|
PR TRACHEOBRNCHSC THRU EST TRACHS INC
|
Professional
|
$315.64
|
|
|
Service Code
|
CPT 31615
|
| Hospital Charge Code |
Z12518
|
| Min. Negotiated Rate |
$107.44 |
| Max. Negotiated Rate |
$378.77 |
| Rate for Payer: Aetna Medicare |
$107.44
|
| Rate for Payer: Anthem Exchange |
$227.00
|
| Rate for Payer: Anthem Medicare |
$107.44
|
| Rate for Payer: Anthem PPO |
$227.00
|
| Rate for Payer: Anthem Traditional |
$227.00
|
| Rate for Payer: Caresource Just 4 Me |
$123.56
|
| Rate for Payer: Caresource Medicare |
$118.18
|
| Rate for Payer: Centivo/Paragon All Products |
$166.53
|
| Rate for Payer: Coventry/First Health All Products |
$378.77
|
| Rate for Payer: Frontpath All Products |
$148.07
|
| Rate for Payer: Humana ChoiceCare |
$315.64
|
| Rate for Payer: Humana Medicare |
$107.44
|
| Rate for Payer: Lucent/Coldwater Veneers |
$182.65
|
| Rate for Payer: Lutheran Preferred All Products |
$172.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$236.73
|
| Rate for Payer: PHP All Products |
$146.74
|
| Rate for Payer: Plain Church Group Ministry All Products |
$107.44
|
| Rate for Payer: Signature Care EPO |
$246.50
|
| Rate for Payer: Signature Care PPO |
$246.50
|
| Rate for Payer: Three Rivers Preferred All Products |
$161.00
|
| Rate for Payer: United Healthcare Commercial |
$144.49
|
| Rate for Payer: United Healthcare Medicare |
$157.82
|
|
|
PR TRANSFER SKIN PEDICLE FLAP
|
Professional
|
$983.02
|
|
|
Service Code
|
CPT 15650
|
| Hospital Charge Code |
Z12082
|
| Min. Negotiated Rate |
$374.44 |
| Max. Negotiated Rate |
$1,179.62 |
| Rate for Payer: Aetna Medicare |
$374.44
|
| Rate for Payer: Anthem Exchange |
$512.87
|
| Rate for Payer: Anthem Medicare |
$374.44
|
| Rate for Payer: Anthem PPO |
$512.87
|
| Rate for Payer: Anthem Traditional |
$512.87
|
| Rate for Payer: Caresource Just 4 Me |
$430.61
|
| Rate for Payer: Caresource Medicare |
$411.88
|
| Rate for Payer: Centivo/Paragon All Products |
$580.38
|
| Rate for Payer: Coventry/First Health All Products |
$1,179.62
|
| Rate for Payer: Frontpath All Products |
$485.06
|
| Rate for Payer: Humana ChoiceCare |
$983.02
|
| Rate for Payer: Humana Medicare |
$374.44
|
| Rate for Payer: Lucent/Coldwater Veneers |
$636.55
|
| Rate for Payer: Lutheran Preferred All Products |
$487.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$737.26
|
| Rate for Payer: PHP All Products |
$511.44
|
| Rate for Payer: Plain Church Group Ministry All Products |
$374.44
|
| Rate for Payer: Signature Care EPO |
$432.65
|
| Rate for Payer: Signature Care PPO |
$432.65
|
| Rate for Payer: Three Rivers Preferred All Products |
$449.00
|
| Rate for Payer: United Healthcare Commercial |
$412.15
|
| Rate for Payer: United Healthcare Medicare |
$491.51
|
|
|
PR TREAT ECTOPIC PREG,NON REMVAL
|
Professional
|
$1,449.02
|
|
|
Service Code
|
CPT 59121
|
| Hospital Charge Code |
Z12789
|
| Min. Negotiated Rate |
$724.51 |
| Max. Negotiated Rate |
$1,738.82 |
| Rate for Payer: Aetna Medicare |
$742.62
|
| Rate for Payer: Anthem Exchange |
$1,016.67
|
| Rate for Payer: Anthem Medicare |
$742.62
|
| Rate for Payer: Anthem PPO |
$1,016.67
|
| Rate for Payer: Anthem Traditional |
$1,016.67
|
| Rate for Payer: Caresource Just 4 Me |
$854.01
|
| Rate for Payer: Caresource Medicare |
$816.88
|
| Rate for Payer: Centivo/Paragon All Products |
$1,151.06
|
| Rate for Payer: Coventry/First Health All Products |
$1,738.82
|
| Rate for Payer: Frontpath All Products |
$1,063.28
|
| Rate for Payer: Humana ChoiceCare |
$1,449.02
|
| Rate for Payer: Humana Medicare |
$742.62
|
| Rate for Payer: Lucent/Coldwater Veneers |
$1,262.45
|
| Rate for Payer: Lutheran Preferred All Products |
$1,040.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$1,086.76
|
| Rate for Payer: PHP All Products |
$956.36
|
| Rate for Payer: Plain Church Group Ministry All Products |
$742.62
|
| Rate for Payer: Signature Care EPO |
