|
PR SPEECH THRESHOLD AUDIOMETRY
|
Professional
|
$49.10
|
|
|
Service Code
|
CPT 92555
|
| Hospital Charge Code |
Z13042
|
| Min. Negotiated Rate |
$17.64 |
| Max. Negotiated Rate |
$58.92 |
| Rate for Payer: Aetna Medicare |
$25.17
|
| Rate for Payer: Anthem Exchange |
$17.76
|
| Rate for Payer: Anthem Medicare |
$25.17
|
| Rate for Payer: Anthem PPO |
$17.76
|
| Rate for Payer: Anthem Traditional |
$17.76
|
| Rate for Payer: Caresource Just 4 Me |
$28.95
|
| Rate for Payer: Caresource Medicare |
$27.69
|
| Rate for Payer: Centivo/Paragon All Products |
$39.01
|
| Rate for Payer: Coventry/First Health All Products |
$58.92
|
| Rate for Payer: Frontpath All Products |
$26.14
|
| Rate for Payer: Humana ChoiceCare |
$49.10
|
| Rate for Payer: Humana Medicare |
$25.17
|
| Rate for Payer: Lucent/Coldwater Veneers |
$42.79
|
| Rate for Payer: Lutheran Preferred All Products |
$33.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$36.83
|
| Rate for Payer: PHP All Products |
$35.60
|
| Rate for Payer: Plain Church Group Ministry All Products |
$25.17
|
| Rate for Payer: Signature Care EPO |
$19.73
|
| Rate for Payer: Signature Care PPO |
$19.73
|
| Rate for Payer: Three Rivers Preferred All Products |
$30.00
|
| Rate for Payer: United Healthcare Commercial |
$17.64
|
| Rate for Payer: United Healthcare Medicare |
$24.55
|
|
|
PR SPLINT FINGER FOAM 3 INCH
|
Professional
|
$4.77
|
|
|
Service Code
|
CPT L3927
|
| Hospital Charge Code |
Z13261
|
| Min. Negotiated Rate |
$3.58 |
| Max. Negotiated Rate |
$24.52 |
| Rate for Payer: Coventry/First Health All Products |
$5.72
|
| Rate for Payer: Humana ChoiceCare |
$4.77
|
| Rate for Payer: PHCS/Multiplan All Products |
$3.58
|
| Rate for Payer: Signature Care EPO |
$4.77
|
| Rate for Payer: Signature Care PPO |
$4.77
|
| Rate for Payer: United Healthcare Commercial |
$24.52
|
|
|
PR SPLINT FINGER FOAM 6 INCH
|
Professional
|
$2.41
|
|
|
Service Code
|
CPT L3927
|
| Hospital Charge Code |
Z13262
|
| Min. Negotiated Rate |
$1.81 |
| Max. Negotiated Rate |
$24.52 |
| Rate for Payer: Coventry/First Health All Products |
$2.89
|
| Rate for Payer: Humana ChoiceCare |
$2.41
|
| Rate for Payer: PHCS/Multiplan All Products |
$1.81
|
| Rate for Payer: Signature Care EPO |
$2.41
|
| Rate for Payer: Signature Care PPO |
$2.41
|
| Rate for Payer: United Healthcare Commercial |
$24.52
|
|
|
PR SPLINT FINGER FOAM MED
|
Professional
|
$4.20
|
|
|
Service Code
|
CPT L3927
|
| Hospital Charge Code |
Z13263
|
| Min. Negotiated Rate |
$3.15 |
| Max. Negotiated Rate |
$24.52 |
| Rate for Payer: Coventry/First Health All Products |
$5.04
|
| Rate for Payer: Humana ChoiceCare |
$4.20
|
| Rate for Payer: PHCS/Multiplan All Products |
$3.15
|
| Rate for Payer: Signature Care EPO |
$4.20
|
| Rate for Payer: Signature Care PPO |
$4.20
|
| Rate for Payer: United Healthcare Commercial |
$24.52
|
|
|
PR SPLINT FINGER FOAM XLG
|
Professional
|
$2.59
|
|
|
Service Code
|
CPT L3927
|
| Hospital Charge Code |
Z13264
|
| Min. Negotiated Rate |
$1.94 |
| Max. Negotiated Rate |
$24.52 |
| Rate for Payer: Coventry/First Health All Products |
