Health All Products |
$175.85
|
| Rate for Payer: Frontpath All Products |
$61.00
|
| Rate for Payer: Humana ChoiceCare |
$146.54
|
| Rate for Payer: Humana Medicare |
$44.23
|
| Rate for Payer: Lucent/Coldwater Veneers |
$75.19
|
| Rate for Payer: Lutheran Preferred All Products |
$71.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$109.91
|
| Rate for Payer: PHP All Products |
$56.09
|
| Rate for Payer: Plain Church Group Ministry All Products |
$44.23
|
| Rate for Payer: Signature Care EPO |
$127.74
|
| Rate for Payer: Signature Care PPO |
$127.74
|
| Rate for Payer: Three Rivers Preferred All Products |
$66.00
|
| Rate for Payer: United Healthcare Commercial |
$61.16
|
| Rate for Payer: United Healthcare Medicare |
$73.27
|
|
|
PR REMV EXT CANAL SOFT TISSUE LESN
|
Professional
|
$756.08
|
|
|
Service Code
|
CPT 69145
|
| Hospital Charge Code |
Z12845
|
| Min. Negotiated Rate |
$242.71 |
| Max. Negotiated Rate |
$907.30 |
| Rate for Payer: Aetna Medicare |
$242.71
|
| Rate for Payer: Anthem Exchange |
$320.29
|
| Rate for Payer: Anthem Medicare |
$242.71
|
| Rate for Payer: Anthem PPO |
$320.29
|
| Rate for Payer: Anthem Traditional |
$320.29
|
| Rate for Payer: Caresource Just 4 Me |
$279.12
|
| Rate for Payer: Caresource Medicare |
$266.98
|
| Rate for Payer: Centivo/Paragon All Products |
$376.20
|
| Rate for Payer: Coventry/First Health All Products |
$907.30
|
| Rate for Payer: Frontpath All Products |
$328.78
|
| Rate for Payer: Humana ChoiceCare |
$756.08
|
| Rate for Payer: Humana Medicare |
$242.71
|
| Rate for Payer: Lucent/Coldwater Veneers |
$412.61
|
| Rate for Payer: Lutheran Preferred All Products |
$388.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$567.06
|
| Rate for Payer: PHP All Products |
$307.82
|
| Rate for Payer: Plain Church Group Ministry All Products |
$242.71
|
| Rate for Payer: Signature Care EPO |
$332.02
|
| Rate for Payer: Signature Care PPO |
$332.02
|
| Rate for Payer: Three Rivers Preferred All Products |
$364.00
|
| Rate for Payer: United Healthcare Commercial |
$264.20
|
| Rate for Payer: United Healthcare Medicare |
$378.04
|
|
|
PR REMV F.B.,EYE,CORNEA,NO SLIT
|
Professional
|
$109.72
|
|
|
Service Code
|
CPT 65220
|
| Hospital Charge Code |
Z12837
|
| Min. Negotiated Rate |
$38.64 |
| Max. Negotiated Rate |
$140.64 |
| Rate for Payer: Aetna Medicare |
$38.64
|
| Rate for Payer: Anthem Exchange |
$140.64
|
| Rate for Payer: Anthem Medicare |
$38.64
|
| Rate for Payer: Anthem PPO |
$140.64
|
| Rate for Payer: Anthem Traditional |
$140.64
|
| Rate for Payer: Caresource Just 4 Me |
$44.44
|
| Rate for Payer: Caresource Medicare |
$42.50
|
| Rate for Payer: Centivo/Paragon All Products |
$59.89
|
| Rate for Payer: Coventry/First Health All Products |
$131.66
|
| Rate for Payer: Frontpath All Products |
$52.81
|
| Rate for Payer: Humana ChoiceCare |
$109.72
|
| Rate for Payer: Humana Medicare |
$38.64
|
| Rate for Payer: Lucent/Coldwater Veneers |
$65.69
|
| Rate for Payer: Lutheran Preferred All Products |
$62.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$82.29
|
| Rate for Payer: PHP All Products |
$69.73
|
| Rate for Payer: Plain Church Group Ministry All Products |
