|
PR REVISE KNEE JOINT REPLACE,1 PART
|
Professional
|
$2,530.16
|
|
|
Service Code
|
CPT 27486
|
| Hospital Charge Code |
Z12353
|
| Min. Negotiated Rate |
$1,265.08 |
| Max. Negotiated Rate |
$3,036.19 |
| Rate for Payer: Aetna Medicare |
$1,296.70
|
| Rate for Payer: Anthem Exchange |
$1,887.30
|
| Rate for Payer: Anthem Medicare |
$1,296.70
|
| Rate for Payer: Anthem PPO |
$1,887.30
|
| Rate for Payer: Anthem Traditional |
$1,887.30
|
| Rate for Payer: Caresource Just 4 Me |
$1,491.20
|
| Rate for Payer: Caresource Medicare |
$1,426.37
|
| Rate for Payer: Centivo/Paragon All Products |
$2,009.89
|
| Rate for Payer: Coventry/First Health All Products |
$3,036.19
|
| Rate for Payer: Frontpath All Products |
$1,824.88
|
| Rate for Payer: Humana ChoiceCare |
$2,530.16
|
| Rate for Payer: Humana Medicare |
$1,296.70
|
| Rate for Payer: Lucent/Coldwater Veneers |
$2,204.39
|
| Rate for Payer: Lutheran Preferred All Products |
$2,075.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$1,897.62
|
| Rate for Payer: PHP All Products |
$2,201.24
|
| Rate for Payer: Plain Church Group Ministry All Products |
$1,296.70
|
| Rate for Payer: Signature Care EPO |
$1,918.45
|
| Rate for Payer: Signature Care PPO |
$1,918.45
|
| Rate for Payer: Three Rivers Preferred All Products |
$1,945.00
|
| Rate for Payer: United Healthcare Commercial |
$1,551.89
|
| Rate for Payer: United Healthcare Medicare |
$1,265.08
|
|
|
PR REVISE KNEE JOINT REPLACE,ALL PARTS
|
Professional
|
$3,153.08
|
|
|
Service Code
|
CPT 27487
|
| Hospital Charge Code |
Z12354
|
| Min. Negotiated Rate |
$1,576.54 |
| Max. Negotiated Rate |
$3,783.70 |
| Rate for Payer: Aetna Medicare |
$1,615.79
|
| Rate for Payer: Anthem Exchange |
$2,439.30
|
| Rate for Payer: Anthem Medicare |
$1,615.79
|
| Rate for Payer: Anthem PPO |
$2,439.30
|
| Rate for Payer: Anthem Traditional |
$2,439.30
|
| Rate for Payer: Caresource Just 4 Me |
$1,858.16
|
| Rate for Payer: Caresource Medicare |
$1,777.37
|
| Rate for Payer: Centivo/Paragon All Products |
$2,504.47
|
| Rate for Payer: Coventry/First Health All Products |
$3,783.70
|
| Rate for Payer: Frontpath All Products |
$2,281.07
|
| Rate for Payer: Humana ChoiceCare |
$3,153.08
|
| Rate for Payer: Humana Medicare |
$1,615.79
|
| Rate for Payer: Lucent/Coldwater Veneers |
$2,746.84
|
| Rate for Payer: Lutheran Preferred All Products |
$2,585.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$2,364.81
|
| Rate for Payer: PHP All Products |
$2,743.18
|
| Rate for Payer: Plain Church Group Ministry All Products |
$1,615.79
|
| Rate for Payer: Signature Care EPO |
$2,458.20
|
| Rate for Payer: Signature Care PPO |
$2,458.20
|
| Rate for Payer: Three Rivers Preferred All Products |
$2,424.00
|
| Rate for Payer: United Healthcare Commercial |
$1,960.26
|
| Rate for Payer: United Healthcare Medicare |
$1,576.54
|
|
|
PR REVISE MEDIAN N/CARPAL TUNNEL SURG
|
Professional
|
$810.86
|
|
|
Service Code
|
CPT 64721
|
| Hospital Charge Code |
Z12831
|
| Min. Negotiated Rate |
$405.43 |
| Max. Negotiated Rate |
$973.03 |
| Rate for Payer: Aetna Medicare |
$408.16
|
| Rate for Payer: Anthem Exchange |
$490.67
|
| Rate for Payer: Anthem Medicare |
$408.16
|
| Rate for Payer: Anthem PPO |
$490.67
|
| Rate for Payer: Anthem Traditional |
$490.67
|
| Rate for Payer: Caresource Just 4 Me |
$469.38
|
| Rate for Payer: Caresource Medicare |
$448.98
|
| Rate for Payer: Centivo/Paragon All Products |
$632.65
|
| Rate for Payer: Coventry/First Health All Products |
$973.03
|
| Rate for Payer: Frontpath All Products |
$560.25
|
| Rate for Payer: Humana ChoiceCare |
$810.86
|
| Rate for Payer: Humana Medicare |
$408.16
|
| Rate for Payer: Lucent/Coldwater Veneers |
$693.87
|
| Rate for Payer: Lutheran Preferred All Products |
$653.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$608.14
|
| Rate for Payer: PHP All Products |
$696.86
|
| Rate for Payer: Plain Church Group Ministry All Products |
$408.16
|
| Rate for Payer: Signature Care EPO |
$646.00
|
| Rate for Payer: Signature Care PPO |
$646.00
|
| Rate for Payer: Three Rivers Preferred All Products |
$612.00
|
| Rate for Payer: United Healthcare Commercial |
$439.89
|
| Rate for Payer: United Healthcare Medicare |
$405.43
|
|
|
