Table 5. Average Medicare and PPO Payments per Service for Selected Services: 1993.

CPT Code and Service Description		Average Payment Per Service			Difference Between Medicare and PPO Payment Rate
		Medicare	Payer 1 PPO	Payer 2 PPO
					Payer 1	Payer 2
					Percent
Evaluation and Management
99213	Office or Other Outpatient Evaluation of an Established Patient, 15 Minutes	$30	$32	$39	6.3	23.1
99232	Subsequent Hospital Evaluation of a Patient, 25 Minutes	40	58	58	31.0	31.0
99244	Office Consultation with a New or Established Patient, 60 Minutes	107	131	141	18.3	24.1
Procedures
45378	Diagnostic Colonoscopy	284	583	572	51.3	50.3
49505	Inguinal Hernial Repair	376	892	827	57.8	5
67228	Destruction of Retinal Lesion by Laser Treatment(s)	671	1,042	996	35.6	32.6
92982	Percutaneous Transluminal Coronary Balloon Angioplasty, Single Vessel	1,181	2,195	2,061	46.2	42.7
Imaging1
70470	Contrast CAT Scan of the Head	293	495	454	40.8	35.5
70553	Magnetic Resonance Image of the Brain, Without Contrast Material	879	1,102	996	20.2	11.7
71020	Chest X Ray, Two Views	31	54	53	42.6	41.5
76805	Echography Exam of a Pregnant Uuterus	117	164	153	28.7	23.5
Tests2
93015	Cardiovascular Stress Test	109	198	205	44.9	46.8
94060	Evaluation of Wheezing	51	75	71	32.0	28.2
95904	Sensory Nerve Conduction Study	30	57	50	47.3	40.0

¹Includes performing procedure and interpretation of imaging results.

²Includes performing procedure and interpretation of test results.

NOTE: PPO is preferred provider organization.

SOURCE: Urban Institute analysis of 1993 claims from the Medicare National Claims History System and two large private payers.