|
PR REPAIR OF PERINEUM,NON OBSTETRICAL
|
Professional
|
$497.48
|
|
|
Service Code
|
CPT 56810
|
| Hospital Charge Code |
Z12696
|
| Min. Negotiated Rate |
$248.74 |
| Max. Negotiated Rate |
$596.98 |
| Rate for Payer: Aetna Medicare |
$254.96
|
| Rate for Payer: Anthem Exchange |
$338.24
|
| Rate for Payer: Anthem Medicare |
$254.96
|
| Rate for Payer: Anthem PPO |
$338.24
|
| Rate for Payer: Anthem Traditional |
$338.24
|
| Rate for Payer: Caresource Just 4 Me |
$293.20
|
| Rate for Payer: Caresource Medicare |
$280.46
|
| Rate for Payer: Centivo/Paragon All Products |
$395.19
|
| Rate for Payer: Coventry/First Health All Products |
$596.98
|
| Rate for Payer: Frontpath All Products |
$355.03
|
| Rate for Payer: Humana ChoiceCare |
$497.48
|
| Rate for Payer: Humana Medicare |
$254.96
|
| Rate for Payer: Lucent/Coldwater Veneers |
$433.43
|
| Rate for Payer: Lutheran Preferred All Products |
$357.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$373.11
|
| Rate for Payer: PHP All Products |
$328.34
|
| Rate for Payer: Plain Church Group Ministry All Products |
$254.96
|
| Rate for Payer: Signature Care EPO |
$320.45
|
| Rate for Payer: Signature Care PPO |
$320.45
|
| Rate for Payer: Three Rivers Preferred All Products |
$331.00
|
| Rate for Payer: United Healthcare Commercial |
$294.69
|
| Rate for Payer: United Healthcare Medicare |
$248.74
|
|
|
PR REPAIR OF RUPTURED UTERUS
|
Professional
|
$488.48
|
|
|
Service Code
|
CPT 59350
|
| Hospital Charge Code |
Z12796
|
| Min. Negotiated Rate |
$244.24 |
| Max. Negotiated Rate |
$586.18 |
| Rate for Payer: Aetna Medicare |
$250.35
|
| Rate for Payer: Anthem Exchange |
$391.10
|
| Rate for Payer: Anthem Medicare |
$250.35
|
| Rate for Payer: Anthem PPO |
$391.10
|
| Rate for Payer: Anthem Traditional |
$391.10
|
| Rate for Payer: Caresource Just 4 Me |
$287.90
|
| Rate for Payer: Caresource Medicare |
$275.38
|
| Rate for Payer: Centivo/Paragon All Products |
$388.04
|
| Rate for Payer: Coventry/First Health All Products |
$586.18
|
| Rate for Payer: Frontpath All Products |
$362.37
|
| Rate for Payer: Humana ChoiceCare |
$488.48
|
| Rate for Payer: Humana Medicare |
$250.35
|
| Rate for Payer: Lucent/Coldwater Veneers |
$425.59
|
| Rate for Payer: Lutheran Preferred All Products |
$350.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$366.36
|
| Rate for Payer: PHP All Products |
$322.40
|
| Rate for Payer: Plain Church Group Ministry All Products |
$250.35
|
| Rate for Payer: Signature Care EPO |
$351.05
|
| Rate for Payer: Signature Care PPO |
$351.05
|
| Rate for Payer: Three Rivers Preferred All Products |
$325.00
|
| Rate for Payer: United Healthcare Commercial |
$314.73
|
| Rate for Payer: United Healthcare Medicare |
$244.24
|
|
|
PR REPAIR RECURR INGUIN HERN,REDUCIBL
|
Professional
|
$1,132.68
|
|
|
Service Code
|
CPT 49520
|
| Hospital Charge Code |
Z12670
|
| Min. Negotiated Rate |
$566.34 |
| Max. Negotiated Rate |
$1,359.22 |
| Rate for Payer: Aetna Medicare |
$580.34
|
| Rate for Payer: Anthem Exchange |
$672.10
|
| Rate for Payer: Anthem Medicare |
$580.34
|
| Rate for Payer: Anthem PPO |
$672.10
|
| Rate for Payer: Anthem Traditional |
$672.10
|
| Rate for Payer: Caresource Just 4 Me |
$667.39
|
| Rate for Payer: Caresource Medicare |
$638.37
|
| Rate for Payer: Centivo/Paragon All Products |
$899.53
|
| Rate for Payer: Coventry/First Health All Products |
$1,359.22
|
| Rate for Payer: Frontpath All Products |
$838.55
|
| Rate for Payer: Humana ChoiceCare |
$1,132.68
|
| Rate for Payer: Humana Medicare |
$580.34
|
| Rate for Payer: Lucent/Coldwater Veneers |
$986.58
|
| Rate for Payer: Lutheran Preferred All Products |
$871.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$849.51
|
| Rate for Payer: PHP All Products |
$991.09
|
| Rate for Payer: Plain Church Group Ministry All Products |
$580.34
|
| Rate for Payer: Signature Care EPO |
$812.60
|
| Rate for Payer: Signature Care PPO |
$812.60
|
| Rate for Payer: Three Rivers Preferred All Products |
$812.00
|
| Rate for Payer: United Healthcare Commercial |
$667.58
|
| Rate for Payer: United Healthcare Medicare |
$566.34
|
|
|
PR REPAIR ROTATOR CUFF,ACUTE
|
Professional
|
$1,489.40
|
|
|
Service Code
|
CPT 23410
|
| Hospital Charge Code |
