|
PR PRESSURIZED/NONPRESSURIZED INHALATION TREATMENT
|
Professional
|
$15.98
|
|
|
Service Code
|
CPT 94640
|
| Hospital Charge Code |
z94640
|
| Min. Negotiated Rate |
$8.19 |
| Max. Negotiated Rate |
$25.05 |
| Rate for Payer: Aetna Medicare |
$8.19
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$25.05
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$25.05
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$9.42
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$9.01
|
| Rate for Payer: Cash Price |
$9.91
|
| Rate for Payer: Cash Price |
$9.91
|
| Rate for Payer: Coventry All Commercial |
$9.83
|
| Rate for Payer: Frontpath All Commercial |
$11.54
|
| Rate for Payer: Humana ChoiceCare |
$14.83
|
| Rate for Payer: Humana Medicare |
$8.19
|
| Rate for Payer: Lucent All Commercial |
$13.92
|
| Rate for Payer: Lutheran Preferred All Commercial |
$11.00
|
| Rate for Payer: PHCS All Commercial |
$11.98
|
| Rate for Payer: PHP All Commercial |
$10.78
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$8.19
|
| Rate for Payer: Signature Care EPO |
$16.15
|
| Rate for Payer: Signature Care PPO |
$16.15
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$10.00
|
| Rate for Payer: United Healthcare Commercial |
$15.03
|
| Rate for Payer: United Healthcare Medicare |
$8.19
|
|
|
PR PREVENTIVE VISIT,EST,12-17
|
Professional
|
$210.12
|
|
|
Service Code
|
CPT 99394
|
| Hospital Charge Code |
z99394
|
| Min. Negotiated Rate |
$68.97 |
| Max. Negotiated Rate |
$157.59 |
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$124.43
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$124.43
|
| Rate for Payer: Cash Price |
$130.27
|
| Rate for Payer: Cash Price |
$130.27
|
| Rate for Payer: Frontpath All Commercial |
$85.84
|
| Rate for Payer: Humana ChoiceCare |
$70.22
|
| Rate for Payer: Lutheran Preferred All Commercial |
$84.00
|
| Rate for Payer: PHCS All Commercial |
$157.59
|
| Rate for Payer: PHP All Commercial |
$79.98
|
| Rate for Payer: Signature Care EPO |
$85.00
|
| Rate for Payer: Signature Care PPO |
$85.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$82.00
|
| Rate for Payer: United Healthcare Commercial |
$68.97
|
|
|
PR PREVENTIVE VISIT,EST,18-39
|
Professional
|
$214.94
|
|
|
Service Code
|
CPT 99395
|
| Hospital Charge Code |
z99395
|
| Min. Negotiated Rate |
$68.97 |
| Max. Negotiated Rate |
$161.20 |
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$116.76
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$116.76
|
| Rate for Payer: Cash Price |
$133.26
|
| Rate for Payer: Cash Price |
$133.26
|
| Rate for Payer: Frontpath All Commercial |
$88.25
|
| Rate for Payer: Humana ChoiceCare |
$70.22
|
| Rate for Payer: Lutheran Preferred All Commercial |
$86.00
|
| Rate for Payer: PHCS All Commercial |
$161.20
|
| Rate for Payer: PHP All Commercial |
$82.47
|
| Rate for Payer: Signature Care EPO |
$86.70
|
| Rate for Payer: Signature Care PPO |
$86.70
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$85.00
|
| Rate for Payer: United Healthcare Commercial |
$68.97
|
|
|
PR PREVENTIVE VISIT,EST,40-64
|
Professional
|
$228.48
|
|
|
Service Code
|
CPT 99396
|
| Hospital Charge Code |
z99396
|
| Min. Negotiated Rate |
$77.73 |
| Max. Negotiated Rate |
$171.36 |
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$131.20
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$131.20
|
| Rate for Payer: Cash Price |
$141.66
|
| Rate for Payer: Cash Price |
$141.66
|
| Rate for Payer: Frontpath All Commercial |
