|
PR PERCUT SKELETAL FIX, DISTAL RADIUS FX
|
Professional
|
$1,221.12
|
|
|
Service Code
|
CPT 25606
|
| Hospital Charge Code |
z25606
|
| Min. Negotiated Rate |
$625.50 |
| Max. Negotiated Rate |
$1,063.35 |
| Rate for Payer: Aetna Medicare |
$625.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$753.20
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$753.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$719.32
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$688.05
|
| Rate for Payer: Cash Price |
$757.09
|
| Rate for Payer: Cash Price |
$757.09
|
| Rate for Payer: Coventry All Commercial |
$750.60
|
| Rate for Payer: Frontpath All Commercial |
$863.99
|
| Rate for Payer: Humana ChoiceCare |
$675.24
|
| Rate for Payer: Humana Medicare |
$625.50
|
| Rate for Payer: Lucent All Commercial |
$1,063.35
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,001.00
|
| Rate for Payer: PHCS All Commercial |
$915.84
|
| Rate for Payer: PHP All Commercial |
$1,062.38
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$625.50
|
| Rate for Payer: Signature Care EPO |
$916.30
|
| Rate for Payer: Signature Care PPO |
$916.30
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$938.00
|
| Rate for Payer: United Healthcare Commercial |
$704.64
|
| Rate for Payer: United Healthcare Medicare |
$625.50
|
|
|
PR PERI-PX DEV EVAL PM/LDLS PM PHYS/QHP IN PERSON
|
Professional
|
$84.32
|
|
|
Service Code
|
CPT 93286
|
| Hospital Charge Code |
z93286
|
| Min. Negotiated Rate |
$31.99 |
| Max. Negotiated Rate |
$73.46 |
| Rate for Payer: Aetna Medicare |
$43.21
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$38.13
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$38.13
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$49.69
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$47.53
|
| Rate for Payer: Cash Price |
$52.28
|
| Rate for Payer: Cash Price |
$52.28
|
| Rate for Payer: Coventry All Commercial |
$51.85
|
| Rate for Payer: Frontpath All Commercial |
$50.48
|
| Rate for Payer: Humana ChoiceCare |
$34.78
|
| Rate for Payer: Humana Medicare |
$43.21
|
| Rate for Payer: Lucent All Commercial |
$73.46
|
| Rate for Payer: Lutheran Preferred All Commercial |
$69.00
|
| Rate for Payer: PHCS All Commercial |
$63.24
|
| Rate for Payer: PHP All Commercial |
$61.97
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$43.21
|
| Rate for Payer: Signature Care EPO |
$39.15
|
| Rate for Payer: Signature Care PPO |
$39.15
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$65.00
|
| Rate for Payer: United Healthcare Commercial |
$31.99
|
| Rate for Payer: United Healthcare Medicare |
$43.21
|
|
|
PR PERI-PX DEV EVAL & PROG SING/DUAL/MULTI LEAD DFB
|
Professional
|
$98.46
|
|
|
Service Code
|
CPT 93287
|
| Hospital Charge Code |
z93287
|
| Min. Negotiated Rate |
$42.33 |
| Max. Negotiated Rate |
$85.78 |
| Rate for Payer: Aetna Medicare |
$50.46
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$50.45
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$50.45
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$58.03
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$55.51
|
| Rate for Payer: Cash Price |
$61.05
|
| Rate for Payer: Cash Price |
$61.05
|
| Rate for Payer: Coventry All Commercial |
$60.55
|
| Rate for Payer: Frontpath All Commercial |
$58.70
|
| Rate for Payer: Humana ChoiceCare |
$46.02
|
| Rate for Payer: Humana Medicare |
$50.46
|
| Rate for Payer: Lucent All Commercial |
$85.78
|
| Rate for Payer: Lutheran Preferred All Commercial |
$81.00
|
| Rate for Payer: PHCS All Commercial |
$73.84
|
| Rate for Payer: PHP All Commercial |
$72.36
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$50.46
|
| Rate for Payer: Signature Care EPO |
