|
PR SBSQ NURSING FACILITY CARE HIGH MDM 45 MINUTES
|
Professional
|
$283.88
|
|
|
Service Code
|
CPT 99310
|
| Hospital Charge Code |
Z13197
|
| Min. Negotiated Rate |
$99.95 |
| Max. Negotiated Rate |
$340.66 |
| Rate for Payer: Aetna Medicare |
$145.48
|
| Rate for Payer: Anthem Exchange |
$99.95
|
| Rate for Payer: Anthem Medicare |
$145.48
|
| Rate for Payer: Anthem PPO |
$99.95
|
| Rate for Payer: Anthem Traditional |
$99.95
|
| Rate for Payer: Caresource Just 4 Me |
$167.30
|
| Rate for Payer: Caresource Medicare |
$160.03
|
| Rate for Payer: Centivo/Paragon All Products |
$225.49
|
| Rate for Payer: Coventry/First Health All Products |
$340.66
|
| Rate for Payer: Frontpath All Products |
$135.11
|
| Rate for Payer: Humana ChoiceCare |
$283.88
|
| Rate for Payer: Humana Medicare |
$145.48
|
| Rate for Payer: Lucent/Coldwater Veneers |
$247.32
|
| Rate for Payer: Lutheran Preferred All Products |
$153.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$212.91
|
| Rate for Payer: PHP All Products |
$146.19
|
| Rate for Payer: Plain Church Group Ministry All Products |
$145.48
|
| Rate for Payer: Signature Care EPO |
$110.90
|
| Rate for Payer: Signature Care PPO |
$110.90
|
| Rate for Payer: Three Rivers Preferred All Products |
$150.00
|
| Rate for Payer: United Healthcare Commercial |
$120.71
|
| Rate for Payer: United Healthcare Medicare |
$141.94
|
|
|
PR SBSQ NURSING FACILITY CARE LOW MDM 15 MINUTES
|
Professional
|
$137.28
|
|
|
Service Code
|
CPT 99308
|
| Hospital Charge Code |
Z13195
|
| Min. Negotiated Rate |
$56.25 |
| Max. Negotiated Rate |
$164.74 |
| Rate for Payer: Aetna Medicare |
$70.36
|
| Rate for Payer: Anthem Exchange |
$56.71
|
| Rate for Payer: Anthem Medicare |
$70.36
|
| Rate for Payer: Anthem PPO |
$56.71
|
| Rate for Payer: Anthem Traditional |
$56.71
|
| Rate for Payer: Caresource Just 4 Me |
$80.91
|
| Rate for Payer: Caresource Medicare |
$77.40
|
| Rate for Payer: Centivo/Paragon All Products |
$109.06
|
| Rate for Payer: Coventry/First Health All Products |
$164.74
|
| Rate for Payer: Frontpath All Products |
$69.61
|
| Rate for Payer: Humana ChoiceCare |
$137.28
|
| Rate for Payer: Humana Medicare |
$70.36
|
| Rate for Payer: Lucent/Coldwater Veneers |
$119.61
|
| Rate for Payer: Lutheran Preferred All Products |
$74.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$102.96
|
| Rate for Payer: PHP All Products |
$70.70
|
| Rate for Payer: Plain Church Group Ministry All Products |
$70.36
|
| Rate for Payer: Signature Care EPO |
$56.25
|
| Rate for Payer: Signature Care PPO |
$56.25
|
| Rate for Payer: Three Rivers Preferred All Products |
$72.00
|
| Rate for Payer: United Healthcare Commercial |
$61.52
|
| Rate for Payer: United Healthcare Medicare |
$68.64
|
|
|
PR SBSQ NURSING FACILITY CARE MOD MDM 30 MINUTES
|
Professional
|
$197.58
|
|
|
Service Code
|
CPT 99309
|
| Hospital Charge Code |
Z13196
|
| Min. Negotiated Rate |
$74.80 |
| Max. Negotiated Rate |
$237.10 |
| Rate for Payer: Aetna Medicare |
$101.26
|
| Rate for Payer: Anthem Exchange |
$79.90
|
| Rate for Payer: Anthem Medicare |
$101.26
|
| Rate for Payer: Anthem PPO |
$79.90
|
| Rate for Payer: Anthem Traditional |
$79.90
|
| Rate for Payer: Caresource Just 4 Me |
$116.45
|
| Rate for Payer: Caresource Medicare |
$111.39
|
| Rate for Payer: Centivo/Paragon All Products |
$156.95
|
| Rate for Payer: Coventry/First Health All Products |
$237.10
|
| Rate for Payer: Frontpath All Products |
$91.59
|
| Rate for Payer: Humana ChoiceCare |
$197.58
|
| Rate for Payer: Humana Medicare |
$101.26
|
| Rate for Payer: Lucent/Coldwater Veneers |
$172.14
|
| Rate for Payer: Lutheran Preferred All Products |