$97.08
|
| Rate for Payer: Humana ChoiceCare |
$79.23
|
| Rate for Payer: Lutheran Preferred All Commercial |
$93.00
|
| Rate for Payer: PHCS All Commercial |
$171.36
|
| Rate for Payer: PHP All Commercial |
$89.44
|
| Rate for Payer: Signature Care EPO |
$95.20
|
| Rate for Payer: Signature Care PPO |
$95.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$92.00
|
| Rate for Payer: United Healthcare Commercial |
$77.73
|
|
|
PR PREVENTIVE VISIT,EST,65 & OVER
|
Professional
|
$246.24
|
|
|
Service Code
|
CPT 99397
|
| Hospital Charge Code |
z99397
|
| Min. Negotiated Rate |
$86.98 |
| Max. Negotiated Rate |
$184.68 |
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$146.65
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$146.65
|
| Rate for Payer: Cash Price |
$152.67
|
| Rate for Payer: Cash Price |
$152.67
|
| Rate for Payer: Frontpath All Commercial |
$102.28
|
| Rate for Payer: Humana ChoiceCare |
$88.46
|
| Rate for Payer: Lutheran Preferred All Commercial |
$98.00
|
| Rate for Payer: PHCS All Commercial |
$184.68
|
| Rate for Payer: PHP All Commercial |
$93.93
|
| Rate for Payer: Signature Care EPO |
$105.40
|
| Rate for Payer: Signature Care PPO |
$105.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$96.00
|
| Rate for Payer: United Healthcare Commercial |
$86.98
|
|
|
PR PREVENTIVE VISIT,EST,AGE 1-4
|
Professional
|
$192.68
|
|
|
Service Code
|
CPT 99392
|
| Hospital Charge Code |
z99392
|
| Min. Negotiated Rate |
$60.45 |
| Max. Negotiated Rate |
$144.51 |
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$108.98
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$108.98
|
| Rate for Payer: Cash Price |
$119.46
|
| Rate for Payer: Cash Price |
$119.46
|
| Rate for Payer: Frontpath All Commercial |
$75.83
|
| Rate for Payer: Humana ChoiceCare |
$61.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$74.00
|
| Rate for Payer: PHCS All Commercial |
$144.51
|
| Rate for Payer: PHP All Commercial |
$70.69
|
| Rate for Payer: Signature Care EPO |
$78.20
|
| Rate for Payer: Signature Care PPO |
$78.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$72.00
|
| Rate for Payer: United Healthcare Commercial |
$60.45
|
|
|
PR PREVENTIVE VISIT,EST,AGE5-11
|
Professional
|
$192.08
|
|
|
Service Code
|
CPT 99393
|
| Hospital Charge Code |
z99393
|
| Min. Negotiated Rate |
$60.45 |
| Max. Negotiated Rate |
$144.06 |
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$108.98
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$108.98
|
| Rate for Payer: Cash Price |
$119.09
|
| Rate for Payer: Cash Price |
$119.09
|
| Rate for Payer: Frontpath All Commercial |
$75.83
|
| Rate for Payer: Humana ChoiceCare |
$61.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$74.00
|
| Rate for Payer: PHCS All Commercial |
$144.06
|
| Rate for Payer: PHP All Commercial |
$70.69
|
| Rate for Payer: Signature Care EPO |
$77.35
|
| Rate for Payer: Signature Care PPO |
$77.35
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$72.00
|
| Rate for Payer: United Healthcare Commercial |
$60.45
|
|
|
PR PREVENTIVE VISIT,EST, INFANT < 1 YR
|
Professional
|
$180.44
|
|
|
Service Code
|
CPT 99391
|
| Hospital Charge Code |
z99391
|
| Min. Negotiated Rate |
$51.70 |
| Max. Negotiated Rate |
$135.33 |
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$100.71
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$100.71
|
| Rate for Payer: Cash Price |
$111.87
|
| Rate for Payer: Cash Price |
$111.87
|