Z12162
|
| Min. Negotiated Rate |
$744.70 |
| Max. Negotiated Rate |
$1,787.28 |
| Rate for Payer: Aetna Medicare |
$763.32
|
| Rate for Payer: Anthem Exchange |
$1,192.70
|
| Rate for Payer: Anthem Medicare |
$763.32
|
| Rate for Payer: Anthem PPO |
$1,192.70
|
| Rate for Payer: Anthem Traditional |
$1,192.70
|
| Rate for Payer: Caresource Just 4 Me |
$877.82
|
| Rate for Payer: Caresource Medicare |
$839.65
|
| Rate for Payer: Centivo/Paragon All Products |
$1,183.15
|
| Rate for Payer: Coventry/First Health All Products |
$1,787.28
|
| Rate for Payer: Frontpath All Products |
$1,064.61
|
| Rate for Payer: Humana ChoiceCare |
$1,489.40
|
| Rate for Payer: Humana Medicare |
$763.32
|
| Rate for Payer: Lucent/Coldwater Veneers |
$1,297.64
|
| Rate for Payer: Lutheran Preferred All Products |
$1,221.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$1,117.05
|
| Rate for Payer: PHP All Products |
$1,295.78
|
| Rate for Payer: Plain Church Group Ministry All Products |
$763.32
|
| Rate for Payer: Signature Care EPO |
$1,280.10
|
| Rate for Payer: Signature Care PPO |
$1,280.10
|
| Rate for Payer: Three Rivers Preferred All Products |
$1,145.00
|
| Rate for Payer: United Healthcare Commercial |
$903.01
|
| Rate for Payer: United Healthcare Medicare |
$744.70
|
|
|
PR REPAIR ROTATOR CUFF,CHRONIC
|
Professional
|
$1,546.64
|
|
|
Service Code
|
CPT 23412
|
| Hospital Charge Code |
Z12163
|
| Min. Negotiated Rate |
$773.32 |
| Max. Negotiated Rate |
$1,855.97 |
| Rate for Payer: Aetna Medicare |
$792.65
|
| Rate for Payer: Anthem Exchange |
$1,310.40
|
| Rate for Payer: Anthem Medicare |
$792.65
|
| Rate for Payer: Anthem PPO |
$1,310.40
|
| Rate for Payer: Anthem Traditional |
$1,310.40
|
| Rate for Payer: Caresource Just 4 Me |
$911.55
|
| Rate for Payer: Caresource Medicare |
$871.92
|
| Rate for Payer: Centivo/Paragon All Products |
$1,228.61
|
| Rate for Payer: Coventry/First Health All Products |
$1,855.97
|
| Rate for Payer: Frontpath All Products |
$1,106.64
|
| Rate for Payer: Humana ChoiceCare |
$1,546.64
|
| Rate for Payer: Humana Medicare |
$792.65
|
| Rate for Payer: Lucent/Coldwater Veneers |
$1,347.50
|
| Rate for Payer: Lutheran Preferred All Products |
$1,268.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$1,159.98
|
| Rate for Payer: PHP All Products |
$1,345.57
|
| Rate for Payer: Plain Church Group Ministry All Products |
$792.65
|
| Rate for Payer: Signature Care EPO |
$1,349.92
|
| Rate for Payer: Signature Care PPO |
$1,349.92
|
| Rate for Payer: Three Rivers Preferred All Products |
$1,189.00
|
| Rate for Payer: United Healthcare Commercial |
$943.83
|
| Rate for Payer: United Healthcare Medicare |
$773.32
|
|
|
PR REPAIR RUPTURED UTERUS,NON OBSTECTR
|
Professional
|
$1,462.84
|
|
|
Service Code
|
CPT 58520
|
| Hospital Charge Code |
Z12747
|
| Min. Negotiated Rate |
$731.42 |
| Max. Negotiated Rate |
$1,755.41 |
| Rate for Payer: Aetna Medicare |
$749.70
|
| Rate for Payer: Anthem Medicare |
$749.70
|
| Rate for Payer: Caresource Just 4 Me |
$862.15
|
| Rate for Payer: Caresource Medicare |
$824.67
|
| Rate for Payer: Centivo/Paragon All Products |
$1,162.04
|
| Rate for Payer: Coventry/First Health All Products |
$1,755.41
|
| Rate for Payer: Frontpath All Products |
$1,049.88
|
| Rate for Payer: Humana ChoiceCare |
$1,462.84
|
| Rate for Payer: Humana Medicare |
$749.70
|
| Rate for Payer: Lucent/Coldwater Veneers |
$1,274.49
|
| Rate for Payer: PHCS/Multiplan All Products |
$1,097.13
|
| Rate for Payer: PHP All Products |
$965.47
|
| Rate for Payer: Plain Church Group Ministry All Products |
$749.70
|
| Rate for Payer: Signature Care EPO |
$898.45
|
| Rate for Payer: Signature Care PPO |
$898.45
|
| Rate for Payer: United Healthcare Commercial |
$882.13
|
| Rate for Payer: United Healthcare Medicare |
$731.42
|
|
|
PR REPAIR TYMPANIC MEMBRANE
|
Professional
|
$704.50
|
|
|
Service Code
|
CPT 69610
|
| Hospital Charge Code |
Z12866
|
| Min. Negotiated Rate |
$270.30 |
| Max. Negotiated Rate |
$845.40 |
| Rate for Payer: Aetna Medicare |
$270.30
|
| Rate for Payer: Anthem Exchange |
$374.01
|
| Rate for Payer: Anthem Medicare |
$270.30
|
| Rate for Payer: Anthem PPO |
$374.01
|
| Rate for Payer: Anthem Traditional |
$374.01
|