$906.10
|
| Rate for Payer: Signature Care PPO |
$906.10
|
| Rate for Payer: Three Rivers Preferred All Products |
$965.00
|
| Rate for Payer: United Healthcare Commercial |
$883.59
|
| Rate for Payer: United Healthcare Medicare |
$724.51
|
|
|
PR TREAT ECTOPIC PREG,RMV TUBE/OVARY
|
Professional
|
$1,448.62
|
|
|
Service Code
|
CPT 59120
|
| Hospital Charge Code |
Z12788
|
| Min. Negotiated Rate |
$724.31 |
| Max. Negotiated Rate |
$1,738.34 |
| Rate for Payer: Aetna Medicare |
$742.41
|
| Rate for Payer: Anthem Exchange |
$1,001.00
|
| Rate for Payer: Anthem Medicare |
$742.41
|
| Rate for Payer: Anthem PPO |
$1,001.00
|
| Rate for Payer: Anthem Traditional |
$1,001.00
|
| Rate for Payer: Caresource Just 4 Me |
$853.77
|
| Rate for Payer: Caresource Medicare |
$816.65
|
| Rate for Payer: Centivo/Paragon All Products |
$1,150.74
|
| Rate for Payer: Coventry/First Health All Products |
$1,738.34
|
| Rate for Payer: Frontpath All Products |
$1,062.05
|
| Rate for Payer: Humana ChoiceCare |
$1,448.62
|
| Rate for Payer: Humana Medicare |
$742.41
|
| Rate for Payer: Lucent/Coldwater Veneers |
$1,262.10
|
| Rate for Payer: Lutheran Preferred All Products |
$1,039.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$1,086.46
|
| Rate for Payer: PHP All Products |
$956.08
|
| Rate for Payer: Plain Church Group Ministry All Products |
$742.41
|
| Rate for Payer: Signature Care EPO |
$893.35
|
| Rate for Payer: Signature Care PPO |
$893.35
|
| Rate for Payer: Three Rivers Preferred All Products |
$965.00
|
| Rate for Payer: United Healthcare Commercial |
$879.60
|
| Rate for Payer: United Healthcare Medicare |
$724.31
|
|
|
PR TREAT INTER/SUBTROCH FX,W/PLATE/SCREW
|
Professional
|
$2,214.82
|
|
|
Service Code
|
CPT 27244
|
| Hospital Charge Code |
Z12322
|
| Min. Negotiated Rate |
$1,107.41 |
| Max. Negotiated Rate |
$2,657.78 |
| Rate for Payer: Aetna Medicare |
$1,135.10
|
| Rate for Payer: Anthem Exchange |
$1,520.50
|
| Rate for Payer: Anthem Medicare |
$1,135.10
|
| Rate for Payer: Anthem PPO |
$1,520.50
|
| Rate for Payer: Anthem Traditional |
$1,520.50
|
| Rate for Payer: Caresource Just 4 Me |
$1,305.36
|
| Rate for Payer: Caresource Medicare |
$1,248.61
|
| Rate for Payer: Centivo/Paragon All Products |
$1,759.40
|
| Rate for Payer: Coventry/First Health All Products |
$2,657.78
|
| Rate for Payer: Frontpath All Products |
$1,595.80
|
| Rate for Payer: Humana ChoiceCare |
$2,214.82
|
| Rate for Payer: Humana Medicare |
$1,135.10
|
| Rate for Payer: Lucent/Coldwater Veneers |
$1,929.67
|
| Rate for Payer: Lutheran Preferred All Products |
$1,816.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$1,661.12
|
| Rate for Payer: PHP All Products |
$1,926.90
|
| Rate for Payer: Plain Church Group Ministry All Products |
$1,135.10
|
| Rate for Payer: Signature Care EPO |
$1,598.85
|
| Rate for Payer: Signature Care PPO |
$1,598.85
|
| Rate for Payer: Three Rivers Preferred All Products |
$1,703.00
|
| Rate for Payer: United Healthcare Commercial |
$1,339.75
|
| Rate for Payer: United Healthcare Medicare |
$1,107.41
|
|
|
PR TREAT TIBIAL SHAFT FX, INTRAMED IMPLANT
|
Professional
|
$1,803.98
|
|
|
Service Code
|
CPT 27759
|
| Hospital Charge Code |
Z12390
|
| Min. Negotiated Rate |
$901.99 |
| Max. Negotiated Rate |
$2,164.78 |
| Rate for Payer: Aetna Medicare |
$924.54
|
| Rate for Payer: Anthem Exchange |
$1,345.60
|
| Rate for Payer: Anthem Medicare |
$924.54
|
| Rate for Payer: Anthem PPO |
$1,345.60
|
| Rate for Payer: Anthem Traditional |
$1,345.60
|
| Rate for Payer: Caresource Just 4 Me |
$1,063.22
|
| Rate for Payer: Caresource Medicare |
$1,016.99
|
| Rate for Payer: Centivo/Paragon All Products |
$1,433.04
|
| Rate for Payer: Coventry/First Health All Products |
$2,164.78
|
| Rate for Payer: Frontpath All Products |
$1,296.87
|
| Rate for Payer: Humana ChoiceCare |
$1,803.98
|
| Rate for Payer: Humana Medicare |
$924.54