$51.82
|
| Rate for Payer: Signature Care PPO |
$51.82
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$76.00
|
| Rate for Payer: United Healthcare Commercial |
$42.33
|
| Rate for Payer: United Healthcare Medicare |
$50.46
|
|
|
PR PERITONEAL LAVAGE W/WO IMAGING GUIDANCE
|
Professional
|
$190.64
|
|
|
Service Code
|
CPT 49084
|
| Hospital Charge Code |
z49084
|
| Min. Negotiated Rate |
$97.70 |
| Max. Negotiated Rate |
$166.81 |
| Rate for Payer: Aetna Medicare |
$97.70
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$116.70
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$116.70
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$112.36
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$107.47
|
| Rate for Payer: Cash Price |
$118.20
|
| Rate for Payer: Cash Price |
$118.20
|
| Rate for Payer: Coventry All Commercial |
$117.24
|
| Rate for Payer: Frontpath All Commercial |
$141.04
|
| Rate for Payer: Humana ChoiceCare |
$112.69
|
| Rate for Payer: Humana Medicare |
$97.70
|
| Rate for Payer: Lucent All Commercial |
$166.09
|
| Rate for Payer: Lutheran Preferred All Commercial |
$147.00
|
| Rate for Payer: PHCS All Commercial |
$142.98
|
| Rate for Payer: PHP All Commercial |
$166.81
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$97.70
|
| Rate for Payer: Signature Care EPO |
$104.02
|
| Rate for Payer: Signature Care PPO |
$104.02
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$137.00
|
| Rate for Payer: United Healthcare Commercial |
$124.41
|
| Rate for Payer: United Healthcare Medicare |
$97.70
|
|
|
PR PESSARY, NON RUBBER,ANY TYPE
|
Professional
|
$216.00
|
|
|
Service Code
|
CPT A4562
|
| Hospital Charge Code |
zA4562
|
| Min. Negotiated Rate |
$31.06 |
| Max. Negotiated Rate |
$162.00 |
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$31.06
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$31.06
|
| Rate for Payer: Cash Price |
$133.92
|
| Rate for Payer: Cash Price |
$133.92
|
| Rate for Payer: Humana ChoiceCare |
$57.56
|
| Rate for Payer: PHCS All Commercial |
$162.00
|
| Rate for Payer: PHP All Commercial |
$50.79
|
| Rate for Payer: Signature Care EPO |
$44.55
|
| Rate for Payer: Signature Care PPO |
$44.55
|
| Rate for Payer: United Healthcare Commercial |
$45.45
|
|
|
PR PESSARY RUBBER, ANY TYPE
|
Professional
|
$216.00
|
|
|
Service Code
|
CPT A4561
|
| Hospital Charge Code |
zA4561
|
| Min. Negotiated Rate |
$12.46 |
| Max. Negotiated Rate |
$162.00 |
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$12.46
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$12.46
|
| Rate for Payer: Cash Price |
$133.92
|
| Rate for Payer: Cash Price |
$133.92
|
| Rate for Payer: Humana ChoiceCare |
$23.17
|
| Rate for Payer: PHCS All Commercial |
$162.00
|
| Rate for Payer: PHP All Commercial |
$20.45
|
| Rate for Payer: Signature Care EPO |
$17.93
|
| Rate for Payer: Signature Care PPO |
$17.93
|
| Rate for Payer: United Healthcare Commercial |
$18.28
|
|
|
PR PHONAK CHARGER CASE
|
Professional
|
$100.00
|
|
|
Service Code
|
CPT V5267
|
| Hospital Charge Code |
zV5267P
|
| Min. Negotiated Rate |
$75.00 |
| Max. Negotiated Rate |
$100.00 |
| Rate for Payer: Cash Price |
$62.00
|
| Rate for Payer: PHCS All Commercial |
$75.00
|
| Rate for Payer: Signature Care EPO |
$100.00
|
| Rate for Payer: Signature Care PPO |
$100.00
|
|
|
PR PHONAK CUSTOM SHELL
|
Professional
|
$120.00
|
|
|
Service Code
|
CPT V5264
|
| Hospital Charge Code |
zV5264O
|
| Min. Negotiated Rate |
$90.00 |
| Max. Negotiated Rate |
$120.00 |
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: PHCS All Commercial |
$90.00
|
| Rate for Payer: Signature Care EPO |
$120.00
|
| Rate for Payer: Signature Care PPO |
$120.00