PR REVISE TOTAL HIP REPLACEMENT
|
Professional
|
$3,421.94
|
|
|
Service Code
|
CPT 27134
|
| Hospital Charge Code |
Z12312
|
| Min. Negotiated Rate |
$1,710.97 |
| Max. Negotiated Rate |
$4,106.33 |
| Rate for Payer: Aetna Medicare |
$1,753.74
|
| Rate for Payer: Anthem Exchange |
$2,745.50
|
| Rate for Payer: Anthem Medicare |
$1,753.74
|
| Rate for Payer: Anthem PPO |
$2,745.50
|
| Rate for Payer: Anthem Traditional |
$2,745.50
|
| Rate for Payer: Caresource Just 4 Me |
$2,016.80
|
| Rate for Payer: Caresource Medicare |
$1,929.11
|
| Rate for Payer: Centivo/Paragon All Products |
$2,718.30
|
| Rate for Payer: Coventry/First Health All Products |
$4,106.33
|
| Rate for Payer: Frontpath All Products |
$2,482.45
|
| Rate for Payer: Humana ChoiceCare |
$3,421.94
|
| Rate for Payer: Humana Medicare |
$1,753.74
|
| Rate for Payer: Lucent/Coldwater Veneers |
$2,981.36
|
| Rate for Payer: Lutheran Preferred All Products |
$2,806.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$2,566.45
|
| Rate for Payer: PHP All Products |
$2,977.09
|
| Rate for Payer: Plain Church Group Ministry All Products |
$1,753.74
|
| Rate for Payer: Signature Care EPO |
$2,729.35
|
| Rate for Payer: Signature Care PPO |
$2,729.35
|
| Rate for Payer: Three Rivers Preferred All Products |
$2,631.00
|
| Rate for Payer: United Healthcare Commercial |
$2,158.35
|
| Rate for Payer: United Healthcare Medicare |
$1,710.97
|
|
|
PR REVISE ULNAR NERVE AT ELBOW
|
Professional
|
$1,097.22
|
|
|
Service Code
|
CPT 64718
|
| Hospital Charge Code |
Z12830
|
| Min. Negotiated Rate |
$548.61 |
| Max. Negotiated Rate |
$1,316.66 |
| Rate for Payer: Aetna Medicare |
$562.33
|
| Rate for Payer: Anthem Exchange |
$594.70
|
| Rate for Payer: Anthem Medicare |
$562.33
|
| Rate for Payer: Anthem PPO |
$594.70
|
| Rate for Payer: Anthem Traditional |
$594.70
|
| Rate for Payer: Caresource Just 4 Me |
$646.68
|
| Rate for Payer: Caresource Medicare |
$618.56
|
| Rate for Payer: Centivo/Paragon All Products |
$871.61
|
| Rate for Payer: Coventry/First Health All Products |
$1,316.66
|
| Rate for Payer: Frontpath All Products |
$773.72
|
| Rate for Payer: Humana ChoiceCare |
$1,097.22
|
| Rate for Payer: Humana Medicare |
$562.33
|
| Rate for Payer: Lucent/Coldwater Veneers |
$955.96
|
| Rate for Payer: Lutheran Preferred All Products |
$900.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$822.91
|
| Rate for Payer: PHP All Products |
$960.07
|
| Rate for Payer: Plain Church Group Ministry All Products |
$562.33
|
| Rate for Payer: Signature Care EPO |
$689.35
|
| Rate for Payer: Signature Care PPO |
$689.35
|
| Rate for Payer: Three Rivers Preferred All Products |
$843.00
|
| Rate for Payer: United Healthcare Commercial |
$604.48
|
| Rate for Payer: United Healthcare Medicare |
$548.61
|
|
|
PR REVISION OF UNSTABLE PATELLA
|
Professional
|
$1,356.90
|
|
|
Service Code
|
CPT 27420
|
| Hospital Charge Code |
Z12347
|
| Min. Negotiated Rate |
$678.45 |
| Max. Negotiated Rate |
$1,628.28 |
| Rate for Payer: Aetna Medicare |
$695.41
|
| Rate for Payer: Anthem Exchange |
$987.70
|
| Rate for Payer: Anthem Medicare |
$695.41
|
| Rate for Payer: Anthem PPO |
$987.70
|
| Rate for Payer: Anthem Traditional |
$987.70
|
| Rate for Payer: Caresource Just 4 Me |
$799.72
|
| Rate for Payer: Caresource Medicare |
$764.95
|
| Rate for Payer: Centivo/Paragon All Products |
$1,077.89
|
| Rate for Payer: Coventry/First Health All Products |
$1,628.28
|
| Rate for Payer: Frontpath All Products |
$964.91
|
| Rate for Payer: Humana ChoiceCare |
$1,356.90
|
| Rate for Payer: Humana Medicare |
$695.41
|
| Rate for Payer: Lucent/Coldwater Veneers |
$1,182.20
|
| Rate for Payer: Lutheran Preferred All Products |
$1,113.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$1,017.68
|
| Rate for Payer: PHP All Products |
$1,180.49
|
| Rate for Payer: Plain Church Group Ministry All Products |
$695.41
|
| Rate for Payer: Signature Care EPO |
$1,045.50
|
| Rate for Payer: Signature Care PPO |
$1,045.50
|
| Rate for Payer: Three Rivers Preferred All Products |
$1,043.00
|
| Rate for Payer: United Healthcare Commercial |
$808.61
|
| Rate for Payer: United Healthcare Medicare |
$678.45
|
|
|
PR REVIS SHOULDER ARTHRPLSTY HUMERAL/GLENOID COMPNT
|
Professional