|
| Rate for Payer: Lucent/Coldwater Veneers |
$1,571.72
|
| Rate for Payer: Lutheran Preferred All Products |
$1,479.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$1,352.99
|
| Rate for Payer: PHP All Products |
$1,569.46
|
| Rate for Payer: Plain Church Group Ministry All Products |
$924.54
|
| Rate for Payer: Signature Care EPO |
$1,412.70
|
| Rate for Payer: Signature Care PPO |
$1,412.70
|
| Rate for Payer: Three Rivers Preferred All Products |
$1,387.00
|
| Rate for Payer: United Healthcare Commercial |
$1,096.65
|
| Rate for Payer: United Healthcare Medicare |
$901.99
|
|
|
PR TRIM BENIGN HYPERKERATOTIC SKIN LESION,2-4
|
Professional
|
$150.58
|
|
|
Service Code
|
CPT 11056
|
| Hospital Charge Code |
Z11971
|
| Min. Negotiated Rate |
$20.98 |
| Max. Negotiated Rate |
$180.70 |
| Rate for Payer: Aetna Medicare |
$20.98
|
| Rate for Payer: Anthem Medicare |
$20.98
|
| Rate for Payer: Caresource Just 4 Me |
$24.13
|
| Rate for Payer: Caresource Medicare |
$23.08
|
| Rate for Payer: Centivo/Paragon All Products |
$32.52
|
| Rate for Payer: Coventry/First Health All Products |
$180.70
|
| Rate for Payer: Frontpath All Products |
$28.98
|
| Rate for Payer: Humana ChoiceCare |
$150.58
|
| Rate for Payer: Humana Medicare |
$20.98
|
| Rate for Payer: Lucent/Coldwater Veneers |
$35.67
|
| Rate for Payer: PHCS/Multiplan All Products |
$112.94
|
| Rate for Payer: Plain Church Group Ministry All Products |
$20.98
|
| Rate for Payer: United Healthcare Commercial |
$36.84
|
| Rate for Payer: United Healthcare Medicare |
$75.29
|
|
|
PR TRIM BENIGN HYPERKERATOTIC SKIN LESION,>4
|
Professional
|
$164.70
|
|
|
Service Code
|
CPT 11057
|
| Hospital Charge Code |
Z11972
|
| Min. Negotiated Rate |
$27.30 |
| Max. Negotiated Rate |
$197.64 |
| Rate for Payer: Aetna Medicare |
$27.30
|
| Rate for Payer: Anthem Medicare |
$27.30
|
| Rate for Payer: Caresource Just 4 Me |
$31.39
|
| Rate for Payer: Caresource Medicare |
$30.03
|
| Rate for Payer: Centivo/Paragon All Products |
$42.32
|
| Rate for Payer: Coventry/First Health All Products |
$197.64
|
| Rate for Payer: Frontpath All Products |
$37.45
|
| Rate for Payer: Humana ChoiceCare |
$164.70
|
| Rate for Payer: Humana Medicare |
$27.30
|
| Rate for Payer: Lucent/Coldwater Veneers |
$46.41
|
| Rate for Payer: PHCS/Multiplan All Products |
$123.52
|
| Rate for Payer: Plain Church Group Ministry All Products |
$27.30
|
| Rate for Payer: United Healthcare Commercial |
$47.84
|
| Rate for Payer: United Healthcare Medicare |
$82.35
|
|
|
PR TRIM HYPERKERATOTIC SKIN LESION, ONE
|
Professional
|
$130.42
|
|
|
Service Code
|
CPT 11055
|
| Hospital Charge Code |
Z11970
|
| Min. Negotiated Rate |
$14.97 |
| Max. Negotiated Rate |
$156.50 |
| Rate for Payer: Aetna Medicare |
$14.97
|
| Rate for Payer: Anthem Exchange |
$64.99
|
| Rate for Payer: Anthem Medicare |
$14.97
|
| Rate for Payer: Anthem PPO |
$64.99
|
| Rate for Payer: Anthem Traditional |
$64.99
|
| Rate for Payer: Caresource Just 4 Me |
$17.22
|
| Rate for Payer: Caresource Medicare |
$16.47
|
| Rate for Payer: Centivo/Paragon All Products |
$23.20
|
| Rate for Payer: Coventry/First Health All Products |
$156.50
|
| Rate for Payer: Frontpath All Products |
$20.99
|
| Rate for Payer: Humana ChoiceCare |
$130.42
|
| Rate for Payer: Humana Medicare |
$14.97
|
| Rate for Payer: Lucent/Coldwater Veneers |
$25.45
|
| Rate for Payer: Lutheran Preferred All Products |
$19.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$97.81
|
| Rate for Payer: PHP All Products |
$20.45
|
| Rate for Payer: Plain Church Group Ministry All Products |
$14.97
|
| Rate for Payer: Signature Care EPO |
$57.70
|
| Rate for Payer: Signature Care PPO |
$57.70
|
| Rate for Payer: Three Rivers Preferred All Products |
$18.00
|
| Rate for Payer: United Healthcare Commercial |
$26.11
|
| Rate for Payer: United Healthcare Medicare |
$65.21
|
|
|
PR TRIM NAIL(S)