|
|
|
PR PHONAK MINI CHARGER
|
Professional
|
$80.00
|
|
|
Service Code
|
CPT V5267
|
| Hospital Charge Code |
zV5267MM
|
| Min. Negotiated Rate |
$60.00 |
| Max. Negotiated Rate |
$80.00 |
| Rate for Payer: Cash Price |
$49.60
|
| Rate for Payer: PHCS All Commercial |
$60.00
|
| Rate for Payer: Signature Care EPO |
$80.00
|
| Rate for Payer: Signature Care PPO |
$80.00
|
|
|
PR PHONAK PARTNER MIC
|
Professional
|
$500.00
|
|
|
Service Code
|
CPT V5270
|
| Hospital Charge Code |
zV5270M
|
| Min. Negotiated Rate |
$375.00 |
| Max. Negotiated Rate |
$500.00 |
| Rate for Payer: Cash Price |
$310.00
|
| Rate for Payer: PHCS All Commercial |
$375.00
|
| Rate for Payer: Signature Care EPO |
$500.00
|
| Rate for Payer: Signature Care PPO |
$500.00
|
|
|
PR PHONAK POWERPACK
|
Professional
|
$100.00
|
|
|
Service Code
|
CPT V5267
|
| Hospital Charge Code |
zV5267NN
|
| Min. Negotiated Rate |
$75.00 |
| Max. Negotiated Rate |
$100.00 |
| Rate for Payer: Cash Price |
$62.00
|
| Rate for Payer: PHCS All Commercial |
$75.00
|
| Rate for Payer: Signature Care EPO |
$100.00
|
| Rate for Payer: Signature Care PPO |
$100.00
|
|
|
PR PHONAK TV CONNECTOR
|
Professional
|
$300.00
|
|
|
Service Code
|
CPT V5270
|
| Hospital Charge Code |
zV5270L
|
| Min. Negotiated Rate |
$225.00 |
| Max. Negotiated Rate |
$300.00 |
| Rate for Payer: Cash Price |
$186.00
|
| Rate for Payer: PHCS All Commercial |
$225.00
|
| Rate for Payer: Signature Care EPO |
$300.00
|
| Rate for Payer: Signature Care PPO |
$300.00
|
|
|
PR PHYSICIAN TELEPHONE EVALUATION 21-30 MIN
|
Professional
|
$234.94
|
|
|
Service Code
|
CPT 99443
|
| Hospital Charge Code |
z99443
|
| Min. Negotiated Rate |
$31.63 |
| Max. Negotiated Rate |
$176.20 |
| Rate for Payer: Aetna Medicare |
$92.31
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$46.57
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$46.57
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$106.16
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$101.54
|
| Rate for Payer: Cash Price |
$145.66
|
| Rate for Payer: Cash Price |
$145.66
|
| Rate for Payer: Coventry All Commercial |
$110.77
|
| Rate for Payer: Frontpath All Commercial |
$100.78
|
| Rate for Payer: Humana ChoiceCare |
$31.63
|
| Rate for Payer: Humana Medicare |
$92.31
|
| Rate for Payer: Lucent All Commercial |
$156.93
|
| Rate for Payer: Lutheran Preferred All Commercial |
$97.00
|
| Rate for Payer: PHCS All Commercial |
$176.20
|
| Rate for Payer: PHP All Commercial |
$92.76
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$92.31
|
| Rate for Payer: Signature Care EPO |
$103.39
|
| Rate for Payer: Signature Care PPO |
$103.39
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$95.00
|
| Rate for Payer: United Healthcare Commercial |
$37.78
|
| Rate for Payer: United Healthcare Medicare |
$92.31
|
|
|
PR PHYS/QHP TELEPHONE EVALUATION 11-20 MIN
|
Professional
|
$166.20
|
|
|
Service Code
|
CPT 99442
|
| Hospital Charge Code |
z99442
|
| Min. Negotiated Rate |
$20.97 |
| Max. Negotiated Rate |
$124.65 |
| Rate for Payer: Aetna Medicare |
$62.64
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$31.40
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$31.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$72.04
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$68.90
|
| Rate for Payer: Cash Price |
$103.04
|
| Rate for Payer: Cash Price |
$103.04
|
| Rate for Payer: Coventry All Commercial |
$75.17
|
| Rate for Payer: Frontpath All Commercial |
$68.40
|
| Rate for Payer: Humana ChoiceCare |
$20.97
|
| Rate for Payer: Humana Medicare |
$62.64
|
| Rate for Payer: Lucent All Commercial |
$106.49
|
| Rate for Payer: Lutheran Preferred All Commercial |
$66.00
|