$3.11
|
| Rate for Payer: Humana ChoiceCare |
$2.59
|
| Rate for Payer: PHCS/Multiplan All Products |
$1.94
|
| Rate for Payer: Signature Care EPO |
$2.59
|
| Rate for Payer: Signature Care PPO |
$2.59
|
| Rate for Payer: United Healthcare Commercial |
$24.52
|
|
|
PR SPLINT FINGER STAX #2
|
Professional
|
$5.15
|
|
|
Service Code
|
CPT Q4049
|
| Hospital Charge Code |
Z13282
|
| Min. Negotiated Rate |
$1.62 |
| Max. Negotiated Rate |
$6.18 |
| Rate for Payer: Coventry/First Health All Products |
$6.18
|
| Rate for Payer: Humana ChoiceCare |
$5.15
|
| Rate for Payer: PHCS/Multiplan All Products |
$3.86
|
| Rate for Payer: Signature Care EPO |
$3.50
|
| Rate for Payer: Signature Care PPO |
$3.50
|
| Rate for Payer: United Healthcare Commercial |
$1.62
|
|
|
PR SPLINT FINGER STAX #3
|
Professional
|
$5.15
|
|
|
Service Code
|
CPT Q4049
|
| Hospital Charge Code |
Z13283
|
| Min. Negotiated Rate |
$1.62 |
| Max. Negotiated Rate |
$6.18 |
| Rate for Payer: Coventry/First Health All Products |
$6.18
|
| Rate for Payer: Humana ChoiceCare |
$5.15
|
| Rate for Payer: PHCS/Multiplan All Products |
$3.86
|
| Rate for Payer: Signature Care EPO |
$3.50
|
| Rate for Payer: Signature Care PPO |
$3.50
|
| Rate for Payer: United Healthcare Commercial |
$1.62
|
|
|
PR SPLINT FINGER STAX #4
|
Professional
|
$5.15
|
|
|
Service Code
|
CPT Q4049
|
| Hospital Charge Code |
Z13284
|
| Min. Negotiated Rate |
$1.62 |
| Max. Negotiated Rate |
$6.18 |
| Rate for Payer: Coventry/First Health All Products |
$6.18
|
| Rate for Payer: Humana ChoiceCare |
$5.15
|
| Rate for Payer: PHCS/Multiplan All Products |
$3.86
|
| Rate for Payer: Signature Care EPO |
$3.50
|
| Rate for Payer: Signature Care PPO |
$3.50
|
| Rate for Payer: United Healthcare Commercial |
$1.62
|
|
|
PR SPLINT FINGER STAX #5
|
Professional
|
$5.15
|
|
|
Service Code
|
CPT Q4049
|
| Hospital Charge Code |
Z13285
|
| Min. Negotiated Rate |
$1.62 |
| Max. Negotiated Rate |
$6.18 |
| Rate for Payer: Coventry/First Health All Products |
$6.18
|
| Rate for Payer: Humana ChoiceCare |
$5.15
|
| Rate for Payer: PHCS/Multiplan All Products |
$3.86
|
| Rate for Payer: Signature Care EPO |
$3.50
|
| Rate for Payer: Signature Care PPO |
$3.50
|
| Rate for Payer: United Healthcare Commercial |
$1.62
|
|
|
PR SPLINT FINGER STAX # 5 1/2
|
Professional
|
$5.15
|
|
|
Service Code
|
CPT Q4049
|
| Hospital Charge Code |
Z13288
|
| Min. Negotiated Rate |
$1.62 |
| Max. Negotiated Rate |
$6.18 |
| Rate for Payer: Coventry/First Health All Products |
$6.18
|
| Rate for Payer: Humana ChoiceCare |
$5.15
|
| Rate for Payer: PHCS/Multiplan All Products |
$3.86
|
| Rate for Payer: Signature Care EPO |
$3.50
|
| Rate for Payer: Signature Care PPO |
$3.50
|
| Rate for Payer: United Healthcare Commercial |
$1.62
|
|
|
PR SPLINT FINGER STAX #6
|
Professional
|
$5.15
|
|
|
Service Code
|
CPT Q4049
|
| Hospital Charge Code |
Z13286
|
| Min. Negotiated Rate |
$1.62 |
| Max. Negotiated Rate |
$6.18 |
| Rate for Payer: Coventry/First Health All Products |
$6.18
|
| Rate for Payer: Humana ChoiceCare |