|
Professional
|
$26.02
|
|
|
Service Code
|
CPT G0127
|
| Hospital Charge Code |
Z13252
|
| Min. Negotiated Rate |
$7.16 |
| Max. Negotiated Rate |
$31.22 |
| Rate for Payer: Aetna Medicare |
$7.16
|
| Rate for Payer: Anthem Medicare |
$7.16
|
| Rate for Payer: Caresource Just 4 Me |
$8.23
|
| Rate for Payer: Caresource Medicare |
$7.88
|
| Rate for Payer: Centivo/Paragon All Products |
$11.10
|
| Rate for Payer: Coventry/First Health All Products |
$31.22
|
| Rate for Payer: Humana ChoiceCare |
$26.02
|
| Rate for Payer: Humana Medicare |
$7.16
|
| Rate for Payer: Lucent/Coldwater Veneers |
$12.17
|
| Rate for Payer: PHCS/Multiplan All Products |
$19.52
|
| Rate for Payer: Plain Church Group Ministry All Products |
$7.16
|
| Rate for Payer: United Healthcare Commercial |
$10.00
|
|
|
PR TRIM NAIL(S)
|
Professional
|
$26.02
|
|
|
Service Code
|
CPT 11719
|
| Hospital Charge Code |
Z12020
|
| Min. Negotiated Rate |
$7.16 |
| Max. Negotiated Rate |
$31.22 |
| Rate for Payer: Aetna Medicare |
$7.16
|
| Rate for Payer: Anthem Medicare |
$7.16
|
| Rate for Payer: Caresource Just 4 Me |
$8.23
|
| Rate for Payer: Caresource Medicare |
$7.88
|
| Rate for Payer: Centivo/Paragon All Products |
$11.10
|
| Rate for Payer: Coventry/First Health All Products |
$31.22
|
| Rate for Payer: Frontpath All Products |
$9.79
|
| Rate for Payer: Humana ChoiceCare |
$26.02
|
| Rate for Payer: Humana Medicare |
$7.16
|
| Rate for Payer: Lucent/Coldwater Veneers |
$12.17
|
| Rate for Payer: PHCS/Multiplan All Products |
$19.52
|
| Rate for Payer: Plain Church Group Ministry All Products |
$7.16
|
| Rate for Payer: United Healthcare Commercial |
$10.28
|
| Rate for Payer: United Healthcare Medicare |
$13.01
|
|
|
PR TUBE THORACOSTOMY INCLUDES WATER SEAL
|
Professional
|
$278.50
|
|
|
Service Code
|
CPT 32551
|
| Hospital Charge Code |
Z12520
|
| Min. Negotiated Rate |
$139.25 |
| Max. Negotiated Rate |
$334.20 |
| Rate for Payer: Aetna Medicare |
$142.73
|
| Rate for Payer: Anthem Exchange |
$242.77
|
| Rate for Payer: Anthem Medicare |
$142.73
|
| Rate for Payer: Anthem PPO |
$242.77
|
| Rate for Payer: Anthem Traditional |
$242.77
|
| Rate for Payer: Caresource Just 4 Me |
$164.14
|
| Rate for Payer: Caresource Medicare |
$157.00
|
| Rate for Payer: Centivo/Paragon All Products |
$221.23
|
| Rate for Payer: Coventry/First Health All Products |
$334.20
|
| Rate for Payer: Frontpath All Products |
$205.72
|
| Rate for Payer: Humana ChoiceCare |
$278.50
|
| Rate for Payer: Humana Medicare |
$142.73
|
| Rate for Payer: Lucent/Coldwater Veneers |
$242.64
|
| Rate for Payer: Lutheran Preferred All Products |
$228.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$208.88
|
| Rate for Payer: PHP All Products |
$194.95
|
| Rate for Payer: Plain Church Group Ministry All Products |
$142.73
|
| Rate for Payer: Signature Care EPO |
$206.99
|
| Rate for Payer: Signature Care PPO |
$206.99
|
| Rate for Payer: Three Rivers Preferred All Products |
$214.00
|
| Rate for Payer: United Healthcare Commercial |
$206.70
|
| Rate for Payer: United Healthcare Medicare |
$139.25
|
|
|
PR TYMPANOMETRY
|
Professional
|
$30.40
|
|
|
Service Code
|
CPT 92567
|
| Hospital Charge Code |
Z13049
|
| Min. Negotiated Rate |
$10.33 |
| Max. Negotiated Rate |
$36.48 |
| Rate for Payer: Aetna Medicare |
$10.33
|
| Rate for Payer: Anthem Exchange |
$20.70
|
| Rate for Payer: Anthem Medicare |
$10.33
|
| Rate for Payer: Anthem PPO |
$20.70
|
| Rate for Payer: Anthem Traditional |
$20.70
|
| Rate for Payer: Caresource Just 4 Me |
$11.88
|
| Rate for Payer: Caresource Medicare |
$11.36
|
| Rate for Payer: Centivo/Paragon All Products |
$16.01
|
| Rate for Payer: Coventry/First Health All Products |
$36.48
|
| Rate for Payer: Frontpath All Products |
$11.51
|
| Rate for Payer: Humana ChoiceCare |
$30.40
|
| Rate for Payer: Humana Medicare |
$10.33
|
| Rate for Payer: Lucent/Coldwater Veneers |