$38.64
|
| Rate for Payer: Signature Care EPO |
$68.85
|
| Rate for Payer: Signature Care PPO |
$68.85
|
| Rate for Payer: Three Rivers Preferred All Products |
$58.00
|
| Rate for Payer: United Healthcare Commercial |
$45.36
|
| Rate for Payer: United Healthcare Medicare |
$54.86
|
|
|
PR REMV F.B.,EYE,CORNEA,SLIT LAMP
|
Professional
|
$124.26
|
|
|
Service Code
|
CPT 65222
|
| Hospital Charge Code |
Z12838
|
| Min. Negotiated Rate |
$47.32 |
| Max. Negotiated Rate |
$149.11 |
| Rate for Payer: Aetna Medicare |
$47.32
|
| Rate for Payer: Anthem Exchange |
$89.35
|
| Rate for Payer: Anthem Medicare |
$47.32
|
| Rate for Payer: Anthem PPO |
$89.35
|
| Rate for Payer: Anthem Traditional |
$89.35
|
| Rate for Payer: Caresource Just 4 Me |
$54.42
|
| Rate for Payer: Caresource Medicare |
$52.05
|
| Rate for Payer: Centivo/Paragon All Products |
$73.35
|
| Rate for Payer: Coventry/First Health All Products |
$149.11
|
| Rate for Payer: Frontpath All Products |
$63.66
|
| Rate for Payer: Humana ChoiceCare |
$124.26
|
| Rate for Payer: Humana Medicare |
$47.32
|
| Rate for Payer: Lucent/Coldwater Veneers |
$80.44
|
| Rate for Payer: Lutheran Preferred All Products |
$76.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$93.20
|
| Rate for Payer: PHP All Products |
$85.41
|
| Rate for Payer: Plain Church Group Ministry All Products |
$47.32
|
| Rate for Payer: Signature Care EPO |
$88.40
|
| Rate for Payer: Signature Care PPO |
$88.40
|
| Rate for Payer: Three Rivers Preferred All Products |
$71.00
|
| Rate for Payer: United Healthcare Commercial |
$60.80
|
| Rate for Payer: United Healthcare Medicare |
$62.13
|
|
|
PR REMV F.B.,EYE,SUPERF CONJUNC
|
Professional
|
$53.54
|
|
|
Service Code
|
CPT 65205
|
| Hospital Charge Code |
Z12836
|
| Min. Negotiated Rate |
$26.77 |
| Max. Negotiated Rate |
$102.42 |
| Rate for Payer: Aetna Medicare |
$27.44
|
| Rate for Payer: Anthem Exchange |
$102.42
|
| Rate for Payer: Anthem Medicare |
$27.44
|
| Rate for Payer: Anthem PPO |
$102.42
|
| Rate for Payer: Anthem Traditional |
$102.42
|
| Rate for Payer: Caresource Just 4 Me |
$31.56
|
| Rate for Payer: Caresource Medicare |
$30.18
|
| Rate for Payer: Centivo/Paragon All Products |
$42.53
|
| Rate for Payer: Coventry/First Health All Products |
$64.25
|
| Rate for Payer: Frontpath All Products |
$37.15
|
| Rate for Payer: Humana ChoiceCare |
$53.54
|
| Rate for Payer: Humana Medicare |
$27.44
|
| Rate for Payer: Lucent/Coldwater Veneers |
$46.65
|
| Rate for Payer: Lutheran Preferred All Products |
$44.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$40.16
|
| Rate for Payer: PHP All Products |
$49.52
|
| Rate for Payer: Plain Church Group Ministry All Products |
$27.44
|
| Rate for Payer: Signature Care EPO |
$46.87
|
| Rate for Payer: Signature Care PPO |
$46.87
|
| Rate for Payer: Three Rivers Preferred All Products |
$41.00
|
| Rate for Payer: United Healthcare Commercial |
$46.06
|
| Rate for Payer: United Healthcare Medicare |
$26.77
|
|
|
PR REMV FOOT FOREIGN BODY,DEEP
|
Professional
|
$836.46
|
|
|
Service Code
|
CPT 28192
|
| Hospital Charge Code |
Z12425
|
| Min. Negotiated Rate |
$292.86 |
| Max. Negotiated Rate |
$1,003.75 |