$5.15
|
| Rate for Payer: PHCS/Multiplan All Products |
$3.86
|
| Rate for Payer: Signature Care EPO |
$3.50
|
| Rate for Payer: Signature Care PPO |
$3.50
|
| Rate for Payer: United Healthcare Commercial |
$1.62
|
|
|
PR SPLINT FINGER STAX #7
|
Professional
|
$5.15
|
|
|
Service Code
|
CPT Q4049
|
| Hospital Charge Code |
Z13287
|
| Min. Negotiated Rate |
$1.62 |
| Max. Negotiated Rate |
$6.18 |
| Rate for Payer: Coventry/First Health All Products |
$6.18
|
| Rate for Payer: Humana ChoiceCare |
$5.15
|
| Rate for Payer: PHCS/Multiplan All Products |
$3.86
|
| Rate for Payer: Signature Care EPO |
$3.50
|
| Rate for Payer: Signature Care PPO |
$3.50
|
| Rate for Payer: United Healthcare Commercial |
$1.62
|
|
|
PR SPLIT GRFT,HEAD,FAC,HAND,FEET <100 SQCM
|
Professional
|
$1,538.54
|
|
|
Service Code
|
CPT 15120
|
| Hospital Charge Code |
Z12078
|
| Min. Negotiated Rate |
$641.24 |
| Max. Negotiated Rate |
$1,846.25 |
| Rate for Payer: Caresource Just 4 Me |
$737.43
|
| Rate for Payer: Caresource Medicare |
$705.36
|
| Rate for Payer: Aetna Medicare |
$641.24
|
| Rate for Payer: Anthem Exchange |
$949.01
|
| Rate for Payer: Anthem Medicare |
$641.24
|
| Rate for Payer: Anthem PPO |
$949.01
|
| Rate for Payer: Anthem Traditional |
$949.01
|
| Rate for Payer: Centivo/Paragon All Products |
$993.92
|
| Rate for Payer: Coventry/First Health All Products |
$1,846.25
|
| Rate for Payer: Frontpath All Products |
$886.89
|
| Rate for Payer: Humana ChoiceCare |
$1,538.54
|
| Rate for Payer: Humana Medicare |
$641.24
|
| Rate for Payer: Lucent/Coldwater Veneers |
$1,090.11
|
| Rate for Payer: Lutheran Preferred All Products |
$834.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$1,153.90
|
| Rate for Payer: PHP All Products |
$875.84
|
| Rate for Payer: Plain Church Group Ministry All Products |
$641.24
|
| Rate for Payer: Signature Care EPO |
$848.30
|
| Rate for Payer: Signature Care PPO |
$848.30
|
| Rate for Payer: Three Rivers Preferred All Products |
$769.00
|
| Rate for Payer: United Healthcare Commercial |
$841.21
|
| Rate for Payer: United Healthcare Medicare |
$769.27
|
|
|
PR SPLIT GRFT TRUNK,ARM,LEG <100 SQCM
|
Professional
|
$1,573.86
|
|
|
Service Code
|
CPT 15100
|
| Hospital Charge Code |
Z12076
|
| Min. Negotiated Rate |
$661.81 |
| Max. Negotiated Rate |
$1,888.63 |
| Rate for Payer: Aetna Medicare |
$661.81
|
| Rate for Payer: Anthem Exchange |
$872.30
|
| Rate for Payer: Anthem Medicare |
$661.81
|
| Rate for Payer: Anthem PPO |
$872.30
|
| Rate for Payer: Anthem Traditional |
$872.30
|
| Rate for Payer: Caresource Just 4 Me |
$761.08
|
| Rate for Payer: Caresource Medicare |
$727.99
|
| Rate for Payer: Centivo/Paragon All Products |
$1,025.81
|
| Rate for Payer: Coventry/First Health All Products |
$1,888.63
|
| Rate for Payer: Frontpath All Products |
$923.18
|
| Rate for Payer: Humana ChoiceCare |
$1,573.86
|
| Rate for Payer: Humana Medicare |
$661.81
|
| Rate for Payer: Lucent/Coldwater Veneers |
$1,125.08
|
| Rate for Payer: Lutheran Preferred All Products |
$860.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$1,180.39