|
$2,904.06
|
|
|
Service Code
|
CPT 23473
|
| Hospital Charge Code |
Z12167
|
| Min. Negotiated Rate |
$1,452.03 |
| Max. Negotiated Rate |
$3,484.87 |
| Rate for Payer: Aetna Medicare |
$1,488.16
|
| Rate for Payer: Anthem Medicare |
$1,488.16
|
| Rate for Payer: Caresource Just 4 Me |
$1,711.38
|
| Rate for Payer: Caresource Medicare |
$1,636.98
|
| Rate for Payer: Centivo/Paragon All Products |
$2,306.65
|
| Rate for Payer: Coventry/First Health All Products |
$3,484.87
|
| Rate for Payer: Frontpath All Products |
$2,098.37
|
| Rate for Payer: Humana ChoiceCare |
$2,904.06
|
| Rate for Payer: Humana Medicare |
$1,488.16
|
| Rate for Payer: Lucent/Coldwater Veneers |
$2,529.87
|
| Rate for Payer: PHCS/Multiplan All Products |
$2,178.05
|
| Rate for Payer: Plain Church Group Ministry All Products |
$1,488.16
|
| Rate for Payer: United Healthcare Commercial |
$2,019.96
|
| Rate for Payer: United Healthcare Medicare |
$1,452.03
|
|
|
PR RFIBULA NONUNION/MALUNION W INT FIXATION
|
Professional
|
$1,736.26
|
|
|
Service Code
|
CPT 27726
|
| Hospital Charge Code |
Z12386
|
| Min. Negotiated Rate |
$868.13 |
| Max. Negotiated Rate |
$2,083.51 |
| Rate for Payer: Aetna Medicare |
$889.83
|
| Rate for Payer: Anthem Medicare |
$889.83
|
| Rate for Payer: Caresource Just 4 Me |
$1,023.30
|
| Rate for Payer: Caresource Medicare |
$978.81
|
| Rate for Payer: Centivo/Paragon All Products |
$1,379.24
|
| Rate for Payer: Coventry/First Health All Products |
$2,083.51
|
| Rate for Payer: Frontpath All Products |
$1,247.82
|
| Rate for Payer: Humana ChoiceCare |
$1,736.26
|
| Rate for Payer: Humana Medicare |
$889.83
|
| Rate for Payer: Lucent/Coldwater Veneers |
$1,512.71
|
| Rate for Payer: PHCS/Multiplan All Products |
$1,302.19
|
| Rate for Payer: PHP All Products |
$1,510.54
|
| Rate for Payer: Plain Church Group Ministry All Products |
$889.83
|
| Rate for Payer: Signature Care EPO |
$1,205.61
|
| Rate for Payer: Signature Care PPO |
$1,205.61
|
| Rate for Payer: United Healthcare Commercial |
$1,004.51
|
| Rate for Payer: United Healthcare Medicare |
$868.13
|
|
|
PR RHYTHM ECG WITH REPORT
|
Professional
|
$23.20
|
|
|
Service Code
|
CPT 93040
|
| Hospital Charge Code |
Z13078
|
| Min. Negotiated Rate |
$11.60 |
| Max. Negotiated Rate |
$27.84 |
| Rate for Payer: Aetna Medicare |
$11.89
|
| Rate for Payer: Anthem Exchange |
$18.80
|
| Rate for Payer: Anthem Medicare |
$11.89
|
| Rate for Payer: Anthem PPO |
$18.80
|
| Rate for Payer: Anthem Traditional |
$18.80
|
| Rate for Payer: Caresource Just 4 Me |
$13.67
|
| Rate for Payer: Caresource Medicare |
$13.08
|
| Rate for Payer: Centivo/Paragon All Products |
$18.43
|
| Rate for Payer: Coventry/First Health All Products |
$27.84
|
| Rate for Payer: Frontpath All Products |
$13.50
|
| Rate for Payer: Humana ChoiceCare |
$23.20
|
| Rate for Payer: Humana Medicare |
$11.89
|
| Rate for Payer: Lucent/Coldwater Veneers |
$20.21
|
| Rate for Payer: Lutheran Preferred All Products |
$19.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$17.40
|
| Rate for Payer: PHP All Products |
$17.05
|
| Rate for Payer: Plain Church Group Ministry All Products |
$11.89
|
| Rate for Payer: Signature Care EPO |
$19.96
|
| Rate for Payer: Signature Care PPO |
$19.96
|
| Rate for Payer: Three Rivers Preferred All Products |
$18.00
|
| Rate for Payer: United Healthcare Commercial |
$15.61
|
| Rate for Payer: United Healthcare Medicare |
$11.60
|
|
|
PR RMV KNEE SYNOVIUM,ANT/POST
|
Professional
|
$1,250.66
|
|
|
Service Code
|
CPT 27334
|
| Hospital Charge Code |
Z12334
|
| Min. Negotiated Rate |
$625.33 |
| Max. Negotiated Rate |
$1,500.79 |
| Rate for Payer: Aetna Medicare |
$640.96
|
| Rate for Payer: Anthem Exchange |
$895.80
|
| Rate for Payer: Anthem Medicare |
$640.96
|
| Rate for Payer: Anthem PPO |
$895.80
|
| Rate for Payer: Anthem Traditional |
$895.80
|
| Rate for Payer: Caresource Just 4 Me |
$737.10
|
| Rate for Payer: Caresource Medicare |
$705.06
|
| Rate for Payer: Centivo/Paragon All Products |
$993.49
|
| Rate for Payer: Coventry/First Health All Products |
$1,500.79
|
| Rate for Payer: Frontpath All Products |
$890.67
|
| Rate for Payer: Humana ChoiceCare |
$1,250.66
|
| Rate for Payer: Humana Medicare |
$640.96
|