$106.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$148.19
|
| Rate for Payer: PHP All Products |
$101.76
|
| Rate for Payer: Plain Church Group Ministry All Products |
$101.26
|
| Rate for Payer: Signature Care EPO |
$74.80
|
| Rate for Payer: Signature Care PPO |
$74.80
|
| Rate for Payer: Three Rivers Preferred All Products |
$104.00
|
| Rate for Payer: United Healthcare Commercial |
$81.62
|
| Rate for Payer: United Healthcare Medicare |
$98.79
|
|
|
PR SBSQ NURSING FACILITY CARE SF MDM 10 MINUTES
|
Professional
|
$73.44
|
|
|
Service Code
|
CPT 99307
|
| Hospital Charge Code |
Z13194
|
| Min. Negotiated Rate |
$34.13 |
| Max. Negotiated Rate |
$88.13 |
| Rate for Payer: Aetna Medicare |
$37.64
|
| Rate for Payer: Anthem Exchange |
$34.13
|
| Rate for Payer: Anthem Medicare |
$37.64
|
| Rate for Payer: Anthem PPO |
$34.13
|
| Rate for Payer: Anthem Traditional |
$34.13
|
| Rate for Payer: Caresource Just 4 Me |
$43.29
|
| Rate for Payer: Caresource Medicare |
$41.40
|
| Rate for Payer: Centivo/Paragon All Products |
$58.34
|
| Rate for Payer: Coventry/First Health All Products |
$88.13
|
| Rate for Payer: Frontpath All Products |
$44.11
|
| Rate for Payer: Humana ChoiceCare |
$73.44
|
| Rate for Payer: Humana Medicare |
$37.64
|
| Rate for Payer: Lucent/Coldwater Veneers |
$63.99
|
| Rate for Payer: Lutheran Preferred All Products |
$40.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$55.08
|
| Rate for Payer: PHP All Products |
$37.82
|
| Rate for Payer: Plain Church Group Ministry All Products |
$37.64
|
| Rate for Payer: Signature Care EPO |
$36.44
|
| Rate for Payer: Signature Care PPO |
$36.44
|
| Rate for Payer: Three Rivers Preferred All Products |
$39.00
|
| Rate for Payer: United Healthcare Commercial |
$40.24
|
| Rate for Payer: United Healthcare Medicare |
$36.72
|
|
|
PR SECD CLOS SURG WND EXTEN/COMPLIC
|
Professional
|
$1,442.38
|
|
|
Service Code
|
CPT 13160
|
| Hospital Charge Code |
Z12065
|
| Min. Negotiated Rate |
$721.19 |
| Max. Negotiated Rate |
$1,730.86 |
| Rate for Payer: Aetna Medicare |
$739.22
|
| Rate for Payer: Anthem Exchange |
$772.90
|
| Rate for Payer: Anthem Medicare |
$739.22
|
| Rate for Payer: Anthem PPO |
$772.90
|
| Rate for Payer: Anthem Traditional |
$772.90
|
| Rate for Payer: Caresource Just 4 Me |
$850.10
|
| Rate for Payer: Caresource Medicare |
$813.14
|
| Rate for Payer: Centivo/Paragon All Products |
$1,145.79
|
| Rate for Payer: Coventry/First Health All Products |
$1,730.86
|
| Rate for Payer: Frontpath All Products |
$1,031.85
|
| Rate for Payer: Humana ChoiceCare |
$1,442.38
|
| Rate for Payer: Humana Medicare |
$739.22
|
| Rate for Payer: Lucent/Coldwater Veneers |
$1,256.67
|
| Rate for Payer: Lutheran Preferred All Products |
$961.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$1,081.79
|
| Rate for Payer: PHP All Products |
$1,009.66
|
| Rate for Payer: Plain Church Group Ministry All Products |
$739.22
|
| Rate for Payer: Signature Care EPO |
$742.05
|
| Rate for Payer: Signature Care PPO |
$742.05
|
| Rate for Payer: Three Rivers Preferred All Products |
$887.00
|
| Rate for Payer: United Healthcare Commercial |
$872.94
|
| Rate for Payer: United Healthcare Medicare |
$721.19
|
|
|
PR SENSORINEURAL ACUITY TEST
|
Professional
|
$133.76
|
|
|
Service Code
|
CPT 92575
|
| Hospital Charge Code |
Z13054
|
| Min. Negotiated Rate |
$11.80 |
| Max. Negotiated Rate |
$160.51 |
| Rate for Payer: Aetna Medicare |
$68.55
|
| Rate for Payer: Anthem Exchange |
$11.80
|
| Rate for Payer: Anthem Medicare |
$68.55
|
| Rate for Payer: Anthem PPO |
$11.80
|
| Rate for Payer: Anthem Traditional |
$11.80
|