|
| Rate for Payer: PHP All Products |
$903.94
|
| Rate for Payer: Plain Church Group Ministry All Products |
$661.81
|
| Rate for Payer: Signature Care EPO |
$888.25
|
| Rate for Payer: Signature Care PPO |
$888.25
|
| Rate for Payer: Three Rivers Preferred All Products |
$794.00
|
| Rate for Payer: United Healthcare Commercial |
$766.28
|
| Rate for Payer: United Healthcare Medicare |
$786.93
|
|
|
PR STAGGERED SPONDAIC WORD TEST
|
Professional
|
$84.64
|
|
|
Service Code
|
CPT 92572
|
| Hospital Charge Code |
Z13053
|
| Min. Negotiated Rate |
$3.60 |
| Max. Negotiated Rate |
$101.57 |
| Rate for Payer: Aetna Medicare |
$43.38
|
| Rate for Payer: Anthem Exchange |
$3.60
|
| Rate for Payer: Anthem Medicare |
$43.38
|
| Rate for Payer: Anthem PPO |
$3.60
|
| Rate for Payer: Anthem Traditional |
$3.60
|
| Rate for Payer: Caresource Just 4 Me |
$49.89
|
| Rate for Payer: Caresource Medicare |
$47.72
|
| Rate for Payer: Centivo/Paragon All Products |
$67.24
|
| Rate for Payer: Coventry/First Health All Products |
$101.57
|
| Rate for Payer: Frontpath All Products |
$42.12
|
| Rate for Payer: Humana ChoiceCare |
$84.64
|
| Rate for Payer: Humana Medicare |
$43.38
|
| Rate for Payer: Lucent/Coldwater Veneers |
$73.75
|
| Rate for Payer: Lutheran Preferred All Products |
$56.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$63.48
|
| Rate for Payer: PHP All Products |
$61.37
|
| Rate for Payer: Plain Church Group Ministry All Products |
$43.38
|
| Rate for Payer: Signature Care EPO |
$31.91
|
| Rate for Payer: Signature Care PPO |
$31.91
|
| Rate for Payer: Three Rivers Preferred All Products |
$52.00
|
| Rate for Payer: United Healthcare Commercial |
$19.31
|
| Rate for Payer: United Healthcare Medicare |
$42.32
|
|
|
PR STENGER TEST, PURE TONE
|
Professional
|
$35.86
|
|
|
Service Code
|
CPT 92565
|
| Hospital Charge Code |
Z13048
|
| Min. Negotiated Rate |
$13.91 |
| Max. Negotiated Rate |
$43.03 |
| Rate for Payer: Aetna Medicare |
$18.37
|
| Rate for Payer: Anthem Exchange |
$15.70
|
| Rate for Payer: Anthem Medicare |
$18.37
|
| Rate for Payer: Anthem PPO |
$15.70
|
| Rate for Payer: Anthem Traditional |
$15.70
|
| Rate for Payer: Caresource Just 4 Me |
$21.13
|
| Rate for Payer: Caresource Medicare |
$20.21
|
| Rate for Payer: Centivo/Paragon All Products |
$28.47
|
| Rate for Payer: Coventry/First Health All Products |
$43.03
|
| Rate for Payer: Frontpath All Products |
$19.54
|
| Rate for Payer: Humana ChoiceCare |
$35.86
|
| Rate for Payer: Humana Medicare |
$18.37
|
| Rate for Payer: Lucent/Coldwater Veneers |
$31.23
|
| Rate for Payer: Lutheran Preferred All Products |
$24.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$26.89
|
| Rate for Payer: PHP All Products |
$25.99
|
| Rate for Payer: Plain Church Group Ministry All Products |
$18.37
|
| Rate for Payer: Signature Care EPO |
$17.00
|
| Rate for Payer: Signature Care PPO |
$17.00
|
| Rate for Payer: Three Rivers Preferred All Products |
$22.00
|
| Rate for Payer: United Healthcare Commercial |
$13.91
|
| Rate for Payer: United Healthcare Medicare |