| Rate for Payer: Lucent/Coldwater Veneers |
$1,089.63
|
| Rate for Payer: Lutheran Preferred All Products |
$1,026.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$938.00
|
| Rate for Payer: PHP All Products |
$1,088.07
|
| Rate for Payer: Plain Church Group Ministry All Products |
$640.96
|
| Rate for Payer: Signature Care EPO |
$938.40
|
| Rate for Payer: Signature Care PPO |
$938.40
|
| Rate for Payer: Three Rivers Preferred All Products |
$961.00
|
| Rate for Payer: United Healthcare Commercial |
$730.70
|
| Rate for Payer: United Healthcare Medicare |
$625.33
|
|
|
PR RMVL IMPLTBL DFB PLSE GEN W/REPL PLSE GEN 1 LEAD
|
Professional
|
$662.02
|
|
|
Service Code
|
CPT 33262
|
| Hospital Charge Code |
Z12538
|
| Min. Negotiated Rate |
$331.01 |
| Max. Negotiated Rate |
$794.42 |
| Rate for Payer: Aetna Medicare |
$339.28
|
| Rate for Payer: Anthem Exchange |
$468.23
|
| Rate for Payer: Anthem Medicare |
$339.28
|
| Rate for Payer: Anthem PPO |
$468.23
|
| Rate for Payer: Anthem Traditional |
$468.23
|
| Rate for Payer: Caresource Just 4 Me |
$390.17
|
| Rate for Payer: Caresource Medicare |
$373.21
|
| Rate for Payer: Centivo/Paragon All Products |
$525.88
|
| Rate for Payer: Coventry/First Health All Products |
$794.42
|
| Rate for Payer: Frontpath All Products |
$488.67
|
| Rate for Payer: Humana ChoiceCare |
$662.02
|
| Rate for Payer: Humana Medicare |
$339.28
|
| Rate for Payer: Lucent/Coldwater Veneers |
$576.78
|
| Rate for Payer: Lutheran Preferred All Products |
$543.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$496.51
|
| Rate for Payer: PHP All Products |
$463.41
|
| Rate for Payer: Plain Church Group Ministry All Products |
$339.28
|
| Rate for Payer: Signature Care EPO |
$439.10
|
| Rate for Payer: Signature Care PPO |
$439.10
|
| Rate for Payer: Three Rivers Preferred All Products |
$509.00
|
| Rate for Payer: United Healthcare Commercial |
$454.51
|
| Rate for Payer: United Healthcare Medicare |
$331.01
|
|
|
PR RMVL IMPLTBL DFB PLSE GEN W/RPLCMT PLSE GEN 2 LD
|
Professional
|
$687.46
|
|
|
Service Code
|
CPT 33263
|
| Hospital Charge Code |
Z12539
|
| Min. Negotiated Rate |
$343.73 |
| Max. Negotiated Rate |
$824.95 |
| Rate for Payer: Aetna Medicare |
$352.32
|
| Rate for Payer: Anthem Exchange |
$486.70
|
| Rate for Payer: Anthem Medicare |
$352.32
|
| Rate for Payer: Anthem PPO |
$486.70
|
| Rate for Payer: Anthem Traditional |
$486.70
|
| Rate for Payer: Caresource Just 4 Me |
$405.17
|
| Rate for Payer: Caresource Medicare |
$387.55
|
| Rate for Payer: Centivo/Paragon All Products |
$546.10
|
| Rate for Payer: Coventry/First Health All Products |
$824.95
|
| Rate for Payer: Frontpath All Products |
$508.36
|
| Rate for Payer: Humana ChoiceCare |
$687.46
|
| Rate for Payer: Humana Medicare |
$352.32
|
| Rate for Payer: Lucent/Coldwater Veneers |
$598.94
|
| Rate for Payer: Lutheran Preferred All Products |
$564.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$515.60
|
| Rate for Payer: PHP All Products |
$481.22
|
| Rate for Payer: Plain Church Group Ministry All Products |
$352.32
|
| Rate for Payer: Signature Care EPO |
$456.42
|
| Rate for Payer: Signature Care PPO |
$456.42
|
| Rate for Payer: Three Rivers Preferred All Products |
$528.00
|
| Rate for Payer: United Healthcare Commercial |
$472.45
|
| Rate for Payer: United Healthcare Medicare |
$343.73
|
|
|
PR RMVL IMPLTBL DFB PLS GEN W/RPLCMT PLS GEN MLT LD
|
Professional
|
$717.12
|
|
|
Service Code
|
CPT 33264
|
| Hospital Charge Code |
Z12540
|
| Min. Negotiated Rate |
$358.56 |
| Max. Negotiated Rate |
$860.54 |
| Rate for Payer: Aetna Medicare |
$367.53
|
| Rate for Payer: Anthem Exchange |
$505.17
|
| Rate for Payer: Anthem Medicare |
$367.53
|
| Rate for Payer: Anthem PPO |
$505.17
|
| Rate for Payer: Anthem Traditional |
$505.17
|
| Rate for Payer: Caresource Just 4 Me |
$422.66
|
| Rate for Payer: Caresource Medicare |
$404.28
|
| Rate for Payer: Centivo/Paragon All Products |
$569.67
|
| Rate for Payer: Coventry/First Health All Products |
$860.54
|
| Rate for Payer: Frontpath All Products |
$529.71
|
| Rate for Payer: Humana ChoiceCare |
$717.12
|
| Rate for Payer: Humana Medicare |
$367.53
|
| Rate for Payer: Lucent/Coldwater Veneers |
$624.80
|