| Rate for Payer: Frontpath All Commercial |
$69.63
|
| Rate for Payer: Humana ChoiceCare |
$52.71
|
| Rate for Payer: Lutheran Preferred All Commercial |
$67.00
|
| Rate for Payer: PHCS All Commercial |
$135.33
|
| Rate for Payer: PHP All Commercial |
$64.39
|
| Rate for Payer: Signature Care EPO |
$69.70
|
| Rate for Payer: Signature Care PPO |
$69.70
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$66.00
|
| Rate for Payer: United Healthcare Commercial |
$51.70
|
|
|
PR PREVENTIVE VISIT,NEW,12-17
|
Professional
|
$245.64
|
|
|
Service Code
|
CPT 99384
|
| Hospital Charge Code |
z99384
|
| Min. Negotiated Rate |
$77.73 |
| Max. Negotiated Rate |
$184.23 |
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$139.89
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$139.89
|
| Rate for Payer: Cash Price |
$152.30
|
| Rate for Payer: Cash Price |
$152.30
|
| Rate for Payer: Frontpath All Commercial |
$102.28
|
| Rate for Payer: Humana ChoiceCare |
$79.23
|
| Rate for Payer: Lutheran Preferred All Commercial |
$98.00
|
| Rate for Payer: PHCS All Commercial |
$184.23
|
| Rate for Payer: PHP All Commercial |
$93.93
|
| Rate for Payer: Signature Care EPO |
$105.40
|
| Rate for Payer: Signature Care PPO |
$105.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$96.00
|
| Rate for Payer: United Healthcare Commercial |
$77.73
|
|
|
PR PREVENTIVE VISIT,NEW,18-39
|
Professional
|
$238.54
|
|
|
Service Code
|
CPT 99385
|
| Hospital Charge Code |
z99385
|
| Min. Negotiated Rate |
$77.73 |
| Max. Negotiated Rate |
$178.90 |
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$131.20
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$131.20
|
| Rate for Payer: Cash Price |
$147.89
|
| Rate for Payer: Cash Price |
$147.89
|
| Rate for Payer: Frontpath All Commercial |
$98.11
|
| Rate for Payer: Humana ChoiceCare |
$79.23
|
| Rate for Payer: Lutheran Preferred All Commercial |
$94.00
|
| Rate for Payer: PHCS All Commercial |
$178.90
|
| Rate for Payer: PHP All Commercial |
$90.28
|
| Rate for Payer: Signature Care EPO |
$105.40
|
| Rate for Payer: Signature Care PPO |
$105.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$93.00
|
| Rate for Payer: United Healthcare Commercial |
$77.73
|
|
|
PR PREVENTIVE VISIT,NEW,40-64
|
Professional
|
$275.32
|
|
|
Service Code
|
CPT 99386
|
| Hospital Charge Code |
z99386
|
| Min. Negotiated Rate |
$95.38 |
| Max. Negotiated Rate |
$206.49 |
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$161.10
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$161.10
|
| Rate for Payer: Cash Price |
$170.70
|
| Rate for Payer: Cash Price |
$170.70
|
| Rate for Payer: Frontpath All Commercial |
$118.88
|
| Rate for Payer: Humana ChoiceCare |
$97.13
|
| Rate for Payer: Lutheran Preferred All Commercial |
$114.00
|
| Rate for Payer: PHCS All Commercial |
$206.49
|
| Rate for Payer: PHP All Commercial |
$109.53
|
| Rate for Payer: Signature Care EPO |
$124.10
|
| Rate for Payer: Signature Care PPO |
$124.10
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$112.00
|
| Rate for Payer: United Healthcare Commercial |
$95.38
|
|
|
PR PREVENTIVE VISIT,NEW,65 & OVER
|
Professional
|
$298.94
|
|
|
Service Code
|
CPT 99387
|
| Hospital Charge Code |
z99387
|
| Min. Negotiated Rate |
$104.63 |
| Max. Negotiated Rate |
$224.20 |
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$175.54
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$175.54
|
| Rate for Payer: Cash Price |
$185.34
|