| Rate for Payer: Caresource Just 4 Me |
$78.83
|
| Rate for Payer: Caresource Medicare |
$75.41
|
| Rate for Payer: Centivo/Paragon All Products |
$106.25
|
| Rate for Payer: Coventry/First Health All Products |
$160.51
|
| Rate for Payer: Frontpath All Products |
$72.22
|
| Rate for Payer: Humana ChoiceCare |
$133.76
|
| Rate for Payer: Humana Medicare |
$68.55
|
| Rate for Payer: Lucent/Coldwater Veneers |
$116.53
|
| Rate for Payer: Lutheran Preferred All Products |
$89.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$100.32
|
| Rate for Payer: PHP All Products |
$96.97
|
| Rate for Payer: Plain Church Group Ministry All Products |
$68.55
|
| Rate for Payer: Signature Care EPO |
$55.89
|
| Rate for Payer: Signature Care PPO |
$55.89
|
| Rate for Payer: Three Rivers Preferred All Products |
$82.00
|
| Rate for Payer: United Healthcare Commercial |
$39.03
|
| Rate for Payer: United Healthcare Medicare |
$66.88
|
|
|
PR SHAV SKIN LES <0.5 CM FACE,FACIAL
|
Professional
|
$213.26
|
|
|
Service Code
|
CPT 11310
|
| Hospital Charge Code |
Z11984
|
| Min. Negotiated Rate |
$42.92 |
| Max. Negotiated Rate |
$255.91 |
| Rate for Payer: Aetna Medicare |
$42.92
|
| Rate for Payer: Anthem Medicare |
$42.92
|
| Rate for Payer: Caresource Just 4 Me |
$49.36
|
| Rate for Payer: Caresource Medicare |
$47.21
|
| Rate for Payer: Centivo/Paragon All Products |
$66.53
|
| Rate for Payer: Coventry/First Health All Products |
$255.91
|
| Rate for Payer: Frontpath All Products |
$58.49
|
| Rate for Payer: Humana ChoiceCare |
$213.26
|
| Rate for Payer: Humana Medicare |
$42.92
|
| Rate for Payer: Lucent/Coldwater Veneers |
$72.96
|
| Rate for Payer: PHCS/Multiplan All Products |
$159.94
|
| Rate for Payer: PHP All Products |
$58.62
|
| Rate for Payer: Plain Church Group Ministry All Products |
$42.92
|
| Rate for Payer: Signature Care EPO |
$93.59
|
| Rate for Payer: Signature Care PPO |
$93.59
|
| Rate for Payer: United Healthcare Commercial |
$47.65
|
| Rate for Payer: United Healthcare Medicare |
$106.63
|
|
|
PR SHAV SKIN LES <0.5 CM REMAINDER BODY
|
Professional
|
$194.24
|
|
|
Service Code
|
CPT 11305
|
| Hospital Charge Code |
Z11982
|
| Min. Negotiated Rate |
$35.65 |
| Max. Negotiated Rate |
$233.09 |
| Rate for Payer: Aetna Medicare |
$35.65
|
| Rate for Payer: Anthem Medicare |
$35.65
|
| Rate for Payer: Caresource Just 4 Me |
$41.00
|
| Rate for Payer: Caresource Medicare |
$39.22
|
| Rate for Payer: Centivo/Paragon All Products |
$55.26
|
| Rate for Payer: Coventry/First Health All Products |
$233.09
|
| Rate for Payer: Frontpath All Products |
$49.79
|
| Rate for Payer: Humana ChoiceCare |
$194.24
|
| Rate for Payer: Humana Medicare |
$35.65
|
| Rate for Payer: Lucent/Coldwater Veneers |
$60.60
|
| Rate for Payer: PHCS/Multiplan All Products |
$145.68
|
| Rate for Payer: PHP All Products |
$48.69
|
| Rate for Payer: Plain Church Group Ministry All Products |
$35.65
|
| Rate for Payer: Signature Care EPO |
$86.31
|
| Rate for Payer: Signature Care PPO |
$86.31
|
| Rate for Payer: United Healthcare Commercial |
$41.61
|
| Rate for Payer: United Healthcare Medicare |
$97.12
|
|
|
PR SHAV SKIN LES < 0.5 CM TRUNK,ARM,LEG
|
Professional
|
$185.24
|
|
|
Service Code
|
CPT 11300
|
| Hospital Charge Code |
Z11979
|
| Min. Negotiated Rate |
$31.96 |
| Max. Negotiated Rate |
$222.29 |
| Rate for Payer: Anthem Medicare |
$31.96
|
| Rate for Payer: Caresource Just 4 Me |
$36.75
|
| Rate for Payer: Caresource Medicare |
$35.16
|
| Rate for Payer: Aetna Medicare |
$31.96
|
| Rate for Payer: Centivo/Paragon All Products |
$49.54
|
| Rate for Payer: Coventry/First Health All Products |
$222.29
|
| Rate for Payer: Frontpath All Products |