| Rate for Payer: Lutheran Preferred All Products |
$588.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$537.84
|
| Rate for Payer: PHP All Products |
$501.99
|
| Rate for Payer: Plain Church Group Ministry All Products |
$367.53
|
| Rate for Payer: Signature Care EPO |
$473.74
|
| Rate for Payer: Signature Care PPO |
$473.74
|
| Rate for Payer: Three Rivers Preferred All Products |
$551.00
|
| Rate for Payer: United Healthcare Commercial |
$490.38
|
| Rate for Payer: United Healthcare Medicare |
$358.56
|
|
|
PR RMVL RUPTURED BREAST IMPLANT W/IMPLANT CONTENTS
|
Professional
|
$1,172.50
|
|
|
Service Code
|
CPT 19330
|
| Hospital Charge Code |
Z12113
|
| Min. Negotiated Rate |
$571.20 |
| Max. Negotiated Rate |
$1,407.00 |
| Rate for Payer: Aetna Medicare |
$601.06
|
| Rate for Payer: Anthem Exchange |
$606.90
|
| Rate for Payer: Anthem Medicare |
$601.06
|
| Rate for Payer: Anthem PPO |
$606.90
|
| Rate for Payer: Anthem Traditional |
$606.90
|
| Rate for Payer: Caresource Just 4 Me |
$691.22
|
| Rate for Payer: Caresource Medicare |
$661.17
|
| Rate for Payer: Centivo/Paragon All Products |
$931.64
|
| Rate for Payer: Coventry/First Health All Products |
$1,407.00
|
| Rate for Payer: Frontpath All Products |
$834.65
|
| Rate for Payer: Humana ChoiceCare |
$1,172.50
|
| Rate for Payer: Humana Medicare |
$601.06
|
| Rate for Payer: Lucent/Coldwater Veneers |
$1,021.80
|
| Rate for Payer: Lutheran Preferred All Products |
$781.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$879.38
|
| Rate for Payer: PHP All Products |
$820.74
|
| Rate for Payer: Plain Church Group Ministry All Products |
$601.06
|
| Rate for Payer: Signature Care EPO |
$571.20
|
| Rate for Payer: Signature Care PPO |
$571.20
|
| Rate for Payer: Three Rivers Preferred All Products |
$721.00
|
| Rate for Payer: United Healthcare Commercial |
$669.70
|
| Rate for Payer: United Healthcare Medicare |
$586.25
|
|
|
PR RMVL TRANSVNS PM ELTRD DUAL LEAD SYS
|
Professional
|
$1,129.72
|
|
|
Service Code
|
CPT 33235
|
| Hospital Charge Code |
Z12535
|
| Min. Negotiated Rate |
$564.86 |
| Max. Negotiated Rate |
$1,355.66 |
| Rate for Payer: Aetna Medicare |
$579.14
|
| Rate for Payer: Anthem Medicare |
$579.14
|
| Rate for Payer: Caresource Just 4 Me |
$666.01
|
| Rate for Payer: Caresource Medicare |
$637.05
|
| Rate for Payer: Centivo/Paragon All Products |
$897.67
|
| Rate for Payer: Coventry/First Health All Products |
$1,355.66
|
| Rate for Payer: Frontpath All Products |
$833.29
|
| Rate for Payer: Humana ChoiceCare |
$1,129.72
|
| Rate for Payer: Humana Medicare |
$579.14
|
| Rate for Payer: Lucent/Coldwater Veneers |
$984.54
|
| Rate for Payer: PHCS/Multiplan All Products |
$847.29
|
| Rate for Payer: PHP All Products |
$790.80
|
| Rate for Payer: Plain Church Group Ministry All Products |
$579.14
|
| Rate for Payer: Signature Care EPO |
$908.65
|
| Rate for Payer: Signature Care PPO |
$908.65
|
| Rate for Payer: United Healthcare Commercial |
$762.06
|
| Rate for Payer: United Healthcare Medicare |
$564.86
|
|
|
PR RMVL TUN CTR VAD W/SUBQ PORT/PMP CTR/PRPH INSJ
|
Professional
|
$404.46
|
|
|
Service Code
|
CPT 36590
|
| Hospital Charge Code |
Z12548
|
| Min. Negotiated Rate |
$174.87 |
| Max. Negotiated Rate |
$485.35 |
| Rate for Payer: Aetna Medicare |
$174.87
|
| Rate for Payer: Anthem Exchange |
$470.40
|
| Rate for Payer: Anthem Medicare |
$174.87
|
| Rate for Payer: Anthem PPO |
$470.40
|
| Rate for Payer: Anthem Traditional |
$470.40
|
| Rate for Payer: Caresource Just 4 Me |
$201.10
|
| Rate for Payer: Caresource Medicare |
$192.36
|
| Rate for Payer: Centivo/Paragon All Products |
$271.05
|
| Rate for Payer: Coventry/First Health All Products |
$485.35
|
| Rate for Payer: Frontpath All Products |
$247.04
|
| Rate for Payer: Humana ChoiceCare |
$404.46
|
| Rate for Payer: Humana Medicare |
$174.87
|
| Rate for Payer: Lucent/Coldwater Veneers |
$297.28
|
| Rate for Payer: Lutheran Preferred All Products |
$280.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$303.34
|
| Rate for Payer: PHP All Products |
$290.02
|
| Rate for Payer: Plain Church Group Ministry All Products |
$174.87
|
| Rate for Payer: Signature Care EPO |
$359.45
|
| Rate for Payer: Signature Care PPO |
$359.45
|