| Rate for Payer: Caresource Just 4 Me |
$310.84
|
| Rate for Payer: Caresource Medicare |
$297.33
|
| Rate for Payer: Centivo/Paragon All Products |
$418.97
|
| Rate for Payer: Coventry/First Health All Products |
$845.40
|
| Rate for Payer: Frontpath All Products |
$371.42
|
| Rate for Payer: Humana ChoiceCare |
$704.50
|
| Rate for Payer: Humana Medicare |
$270.30
|
| Rate for Payer: Lucent/Coldwater Veneers |
$459.51
|
| Rate for Payer: Lutheran Preferred All Products |
$432.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$528.38
|
| Rate for Payer: PHP All Products |
$342.82
|
| Rate for Payer: Plain Church Group Ministry All Products |
$270.30
|
| Rate for Payer: Signature Care EPO |
$470.05
|
| Rate for Payer: Signature Care PPO |
$470.05
|
| Rate for Payer: Three Rivers Preferred All Products |
$405.00
|
| Rate for Payer: United Healthcare Commercial |
$327.01
|
| Rate for Payer: United Healthcare Medicare |
$352.25
|
|
|
PR REPAIR VAGINA/PERINEUM
|
Professional
|
$719.96
|
|
|
Service Code
|
CPT 57210
|
| Hospital Charge Code |
Z12705
|
| Min. Negotiated Rate |
$359.98 |
| Max. Negotiated Rate |
$863.95 |
| Rate for Payer: Aetna Medicare |
$368.98
|
| Rate for Payer: Anthem Exchange |
$451.31
|
| Rate for Payer: Anthem Medicare |
$368.98
|
| Rate for Payer: Anthem PPO |
$451.31
|
| Rate for Payer: Anthem Traditional |
$451.31
|
| Rate for Payer: Caresource Just 4 Me |
$424.33
|
| Rate for Payer: Caresource Medicare |
$405.88
|
| Rate for Payer: Centivo/Paragon All Products |
$571.92
|
| Rate for Payer: Coventry/First Health All Products |
$863.95
|
| Rate for Payer: Frontpath All Products |
$514.19
|
| Rate for Payer: Humana ChoiceCare |
$719.96
|
| Rate for Payer: Humana Medicare |
$368.98
|
| Rate for Payer: Lucent/Coldwater Veneers |
$627.27
|
| Rate for Payer: Lutheran Preferred All Products |
$517.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$539.97
|
| Rate for Payer: PHP All Products |
$475.18
|
| Rate for Payer: Plain Church Group Ministry All Products |
$368.98
|
| Rate for Payer: Signature Care EPO |
$425.85
|
| Rate for Payer: Signature Care PPO |
$425.85
|
| Rate for Payer: Three Rivers Preferred All Products |
$480.00
|
| Rate for Payer: United Healthcare Commercial |
$411.69
|
| Rate for Payer: United Healthcare Medicare |
$359.98
|
|
|
PR REPEAT CONTROL OF NOSEBLEED
|
Professional
|
$682.94
|
|
|
Service Code
|
CPT 30906
|
| Hospital Charge Code |
Z12510
|
| Min. Negotiated Rate |
$124.33 |
| Max. Negotiated Rate |
$819.53 |
| Rate for Payer: Aetna Medicare |
$124.33
|
| Rate for Payer: Anthem Exchange |
$251.40
|
| Rate for Payer: Anthem Medicare |
$124.33
|
| Rate for Payer: Anthem PPO |
$251.40
|
| Rate for Payer: Anthem Traditional |
$251.40
|
| Rate for Payer: Caresource Just 4 Me |
$142.98
|
| Rate for Payer: Caresource Medicare |
$136.76
|
| Rate for Payer: Centivo/Paragon All Products |
$192.71
|
| Rate for Payer: Coventry/First Health All Products |
$819.53
|
| Rate for Payer: Frontpath All Products |
$177.06
|
| Rate for Payer: Humana ChoiceCare |
$682.94
|
| Rate for Payer: Humana Medicare |
$124.33
|
| Rate for Payer: Lucent/Coldwater Veneers |
$211.36
|
| Rate for Payer: Lutheran Preferred All Products |
$199.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$512.21
|
| Rate for Payer: PHP All Products |
$169.82
|
| Rate for Payer: Plain Church Group Ministry All Products |
$124.33
|
| Rate for Payer: Signature Care EPO |
$332.35
|
| Rate for Payer: Signature Care PPO |
$332.35
|
| Rate for Payer: Three Rivers Preferred All Products |
$187.00
|
| Rate for Payer: United Healthcare Commercial |
$153.93
|
| Rate for Payer: United Healthcare Medicare |
$341.47
|
|
|
PR REPR,EYELID,NOSE,EAR,LIP+5 CM
|
Professional
|
$338.54
|
|
|
Service Code
|
CPT 13153
|
| Hospital Charge Code |
Z12064
|
| Min. Negotiated Rate |
$126.89 |
| Max. Negotiated Rate |
$406.25 |
| Rate for Payer: Aetna Medicare |
$126.89
|
| Rate for Payer: Anthem Exchange |
$190.28
|
| Rate for Payer: Anthem Medicare |
$126.89
|
| Rate for Payer: Anthem PPO |
$190.28
|
| Rate for Payer: Anthem Traditional |
$190.28
|
| Rate for Payer: Caresource Just 4 Me |
$145.92
|
| Rate for Payer: Caresource Medicare |
$139.58
|
| Rate for Payer: Centivo/Paragon All Products |