$17.56
|
| Rate for Payer: Lutheran Preferred All Products |
$13.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$22.80
|
| Rate for Payer: PHP All Products |
$14.62
|
| Rate for Payer: Plain Church Group Ministry All Products |
$10.33
|
| Rate for Payer: Signature Care EPO |
$22.10
|
| Rate for Payer: Signature Care PPO |
$22.10
|
| Rate for Payer: Three Rivers Preferred All Products |
$12.00
|
| Rate for Payer: United Healthcare Commercial |
$18.09
|
| Rate for Payer: United Healthcare Medicare |
$15.20
|
|
|
PR TYMPANOMETRY AND REFLEX THRESHOLD MEASUREMENTS
|
Professional
|
$41.52
|
|
|
Service Code
|
CPT 92550
|
| Hospital Charge Code |
Z13038
|
| Min. Negotiated Rate |
$20.76 |
| Max. Negotiated Rate |
$49.82 |
| Rate for Payer: Aetna Medicare |
$21.28
|
| Rate for Payer: Anthem Exchange |
$24.67
|
| Rate for Payer: Anthem Medicare |
$21.28
|
| Rate for Payer: Anthem PPO |
$24.67
|
| Rate for Payer: Anthem Traditional |
$24.67
|
| Rate for Payer: Caresource Just 4 Me |
$24.47
|
| Rate for Payer: Caresource Medicare |
$23.41
|
| Rate for Payer: Centivo/Paragon All Products |
$32.98
|
| Rate for Payer: Coventry/First Health All Products |
$49.82
|
| Rate for Payer: Frontpath All Products |
$24.23
|
| Rate for Payer: Humana ChoiceCare |
$41.52
|
| Rate for Payer: Humana Medicare |
$21.28
|
| Rate for Payer: Lucent/Coldwater Veneers |
$36.18
|
| Rate for Payer: Lutheran Preferred All Products |
$28.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$31.14
|
| Rate for Payer: PHP All Products |
$30.11
|
| Rate for Payer: Plain Church Group Ministry All Products |
$21.28
|
| Rate for Payer: Signature Care EPO |
$22.10
|
| Rate for Payer: Signature Care PPO |
$22.10
|
| Rate for Payer: Three Rivers Preferred All Products |
$26.00
|
| Rate for Payer: United Healthcare Commercial |
$24.74
|
| Rate for Payer: United Healthcare Medicare |
$20.76
|
|
|
PR ULTRASOUND,PELVIC NON-OB
|
Professional
|
$194.18
|
|
|
Service Code
|
CPT 76856
|
| Hospital Charge Code |
Z12962
|
| Min. Negotiated Rate |
$99.51 |
| Max. Negotiated Rate |
$233.02 |
| Rate for Payer: Aetna Medicare |
$99.51
|
| Rate for Payer: Anthem Exchange |
$105.30
|
| Rate for Payer: Anthem Medicare |
$99.51
|
| Rate for Payer: Anthem PPO |
$105.30
|
| Rate for Payer: Anthem Traditional |
$105.30
|
| Rate for Payer: Caresource Just 4 Me |
$114.44
|
| Rate for Payer: Caresource Medicare |
$109.46
|
| Rate for Payer: Centivo/Paragon All Products |
$154.24
|
| Rate for Payer: Coventry/First Health All Products |
$233.02
|
| Rate for Payer: Frontpath All Products |
$175.41
|
| Rate for Payer: Humana ChoiceCare |
$194.18
|
| Rate for Payer: Humana Medicare |
$99.51
|
| Rate for Payer: Lucent/Coldwater Veneers |
$169.17
|
| Rate for Payer: Lutheran Preferred All Products |
$154.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$145.63
|
| Rate for Payer: PHP All Products |
$126.21
|
| Rate for Payer: Plain Church Group Ministry All Products |
$99.51
|
| Rate for Payer: Signature Care EPO |
$113.05
|
| Rate for Payer: Signature Care PPO |
$113.05
|
| Rate for Payer: Three Rivers Preferred All Products |
$144.00
|
| Rate for Payer: United Healthcare Commercial |
$110.80
|
|
|
PR ULTRASOUND,PELVIC NON-OB
|
Professional
|
$194.18
|
|
|
Service Code
|
CPT 76856
|
| Hospital Charge Code |
Z12961
|
| Min. Negotiated Rate |
$99.51 |
| Max. Negotiated Rate |
$233.02 |
| Rate for Payer: Aetna Medicare |
$99.51
|
| Rate for Payer: Anthem Exchange |
$105.30
|
| Rate for Payer: Anthem Medicare |
$99.51
|
| Rate for Payer: Anthem PPO |
$105.30
|
| Rate for Payer: Anthem Traditional |
$105.30
|
| Rate for Payer: Caresource Just 4 Me |
$114.44
|
| Rate for Payer: Caresource Medicare |
$109.46
|
| Rate for Payer: Centivo/Paragon All Products |
$154.24
|
| Rate for Payer: Coventry/First Health All Products |
$233.02
|
| Rate for Payer: Frontpath All Products |
$175.41
|