$17.93
|
|
|
PR STENGER TEST, SPEECH
|
Professional
|
$36.46
|
|
|
Service Code
|
CPT 92577
|
| Hospital Charge Code |
Z13056
|
| Min. Negotiated Rate |
$14.66 |
| Max. Negotiated Rate |
$43.75 |
| Rate for Payer: Aetna Medicare |
$18.68
|
| Rate for Payer: Anthem Exchange |
$28.20
|
| Rate for Payer: Anthem Medicare |
$18.68
|
| Rate for Payer: Anthem PPO |
$28.20
|
| Rate for Payer: Anthem Traditional |
$28.20
|
| Rate for Payer: Caresource Just 4 Me |
$21.48
|
| Rate for Payer: Caresource Medicare |
$20.55
|
| Rate for Payer: Centivo/Paragon All Products |
$28.95
|
| Rate for Payer: Coventry/First Health All Products |
$43.75
|
| Rate for Payer: Frontpath All Products |
$19.18
|
| Rate for Payer: Humana ChoiceCare |
$36.46
|
| Rate for Payer: Humana Medicare |
$18.68
|
| Rate for Payer: Lucent/Coldwater Veneers |
$31.76
|
| Rate for Payer: Lutheran Preferred All Products |
$24.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$27.34
|
| Rate for Payer: PHP All Products |
$26.43
|
| Rate for Payer: Plain Church Group Ministry All Products |
$18.68
|
| Rate for Payer: Signature Care EPO |
$14.66
|
| Rate for Payer: Signature Care PPO |
$14.66
|
| Rate for Payer: Three Rivers Preferred All Products |
$22.00
|
| Rate for Payer: United Healthcare Commercial |
$18.86
|
| Rate for Payer: United Healthcare Medicare |
$18.23
|
|
|
PR STRAPPING OF TOES
|
Professional
|
$35.22
|
|
|
Service Code
|
CPT 29550
|
| Hospital Charge Code |
Z12464
|
| Min. Negotiated Rate |
$10.65 |
| Max. Negotiated Rate |
$42.26 |
| Rate for Payer: Aetna Medicare |
$10.65
|
| Rate for Payer: Anthem Exchange |
$36.15
|
| Rate for Payer: Anthem Medicare |
$10.65
|
| Rate for Payer: Anthem PPO |
$36.15
|
| Rate for Payer: Anthem Traditional |
$36.15
|
| Rate for Payer: Caresource Just 4 Me |
$12.25
|
| Rate for Payer: Caresource Medicare |
$11.72
|
| Rate for Payer: Centivo/Paragon All Products |
$16.51
|
| Rate for Payer: Coventry/First Health All Products |
$42.26
|
| Rate for Payer: Frontpath All Products |
$14.69
|
| Rate for Payer: Humana ChoiceCare |
$35.22
|
| Rate for Payer: Humana Medicare |
$10.65
|
| Rate for Payer: Lucent/Coldwater Veneers |
$18.11
|
| Rate for Payer: Lutheran Preferred All Products |
$17.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$26.41
|
| Rate for Payer: PHP All Products |
$18.07
|
| Rate for Payer: Plain Church Group Ministry All Products |
$10.65
|
| Rate for Payer: Signature Care EPO |
$30.62
|
| Rate for Payer: Signature Care PPO |
$30.62
|
| Rate for Payer: Three Rivers Preferred All Products |
$16.00
|
| Rate for Payer: United Healthcare Commercial |
$34.81
|
| Rate for Payer: United Healthcare Medicare |
$17.61
|
|
|
PR STRAPPING UNNA BOOT
|
Professional
|
$115.06
|
|
|
Service Code
|
CPT 29580
|
| Hospital Charge Code |
Z12465
|
| Min. Negotiated Rate |
$24.70 |
| Max. Negotiated Rate |
$138.07 |
| Rate for Payer: Aetna Medicare |
$24.70
|
| Rate for Payer: Anthem Exchange |
$65.05
|
| Rate for Payer: Anthem Medicare |
$24.70
|
| Rate for Payer: Anthem PPO |
$65.05
|
| Rate for Payer: Anthem Traditional |