$196.68
|
| Rate for Payer: Coventry/First Health All Products |
$406.25
|
| Rate for Payer: Frontpath All Products |
$176.38
|
| Rate for Payer: Humana ChoiceCare |
$338.54
|
| Rate for Payer: Humana Medicare |
$126.89
|
| Rate for Payer: Lucent/Coldwater Veneers |
$215.71
|
| Rate for Payer: Lutheran Preferred All Products |
$165.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$253.91
|
| Rate for Payer: PHP All Products |
$173.31
|
| Rate for Payer: Plain Church Group Ministry All Products |
$126.89
|
| Rate for Payer: Signature Care EPO |
$156.34
|
| Rate for Payer: Signature Care PPO |
$156.34
|
| Rate for Payer: Three Rivers Preferred All Products |
$152.00
|
| Rate for Payer: United Healthcare Commercial |
$159.30
|
| Rate for Payer: United Healthcare Medicare |
$169.27
|
|
|
PR REP,SKIN,SCALP/EXTREM+5 CM/<
|
Professional
|
$232.24
|
|
|
Service Code
|
CPT 13122
|
| Hospital Charge Code |
Z12060
|
| Min. Negotiated Rate |
$76.73 |
| Max. Negotiated Rate |
$278.69 |
| Rate for Payer: Aetna Medicare |
$76.73
|
| Rate for Payer: Anthem Exchange |
$122.23
|
| Rate for Payer: Anthem Medicare |
$76.73
|
| Rate for Payer: Anthem PPO |
$122.23
|
| Rate for Payer: Anthem Traditional |
$122.23
|
| Rate for Payer: Caresource Just 4 Me |
$88.24
|
| Rate for Payer: Caresource Medicare |
$84.40
|
| Rate for Payer: Centivo/Paragon All Products |
$118.93
|
| Rate for Payer: Coventry/First Health All Products |
$278.69
|
| Rate for Payer: Frontpath All Products |
$106.25
|
| Rate for Payer: Humana ChoiceCare |
$232.24
|
| Rate for Payer: Humana Medicare |
$76.73
|
| Rate for Payer: Lucent/Coldwater Veneers |
$130.44
|
| Rate for Payer: Lutheran Preferred All Products |
$100.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$174.18
|
| Rate for Payer: PHP All Products |
$104.80
|
| Rate for Payer: Plain Church Group Ministry All Products |
$76.73
|
| Rate for Payer: Signature Care EPO |
$107.13
|
| Rate for Payer: Signature Care PPO |
$107.13
|
| Rate for Payer: Three Rivers Preferred All Products |
$92.00
|
| Rate for Payer: United Healthcare Commercial |
$94.63
|
| Rate for Payer: United Healthcare Medicare |
$116.12
|
|
|
PR RESEC HEAD OF PHALANX,TOE
|
Professional
|
$738.12
|
|
|
Service Code
|
CPT 28153
|
| Hospital Charge Code |
Z12423
|
| Min. Negotiated Rate |
$248.94 |
| Max. Negotiated Rate |
$885.74 |
| Rate for Payer: Aetna Medicare |
$248.94
|
| Rate for Payer: Anthem Exchange |
$373.81
|
| Rate for Payer: Anthem Medicare |
$248.94
|
| Rate for Payer: Anthem PPO |
$373.81
|
| Rate for Payer: Anthem Traditional |
$373.81
|
| Rate for Payer: Caresource Just 4 Me |
$286.28
|
| Rate for Payer: Caresource Medicare |
$273.83
|
| Rate for Payer: Centivo/Paragon All Products |
$385.86
|
| Rate for Payer: Coventry/First Health All Products |
$885.74
|
| Rate for Payer: Frontpath All Products |
$337.04
|
| Rate for Payer: Humana ChoiceCare |
$738.12
|
| Rate for Payer: Humana Medicare |
$248.94
|
| Rate for Payer: Lucent/Coldwater Veneers |
$423.20
|
| Rate for Payer: Lutheran Preferred All Products |
$398.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$553.59
|
| Rate for Payer: PHP All Products |
$422.59
|
| Rate for Payer: Plain Church Group Ministry All Products |
$248.94
|
| Rate for Payer: Signature Care EPO |
$516.80
|
| Rate for Payer: Signature Care PPO |
$516.80
|
| Rate for Payer: Three Rivers Preferred All Products |
$373.00
|
| Rate for Payer: United Healthcare Commercial |
$296.25
|
| Rate for Payer: United Healthcare Medicare |
$369.06
|
|
|
PR RESECT SMALL INTEST,SINGL RESEC/ANAS
|
Professional
|
$2,172.98
|
|
|
Service Code
|
CPT 44120
|
| Hospital Charge Code |
Z12600
|
| Min. Negotiated Rate |
$1,086.49 |
| Max. Negotiated Rate |
$2,607.58 |
| Rate for Payer: Aetna Medicare |
$1,113.65
|
| Rate for Payer: Anthem Exchange |
$1,148.60
|
| Rate for Payer: Anthem Medicare |
$1,113.65
|
| Rate for Payer: Anthem PPO |
$1,148.60
|
| Rate for Payer: Anthem Traditional |
$1,148.60
|
| Rate for Payer: Caresource Just 4 Me |
$1,280.70
|
| Rate for Payer: Caresource Medicare |
$1,225.02
|
| Rate for Payer: Centivo/Paragon All Products |
$1,726.16
|
| Rate for Payer: Coventry/First Health All Products |
$2,607.58
|