| Rate for Payer: Three Rivers Preferred All Products |
$262.00
|
| Rate for Payer: United Healthcare Commercial |
$231.09
|
| Rate for Payer: United Healthcare Medicare |
$202.23
|
|
|
PR ROUT OB CARE,C-SEC,PREV C-SEC
|
Professional
|
$4,729.96
|
|
|
Service Code
|
CPT 59618
|
| Hospital Charge Code |
Z12811
|
| Min. Negotiated Rate |
$2,021.25 |
| Max. Negotiated Rate |
$5,675.95 |
| Rate for Payer: Aetna Medicare |
$2,424.26
|
| Rate for Payer: Anthem Exchange |
$2,021.25
|
| Rate for Payer: Anthem Medicare |
$2,424.26
|
| Rate for Payer: Anthem PPO |
$2,021.25
|
| Rate for Payer: Anthem Traditional |
$2,021.25
|
| Rate for Payer: Caresource Just 4 Me |
$2,787.90
|
| Rate for Payer: Caresource Medicare |
$2,666.69
|
| Rate for Payer: Centivo/Paragon All Products |
$3,757.60
|
| Rate for Payer: Coventry/First Health All Products |
$5,675.95
|
| Rate for Payer: Frontpath All Products |
$3,460.15
|
| Rate for Payer: Humana ChoiceCare |
$4,729.96
|
| Rate for Payer: Humana Medicare |
$2,424.26
|
| Rate for Payer: Lucent/Coldwater Veneers |
$4,121.24
|
| Rate for Payer: Lutheran Preferred All Products |
$3,394.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$3,547.47
|
| Rate for Payer: PHP All Products |
$3,121.77
|
| Rate for Payer: Plain Church Group Ministry All Products |
$2,424.26
|
| Rate for Payer: Signature Care EPO |
$2,306.05
|
| Rate for Payer: Signature Care PPO |
$2,306.05
|
| Rate for Payer: Three Rivers Preferred All Products |
$3,152.00
|
| Rate for Payer: United Healthcare Commercial |
$2,328.48
|
| Rate for Payer: United Healthcare Medicare |
$2,364.98
|
|
|
PR ROUT OB CARE,VAG DELIV,PREV C-SEC
|
Professional
|
$4,431.32
|
|
|
Service Code
|
CPT 59610
|
| Hospital Charge Code |
Z12808
|
| Min. Negotiated Rate |
$2,021.25 |
| Max. Negotiated Rate |
$5,317.58 |
| Rate for Payer: Aetna Medicare |
$2,271.05
|
| Rate for Payer: Anthem Exchange |
$2,021.25
|
| Rate for Payer: Anthem Medicare |
$2,271.05
|
| Rate for Payer: Anthem PPO |
$2,021.25
|
| Rate for Payer: Anthem Traditional |
$2,021.25
|
| Rate for Payer: Caresource Just 4 Me |
$2,611.71
|
| Rate for Payer: Caresource Medicare |
$2,498.16
|
| Rate for Payer: Centivo/Paragon All Products |
$3,520.13
|
| Rate for Payer: Coventry/First Health All Products |
$5,317.58
|
| Rate for Payer: Frontpath All Products |
$3,242.23
|
| Rate for Payer: Humana ChoiceCare |
$4,431.32
|
| Rate for Payer: Humana Medicare |
$2,271.05
|
| Rate for Payer: Lucent/Coldwater Veneers |
$3,860.79
|
| Rate for Payer: Lutheran Preferred All Products |
$3,179.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$3,323.49
|
| Rate for Payer: PHP All Products |
$2,924.67
|
| Rate for Payer: Plain Church Group Ministry All Products |
$2,271.05
|
| Rate for Payer: Signature Care EPO |
$2,029.80
|
| Rate for Payer: Signature Care PPO |
$2,029.80
|
| Rate for Payer: Three Rivers Preferred All Products |
$2,952.00
|
| Rate for Payer: United Healthcare Commercial |
$2,069.74
|
| Rate for Payer: United Healthcare Medicare |
$2,215.66
|
|
|
PR RPSG PREV IMPLTED PM/DFB R ATR/R VENTR ELECTRODE
|
Professional
|
$549.92
|
|
|
Service Code
|
CPT 33215
|
| Hospital Charge Code |
Z12526
|
| Min. Negotiated Rate |
$274.96 |
| Max. Negotiated Rate |
$659.90 |
| Rate for Payer: Aetna Medicare |
$281.84
|
| Rate for Payer: Anthem Exchange |
$559.60
|
| Rate for Payer: Anthem Medicare |
$281.84
|
| Rate for Payer: Anthem PPO |
$559.60
|
| Rate for Payer: Anthem Traditional |
$559.60
|
| Rate for Payer: Caresource Just 4 Me |
$324.12
|
| Rate for Payer: Caresource Medicare |
$310.02
|
| Rate for Payer: Centivo/Paragon All Products |
$436.85
|
| Rate for Payer: Coventry/First Health All Products |
$659.90
|
| Rate for Payer: Frontpath All Products |
$405.03
|
| Rate for Payer: Humana ChoiceCare |
$549.92
|
| Rate for Payer: Humana Medicare |
$281.84
|
| Rate for Payer: Lucent/Coldwater Veneers |
$479.13
|
| Rate for Payer: Lutheran Preferred All Products |
$451.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$412.44
|
| Rate for Payer: PHP All Products |
$384.95
|
| Rate for Payer: Plain Church Group Ministry All Products |
$281.84
|
| Rate for Payer: Signature Care EPO |
$445.40
|
| Rate for Payer: Signature Care PPO |
$445.40
|