$65.05
|
| Rate for Payer: Caresource Just 4 Me |
$28.40
|
| Rate for Payer: Caresource Medicare |
$27.17
|
| Rate for Payer: Centivo/Paragon All Products |
$38.28
|
| Rate for Payer: Coventry/First Health All Products |
$138.07
|
| Rate for Payer: Frontpath All Products |
$35.26
|
| Rate for Payer: Humana ChoiceCare |
$115.06
|
| Rate for Payer: Humana Medicare |
$24.70
|
| Rate for Payer: Lucent/Coldwater Veneers |
$41.99
|
| Rate for Payer: Lutheran Preferred All Products |
$40.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$86.30
|
| Rate for Payer: PHP All Products |
$41.94
|
| Rate for Payer: Plain Church Group Ministry All Products |
$24.70
|
| Rate for Payer: Signature Care EPO |
$69.70
|
| Rate for Payer: Signature Care PPO |
$69.70
|
| Rate for Payer: Three Rivers Preferred All Products |
$37.00
|
| Rate for Payer: United Healthcare Commercial |
$40.76
|
| Rate for Payer: United Healthcare Medicare |
$57.53
|
|
|
PR SUBSEQUENT HOSPITAL CARE, NORMAL NEWBORN
|
Professional
|
$76.10
|
|
|
Service Code
|
CPT 99462
|
| Hospital Charge Code |
Z13230
|
| Min. Negotiated Rate |
$30.53 |
| Max. Negotiated Rate |
$145.00 |
| Rate for Payer: Aetna Medicare |
$39.00
|
| Rate for Payer: Anthem Exchange |
$56.30
|
| Rate for Payer: Anthem Medicare |
$39.00
|
| Rate for Payer: Anthem PPO |
$56.30
|
| Rate for Payer: Anthem Traditional |
$56.30
|
| Rate for Payer: Caresource Just 4 Me |
$44.85
|
| Rate for Payer: Caresource Medicare |
$42.90
|
| Rate for Payer: Centivo/Paragon All Products |
$60.45
|
| Rate for Payer: Coventry/First Health All Products |
$91.32
|
| Rate for Payer: Frontpath All Products |
$43.17
|
| Rate for Payer: Humana ChoiceCare |
$76.10
|
| Rate for Payer: Humana Medicare |
$39.00
|
| Rate for Payer: Lucent/Coldwater Veneers |
$66.30
|
| Rate for Payer: Lutheran Preferred All Products |
$145.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$57.07
|
| Rate for Payer: PHP All Products |
$39.19
|
| Rate for Payer: Plain Church Group Ministry All Products |
$39.00
|
| Rate for Payer: Signature Care EPO |
$34.40
|
| Rate for Payer: Signature Care PPO |
$34.40
|
| Rate for Payer: Three Rivers Preferred All Products |
$145.00
|
| Rate for Payer: United Healthcare Commercial |
$30.53
|
| Rate for Payer: United Healthcare Medicare |
$38.05
|
|
|
PR SUPRACERV ABD HYSTERECTOMY
|
Professional
|
$1,749.00
|
|
|
Service Code
|
CPT 58180
|
| Hospital Charge Code |
Z12736
|
| Min. Negotiated Rate |
$874.50 |
| Max. Negotiated Rate |
$2,098.80 |
| Rate for Payer: Aetna Medicare |
$896.36
|
| Rate for Payer: Anthem Exchange |
$1,193.37
|
| Rate for Payer: Anthem Medicare |
$896.36
|
| Rate for Payer: Anthem PPO |
$1,193.37
|
| Rate for Payer: Anthem Traditional |
$1,193.37
|
| Rate for Payer: Caresource Just 4 Me |
$1,030.81
|
| Rate for Payer: Caresource Medicare |
$986.00
|
| Rate for Payer: Centivo/Paragon All Products |
$1,389.36
|
| Rate for Payer: Coventry/First Health All Products |
$2,098.80
|
| Rate for Payer: Frontpath All Products |
$1,258.14
|
| Rate for Payer: Humana ChoiceCare |
$1,749.00
|