| Rate for Payer: PHCS All Commercial |
$124.65
|
| Rate for Payer: PHP All Commercial |
$62.95
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$62.64
|
| Rate for Payer: Signature Care EPO |
$72.83
|
| Rate for Payer: Signature Care PPO |
$72.83
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$65.00
|
| Rate for Payer: United Healthcare Commercial |
$25.29
|
| Rate for Payer: United Healthcare Medicare |
$62.64
|
|
|
PR PHYS/QHP TELEPHONE EVALUATION 5-10 MIN
|
Professional
|
$102.96
|
|
|
Service Code
|
CPT 99441
|
| Hospital Charge Code |
z99441
|
| Min. Negotiated Rate |
$10.85 |
| Max. Negotiated Rate |
$77.22 |
| Rate for Payer: Aetna Medicare |
$33.32
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$16.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$16.00
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$38.32
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$36.65
|
| Rate for Payer: Cash Price |
$63.84
|
| Rate for Payer: Cash Price |
$63.84
|
| Rate for Payer: Coventry All Commercial |
$39.98
|
| Rate for Payer: Frontpath All Commercial |
$36.69
|
| Rate for Payer: Humana ChoiceCare |
$10.85
|
| Rate for Payer: Humana Medicare |
$33.32
|
| Rate for Payer: Lucent All Commercial |
$56.64
|
| Rate for Payer: Lutheran Preferred All Commercial |
$35.00
|
| Rate for Payer: PHCS All Commercial |
$77.22
|
| Rate for Payer: PHP All Commercial |
$33.48
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$33.32
|
| Rate for Payer: Signature Care EPO |
$44.84
|
| Rate for Payer: Signature Care PPO |
$44.84
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$34.00
|
| Rate for Payer: United Healthcare Commercial |
$12.71
|
| Rate for Payer: United Healthcare Medicare |
$33.32
|
|
|
PR PLACEMENT,SETON
|
Professional
|
$209.88
|
|
|
Service Code
|
CPT 46020
|
| Hospital Charge Code |
z46020
|
| Min. Negotiated Rate |
$107.56 |
| Max. Negotiated Rate |
$291.20 |
| Rate for Payer: Aetna Medicare |
$107.56
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$291.20
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$291.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$123.69
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$118.32
|
| Rate for Payer: Cash Price |
$130.13
|
| Rate for Payer: Cash Price |
$130.13
|
| Rate for Payer: Coventry All Commercial |
$129.07
|
| Rate for Payer: Frontpath All Commercial |
$150.53
|
| Rate for Payer: Humana ChoiceCare |
$214.13
|
| Rate for Payer: Humana Medicare |
$107.56
|
| Rate for Payer: Lucent All Commercial |
$182.85
|
| Rate for Payer: Lutheran Preferred All Commercial |
$161.00
|
| Rate for Payer: PHCS All Commercial |
$157.41
|
| Rate for Payer: PHP All Commercial |
$183.64
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$107.56
|
| Rate for Payer: Signature Care EPO |
$183.33
|
| Rate for Payer: Signature Care PPO |
$183.33
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$151.00
|
| Rate for Payer: United Healthcare Commercial |
$231.96
|
| Rate for Payer: United Healthcare Medicare |
$107.56
|
|
|
PR PLASTY KNEE,MED OR LAT COMPARTMT
|
Professional
|
$2,070.42
|
|
|
Service Code
|
CPT 27446
|
| Hospital Charge Code |
z27446
|
| Min. Negotiated Rate |
$1,061.09 |
| Max. Negotiated Rate |
$1,803.85 |
| Rate for Payer: Aetna Medicare |
$1,061.09
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,220.25
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,167.20
|
| Rate for Payer: Cash Price |
$1,283.66
|
| Rate for Payer: Cash Price |
$1,283.66
|
| Rate for Payer: Coventry All Commercial |
$1,273.31
|
| Rate for Payer: Frontpath All Commercial |
$1,501.40
|
| Rate for Payer: Humana ChoiceCare |
$1,190.93
|
| Rate for Payer: Humana Medicare |
$1,061.09
|