| Rate for Payer: Humana ChoiceCare |
$194.18
|
| Rate for Payer: Humana Medicare |
$99.51
|
| Rate for Payer: Lucent/Coldwater Veneers |
$169.17
|
| Rate for Payer: Lutheran Preferred All Products |
$154.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$145.63
|
| Rate for Payer: PHP All Products |
$126.21
|
| Rate for Payer: Plain Church Group Ministry All Products |
$99.51
|
| Rate for Payer: Signature Care EPO |
$113.05
|
| Rate for Payer: Signature Care PPO |
$113.05
|
| Rate for Payer: Three Rivers Preferred All Products |
$144.00
|
| Rate for Payer: United Healthcare Commercial |
$110.80
|
|
|
PR ULTRASOUND,TRANSVAGINAL NON-OB
|
Professional
|
$220.08
|
|
|
Service Code
|
CPT 76830
|
| Hospital Charge Code |
Z12958
|
| Min. Negotiated Rate |
$105.30 |
| Max. Negotiated Rate |
$264.10 |
| Rate for Payer: Aetna Medicare |
$112.79
|
| Rate for Payer: Anthem Exchange |
$105.30
|
| Rate for Payer: Anthem Medicare |
$112.79
|
| Rate for Payer: Anthem PPO |
$105.30
|
| Rate for Payer: Anthem Traditional |
$105.30
|
| Rate for Payer: Caresource Just 4 Me |
$129.71
|
| Rate for Payer: Caresource Medicare |
$124.07
|
| Rate for Payer: Centivo/Paragon All Products |
$174.82
|
| Rate for Payer: Coventry/First Health All Products |
$264.10
|
| Rate for Payer: Frontpath All Products |
$197.96
|
| Rate for Payer: Humana ChoiceCare |
$220.08
|
| Rate for Payer: Humana Medicare |
$112.79
|
| Rate for Payer: Lucent/Coldwater Veneers |
$191.74
|
| Rate for Payer: Lutheran Preferred All Products |
$175.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$165.06
|
| Rate for Payer: PHP All Products |
$143.05
|
| Rate for Payer: Plain Church Group Ministry All Products |
$112.79
|
| Rate for Payer: Signature Care EPO |
$113.05
|
| Rate for Payer: Signature Care PPO |
$113.05
|
| Rate for Payer: Three Rivers Preferred All Products |
$164.00
|
| Rate for Payer: United Healthcare Commercial |
$110.14
|
|
|
PR ULTRASOUND,TRANSVAGINAL NON-OB
|
Professional
|
$220.08
|
|
|
Service Code
|
CPT 76830
|
| Hospital Charge Code |
Z12957
|
| Min. Negotiated Rate |
$105.30 |
| Max. Negotiated Rate |
$264.10 |
| Rate for Payer: Aetna Medicare |
$112.79
|
| Rate for Payer: Anthem Exchange |
$105.30
|
| Rate for Payer: Anthem Medicare |
$112.79
|
| Rate for Payer: Anthem PPO |
$105.30
|
| Rate for Payer: Anthem Traditional |
$105.30
|
| Rate for Payer: Caresource Just 4 Me |
$129.71
|
| Rate for Payer: Caresource Medicare |
$124.07
|
| Rate for Payer: Centivo/Paragon All Products |
$174.82
|
| Rate for Payer: Coventry/First Health All Products |
$264.10
|
| Rate for Payer: Frontpath All Products |
$197.96
|
| Rate for Payer: Humana ChoiceCare |
$220.08
|
| Rate for Payer: Humana Medicare |
$112.79
|
| Rate for Payer: Lucent/Coldwater Veneers |
$191.74
|
| Rate for Payer: Lutheran Preferred All Products |
$175.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$165.06
|
| Rate for Payer: PHP All Products |
$143.05
|
| Rate for Payer: Plain Church Group Ministry All Products |
$112.79
|
| Rate for Payer: Signature Care EPO |
$113.05
|
| Rate for Payer: Signature Care PPO |
$113.05
|
| Rate for Payer: Three Rivers Preferred All Products |
$164.00
|
| Rate for Payer: United Healthcare Commercial |
$110.14
|
|
|
PR UNLISTED OTORHINOLARYNG SERVICE/PROC
|
Professional
|
$52.93
|
|
|
Service Code
|
CPT 92700
|
| Hospital Charge Code |
Z13070
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$63.52 |
| Rate for Payer: Anthem Exchange |
$0.01
|
| Rate for Payer: Anthem PPO |
$0.01
|
| Rate for Payer: Anthem Traditional |
$0.01
|
| Rate for Payer: Coventry/First Health All Products |
$63.52
|
| Rate for Payer: Humana ChoiceCare |
$52.93
|
| Rate for Payer: Lutheran Preferred All Products |
$44.99
|
| Rate for Payer: PHCS/Multiplan All Products |
$39.70
|
| Rate for Payer: Signature Care EPO |
$33.75
|
| Rate for Payer: Signature Care PPO |
$33.75
|