| Rate for Payer: Humana Medicare |
$896.36
|
| Rate for Payer: Lucent/Coldwater Veneers |
$1,523.81
|
| Rate for Payer: Lutheran Preferred All Products |
$1,255.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$1,311.75
|
| Rate for Payer: PHP All Products |
$1,154.34
|
| Rate for Payer: Plain Church Group Ministry All Products |
$896.36
|
| Rate for Payer: Signature Care EPO |
$1,211.25
|
| Rate for Payer: Signature Care PPO |
$1,211.25
|
| Rate for Payer: Three Rivers Preferred All Products |
$1,165.00
|
| Rate for Payer: United Healthcare Commercial |
$1,071.66
|
| Rate for Payer: United Healthcare Medicare |
$874.50
|
|
|
PR SURG EXCISION OF ANAL LESION(S)
|
Professional
|
$572.80
|
|
|
Service Code
|
CPT 46922
|
| Hospital Charge Code |
Z12649
|
| Min. Negotiated Rate |
$128.09 |
| Max. Negotiated Rate |
$687.36 |
| Rate for Payer: Aetna Medicare |
$128.09
|
| Rate for Payer: Anthem Exchange |
$210.60
|
| Rate for Payer: Anthem Medicare |
$128.09
|
| Rate for Payer: Anthem PPO |
$210.60
|
| Rate for Payer: Anthem Traditional |
$210.60
|
| Rate for Payer: Caresource Just 4 Me |
$147.30
|
| Rate for Payer: Caresource Medicare |
$140.90
|
| Rate for Payer: Centivo/Paragon All Products |
$198.54
|
| Rate for Payer: Coventry/First Health All Products |
$687.36
|
| Rate for Payer: Frontpath All Products |
$177.41
|
| Rate for Payer: Humana ChoiceCare |
$572.80
|
| Rate for Payer: Humana Medicare |
$128.09
|
| Rate for Payer: Lucent/Coldwater Veneers |
$217.75
|
| Rate for Payer: Lutheran Preferred All Products |
$192.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$429.60
|
| Rate for Payer: PHP All Products |
$218.69
|
| Rate for Payer: Plain Church Group Ministry All Products |
$128.09
|
| Rate for Payer: Signature Care EPO |
$286.45
|
| Rate for Payer: Signature Care PPO |
$286.45
|
| Rate for Payer: Three Rivers Preferred All Products |
$179.00
|
| Rate for Payer: United Healthcare Commercial |
$139.54
|
| Rate for Payer: United Healthcare Medicare |
$286.40
|
|
|
PR SURGICAL ARTHROSCOPY SHOULDER LMTD DBRDMT 1/2
|
Professional
|
$985.82
|
|
|
Service Code
|
CPT 29822
|
| Hospital Charge Code |
Z12471
|
| Min. Negotiated Rate |
$492.91 |
| Max. Negotiated Rate |
$1,182.98 |
| Rate for Payer: Aetna Medicare |
$505.24
|
| Rate for Payer: Anthem Exchange |
$798.20
|
| Rate for Payer: Anthem Medicare |
$505.24
|
| Rate for Payer: Anthem PPO |
$798.20
|
| Rate for Payer: Anthem Traditional |
$798.20
|
| Rate for Payer: Caresource Just 4 Me |
$581.03
|
| Rate for Payer: Caresource Medicare |
$555.76
|
| Rate for Payer: Centivo/Paragon All Products |
$783.12
|
| Rate for Payer: Coventry/First Health All Products |
$1,182.98
|
| Rate for Payer: Frontpath All Products |
$701.02
|
| Rate for Payer: Humana ChoiceCare |
$985.82
|
| Rate for Payer: Humana Medicare |
$505.24
|
| Rate for Payer: Lucent/Coldwater Veneers |
$858.91
|
| Rate for Payer: Lutheran Preferred All Products |
$808.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$739.37
|
| Rate for Payer: PHP All Products |
$857.67
|
| Rate for Payer: Plain Church Group Ministry All Products |