| Rate for Payer: Aetna Medicare |
$292.86
|
| Rate for Payer: Anthem Exchange |
$438.00
|
| Rate for Payer: Anthem Medicare |
$292.86
|
| Rate for Payer: Anthem PPO |
$438.00
|
| Rate for Payer: Anthem Traditional |
$438.00
|
| Rate for Payer: Caresource Just 4 Me |
$336.79
|
| Rate for Payer: Caresource Medicare |
$322.15
|
| Rate for Payer: Centivo/Paragon All Products |
$453.93
|
| Rate for Payer: Coventry/First Health All Products |
$1,003.75
|
| Rate for Payer: Frontpath All Products |
$396.89
|
| Rate for Payer: Humana ChoiceCare |
$836.46
|
| Rate for Payer: Humana Medicare |
$292.86
|
| Rate for Payer: Lucent/Coldwater Veneers |
$497.86
|
| Rate for Payer: Lutheran Preferred All Products |
$469.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$627.35
|
| Rate for Payer: PHP All Products |
$497.14
|
| Rate for Payer: Plain Church Group Ministry All Products |
$292.86
|
| Rate for Payer: Signature Care EPO |
$629.85
|
| Rate for Payer: Signature Care PPO |
$629.85
|
| Rate for Payer: Three Rivers Preferred All Products |
$439.00
|
| Rate for Payer: United Healthcare Commercial |
$362.84
|
| Rate for Payer: United Healthcare Medicare |
$418.23
|
|
|
PR REMV FOOT FOREIGN BODY,SUBCUTANEOUS
|
Professional
|
$439.46
|
|
|
Service Code
|
CPT 28190
|
| Hospital Charge Code |
Z12424
|
| Min. Negotiated Rate |
$124.58 |
| Max. Negotiated Rate |
$527.35 |
| Rate for Payer: Aetna Medicare |
$124.58
|
| Rate for Payer: Anthem Exchange |
$229.80
|
| Rate for Payer: Anthem Medicare |
$124.58
|
| Rate for Payer: Anthem PPO |
$229.80
|
| Rate for Payer: Anthem Traditional |
$229.80
|
| Rate for Payer: Caresource Just 4 Me |
$143.27
|
| Rate for Payer: Caresource Medicare |
$137.04
|
| Rate for Payer: Centivo/Paragon All Products |
$193.10
|
| Rate for Payer: Coventry/First Health All Products |
$527.35
|
| Rate for Payer: Frontpath All Products |
$169.27
|
| Rate for Payer: Humana ChoiceCare |
$439.46
|
| Rate for Payer: Humana Medicare |
$124.58
|
| Rate for Payer: Lucent/Coldwater Veneers |
$211.79
|
| Rate for Payer: Lutheran Preferred All Products |
$199.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$329.59
|
| Rate for Payer: PHP All Products |
$211.48
|
| Rate for Payer: Plain Church Group Ministry All Products |
$124.58
|
| Rate for Payer: Signature Care EPO |
$389.52
|
| Rate for Payer: Signature Care PPO |
$389.52
|
| Rate for Payer: Three Rivers Preferred All Products |
$187.00
|
| Rate for Payer: United Healthcare Commercial |
$151.49
|
| Rate for Payer: United Healthcare Medicare |
$219.73
|
|
|
PR REMV FOREIGN BODY,KNEE/THIGH,DEEP
|
Professional
|
$1,071.72
|
|
|
Service Code
|
CPT 27372
|
| Hospital Charge Code |
Z12341
|
| Min. Negotiated Rate |
$373.29 |
| Max. Negotiated Rate |
$1,286.06 |
| Rate for Payer: Aetna Medicare |
$373.29
|
| Rate for Payer: Anthem Exchange |
$616.48
|
| Rate for Payer: Anthem Medicare |
$373.29
|
| Rate for Payer: Anthem PPO |
$616.48
|
| Rate for Payer: Anthem Traditional |
$616.48
|
| Rate for Payer: Caresource Just 4 Me |
$429.28
|
| Rate for Payer: Caresource Medicare |
$410.62
|
| Rate for Payer: Centivo/Paragon All Products |
$578.60
|
| Rate for Payer: Coventry/First Health All Products |