| Rate for Payer: Frontpath All Products |
$1,615.25
|
| Rate for Payer: Humana ChoiceCare |
$2,172.98
|
| Rate for Payer: Humana Medicare |
$1,113.65
|
| Rate for Payer: Lucent/Coldwater Veneers |
$1,893.21
|
| Rate for Payer: Lutheran Preferred All Products |
$1,670.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$1,629.74
|
| Rate for Payer: PHP All Products |
$1,901.36
|
| Rate for Payer: Plain Church Group Ministry All Products |
$1,113.65
|
| Rate for Payer: Signature Care EPO |
$1,390.60
|
| Rate for Payer: Signature Care PPO |
$1,390.60
|
| Rate for Payer: Three Rivers Preferred All Products |
$1,559.00
|
| Rate for Payer: United Healthcare Commercial |
$1,302.05
|
| Rate for Payer: United Healthcare Medicare |
$1,086.49
|
|
|
PR RESUPERF WND BODY 12.6-20 CM
|
Professional
|
$320.78
|
|
|
Service Code
|
CPT 12005
|
| Hospital Charge Code |
Z12041
|
| Min. Negotiated Rate |
$87.22 |
| Max. Negotiated Rate |
$384.94 |
| Rate for Payer: Aetna Medicare |
$87.22
|
| Rate for Payer: Anthem Exchange |
$243.08
|
| Rate for Payer: Anthem Medicare |
$87.22
|
| Rate for Payer: Anthem PPO |
$243.08
|
| Rate for Payer: Anthem Traditional |
$243.08
|
| Rate for Payer: Caresource Just 4 Me |
$100.30
|
| Rate for Payer: Caresource Medicare |
$95.94
|
| Rate for Payer: Centivo/Paragon All Products |
$135.19
|
| Rate for Payer: Coventry/First Health All Products |
$384.94
|
| Rate for Payer: Frontpath All Products |
$126.31
|
| Rate for Payer: Humana ChoiceCare |
$320.78
|
| Rate for Payer: Humana Medicare |
$87.22
|
| Rate for Payer: Lucent/Coldwater Veneers |
$148.27
|
| Rate for Payer: Lutheran Preferred All Products |
$113.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$240.58
|
| Rate for Payer: PHP All Products |
$119.13
|
| Rate for Payer: Plain Church Group Ministry All Products |
$87.22
|
| Rate for Payer: Signature Care EPO |
$235.45
|
| Rate for Payer: Signature Care PPO |
$235.45
|
| Rate for Payer: Three Rivers Preferred All Products |
$105.00
|
| Rate for Payer: United Healthcare Commercial |
$182.65
|
| Rate for Payer: United Healthcare Medicare |
$160.39
|
|
|
PR RESUPERF WND BODY <2.5CM
|
Professional
|
$170.52
|
|
|
Service Code
|
CPT 12001
|
| Hospital Charge Code |
Z12038
|
| Min. Negotiated Rate |
$41.39 |
| Max. Negotiated Rate |
$204.62 |
| Rate for Payer: Aetna Medicare |
$41.39
|
| Rate for Payer: Anthem Exchange |
$154.80
|
| Rate for Payer: Anthem Medicare |
$41.39
|
| Rate for Payer: Anthem PPO |
$154.80
|
| Rate for Payer: Anthem Traditional |
$154.80
|
| Rate for Payer: Caresource Just 4 Me |
$47.60
|
| Rate for Payer: Caresource Medicare |
$45.53
|
| Rate for Payer: Centivo/Paragon All Products |
$64.15
|
| Rate for Payer: Coventry/First Health All Products |
$204.62
|
| Rate for Payer: Frontpath All Products |
$59.31
|
| Rate for Payer: Humana ChoiceCare |
$170.52
|
| Rate for Payer: Humana Medicare |
$41.39
|
| Rate for Payer: Lucent/Coldwater Veneers |
$70.36
|
| Rate for Payer: Lutheran Preferred All Products |
$54.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$127.89
|
| Rate for Payer: PHP All Products |
$56.53
|
| Rate for Payer: Plain Church Group Ministry All Products |
$41.39
|
| Rate for Payer: Signature Care EPO |
$148.85
|
| Rate for Payer: Signature Care PPO |
$148.85
|
| Rate for Payer: Three Rivers Preferred All Products |
$50.00
|
| Rate for Payer: United Healthcare Commercial |
$112.23
|
| Rate for Payer: United Healthcare Medicare |
$85.26
|
|
|
PR RESUPERF WND BODY >30 CM
|
Professional
|
$419.56
|
|
|
Service Code
|
CPT 12007
|
| Hospital Charge Code |
Z12042
|
| Min. Negotiated Rate |
$133.22 |
| Max. Negotiated Rate |
$503.47 |
| Rate for Payer: Aetna Medicare |
$133.22
|
| Rate for Payer: Anthem Medicare |
$133.22
|
| Rate for Payer: Caresource Just 4 Me |
$153.20
|
| Rate for Payer: Caresource Medicare |
$146.54
|
| Rate for Payer: Centivo/Paragon All Products |
$206.49
|
| Rate for Payer: Coventry/First Health All Products |
$503.47
|
| Rate for Payer: Frontpath All Products |
$192.53
|
| Rate for Payer: Humana ChoiceCare |
$419.56
|
| Rate for Payer: Humana Medicare |
$133.22
|
| Rate for Payer: Lucent/Coldwater Veneers |
$226.47
|
| Rate for Payer: PHCS/Multiplan All Products |
$314.67
|
| Rate for Payer: PHP All Products |