$43.99
|
| Rate for Payer: Humana ChoiceCare |
$185.24
|
| Rate for Payer: Humana Medicare |
$31.96
|
| Rate for Payer: Lucent/Coldwater Veneers |
$54.33
|
| Rate for Payer: PHCS/Multiplan All Products |
$138.93
|
| Rate for Payer: PHP All Products |
$43.65
|
| Rate for Payer: Plain Church Group Ministry All Products |
$31.96
|
| Rate for Payer: Signature Care EPO |
$81.88
|
| Rate for Payer: Signature Care PPO |
$81.88
|
| Rate for Payer: United Healthcare Commercial |
$32.91
|
| Rate for Payer: United Healthcare Medicare |
$92.62
|
|
|
PR SHAV SKIN LES 0.6-1.0 CM TRUNK,ARM,LEG
|
Professional
|
$223.48
|
|
|
Service Code
|
CPT 11301
|
| Hospital Charge Code |
Z11980
|
| Min. Negotiated Rate |
$48.16 |
| Max. Negotiated Rate |
$268.18 |
| Rate for Payer: Aetna Medicare |
$48.16
|
| Rate for Payer: Anthem Exchange |
$92.12
|
| Rate for Payer: Anthem Medicare |
$48.16
|
| Rate for Payer: Anthem PPO |
$92.12
|
| Rate for Payer: Anthem Traditional |
$92.12
|
| Rate for Payer: Caresource Just 4 Me |
$55.38
|
| Rate for Payer: Caresource Medicare |
$52.98
|
| Rate for Payer: Centivo/Paragon All Products |
$74.65
|
| Rate for Payer: Coventry/First Health All Products |
$268.18
|
| Rate for Payer: Frontpath All Products |
$65.46
|
| Rate for Payer: Humana ChoiceCare |
$223.48
|
| Rate for Payer: Humana Medicare |
$48.16
|
| Rate for Payer: Lucent/Coldwater Veneers |
$81.87
|
| Rate for Payer: Lutheran Preferred All Products |
$63.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$167.61
|
| Rate for Payer: PHP All Products |
$65.78
|
| Rate for Payer: Plain Church Group Ministry All Products |
$48.16
|
| Rate for Payer: Signature Care EPO |
$98.39
|
| Rate for Payer: Signature Care PPO |
$98.39
|
| Rate for Payer: Three Rivers Preferred All Products |
$58.00
|
| Rate for Payer: United Healthcare Commercial |
$55.95
|
| Rate for Payer: United Healthcare Medicare |
$111.74
|
|
|
PR SHAV SKIN LES 1.1-2.0 CM REMAINDER BODY
|
Professional
|
$256.00
|
|
|
Service Code
|
CPT 11307
|
| Hospital Charge Code |
Z11983
|
| Min. Negotiated Rate |
$59.27 |
| Max. Negotiated Rate |
$307.20 |
| Rate for Payer: Aetna Medicare |
$59.27
|
| Rate for Payer: Anthem Medicare |
$59.27
|
| Rate for Payer: Caresource Just 4 Me |
$68.16
|
| Rate for Payer: Caresource Medicare |
$65.20
|
| Rate for Payer: Centivo/Paragon All Products |
$91.87
|
| Rate for Payer: Coventry/First Health All Products |
$307.20
|
| Rate for Payer: Frontpath All Products |
$81.17
|
| Rate for Payer: Humana ChoiceCare |
$256.00
|
| Rate for Payer: Humana Medicare |
$59.27
|
| Rate for Payer: Lucent/Coldwater Veneers |
$100.76
|
| Rate for Payer: PHCS/Multiplan All Products |
$192.00
|
| Rate for Payer: Plain Church Group Ministry All Products |
$59.27
|
| Rate for Payer: United Healthcare Commercial |
$74.39
|
| Rate for Payer: United Healthcare Medicare |
$128.00
|
|
|
PR SHAV SKIN LES 1.1-2.0 CM TRUNK,ARM,LEG
|
Professional
|
$251.78
|
|
|
Service Code
|
CPT 11302
|
| Hospital Charge Code |
Z11981
|
| Min. Negotiated Rate |
$56.18 |
| Max. Negotiated Rate |
$302.14 |
| Rate for Payer: Aetna Medicare |
$56.18
|
| Rate for Payer: Anthem Medicare |
$56.18
|
| Rate for Payer: Caresource Just 4 Me |
$64.61
|
| Rate for Payer: Caresource Medicare |
$61.80
|
| Rate for Payer: Centivo/Paragon All Products |
$87.08
|
| Rate for Payer: Coventry/First Health All Products |
$302.14
|
| Rate for Payer: Frontpath All Products |
$76.88
|
| Rate for Payer: Humana ChoiceCare |
$251.78
|
| Rate for Payer: Humana Medicare |
$56.18
|
| Rate for Payer: Lucent/Coldwater Veneers |
$95.51
|
| Rate for Payer: PHCS/Multiplan All Products |
$188.84