$1,286.06
|
| Rate for Payer: Frontpath All Products |
$521.17
|
| Rate for Payer: Humana ChoiceCare |
$1,071.72
|
| Rate for Payer: Humana Medicare |
$373.29
|
| Rate for Payer: Lucent/Coldwater Veneers |
$634.59
|
| Rate for Payer: Lutheran Preferred All Products |
$597.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$803.79
|
| Rate for Payer: PHP All Products |
$633.67
|
| Rate for Payer: Plain Church Group Ministry All Products |
$373.29
|
| Rate for Payer: Signature Care EPO |
$634.95
|
| Rate for Payer: Signature Care PPO |
$634.95
|
| Rate for Payer: Three Rivers Preferred All Products |
$560.00
|
| Rate for Payer: United Healthcare Commercial |
$430.65
|
| Rate for Payer: United Healthcare Medicare |
$535.86
|
|
|
PR REMVL COLON & TERM ILEUM W/ILEOCOLOSTOMY
|
Professional
|
$2,214.12
|
|
|
Service Code
|
CPT 44160
|
| Hospital Charge Code |
Z12606
|
| Min. Negotiated Rate |
$1,107.06 |
| Max. Negotiated Rate |
$2,656.94 |
| Rate for Payer: Aetna Medicare |
$1,134.74
|
| Rate for Payer: Anthem Exchange |
$1,317.90
|
| Rate for Payer: Anthem Medicare |
$1,134.74
|
| Rate for Payer: Anthem PPO |
$1,317.90
|
| Rate for Payer: Anthem Traditional |
$1,317.90
|
| Rate for Payer: Caresource Just 4 Me |
$1,304.95
|
| Rate for Payer: Caresource Medicare |
$1,248.21
|
| Rate for Payer: Centivo/Paragon All Products |
$1,758.85
|
| Rate for Payer: Coventry/First Health All Products |
$2,656.94
|
| Rate for Payer: Frontpath All Products |
$1,636.65
|
| Rate for Payer: Humana ChoiceCare |
$2,214.12
|
| Rate for Payer: Humana Medicare |
$1,134.74
|
| Rate for Payer: Lucent/Coldwater Veneers |
$1,929.06
|
| Rate for Payer: Lutheran Preferred All Products |
$1,702.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$1,660.59
|
| Rate for Payer: PHP All Products |
$1,937.36
|
| Rate for Payer: Plain Church Group Ministry All Products |
$1,134.74
|
| Rate for Payer: Signature Care EPO |
$1,531.70
|
| Rate for Payer: Signature Care PPO |
$1,531.70
|
| Rate for Payer: Three Rivers Preferred All Products |
$1,589.00
|
| Rate for Payer: United Healthcare Commercial |
$1,324.89
|
| Rate for Payer: United Healthcare Medicare |
$1,107.06
|
|
|
PR REMVL PERM PM PLSE GEN W/REPL PLSE GEN SNGL LEAD
|
Professional
|
$601.94
|
|
|
Service Code
|
CPT 33227
|
| Hospital Charge Code |
Z12531
|
| Min. Negotiated Rate |
$300.97 |
| Max. Negotiated Rate |
$722.33 |
| Rate for Payer: Aetna Medicare |
$308.49
|
| Rate for Payer: Anthem Exchange |
$475.16
|
| Rate for Payer: Anthem Medicare |
$308.49
|
| Rate for Payer: Anthem PPO |
$475.16
|
| Rate for Payer: Anthem Traditional |
$475.16
|
| Rate for Payer: Caresource Just 4 Me |
$354.76
|
| Rate for Payer: Caresource Medicare |
$339.34
|
| Rate for Payer: Centivo/Paragon All Products |
$478.16
|
| Rate for Payer: Coventry/First Health All Products |
$722.33
|
| Rate for Payer: Frontpath All Products |
$443.52
|
| Rate for Payer: Humana ChoiceCare |
$601.94
|
| Rate for Payer: Humana Medicare |
$308.49
|
| Rate for Payer: Lucent/Coldwater Veneers |
$524.43
|
| Rate for Payer: Lutheran Preferred All Products |
$494.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$451.46