$181.96
|
| Rate for Payer: Plain Church Group Ministry All Products |
$133.22
|
| Rate for Payer: Signature Care EPO |
$329.80
|
| Rate for Payer: Signature Care PPO |
$329.80
|
| Rate for Payer: United Healthcare Commercial |
$263.74
|
| Rate for Payer: United Healthcare Medicare |
$209.78
|
|
|
PR RESUPERF WND BODY 7.6-12.5 CM
|
Professional
|
$239.82
|
|
|
Service Code
|
CPT 12004
|
| Hospital Charge Code |
Z12040
|
| Min. Negotiated Rate |
$67.34 |
| Max. Negotiated Rate |
$287.78 |
| Rate for Payer: Caresource Medicare |
$74.07
|
| Rate for Payer: Aetna Medicare |
$67.34
|
| Rate for Payer: Anthem Exchange |
$194.89
|
| Rate for Payer: Anthem Medicare |
$67.34
|
| Rate for Payer: Anthem PPO |
$194.89
|
| Rate for Payer: Anthem Traditional |
$194.89
|
| Rate for Payer: Caresource Just 4 Me |
$77.44
|
| Rate for Payer: Centivo/Paragon All Products |
$104.38
|
| Rate for Payer: Coventry/First Health All Products |
$287.78
|
| Rate for Payer: Frontpath All Products |
$96.15
|
| Rate for Payer: Humana ChoiceCare |
$239.82
|
| Rate for Payer: Humana Medicare |
$67.34
|
| Rate for Payer: Lucent/Coldwater Veneers |
$114.48
|
| Rate for Payer: Lutheran Preferred All Products |
$88.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$179.87
|
| Rate for Payer: PHP All Products |
$91.98
|
| Rate for Payer: Plain Church Group Ministry All Products |
$67.34
|
| Rate for Payer: Signature Care EPO |
$188.70
|
| Rate for Payer: Signature Care PPO |
$188.70
|
| Rate for Payer: Three Rivers Preferred All Products |
$81.00
|
| Rate for Payer: United Healthcare Commercial |
$146.46
|
| Rate for Payer: United Healthcare Medicare |
$119.91
|
|
|
PR RESUPERF WND FACE <2.5 CM
|
Professional
|
$204.14
|
|
|
Service Code
|
CPT 12011
|
| Hospital Charge Code |
Z12043
|
| Min. Negotiated Rate |
$50.90 |
| Max. Negotiated Rate |
$244.97 |
| Rate for Payer: Aetna Medicare |
$50.90
|
| Rate for Payer: Anthem Exchange |
$197.34
|
| Rate for Payer: Anthem Medicare |
$50.90
|
| Rate for Payer: Anthem PPO |
$197.34
|
| Rate for Payer: Anthem Traditional |
$197.34
|
| Rate for Payer: Caresource Just 4 Me |
$58.53
|
| Rate for Payer: Caresource Medicare |
$55.99
|
| Rate for Payer: Centivo/Paragon All Products |
$78.89
|
| Rate for Payer: Coventry/First Health All Products |
$244.97
|
| Rate for Payer: Frontpath All Products |
$72.85
|
| Rate for Payer: Humana ChoiceCare |
$204.14
|
| Rate for Payer: Humana Medicare |
$50.90
|
| Rate for Payer: Lucent/Coldwater Veneers |
$86.53
|
| Rate for Payer: Lutheran Preferred All Products |
$66.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$153.10
|
| Rate for Payer: PHP All Products |
$69.52
|
| Rate for Payer: Plain Church Group Ministry All Products |
$50.90
|
| Rate for Payer: Signature Care EPO |
$160.65
|
| Rate for Payer: Signature Care PPO |
$160.65
|
| Rate for Payer: Three Rivers Preferred All Products |
$61.00
|
| Rate for Payer: United Healthcare Commercial |
$116.03
|
| Rate for Payer: United Healthcare Medicare |
$102.07
|
|
|
PR RESUPERF WND FACE 2.6-5 CM
|
Professional
|
$213.20
|
|
|
Service Code
|
CPT 12013
|
| Hospital Charge Code |
Z12044
|
| Min. Negotiated Rate |
$53.70 |
| Max. Negotiated Rate |
$255.84 |
| Rate for Payer: Aetna Medicare |
$53.70
|
| Rate for Payer: Anthem Exchange |
$217.88
|
| Rate for Payer: Anthem Medicare |
$53.70
|
| Rate for Payer: Anthem PPO |
$217.88
|
| Rate for Payer: Anthem Traditional |
$217.88
|
| Rate for Payer: Caresource Just 4 Me |
$61.75
|
| Rate for Payer: Caresource Medicare |
$59.07
|
| Rate for Payer: Centivo/Paragon All Products |
$83.24
|
| Rate for Payer: Coventry/First Health All Products |
$255.84
|
| Rate for Payer: Frontpath All Products |
$77.38
|
| Rate for Payer: Humana ChoiceCare |
$213.20
|
| Rate for Payer: Humana Medicare |
$53.70
|
| Rate for Payer: Lucent/Coldwater Veneers |
$91.29
|
| Rate for Payer: Lutheran Preferred All Products |
$70.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$159.90
|
| Rate for Payer: PHP All Products |
$73.35
|
| Rate for Payer: Plain Church Group Ministry All Products |
$53.70
|
| Rate for Payer: Signature Care EPO |
$175.95
|
| Rate for Payer: Signature Care PPO |
$175.95
|
| Rate for Payer: Three Rivers Preferred All Products |