|
| Rate for Payer: PHP All Products |
$76.74
|
| Rate for Payer: Plain Church Group Ministry All Products |
$56.18
|
| Rate for Payer: Signature Care EPO |
$111.28
|
| Rate for Payer: Signature Care PPO |
$111.28
|
| Rate for Payer: United Healthcare Commercial |
$69.38
|
| Rate for Payer: United Healthcare Medicare |
$125.89
|
|
|
PR SHLDR ARTHROSCOP,PART ACROMIOPLAS
|
Professional
|
$308.74
|
|
|
Service Code
|
CPT 29826
|
| Hospital Charge Code |
Z12474
|
| Min. Negotiated Rate |
$154.37 |
| Max. Negotiated Rate |
$940.30 |
| Rate for Payer: Aetna Medicare |
$158.23
|
| Rate for Payer: Anthem Exchange |
$940.30
|
| Rate for Payer: Anthem Medicare |
$158.23
|
| Rate for Payer: Anthem PPO |
$940.30
|
| Rate for Payer: Anthem Traditional |
$940.30
|
| Rate for Payer: Caresource Just 4 Me |
$181.96
|
| Rate for Payer: Caresource Medicare |
$174.05
|
| Rate for Payer: Centivo/Paragon All Products |
$245.26
|
| Rate for Payer: Coventry/First Health All Products |
$370.49
|
| Rate for Payer: Frontpath All Products |
$226.11
|
| Rate for Payer: Humana ChoiceCare |
$308.74
|
| Rate for Payer: Humana Medicare |
$158.23
|
| Rate for Payer: Lucent/Coldwater Veneers |
$268.99
|
| Rate for Payer: Lutheran Preferred All Products |
$253.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$231.56
|
| Rate for Payer: PHP All Products |
$268.61
|
| Rate for Payer: Plain Church Group Ministry All Products |
$158.23
|
| Rate for Payer: Signature Care EPO |
$272.32
|
| Rate for Payer: Signature Care PPO |
$272.32
|
| Rate for Payer: Three Rivers Preferred All Products |
$237.00
|
| Rate for Payer: United Healthcare Commercial |
$725.91
|
| Rate for Payer: United Healthcare Medicare |
$154.37
|
|
|
PR SHLDR ARTHROSCOP,SURG,CAPSULORRHAPHY
|
Professional
|
$1,915.64
|
|
|
Service Code
|
CPT 29806
|
| Hospital Charge Code |
Z12469
|
| Min. Negotiated Rate |
$957.82 |
| Max. Negotiated Rate |
$2,298.77 |
| Rate for Payer: Aetna Medicare |
$981.77
|
| Rate for Payer: Anthem Exchange |
$1,299.60
|
| Rate for Payer: Anthem Medicare |
$981.77
|
| Rate for Payer: Anthem PPO |
$1,299.60
|
| Rate for Payer: Anthem Traditional |
$1,299.60
|
| Rate for Payer: Caresource Just 4 Me |
$1,129.04
|
| Rate for Payer: Caresource Medicare |
$1,079.95
|
| Rate for Payer: Centivo/Paragon All Products |
$1,521.74
|
| Rate for Payer: Coventry/First Health All Products |
$2,298.77
|
| Rate for Payer: Frontpath All Products |
$1,375.22
|
| Rate for Payer: Humana ChoiceCare |
$1,915.64
|
| Rate for Payer: Humana Medicare |
$981.77
|
| Rate for Payer: Lucent/Coldwater Veneers |
$1,669.01
|
| Rate for Payer: Lutheran Preferred All Products |
$1,571.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$1,436.73
|
| Rate for Payer: PHP All Products |
$1,666.61
|
| Rate for Payer: Plain Church Group Ministry All Products |
$981.77
|
| Rate for Payer: Signature Care EPO |
$1,483.25
|
| Rate for Payer: Signature Care PPO |
$1,483.25
|
| Rate for Payer: Three Rivers Preferred All Products |
$1,473.00
|
| Rate for Payer: United Healthcare Commercial |
$1,159.10
|
| Rate for Payer: United Healthcare Medicare |
$957.82
|
|
|
PR SHLDR ARTHROSCOP,SURG,DIS CLAVICULECTOMY
|
Professional
|
$1,232.72
|
|
|
Service Code
|
CPT 29824
|
| Hospital Charge Code |
Z12473
|
| Min. Negotiated Rate |
$616.36 |
| Max. Negotiated Rate |
$1,479.26 |
| Rate for Payer: Aetna Medicare |
$631.77
|
| Rate for Payer: Anthem Exchange |
$792.10
|
| Rate for Payer: Anthem Medicare |
$631.77
|
| Rate for Payer: Anthem PPO |
$792.10
|
| Rate for Payer: Anthem Traditional |
$792.10
|
| Rate for Payer: Caresource Just 4 Me |
$726.54
|
| Rate for Payer: Caresource Medicare |