|
| Rate for Payer: PHP All Products |
$421.36
|
| Rate for Payer: Plain Church Group Ministry All Products |
$308.49
|
| Rate for Payer: Signature Care EPO |
$404.00
|
| Rate for Payer: Signature Care PPO |
$404.00
|
| Rate for Payer: Three Rivers Preferred All Products |
$463.00
|
| Rate for Payer: United Healthcare Commercial |
$418.16
|
| Rate for Payer: United Healthcare Medicare |
$300.97
|
|
|
PR REMVL PERM PM PLS GEN W/REPL PLSE GEN 2 LEAD SYS
|
Professional
|
$628.88
|
|
|
Service Code
|
CPT 33228
|
| Hospital Charge Code |
Z12532
|
| Min. Negotiated Rate |
$314.44 |
| Max. Negotiated Rate |
$754.66 |
| Rate for Payer: Aetna Medicare |
$322.30
|
| Rate for Payer: Anthem Exchange |
$495.53
|
| Rate for Payer: Anthem Medicare |
$322.30
|
| Rate for Payer: Anthem PPO |
$495.53
|
| Rate for Payer: Anthem Traditional |
$495.53
|
| Rate for Payer: Caresource Just 4 Me |
$370.64
|
| Rate for Payer: Caresource Medicare |
$354.53
|
| Rate for Payer: Centivo/Paragon All Products |
$499.57
|
| Rate for Payer: Coventry/First Health All Products |
$754.66
|
| Rate for Payer: Frontpath All Products |
$464.54
|
| Rate for Payer: Humana ChoiceCare |
$628.88
|
| Rate for Payer: Humana Medicare |
$322.30
|
| Rate for Payer: Lucent/Coldwater Veneers |
$547.91
|
| Rate for Payer: Lutheran Preferred All Products |
$516.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$471.66
|
| Rate for Payer: PHP All Products |
$440.22
|
| Rate for Payer: Plain Church Group Ministry All Products |
$322.30
|
| Rate for Payer: Signature Care EPO |
$421.32
|
| Rate for Payer: Signature Care PPO |
$421.32
|
| Rate for Payer: Three Rivers Preferred All Products |
$483.00
|
| Rate for Payer: United Healthcare Commercial |
$436.10
|
| Rate for Payer: United Healthcare Medicare |
$314.44
|
|
|
PR REMVL PERM PM PLS GEN W/REPL PLSE GEN MULT LEAD
|
Professional
|
$664.60
|
|
|
Service Code
|
CPT 33229
|
| Hospital Charge Code |
Z12533
|
| Min. Negotiated Rate |
$332.30 |
| Max. Negotiated Rate |
$797.52 |
| Rate for Payer: Aetna Medicare |
$340.60
|
| Rate for Payer: Anthem Exchange |
$515.90
|
| Rate for Payer: Anthem Medicare |
$340.60
|
| Rate for Payer: Anthem PPO |
$515.90
|
| Rate for Payer: Anthem Traditional |
$515.90
|
| Rate for Payer: Caresource Just 4 Me |
$391.69
|
| Rate for Payer: Caresource Medicare |
$374.66
|
| Rate for Payer: Centivo/Paragon All Products |
$527.93
|
| Rate for Payer: Coventry/First Health All Products |
$797.52
|
| Rate for Payer: Frontpath All Products |
$490.23
|
| Rate for Payer: Humana ChoiceCare |
$664.60
|
| Rate for Payer: Humana Medicare |
$340.60
|
| Rate for Payer: Lucent/Coldwater Veneers |
$579.02
|
| Rate for Payer: Lutheran Preferred All Products |
$545.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$498.45
|
| Rate for Payer: PHP All Products |
$465.22
|
| Rate for Payer: Plain Church Group Ministry All Products |
$340.60
|
| Rate for Payer: Signature Care EPO |
$438.63
|
| Rate for Payer: Signature Care PPO |
$438.63
|
| Rate for Payer: Three Rivers Preferred All Products |
$511.00
|
| Rate for Payer: United Healthcare Commercial |
$454.03
|
| Rate for Payer: United Healthcare Medicare |
$332.30
|
|