| Rate for Payer: Lucent All Commercial |
$1,803.85
|
| Rate for Payer: PHCS All Commercial |
$1,552.82
|
| Rate for Payer: PHP All Commercial |
$1,801.27
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,061.09
|
| Rate for Payer: Signature Care EPO |
$1,586.95
|
| Rate for Payer: Signature Care PPO |
$1,586.95
|
| Rate for Payer: United Healthcare Commercial |
$1,226.53
|
| Rate for Payer: United Healthcare Medicare |
$1,061.09
|
|
|
PR POLIOMYELITIS IMMUNIZATN,INACTV,SUB-Q
|
Professional
|
$56.90
|
|
|
Service Code
|
CPT 90713
|
| Hospital Charge Code |
z90713
|
| Min. Negotiated Rate |
$32.01 |
| Max. Negotiated Rate |
$56.90 |
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$38.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$38.00
|
| Rate for Payer: Frontpath All Commercial |
$32.01
|
| Rate for Payer: Humana ChoiceCare |
$46.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$56.90
|
| Rate for Payer: PHP All Commercial |
$42.62
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$56.90
|
|
|
PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND
|
Professional
|
$1,101.08
|
|
|
Service Code
|
CPT 95810
|
| Hospital Charge Code |
z95810
|
| Min. Negotiated Rate |
$564.31 |
| Max. Negotiated Rate |
$972.73 |
| Rate for Payer: Aetna Medicare |
$564.31
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$586.26
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$586.26
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$648.96
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$620.74
|
| Rate for Payer: Cash Price |
$682.67
|
| Rate for Payer: Cash Price |
$682.67
|
| Rate for Payer: Coventry All Commercial |
$677.17
|
| Rate for Payer: Frontpath All Commercial |
$634.21
|
| Rate for Payer: Humana ChoiceCare |
$972.73
|
| Rate for Payer: Humana Medicare |
$564.31
|
| Rate for Payer: Lucent All Commercial |
$959.33
|
| Rate for Payer: Lutheran Preferred All Commercial |
$734.00
|
| Rate for Payer: PHCS All Commercial |
$825.81
|
| Rate for Payer: PHP All Commercial |
$908.40
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$564.31
|
| Rate for Payer: Signature Care EPO |
$852.55
|
| Rate for Payer: Signature Care PPO |
$852.55
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$677.00
|
| Rate for Payer: United Healthcare Commercial |
$885.23
|
| Rate for Payer: United Healthcare Medicare |
$564.31
|
|
|
PR POLYSOM 6/>YRS SLEEP W/CPAP 4/> ADDL PARAM ATTND
|
Professional
|
$1,151.40
|
|
|
Service Code
|
CPT 95811
|
| Hospital Charge Code |
z95811
|
| Min. Negotiated Rate |
$590.10 |
| Max. Negotiated Rate |
$1,062.69 |
| Rate for Payer: Aetna Medicare |
$590.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$616.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$616.00
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$678.62
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$649.11
|
| Rate for Payer: Cash Price |
$713.87
|
| Rate for Payer: Cash Price |
$713.87
|
| Rate for Payer: Coventry All Commercial |
$708.12
|
| Rate for Payer: Frontpath All Commercial |
$662.06
|
| Rate for Payer: Humana ChoiceCare |
$1,062.69
|
| Rate for Payer: Humana Medicare |
$590.10
|
| Rate for Payer: Lucent All Commercial |
$1,003.17
|
| Rate for Payer: Lutheran Preferred All Commercial |
$767.00
|
| Rate for Payer: PHCS All Commercial |
$863.55
|
| Rate for Payer: PHP All Commercial |
$949.91
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$590.10
|
| Rate for Payer: Signature Care EPO |
$784.24
|
| Rate for Payer: Signature Care PPO |
$784.24
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$708.00
|
| Rate for Payer: United Healthcare Commercial |
$975.34
|
| Rate for Payer: United Healthcare Medicare |
$590.10
|