$694.95
|
| Rate for Payer: Centivo/Paragon All Products |
$979.24
|
| Rate for Payer: Coventry/First Health All Products |
$1,479.26
|
| Rate for Payer: Frontpath All Products |
$877.28
|
| Rate for Payer: Humana ChoiceCare |
$1,232.72
|
| Rate for Payer: Humana Medicare |
$631.77
|
| Rate for Payer: Lucent/Coldwater Veneers |
$1,074.01
|
| Rate for Payer: Lutheran Preferred All Products |
$1,011.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$924.54
|
| Rate for Payer: PHP All Products |
$1,072.46
|
| Rate for Payer: Plain Church Group Ministry All Products |
$631.77
|
| Rate for Payer: Signature Care EPO |
$907.80
|
| Rate for Payer: Signature Care PPO |
$907.80
|
| Rate for Payer: Three Rivers Preferred All Products |
$948.00
|
| Rate for Payer: United Healthcare Commercial |
$722.38
|
| Rate for Payer: United Healthcare Medicare |
$616.36
|
|
|
PR SHLDR ARTHROSCOP,SURG,REPAIR,SLAP LESION
|
Professional
|
$1,873.60
|
|
|
Service Code
|
CPT 29807
|
| Hospital Charge Code |
Z12470
|
| Min. Negotiated Rate |
$936.80 |
| Max. Negotiated Rate |
$2,248.32 |
| Rate for Payer: Aetna Medicare |
$960.54
|
| Rate for Payer: Anthem Exchange |
$1,264.90
|
| Rate for Payer: Anthem Medicare |
$960.54
|
| Rate for Payer: Anthem PPO |
$1,264.90
|
| Rate for Payer: Anthem Traditional |
$1,264.90
|
| Rate for Payer: Caresource Just 4 Me |
$1,104.62
|
| Rate for Payer: Caresource Medicare |
$1,056.59
|
| Rate for Payer: Centivo/Paragon All Products |
$1,488.84
|
| Rate for Payer: Coventry/First Health All Products |
$2,248.32
|
| Rate for Payer: Frontpath All Products |
$1,340.94
|
| Rate for Payer: Humana ChoiceCare |
$1,873.60
|
| Rate for Payer: Humana Medicare |
$960.54
|
| Rate for Payer: Lucent/Coldwater Veneers |
$1,632.92
|
| Rate for Payer: Lutheran Preferred All Products |
$1,537.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$1,405.20
|
| Rate for Payer: PHP All Products |
$1,630.03
|
| Rate for Payer: Plain Church Group Ministry All Products |
$960.54
|
| Rate for Payer: Signature Care EPO |
$1,445.85
|
| Rate for Payer: Signature Care PPO |
$1,445.85
|
| Rate for Payer: Three Rivers Preferred All Products |
$1,441.00
|
| Rate for Payer: United Healthcare Commercial |
$1,128.71
|
| Rate for Payer: United Healthcare Medicare |
$936.80
|
|
|
PR SHLDR ARTHROSCOP,SURG,W/ROTAT CUFF REPR
|
Professional
|
$1,935.56
|
|
|
Service Code
|
CPT 29827
|
| Hospital Charge Code |
Z12475
|
| Min. Negotiated Rate |
$967.78 |
| Max. Negotiated Rate |
$2,322.67 |
| Rate for Payer: Aetna Medicare |
$991.97
|
| Rate for Payer: Anthem Exchange |
$1,294.10
|
| Rate for Payer: Anthem Medicare |
$991.97
|
| Rate for Payer: Anthem PPO |
$1,294.10
|
| Rate for Payer: Anthem Traditional |
$1,294.10
|
| Rate for Payer: Caresource Just 4 Me |
$1,140.77
|
| Rate for Payer: Caresource Medicare |
$1,091.17
|
| Rate for Payer: Centivo/Paragon All Products |
$1,537.55
|
| Rate for Payer: Coventry/First Health All Products |
$2,322.67
|
| Rate for Payer: Frontpath All Products |
$1,388.40
|
| Rate for Payer: Humana ChoiceCare |
$1,935.56
|
| Rate for Payer: Humana Medicare |
$991.97
|
| Rate for Payer: Lucent/Coldwater Veneers |
$1,686.35
|
| Rate for Payer: Lutheran Preferred All Products |
$1,587.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$1,451.67
|
| Rate for Payer: PHP All Products |
$1,683.93
|
| Rate for Payer: Plain Church Group Ministry All Products |
$991.97
|
| Rate for Payer: Signature Care EPO |
$1,557.20
|
| Rate for Payer: Signature Care PPO |
$1,557.20
|
| Rate for Payer: Three Rivers Preferred All Products |
$1,488.00
|
| Rate for Payer: United Healthcare Commercial |
$1,188.68
|