$64.00
|
| Rate for Payer: United Healthcare Commercial |
$132.31
|
| Rate for Payer: United Healthcare Medicare |
$106.60
|
|
|
PR RESUPERF WND FACE 5.1-7.5 CM
|
Professional
|
$259.60
|
|
|
Service Code
|
CPT 12014
|
| Hospital Charge Code |
Z12045
|
| Min. Negotiated Rate |
$68.84 |
| Max. Negotiated Rate |
$311.52 |
| Rate for Payer: Aetna Medicare |
$68.84
|
| Rate for Payer: Anthem Exchange |
$257.34
|
| Rate for Payer: Anthem Medicare |
$68.84
|
| Rate for Payer: Anthem PPO |
$257.34
|
| Rate for Payer: Anthem Traditional |
$257.34
|
| Rate for Payer: Caresource Just 4 Me |
$79.17
|
| Rate for Payer: Caresource Medicare |
$75.72
|
| Rate for Payer: Centivo/Paragon All Products |
$106.70
|
| Rate for Payer: Coventry/First Health All Products |
$311.52
|
| Rate for Payer: Frontpath All Products |
$99.44
|
| Rate for Payer: Humana ChoiceCare |
$259.60
|
| Rate for Payer: Humana Medicare |
$68.84
|
| Rate for Payer: Lucent/Coldwater Veneers |
$117.03
|
| Rate for Payer: Lutheran Preferred All Products |
$89.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$194.70
|
| Rate for Payer: PHP All Products |
$94.02
|
| Rate for Payer: Plain Church Group Ministry All Products |
$68.84
|
| Rate for Payer: Signature Care EPO |
$208.25
|
| Rate for Payer: Signature Care PPO |
$208.25
|
| Rate for Payer: Three Rivers Preferred All Products |
$83.00
|
| Rate for Payer: United Healthcare Commercial |
$159.40
|
| Rate for Payer: United Healthcare Medicare |
$129.80
|
|
|
PR RESUP NPTERF WND BODY 2.6-7.5 CM
|
Professional
|
$206.38
|
|
|
Service Code
|
CPT 12002
|
| Hospital Charge Code |
Z12039
|
| Min. Negotiated Rate |
$54.21 |
| Max. Negotiated Rate |
$247.66 |
| Rate for Payer: Aetna Medicare |
$54.21
|
| Rate for Payer: Anthem Exchange |
$205.66
|
| Rate for Payer: Anthem Medicare |
$54.21
|
| Rate for Payer: Anthem PPO |
$205.66
|
| Rate for Payer: Anthem Traditional |
$205.66
|
| Rate for Payer: Caresource Just 4 Me |
$62.34
|
| Rate for Payer: Caresource Medicare |
$59.63
|
| Rate for Payer: Centivo/Paragon All Products |
$84.03
|
| Rate for Payer: Coventry/First Health All Products |
$247.66
|
| Rate for Payer: Frontpath All Products |
$77.73
|
| Rate for Payer: Humana ChoiceCare |
$206.38
|
| Rate for Payer: Humana Medicare |
$54.21
|
| Rate for Payer: Lucent/Coldwater Veneers |
$92.16
|
| Rate for Payer: Lutheran Preferred All Products |
$70.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$154.78
|
| Rate for Payer: PHP All Products |
$74.05
|
| Rate for Payer: Plain Church Group Ministry All Products |
$54.21
|
| Rate for Payer: Signature Care EPO |
$160.65
|
| Rate for Payer: Signature Care PPO |
$160.65
|
| Rate for Payer: Three Rivers Preferred All Products |
$65.00
|
| Rate for Payer: United Healthcare Commercial |
$124.53
|
| Rate for Payer: United Healthcare Medicare |
$103.19
|
|
|
PR REVAGINAL PROLAPSE,SACROSP LIG
|
Professional
|
$1,270.96
|
|
|
Service Code
|
CPT 57282
|
| Hospital Charge Code |
Z12711
|
| Min. Negotiated Rate |
$572.20 |
| Max. Negotiated Rate |
$1,525.15 |
| Rate for Payer: Aetna Medicare |
$651.37
|
| Rate for Payer: Anthem Exchange |
$606.48
|
| Rate for Payer: Anthem Medicare |
$651.37
|
| Rate for Payer: Anthem PPO |
$606.48
|
| Rate for Payer: Anthem Traditional |
$606.48
|
| Rate for Payer: Caresource Just 4 Me |
$749.08
|
| Rate for Payer: Caresource Medicare |
$716.51
|
| Rate for Payer: Centivo/Paragon All Products |
$1,009.62
|
| Rate for Payer: Coventry/First Health All Products |
$1,525.15
|
| Rate for Payer: Frontpath All Products |
$908.61
|
| Rate for Payer: Humana ChoiceCare |
$1,270.96
|
| Rate for Payer: Humana Medicare |
$651.37
|
| Rate for Payer: Lucent/Coldwater Veneers |
$1,107.33
|
| Rate for Payer: Lutheran Preferred All Products |
$912.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$953.22
|
| Rate for Payer: PHP All Products |
$838.84
|
| Rate for Payer: Plain Church Group Ministry All Products |
$651.37
|
| Rate for Payer: Signature Care EPO |
$704.65
|
| Rate for Payer: Signature Care PPO |
$704.65
|
| Rate for Payer: Three Rivers Preferred All Products |
$847.00
|
| Rate for Payer: United Healthcare Commercial |
$572.20
|
| Rate for Payer: United Healthcare Medicare |
$635.48