| Rate for Payer: Three Rivers Preferred All Products |
$31.76
|
|
|
PR UNLISTED PROC, ARTHROSCOPY
|
Professional
|
$508.53
|
|
|
Service Code
|
CPT 29999
|
| Hospital Charge Code |
Z12496
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$610.24 |
| Rate for Payer: Anthem Exchange |
$0.01
|
| Rate for Payer: Anthem PPO |
$0.01
|
| Rate for Payer: Anthem Traditional |
$0.01
|
| Rate for Payer: Coventry/First Health All Products |
$610.24
|
| Rate for Payer: Humana ChoiceCare |
$508.53
|
| Rate for Payer: Lutheran Preferred All Products |
$432.25
|
| Rate for Payer: PHCS/Multiplan All Products |
$381.40
|
| Rate for Payer: Signature Care EPO |
$324.19
|
| Rate for Payer: Signature Care PPO |
$324.19
|
| Rate for Payer: Three Rivers Preferred All Products |
$305.12
|
|
|
PR UPG PACEMAKER SYS CONVERT 1CHMBR SYS 2CHMBR SYS
|
Professional
|
$851.56
|
|
|
Service Code
|
CPT 33214
|
| Hospital Charge Code |
Z12525
|
| Min. Negotiated Rate |
$425.78 |
| Max. Negotiated Rate |
$1,021.87 |
| Rate for Payer: Aetna Medicare |
$436.43
|
| Rate for Payer: Anthem Exchange |
$695.10
|
| Rate for Payer: Anthem Medicare |
$436.43
|
| Rate for Payer: Anthem PPO |
$695.10
|
| Rate for Payer: Anthem Traditional |
$695.10
|
| Rate for Payer: Caresource Just 4 Me |
$501.89
|
| Rate for Payer: Caresource Medicare |
$480.07
|
| Rate for Payer: Centivo/Paragon All Products |
$676.47
|
| Rate for Payer: Coventry/First Health All Products |
$1,021.87
|
| Rate for Payer: Frontpath All Products |
$626.55
|
| Rate for Payer: Humana ChoiceCare |
$851.56
|
| Rate for Payer: Humana Medicare |
$436.43
|
| Rate for Payer: Lucent/Coldwater Veneers |
$741.93
|
| Rate for Payer: Lutheran Preferred All Products |
$698.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$638.67
|
| Rate for Payer: PHP All Products |
$596.10
|
| Rate for Payer: Plain Church Group Ministry All Products |
$436.43
|
| Rate for Payer: Signature Care EPO |
$713.15
|
| Rate for Payer: Signature Care PPO |
$713.15
|
| Rate for Payer: Three Rivers Preferred All Products |
$655.00
|
| Rate for Payer: United Healthcare Commercial |
$581.20
|
| Rate for Payer: United Healthcare Medicare |
$425.78
|
|
|
PR VAG DELIV ONLY,PREV C-SECTN
|
Professional
|
$1,589.64
|
|
|
Service Code
|
CPT 59612
|
| Hospital Charge Code |
Z12809
|
| Min. Negotiated Rate |
$794.82 |
| Max. Negotiated Rate |
$1,907.57 |
| Rate for Payer: Aetna Medicare |
$814.69
|
| Rate for Payer: Anthem Exchange |
$1,072.59
|
| Rate for Payer: Anthem Medicare |
$814.69
|
| Rate for Payer: Anthem PPO |
$1,072.59
|
| Rate for Payer: Anthem Traditional |
$1,072.59
|
| Rate for Payer: Caresource Just 4 Me |
$936.89
|
| Rate for Payer: Caresource Medicare |
$896.16
|
| Rate for Payer: Centivo/Paragon All Products |
$1,262.77
|
| Rate for Payer: Coventry/First Health All Products |
$1,907.57
|
| Rate for Payer: Frontpath All Products |
$1,182.49
|
| Rate for Payer: Humana ChoiceCare |
$1,589.64
|
| Rate for Payer: Humana Medicare |
$814.69
|
| Rate for Payer: Lucent/Coldwater Veneers |
$1,384.97
|
| Rate for Payer: Lutheran Preferred All Products |
$1,141.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$1,192.23
|
| Rate for Payer: PHP All Products |
$1,049.16
|
| Rate for Payer: Plain Church Group Ministry All Products |
$814.69
|
| Rate for Payer: Signature Care EPO |
$1,074.40
|
| Rate for Payer: Signature Care PPO |
$1,074.40
|
| Rate for Payer: Three Rivers Preferred All Products |
$1,059.00
|
| Rate for Payer: United Healthcare Commercial |
$976.96
|
| Rate for Payer: United Healthcare Medicare |
$794.82
|
|
|
PR VAG DELIV+POSTPARTUM CARE,PREV C-SEC
|
Professional
|
$2,010.88
|
|
|
Service Code
|
CPT 59614
|
| Hospital Charge Code |
Z12810
|
| Min. Negotiated Rate |
$1,005.44 |
| Max. Negotiated Rate |
$2,413.06 |
| Rate for Payer: Aetna Medicare |
$1,030.73
|
| Rate for Payer: Anthem Exchange |
$1,164.12
|
| Rate for Payer: Anthem Medicare |