| Rate for Payer: United Healthcare Medicare |
$967.78
|
|
|
PR SHORT ARM CAST, ADULT
|
Professional
|
$36.92
|
|
|
Service Code
|
CPT Q4050
|
| Hospital Charge Code |
Z13291
|
| Min. Negotiated Rate |
$25.11 |
| Max. Negotiated Rate |
$44.30 |
| Rate for Payer: Coventry/First Health All Products |
$44.30
|
| Rate for Payer: Humana ChoiceCare |
$36.92
|
| Rate for Payer: PHCS/Multiplan All Products |
$27.69
|
| Rate for Payer: Signature Care EPO |
$25.11
|
| Rate for Payer: Signature Care PPO |
$25.11
|
|
|
PR SHORT ARM CAST, PEDIATRIC
|
Professional
|
$18.36
|
|
|
Service Code
|
CPT Q4050
|
| Hospital Charge Code |
Z13292
|
| Min. Negotiated Rate |
$12.48 |
| Max. Negotiated Rate |
$22.03 |
| Rate for Payer: Coventry/First Health All Products |
$22.03
|
| Rate for Payer: Humana ChoiceCare |
$18.36
|
| Rate for Payer: PHCS/Multiplan All Products |
$13.77
|
| Rate for Payer: Signature Care EPO |
$12.48
|
| Rate for Payer: Signature Care PPO |
$12.48
|
|
|
PR SHORT LEG CAST, ADULT
|
Professional
|
$40.92
|
|
|
Service Code
|
CPT Q4050
|
| Hospital Charge Code |
Z13295
|
| Min. Negotiated Rate |
$27.83 |
| Max. Negotiated Rate |
$49.10 |
| Rate for Payer: Coventry/First Health All Products |
$49.10
|
| Rate for Payer: Humana ChoiceCare |
$40.92
|
| Rate for Payer: PHCS/Multiplan All Products |
$30.69
|
| Rate for Payer: Signature Care EPO |
$27.83
|
| Rate for Payer: Signature Care PPO |
$27.83
|
|
|
PR SHORT LEG CAST, PEDIATRIC
|
Professional
|
$36.92
|
|
|
Service Code
|
CPT Q4050
|
| Hospital Charge Code |
Z13296
|
| Min. Negotiated Rate |
$25.11 |
| Max. Negotiated Rate |
$44.30 |
| Rate for Payer: Coventry/First Health All Products |
$44.30
|
| Rate for Payer: Humana ChoiceCare |
$36.92
|
| Rate for Payer: PHCS/Multiplan All Products |
$27.69
|
| Rate for Payer: Signature Care EPO |
$25.11
|
| Rate for Payer: Signature Care PPO |
$25.11
|
|
|
PR SIGMOIDOSCOPY,BIOPSY
|
Professional
|
$522.52
|
|
|
Service Code
|
CPT 45331
|
| Hospital Charge Code |
Z12628
|
| Min. Negotiated Rate |
$66.82 |
| Max. Negotiated Rate |
$627.02 |
| Rate for Payer: Humana Medicare |
$66.82
|
| Rate for Payer: Aetna Medicare |
$66.82
|
| Rate for Payer: Anthem Exchange |
$151.50
|
| Rate for Payer: Anthem Medicare |
$66.82
|
| Rate for Payer: Anthem PPO |
$151.50
|
| Rate for Payer: Anthem Traditional |
$151.50
|
| Rate for Payer: Caresource Just 4 Me |
$76.84
|
| Rate for Payer: Caresource Medicare |
$73.50
|
| Rate for Payer: Centivo/Paragon All Products |
$103.57
|
| Rate for Payer: Coventry/First Health All Products |
$627.02
|
| Rate for Payer: Frontpath All Products |
$91.29
|
| Rate for Payer: Humana ChoiceCare |
$522.52
|
| Rate for Payer: Lucent/Coldwater Veneers |
$113.59
|
| Rate for Payer: Lutheran Preferred All Products |
$100.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$391.89
|
| Rate for Payer: PHP All Products |
$114.08
|
| Rate for Payer: Plain Church Group Ministry All Products |
$66.82
|
| Rate for Payer: Signature Care EPO |
$235.85
|
| Rate for Payer: Signature Care PPO |
$235.85
|
| Rate for Payer: Three Rivers Preferred All Products |
$94.00
|
| Rate for Payer: United Healthcare Commercial |
$85.31
|
| Rate for Payer: United Healthcare Medicare |
$261.26
|
|
|
PR SIGMOIDOSCOPY FLX DX W/COLLJ SPEC BR/WA IF PFRMD
|
Professional
|
$338.80
|
|
|
Service Code
|
CPT 45330
|
| Hospital Charge Code |
Z12627
|
| Min. Negotiated Rate |
$52.01 |
| Max. Negotiated Rate |
$406.56 |
| Rate for Payer: Aetna Medicare |
$52.01
|
| Rate for Payer: Anthem Exchange |
$111.20
|
| Rate for Payer: Anthem Medicare |
$52.01
|
| Rate for Payer: Anthem PPO |
$111.20
|
| Rate for Payer: Anthem Traditional |
$111.20