|
|
|
PR REVAGINAL PROLAPSE,UTEROSACRAL
|
Professional
|
$1,279.38
|
|
|
Service Code
|
CPT 57283
|
| Hospital Charge Code |
Z12712
|
| Min. Negotiated Rate |
$639.69 |
| Max. Negotiated Rate |
$1,535.26 |
| Rate for Payer: Aetna Medicare |
$655.69
|
| Rate for Payer: Anthem Exchange |
$870.80
|
| Rate for Payer: Anthem Medicare |
$655.69
|
| Rate for Payer: Anthem PPO |
$870.80
|
| Rate for Payer: Anthem Traditional |
$870.80
|
| Rate for Payer: Caresource Just 4 Me |
$754.04
|
| Rate for Payer: Caresource Medicare |
$721.26
|
| Rate for Payer: Centivo/Paragon All Products |
$1,016.32
|
| Rate for Payer: Coventry/First Health All Products |
$1,535.26
|
| Rate for Payer: Frontpath All Products |
$915.37
|
| Rate for Payer: Humana ChoiceCare |
$1,279.38
|
| Rate for Payer: Humana Medicare |
$655.69
|
| Rate for Payer: Lucent/Coldwater Veneers |
$1,114.67
|
| Rate for Payer: Lutheran Preferred All Products |
$918.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$959.54
|
| Rate for Payer: PHP All Products |
$844.40
|
| Rate for Payer: Plain Church Group Ministry All Products |
$655.69
|
| Rate for Payer: Signature Care EPO |
$838.95
|
| Rate for Payer: Signature Care PPO |
$838.95
|
| Rate for Payer: Three Rivers Preferred All Products |
$852.00
|
| Rate for Payer: United Healthcare Commercial |
$775.99
|
| Rate for Payer: United Healthcare Medicare |
$639.69
|
|
|
PR REVISE ACETABULAR PART OF TOTAL HIP
|
Professional
|
$2,636.28
|
|
|
Service Code
|
CPT 27137
|
| Hospital Charge Code |
Z12313
|
| Min. Negotiated Rate |
$1,318.14 |
| Max. Negotiated Rate |
$3,163.54 |
| Rate for Payer: Aetna Medicare |
$1,350.93
|
| Rate for Payer: Anthem Exchange |
$2,073.90
|
| Rate for Payer: Anthem Medicare |
$1,350.93
|
| Rate for Payer: Anthem PPO |
$2,073.90
|
| Rate for Payer: Anthem Traditional |
$2,073.90
|
| Rate for Payer: Caresource Just 4 Me |
$1,553.57
|
| Rate for Payer: Caresource Medicare |
$1,486.02
|
| Rate for Payer: Centivo/Paragon All Products |
$2,093.94
|
| Rate for Payer: Coventry/First Health All Products |
$3,163.54
|
| Rate for Payer: Frontpath All Products |
$1,907.84
|
| Rate for Payer: Humana ChoiceCare |
$2,636.28
|
| Rate for Payer: Humana Medicare |
$1,350.93
|
| Rate for Payer: Lucent/Coldwater Veneers |
$2,296.58
|
| Rate for Payer: Lutheran Preferred All Products |
$2,161.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$1,977.21
|
| Rate for Payer: PHP All Products |
$2,293.56
|
| Rate for Payer: Plain Church Group Ministry All Products |
$1,350.93
|
| Rate for Payer: Signature Care EPO |
$2,062.95
|
| Rate for Payer: Signature Care PPO |
$2,062.95
|
| Rate for Payer: Three Rivers Preferred All Products |
$2,026.00
|
| Rate for Payer: United Healthcare Commercial |
$1,643.26
|
| Rate for Payer: United Healthcare Medicare |
$1,318.14
|
|
|
PR REVISE FEM PART OFTOTAL HIP
|
Professional
|
$2,738.16
|
|
|
Service Code
|
CPT 27138
|
| Hospital Charge Code |
Z12314
|
| Min. Negotiated Rate |
$1,369.08 |
| Max. Negotiated Rate |
$3,285.79 |
| Rate for Payer: Aetna Medicare |
$1,403.31
|
| Rate for Payer: Anthem Exchange |
$2,158.80
|
| Rate for Payer: Anthem Medicare |
$1,403.31
|
| Rate for Payer: Anthem PPO |
$2,158.80
|
| Rate for Payer: Anthem Traditional |
$2,158.80
|
| Rate for Payer: Caresource Just 4 Me |
$1,613.81
|
| Rate for Payer: Caresource Medicare |
$1,543.64
|
| Rate for Payer: Centivo/Paragon All Products |
$2,175.13
|
| Rate for Payer: Coventry/First Health All Products |
$3,285.79
|
| Rate for Payer: Frontpath All Products |
$1,983.71
|
| Rate for Payer: Humana ChoiceCare |
$2,738.16
|
| Rate for Payer: Humana Medicare |
$1,403.31
|
| Rate for Payer: Lucent/Coldwater Veneers |
$2,385.63
|
| Rate for Payer: Lutheran Preferred All Products |
$2,245.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$2,053.62
|
| Rate for Payer: PHP All Products |
$2,382.20
|
| Rate for Payer: Plain Church Group Ministry All Products |
$1,403.31
|
| Rate for Payer: Signature Care EPO |
$2,150.50
|
| Rate for Payer: Signature Care PPO |
$2,150.50
|
| Rate for Payer: Three Rivers Preferred All Products |
$2,105.00
|
| Rate for Payer: United Healthcare Commercial |
$1,710.74
|
| Rate for Payer: United Healthcare Medicare |
$1,369.08
|
|