| Rate for Payer: Three Rivers Preferred All Products |
$423.00
|
| Rate for Payer: United Healthcare Commercial |
$371.16
|
| Rate for Payer: United Healthcare Medicare |
$274.96
|
|
|
PR RX ECTOP PREG BY LAPAROSCOPE
|
Professional
|
$1,405.86
|
|
|
Service Code
|
CPT 59150
|
| Hospital Charge Code |
Z12791
|
| Min. Negotiated Rate |
$702.93 |
| Max. Negotiated Rate |
$1,687.03 |
| Rate for Payer: Aetna Medicare |
$720.50
|
| Rate for Payer: Anthem Exchange |
$1,000.52
|
| Rate for Payer: Anthem Medicare |
$720.50
|
| Rate for Payer: Anthem PPO |
$1,000.52
|
| Rate for Payer: Anthem Traditional |
$1,000.52
|
| Rate for Payer: Caresource Just 4 Me |
$828.57
|
| Rate for Payer: Caresource Medicare |
$792.55
|
| Rate for Payer: Centivo/Paragon All Products |
$1,116.78
|
| Rate for Payer: Coventry/First Health All Products |
$1,687.03
|
| Rate for Payer: Frontpath All Products |
$1,030.99
|
| Rate for Payer: Humana ChoiceCare |
$1,405.86
|
| Rate for Payer: Humana Medicare |
$720.50
|
| Rate for Payer: Lucent/Coldwater Veneers |
$1,224.85
|
| Rate for Payer: Lutheran Preferred All Products |
$1,009.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$1,054.39
|
| Rate for Payer: PHP All Products |
$927.87
|
| Rate for Payer: Plain Church Group Ministry All Products |
$720.50
|
| Rate for Payer: Signature Care EPO |
$869.55
|
| Rate for Payer: Signature Care PPO |
$869.55
|
| Rate for Payer: Three Rivers Preferred All Products |
$937.00
|
| Rate for Payer: United Healthcare Commercial |
$855.01
|
| Rate for Payer: United Healthcare Medicare |
$702.93
|
|
|
PR RX ECTOP PREG BY SCOPE,RMV TUBE/OVRY
|
Professional
|
$1,375.78
|
|
|
Service Code
|
CPT 59151
|
| Hospital Charge Code |
Z12792
|
| Min. Negotiated Rate |
$687.89 |
| Max. Negotiated Rate |
$1,650.94 |
| Rate for Payer: Aetna Medicare |
$705.09
|
| Rate for Payer: Anthem Exchange |
$992.19
|
| Rate for Payer: Anthem Medicare |
$705.09
|
| Rate for Payer: Anthem PPO |
$992.19
|
| Rate for Payer: Anthem Traditional |
$992.19
|
| Rate for Payer: Caresource Just 4 Me |
$810.85
|
| Rate for Payer: Caresource Medicare |
$775.60
|
| Rate for Payer: Centivo/Paragon All Products |
$1,092.89
|
| Rate for Payer: Coventry/First Health All Products |
$1,650.94
|
| Rate for Payer: Frontpath All Products |
$1,008.63
|
| Rate for Payer: Humana ChoiceCare |
$1,375.78
|
| Rate for Payer: Humana Medicare |
$705.09
|
| Rate for Payer: Lucent/Coldwater Veneers |
$1,198.65
|
| Rate for Payer: Lutheran Preferred All Products |
$987.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$1,031.84
|
| Rate for Payer: PHP All Products |
$908.02
|
| Rate for Payer: Plain Church Group Ministry All Products |
$705.09
|
| Rate for Payer: Signature Care EPO |
$867.85
|
| Rate for Payer: Signature Care PPO |
$867.85
|
| Rate for Payer: Three Rivers Preferred All Products |
$917.00
|
| Rate for Payer: United Healthcare Commercial |
$835.63
|
| Rate for Payer: United Healthcare Medicare |
$687.89
|
|
|
PR RX ECTOP PREG,UTER WALL,PART HYSTREC
|
Professional
|
$1,594.04
|
|
|
Service Code
|
CPT 59136
|
| Hospital Charge Code |
Z12790
|
| Min. Negotiated Rate |
$797.02 |
| Max. Negotiated Rate |
$1,912.85 |
| Rate for Payer: Aetna Medicare |
$817.10
|
| Rate for Payer: Anthem Exchange |
$1,121.42
|
| Rate for Payer: Anthem Medicare |
$817.10
|
| Rate for Payer: Anthem PPO |
$1,121.42
|
| Rate for Payer: Anthem Traditional |
$1,121.42
|
| Rate for Payer: Caresource Just 4 Me |
$939.66
|
| Rate for Payer: Caresource Medicare |
$898.81
|
| Rate for Payer: Centivo/Paragon All Products |
$1,266.51
|
| Rate for Payer: Coventry/First Health All Products |
$1,912.85
|
| Rate for Payer: Frontpath All Products |
$1,171.64
|
| Rate for Payer: Humana ChoiceCare |
$1,594.04
|
| Rate for Payer: Humana Medicare |
$817.10
|
| Rate for Payer: Lucent/Coldwater Veneers |
$1,389.07
|
| Rate for Payer: Lutheran Preferred All Products |
$1,144.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$1,195.53
|
| Rate for Payer: PHP All Products |
$1,052.06
|
| Rate for Payer: Plain Church Group Ministry All Products |
$817.10
|
| Rate for Payer: Signature Care EPO |
$999.60
|
| Rate for Payer: Signature Care PPO |
$999.60
|
| Rate for Payer: Three Rivers Preferred All Products |
$1,062.00