|
| Rate for Payer: Caresource Just 4 Me |
$59.81
|
| Rate for Payer: Caresource Medicare |
$57.21
|
| Rate for Payer: Centivo/Paragon All Products |
$80.62
|
| Rate for Payer: Coventry/First Health All Products |
$406.56
|
| Rate for Payer: Frontpath All Products |
$71.54
|
| Rate for Payer: Humana ChoiceCare |
$338.80
|
| Rate for Payer: Humana Medicare |
$52.01
|
| Rate for Payer: Lucent/Coldwater Veneers |
$88.42
|
| Rate for Payer: Lutheran Preferred All Products |
$78.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$254.10
|
| Rate for Payer: PHP All Products |
$88.79
|
| Rate for Payer: Plain Church Group Ministry All Products |
$52.01
|
| Rate for Payer: Signature Care EPO |
$172.55
|
| Rate for Payer: Signature Care PPO |
$172.55
|
| Rate for Payer: Three Rivers Preferred All Products |
$73.00
|
| Rate for Payer: United Healthcare Commercial |
$70.28
|
| Rate for Payer: United Healthcare Medicare |
$169.40
|
|
|
PR SIGMOIDOSCOPY FLX TNDSC BALO DILAT
|
Professional
|
$834.64
|
|
|
Service Code
|
CPT 45340
|
| Hospital Charge Code |
Z12629
|
| Min. Negotiated Rate |
$72.42 |
| Max. Negotiated Rate |
$1,001.57 |
| Rate for Payer: Aetna Medicare |
$72.42
|
| Rate for Payer: Anthem Exchange |
$371.38
|
| Rate for Payer: Anthem Medicare |
$72.42
|
| Rate for Payer: Anthem PPO |
$371.38
|
| Rate for Payer: Anthem Traditional |
$371.38
|
| Rate for Payer: Caresource Just 4 Me |
$83.28
|
| Rate for Payer: Caresource Medicare |
$79.66
|
| Rate for Payer: Centivo/Paragon All Products |
$112.25
|
| Rate for Payer: Coventry/First Health All Products |
$1,001.57
|
| Rate for Payer: Frontpath All Products |
$100.41
|
| Rate for Payer: Humana ChoiceCare |
$834.64
|
| Rate for Payer: Humana Medicare |
$72.42
|
| Rate for Payer: Lucent/Coldwater Veneers |
$123.11
|
| Rate for Payer: Lutheran Preferred All Products |
$109.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$625.98
|
| Rate for Payer: PHP All Products |
$123.65
|
| Rate for Payer: Plain Church Group Ministry All Products |
$72.42
|
| Rate for Payer: Signature Care EPO |
$464.10
|
| Rate for Payer: Signature Care PPO |
$464.10
|
| Rate for Payer: Three Rivers Preferred All Products |
$101.00
|
| Rate for Payer: United Healthcare Commercial |
$131.06
|
| Rate for Payer: United Healthcare Medicare |
$417.32
|
|
|
PR SPEECH AUDIOMETRY, COMPLETE
|
Professional
|
$76.22
|
|
|
Service Code
|
CPT 92556
|
| Hospital Charge Code |
Z13043
|
| Min. Negotiated Rate |
$22.50 |
| Max. Negotiated Rate |
$91.46 |
| Rate for Payer: Aetna Medicare |
$39.06
|
| Rate for Payer: Anthem Exchange |
$22.50
|
| Rate for Payer: Anthem Medicare |
$39.06
|
| Rate for Payer: Anthem PPO |
$22.50
|
| Rate for Payer: Anthem Traditional |
$22.50
|
| Rate for Payer: Caresource Just 4 Me |
$44.92
|
| Rate for Payer: Caresource Medicare |
$42.97
|
| Rate for Payer: Centivo/Paragon All Products |
$60.54
|
| Rate for Payer: Coventry/First Health All Products |
$91.46
|
| Rate for Payer: Frontpath All Products |
$41.09
|
| Rate for Payer: Humana ChoiceCare |
$76.22
|
| Rate for Payer: Humana Medicare |
$39.06
|
| Rate for Payer: Lucent/Coldwater Veneers |
$66.40
|
| Rate for Payer: Lutheran Preferred All Products |
$51.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$57.16
|
| Rate for Payer: PHP All Products |
$55.25
|
| Rate for Payer: Plain Church Group Ministry All Products |
$39.06
|
| Rate for Payer: Signature Care EPO |
$31.11
|
| Rate for Payer: Signature Care PPO |
$31.11
|
| Rate for Payer: Three Rivers Preferred All Products |
$47.00
|
| Rate for Payer: United Healthcare Commercial |
$27.28
|
| Rate for Payer: United Healthcare Medicare |
$38.11
|
|