$1,030.73
|
| Rate for Payer: Anthem PPO |
$1,164.12
|
| Rate for Payer: Anthem Traditional |
$1,164.12
|
| Rate for Payer: Caresource Just 4 Me |
$1,185.34
|
| Rate for Payer: Caresource Medicare |
$1,133.80
|
| Rate for Payer: Centivo/Paragon All Products |
$1,597.63
|
| Rate for Payer: Coventry/First Health All Products |
$2,413.06
|
| Rate for Payer: Frontpath All Products |
$1,494.31
|
| Rate for Payer: Humana ChoiceCare |
$2,010.88
|
| Rate for Payer: Humana Medicare |
$1,030.73
|
| Rate for Payer: Lucent/Coldwater Veneers |
$1,752.24
|
| Rate for Payer: Lutheran Preferred All Products |
$1,443.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$1,508.16
|
| Rate for Payer: PHP All Products |
$1,327.18
|
| Rate for Payer: Plain Church Group Ministry All Products |
$1,030.73
|
| Rate for Payer: Signature Care EPO |
$1,182.35
|
| Rate for Payer: Signature Care PPO |
$1,182.35
|
| Rate for Payer: Three Rivers Preferred All Products |
$1,340.00
|
| Rate for Payer: United Healthcare Commercial |
$1,093.85
|
| Rate for Payer: United Healthcare Medicare |
$1,005.44
|
|
|
PR VAG HYST,REV VAG/URETHR,FIX ENTEROCE
|
Professional
|
$1,637.12
|
|
|
Service Code
|
CPT 58270
|
| Hospital Charge Code |
Z12740
|
| Min. Negotiated Rate |
$818.56 |
| Max. Negotiated Rate |
$1,964.54 |
| Rate for Payer: Aetna Medicare |
$839.03
|
| Rate for Payer: Anthem Exchange |
$1,128.27
|
| Rate for Payer: Anthem Medicare |
$839.03
|
| Rate for Payer: Anthem PPO |
$1,128.27
|
| Rate for Payer: Anthem Traditional |
$1,128.27
|
| Rate for Payer: Caresource Just 4 Me |
$964.88
|
| Rate for Payer: Caresource Medicare |
$922.93
|
| Rate for Payer: Centivo/Paragon All Products |
$1,300.50
|
| Rate for Payer: Coventry/First Health All Products |
$1,964.54
|
| Rate for Payer: Frontpath All Products |
$1,176.42
|
| Rate for Payer: Humana ChoiceCare |
$1,637.12
|
| Rate for Payer: Humana Medicare |
$839.03
|
| Rate for Payer: Lucent/Coldwater Veneers |
$1,426.35
|
| Rate for Payer: Lutheran Preferred All Products |
$1,175.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$1,227.84
|
| Rate for Payer: PHP All Products |
$1,080.50
|
| Rate for Payer: Plain Church Group Ministry All Products |
$839.03
|
| Rate for Payer: Signature Care EPO |
$1,066.75
|
| Rate for Payer: Signature Care PPO |
$1,066.75
|
| Rate for Payer: Three Rivers Preferred All Products |
$1,091.00
|
| Rate for Payer: United Healthcare Commercial |
$997.95
|
| Rate for Payer: United Healthcare Medicare |
$818.56
|
|
|
PR VAG HYST,RMV TUBE/OVARY
|
Professional
|
$1,694.90
|
|
|
Service Code
|
CPT 58262
|
| Hospital Charge Code |
Z12738
|
| Min. Negotiated Rate |
$847.45 |
| Max. Negotiated Rate |
$2,033.88 |
| Rate for Payer: Aetna Medicare |
$868.63
|
| Rate for Payer: Anthem Exchange |
$1,171.84
|
| Rate for Payer: Anthem Medicare |
$868.63
|
| Rate for Payer: Anthem PPO |
$1,171.84
|
| Rate for Payer: Anthem Traditional |
$1,171.84
|
| Rate for Payer: Caresource Just 4 Me |
$998.92
|
| Rate for Payer: Caresource Medicare |
$955.49
|
| Rate for Payer: Centivo/Paragon All Products |
$1,346.38
|
| Rate for Payer: Coventry/First Health All Products |
$2,033.88
|
| Rate for Payer: Frontpath All Products |
$1,217.37
|
| Rate for Payer: Humana ChoiceCare |
$1,694.90
|
| Rate for Payer: Humana Medicare |
$868.63
|
| Rate for Payer: Lucent/Coldwater Veneers |
$1,476.67
|
| Rate for Payer: Lutheran Preferred All Products |
$1,216.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$1,271.18
|
| Rate for Payer: PHP All Products |
$1,118.63
|
| Rate for Payer: Plain Church Group Ministry All Products |
$868.63
|
| Rate for Payer: Signature Care EPO |
$1,183.20
|
| Rate for Payer: Signature Care PPO |
$1,183.20
|
| Rate for Payer: Three Rivers Preferred All Products |
$1,129.00
|
| Rate for Payer: United Healthcare Commercial |
$1,040.74
|
| Rate for Payer: United Healthcare Medicare |
$847.45
|
|