|
| Rate for Payer: United Healthcare Commercial |
$976.01
|
| Rate for Payer: United Healthcare Medicare |
$797.02
|
|
|
PR SBSQ HOSPITAL IP/OBS CARE HIGH MDM 50 MINUTES
|
Professional
|
$220.96
|
|
|
Service Code
|
CPT 99233
|
| Hospital Charge Code |
Z13170
|
| Min. Negotiated Rate |
$85.80 |
| Max. Negotiated Rate |
$265.15 |
| Rate for Payer: Aetna Medicare |
$113.25
|
| Rate for Payer: Anthem Exchange |
$105.51
|
| Rate for Payer: Anthem Medicare |
$113.25
|
| Rate for Payer: Anthem PPO |
$105.51
|
| Rate for Payer: Anthem Traditional |
$105.51
|
| Rate for Payer: Caresource Just 4 Me |
$130.24
|
| Rate for Payer: Caresource Medicare |
$124.58
|
| Rate for Payer: Centivo/Paragon All Products |
$175.54
|
| Rate for Payer: Coventry/First Health All Products |
$265.15
|
| Rate for Payer: Frontpath All Products |
$104.44
|
| Rate for Payer: Humana ChoiceCare |
$220.96
|
| Rate for Payer: Humana Medicare |
$113.25
|
| Rate for Payer: Lucent/Coldwater Veneers |
$192.53
|
| Rate for Payer: Lutheran Preferred All Products |
$119.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$165.72
|
| Rate for Payer: PHP All Products |
$113.80
|
| Rate for Payer: Plain Church Group Ministry All Products |
$113.25
|
| Rate for Payer: Signature Care EPO |
$85.80
|
| Rate for Payer: Signature Care PPO |
$85.80
|
| Rate for Payer: Three Rivers Preferred All Products |
$117.00
|
| Rate for Payer: United Healthcare Commercial |
$97.61
|
| Rate for Payer: United Healthcare Medicare |
$110.48
|
|
|
PR SBSQ HOSPITAL IP/OBS CARE MOD MDM 35 MINUTES
|
Professional
|
$146.86
|
|
|
Service Code
|
CPT 99232
|
| Hospital Charge Code |
Z13169
|
| Min. Negotiated Rate |
$59.61 |
| Max. Negotiated Rate |
$176.23 |
| Rate for Payer: Aetna Medicare |
$75.26
|
| Rate for Payer: Anthem Exchange |
$73.21
|
| Rate for Payer: Anthem Medicare |
$75.26
|
| Rate for Payer: Anthem PPO |
$73.21
|
| Rate for Payer: Anthem Traditional |
$73.21
|
| Rate for Payer: Caresource Just 4 Me |
$86.55
|
| Rate for Payer: Caresource Medicare |
$82.79
|
| Rate for Payer: Centivo/Paragon All Products |
$116.65
|
| Rate for Payer: Coventry/First Health All Products |
$176.23
|
| Rate for Payer: Frontpath All Products |
$72.70
|
| Rate for Payer: Humana ChoiceCare |
$146.86
|
| Rate for Payer: Humana Medicare |
$75.26
|
| Rate for Payer: Lucent/Coldwater Veneers |
$127.94
|
| Rate for Payer: Lutheran Preferred All Products |
$79.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$110.15
|
| Rate for Payer: PHP All Products |
$75.63
|
| Rate for Payer: Plain Church Group Ministry All Products |
$75.26
|
| Rate for Payer: Signature Care EPO |
$59.61
|
| Rate for Payer: Signature Care PPO |
$59.61
|
| Rate for Payer: Three Rivers Preferred All Products |
$78.00
|
| Rate for Payer: United Healthcare Commercial |
$68.15
|
| Rate for Payer: United Healthcare Medicare |
$73.43
|
|
|
PR SBSQ HOSPITAL IP/OBS CARE SF/LOW MDM 25 MINUTES
|
Professional
|
$91.54
|
|
|
Service Code
|
CPT 99231
|
| Hospital Charge Code |
Z13168
|
| Min. Negotiated Rate |
$35.70 |
| Max. Negotiated Rate |
$109.85 |
| Rate for Payer: Aetna Medicare |
$46.92
|
| Rate for Payer: Anthem Exchange |
$41.16
|
| Rate for Payer: Anthem Medicare |
$46.92
|
| Rate for Payer: Anthem PPO |
$41.16
|
| Rate for Payer: Anthem Traditional |
$41.16
|
| Rate for Payer: Caresource Just 4 Me |
$53.96
|
| Rate for Payer: Caresource Medicare |
$51.61
|
| Rate for Payer: Centivo/Paragon All Products |
$72.73
|
| Rate for Payer: Coventry/First Health All Products |
$109.85
|
| Rate for Payer: Frontpath All Products |
$39.63
|
| Rate for Payer: Humana ChoiceCare |
$91.54
|
| Rate for Payer: Humana Medicare |
$46.92
|
| Rate for Payer: Lucent/Coldwater Veneers |
$79.76
|
| Rate for Payer: Lutheran Preferred All Products |
$49.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$68.66
|
| Rate for Payer: PHP All Products |
$47.15
|
| Rate for Payer: Plain Church Group Ministry All Products |
$46.92
|
| Rate for Payer: Signature Care EPO |
$35.70
|
| Rate for Payer: Signature Care PPO |
$35.70
|
| Rate for Payer: Three Rivers Preferred All Products |
$48.00
|
| Rate for Payer: United Healthcare Commercial |
$37.80
|
| Rate for Payer: United Healthcare Medicare |
$45.77
|
|