$505.24
|
| Rate for Payer: Signature Care EPO |
$846.60
|
| Rate for Payer: Signature Care PPO |
$846.60
|
| Rate for Payer: Three Rivers Preferred All Products |
$758.00
|
| Rate for Payer: United Healthcare Commercial |
$619.31
|
| Rate for Payer: United Healthcare Medicare |
$492.91
|
|
|
PR SURGICAL ARTHROSCOPY SHOULDER XTNSV DBRDMT 3+
|
Professional
|
$1,079.60
|
|
|
Service Code
|
CPT 29823
|
| Hospital Charge Code |
Z12472
|
| Min. Negotiated Rate |
$539.80 |
| Max. Negotiated Rate |
$1,295.52 |
| Rate for Payer: Aetna Medicare |
$553.29
|
| Rate for Payer: Anthem Exchange |
$862.50
|
| Rate for Payer: Anthem Medicare |
$553.29
|
| Rate for Payer: Anthem PPO |
$862.50
|
| Rate for Payer: Anthem Traditional |
$862.50
|
| Rate for Payer: Caresource Just 4 Me |
$636.28
|
| Rate for Payer: Caresource Medicare |
$608.62
|
| Rate for Payer: Centivo/Paragon All Products |
$857.60
|
| Rate for Payer: Coventry/First Health All Products |
$1,295.52
|
| Rate for Payer: Frontpath All Products |
$768.56
|
| Rate for Payer: Humana ChoiceCare |
$1,079.60
|
| Rate for Payer: Humana Medicare |
$553.29
|
| Rate for Payer: Lucent/Coldwater Veneers |
$940.59
|
| Rate for Payer: Lutheran Preferred All Products |
$885.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$809.70
|
| Rate for Payer: PHP All Products |
$939.25
|
| Rate for Payer: Plain Church Group Ministry All Products |
$553.29
|
| Rate for Payer: Signature Care EPO |
$926.50
|
| Rate for Payer: Signature Care PPO |
$926.50
|
| Rate for Payer: Three Rivers Preferred All Products |
$830.00
|
| Rate for Payer: United Healthcare Commercial |
$677.75
|
| Rate for Payer: United Healthcare Medicare |
$539.80
|
|
|
PR SURG RX INCOMPLETE ABORTN
|
Professional
|
$650.04
|
|
|
Service Code
|
CPT 59812
|
| Hospital Charge Code |
Z12814
|
| Min. Negotiated Rate |
$280.36 |
| Max. Negotiated Rate |
$780.05 |
| Rate for Payer: Aetna Medicare |
$280.36
|
| Rate for Payer: Anthem Exchange |
$367.12
|
| Rate for Payer: Anthem Medicare |
$280.36
|
| Rate for Payer: Anthem PPO |
$367.12
|
| Rate for Payer: Anthem Traditional |
$367.12
|
| Rate for Payer: Caresource Just 4 Me |
$322.41
|
| Rate for Payer: Caresource Medicare |
$308.40
|
| Rate for Payer: Centivo/Paragon All Products |
$434.56
|
| Rate for Payer: Coventry/First Health All Products |
$780.05
|
| Rate for Payer: Frontpath All Products |
$398.55
|
| Rate for Payer: Humana ChoiceCare |
$650.04
|
| Rate for Payer: Humana Medicare |
$280.36
|
| Rate for Payer: Lucent/Coldwater Veneers |
$476.61
|
| Rate for Payer: Lutheran Preferred All Products |
$393.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$487.53
|
| Rate for Payer: PHP All Products |
$361.05
|
| Rate for Payer: Plain Church Group Ministry All Products |
$280.36
|
| Rate for Payer: Signature Care EPO |
$324.70
|
| Rate for Payer: Signature Care PPO |
$324.70
|
| Rate for Payer: Three Rivers Preferred All Products |
$364.00
|
| Rate for Payer: United Healthcare Commercial |
$324.96
|
| Rate for Payer: United Healthcare Medicare |
$325.02
|
|
