Maine Consolidated Procedure payments

Statewide Procedure Payments

Description: The chart below contains statewide pricing information across all insurance carriers and all medical providers. The chart provides average total charge and payment information, and the individual professional and facility components.

Data used for report: 12/01/2005 through 12/27/2007

Procedure Description	CPT4 Procedure Code	Average Professional Charges	Average Professional Payments	Average Facility Charges	Average Facility Payments	Average Total Charges	Average Total Payments
Arthroscopic Knee Surgery (Outpatient) View Histogram	29881	$2,998	$1,493	$4,221	$3,698	$7,219	$5,191
Biopsy - Breast (Auto Vacuum) View Histogram	19103	$1,475	$671	$2,502	$2,190	$3,977	$2,861
Bronchoscopy View Histogram	31622	$4,338	$2,203	$7,304	$6,559	$11,643	$8,762
Carpal Tunnel Release View Histogram	64721	$1,729	$898	$2,341	$2,034	$4,070	$2,932
Colonoscopy View Histogram	45378	$751	$349	$1,223	$1,054	$1,974	$1,403
Colposcopy With Biopsy View Histogram	57454	$618	$355	$271	$258	$889	$613
CT - Abdomen View Histogram	74160	$288	$101	$1,164	$951	$1,452	$1,053
CT - Chest View Histogram	71260	$289	$93	$1,140	$968	$1,429	$1,061
CT - Head (Without Contrast Material) View Histogram	70450	$178	$66	$797	$652	$974	$718
CT - Pelvis View Histogram	72193	$251	$90	$1,042	$852	$1,293	$942
Gallbladder Removal View Histogram	47562	$3,442	$1,907	$7,573	$6,643	$11,016	$8,551
Hernia Repair (Outpatient) View Histogram	49505	$2,117	$1,323	$4,998	$4,358	$7,115	$5,681
Kidney Stone Removal View Histogram	50590	$3,053	$1,466	$6,566	$5,578	$9,619	$7,044
Mammogram (Screening) View Histogram	76092, 77057, G0202	$81	$50	$140	$127	$221	$177
MRI - Back View Histogram	72148	$318	$117	$1,288	$1,048	$1,606	$1,166
MRI - Knee View Histogram	73721	$253	$109	$1,162	$973	$1,416	$1,083
MRI - Pelvis View Histogram	72195	$258	$114	$1,270	$1,019	$1,527	$1,134
Myocardial Perfusion Imaging View Histogram	78465	$615	$334	$2,594	$2,283	$3,209	$2,616
Tonsillectomy With Adenoidectomy View Histogram	42820	$1,594	$947	$3,069	$2,680	$4,663	$3,627
Total Hip Replacement View Histogram	27130	$7,403	$3,968	$23,825	$19,218	$31,228	$23,186
Ultrasound - Breast View Histogram	76645	$108	$43	$272	$217	$380	$260
Ultrasound - Pelvic View Histogram	76856	$125	$55	$396	$316	$521	$371
X-Ray Ankle View Histogram	73610	$37	$14	$165	$135	$202	$149
X-Ray Chest View Histogram	71020	$43	$17	$173	$139	$216	$155
X-Ray Foot View Histogram	73630	$37	$14	$169	$136	$205	$151
X-Ray Knee View Histogram	73562	$37	$15	$184	$143	$221	$158
X-Ray Shoulder View Histogram	73030	$38	$15	$195	$160	$233	$175
X-Ray Spine View Histogram	72100	$45	$17	$219	$174	$264	$191
X-Ray Wrist View Histogram	73110	$38	$14	$165	$134	$203	$148
Notes: Procedure: This is the common procedure description for the specific CPT4 code displayed. Average Professional Charges: This figure represents the average charges for professional services reported for the procedure by all insurance companies to any health care provider. Average Professional Payments: This figure represents the average payments for professional services reported for the procedure by all insurance companies to any health care provider. Average Facility Charges: This figure represents the average charges for facility services reported for the procedure by all insurance companies to any health care provider. Average Facility Payments: This figure represents the average payments for facility services reported for the procedure by all insurance companies to any health care provider.