|
|
PR POST COLPORRHAPHY,RECTUM/VAGINA
|
Professional
|
$1,127.56
|
|
|
Service Code
|
CPT 57250
|
| Hospital Charge Code |
z57250
|
| Min. Negotiated Rate |
$401.13 |
| Max. Negotiated Rate |
$982.40 |
| Rate for Payer: Aetna Medicare |
$577.88
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$477.25
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$477.25
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$664.56
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$635.67
|
| Rate for Payer: Cash Price |
$699.09
|
| Rate for Payer: Cash Price |
$699.09
|
| Rate for Payer: Coventry All Commercial |
$693.46
|
| Rate for Payer: Frontpath All Commercial |
$806.94
|
| Rate for Payer: Humana ChoiceCare |
$401.13
|
| Rate for Payer: Humana Medicare |
$577.88
|
| Rate for Payer: Lucent All Commercial |
$982.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$809.00
|
| Rate for Payer: PHCS All Commercial |
$845.67
|
| Rate for Payer: PHP All Commercial |
$744.20
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$577.88
|
| Rate for Payer: Signature Care EPO |
$552.76
|
| Rate for Payer: Signature Care PPO |
$552.76
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$751.00
|
| Rate for Payer: United Healthcare Commercial |
$733.13
|
| Rate for Payer: United Healthcare Medicare |
$577.88
|
|
|
PR POST-OP FOLLOW-UP VISIT
|
Professional
|
$10.00
|
|
|
Service Code
|
CPT 99024
|
| Hospital Charge Code |
z99024
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$10.00 |
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$10.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$10.00
|
|
|
PR PPPS, SUBSEQ VISIT
|
Professional
|
$130.00
|
|
|
Service Code
|
CPT G0439
|
| Hospital Charge Code |
zG0439
|
| Min. Negotiated Rate |
$97.50 |
| Max. Negotiated Rate |
$208.35 |
| Rate for Payer: Aetna Medicare |
$122.56
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$145.20
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$145.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$140.94
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$134.82
|
| Rate for Payer: Cash Price |
$80.60
|
| Rate for Payer: Cash Price |
$80.60
|
| Rate for Payer: Coventry All Commercial |
$147.07
|
| Rate for Payer: Humana ChoiceCare |
$104.18
|
| Rate for Payer: Humana Medicare |
$122.56
|
| Rate for Payer: Lucent All Commercial |
$208.35
|
| Rate for Payer: PHCS All Commercial |
$97.50
|
| Rate for Payer: PHP All Commercial |
$123.16
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$122.56
|
| Rate for Payer: Signature Care EPO |
$105.64
|
| Rate for Payer: Signature Care PPO |
$105.64
|
| Rate for Payer: United Healthcare Commercial |
$114.16
|
| Rate for Payer: United Healthcare Medicare |
$122.56
|
|
|
PR PPSV23 VACCINE 2 YRS OR OLDER FOR SUBQ/IM USE
|
Professional
|
$163.91
|
|
|
Service Code
|
CPT 90732
|
| Hospital Charge Code |
z90732
|
| Min. Negotiated Rate |
$128.79 |
| Max. Negotiated Rate |
$163.91 |
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$133.47
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$133.47
|
| Rate for Payer: Frontpath All Commercial |
$146.82
|
| Rate for Payer: Humana ChoiceCare |
$133.47
|
| Rate for Payer: Lutheran Preferred All Commercial |
$163.91
|
| Rate for Payer: PHP All Commercial |
$128.79
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$163.91
|
| Rate for Payer: United Healthcare Commercial |
$140.50
|
|
|
PR PREDNISOLONE ORAL PER 5 MG
|
Professional
|
$0.23
|
|
|
Service Code
|
CPT J7510
|
| Hospital Charge Code |
zJ7510
|
| Min. Negotiated Rate |
$0.23 |
| Max. Negotiated Rate |
$0.23 |
| Rate for Payer: Humana ChoiceCare |
$0.23
|
| Rate for Payer: United Healthcare Commercial |
$0.23
|
|