| Rate for Payer: Cash Price |
$185.34
|
| Rate for Payer: Frontpath All Commercial |
$127.51
|
| Rate for Payer: Humana ChoiceCare |
$106.35
|
| Rate for Payer: Lutheran Preferred All Commercial |
$123.00
|
| Rate for Payer: PHCS All Commercial |
$224.20
|
| Rate for Payer: PHP All Commercial |
$117.66
|
| Rate for Payer: Signature Care EPO |
$134.30
|
| Rate for Payer: Signature Care PPO |
$134.30
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$121.00
|
| Rate for Payer: United Healthcare Commercial |
$104.63
|
|
|
PR PREVENTIVE VISIT,NEW,AGE 1-4
|
Professional
|
$216.00
|
|
|
Service Code
|
CPT 99382
|
| Hospital Charge Code |
z99382
|
| Min. Negotiated Rate |
$68.97 |
| Max. Negotiated Rate |
$162.00 |
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$124.43
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$124.43
|
| Rate for Payer: Cash Price |
$133.92
|
| Rate for Payer: Cash Price |
$133.92
|
| Rate for Payer: Frontpath All Commercial |
$81.03
|
| Rate for Payer: Humana ChoiceCare |
$70.22
|
| Rate for Payer: Lutheran Preferred All Commercial |
$79.00
|
| Rate for Payer: PHCS All Commercial |
$162.00
|
| Rate for Payer: PHP All Commercial |
$75.34
|
| Rate for Payer: Signature Care EPO |
$98.60
|
| Rate for Payer: Signature Care PPO |
$98.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$77.00
|
| Rate for Payer: United Healthcare Commercial |
$68.97
|
|
|
PR PREVENTIVE VISIT,NEW,AGE5-11
|
Professional
|
$217.94
|
|
|
Service Code
|
CPT 99383
|
| Hospital Charge Code |
z99383
|
| Min. Negotiated Rate |
$68.97 |
| Max. Negotiated Rate |
$163.46 |
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$124.43
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$124.43
|
| Rate for Payer: Cash Price |
$135.12
|
| Rate for Payer: Cash Price |
$135.12
|
| Rate for Payer: Frontpath All Commercial |
$85.84
|
| Rate for Payer: Humana ChoiceCare |
$70.22
|
| Rate for Payer: Lutheran Preferred All Commercial |
$84.00
|
| Rate for Payer: PHCS All Commercial |
$163.46
|
| Rate for Payer: PHP All Commercial |
$79.98
|
| Rate for Payer: Signature Care EPO |
$96.90
|
| Rate for Payer: Signature Care PPO |
$96.90
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$82.00
|
| Rate for Payer: United Healthcare Commercial |
$68.97
|
|
|
PR PREVENTIVE VISIT,NEW,INFANT < 1 YR
|
Professional
|
$216.00
|
|
|
Service Code
|
CPT 99381
|
| Hospital Charge Code |
z99381
|
| Min. Negotiated Rate |
$60.45 |
| Max. Negotiated Rate |
$162.00 |
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$112.99
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$112.99
|
| Rate for Payer: Cash Price |
$133.92
|
| Rate for Payer: Cash Price |
$133.92
|
| Rate for Payer: Frontpath All Commercial |
$75.83
|
| Rate for Payer: Humana ChoiceCare |
$61.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$74.00
|
| Rate for Payer: PHCS All Commercial |
$162.00
|
| Rate for Payer: PHP All Commercial |
$70.69
|
| Rate for Payer: Signature Care EPO |
$91.80
|
| Rate for Payer: Signature Care PPO |
$91.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$72.00
|
| Rate for Payer: United Healthcare Commercial |
$60.45
|
|
|
PR PREV MED CNSL&/RSK FCTR RDCTJ INDV APPROX 15 MIN
|
Professional
|
$70.94
|
|
|
Service Code
|
CPT 99401
|
| Hospital Charge Code |
z99401
|
| Min. Negotiated Rate |
$22.89 |
| Max. Negotiated Rate |
$53.20 |
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$42.75
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$42.75
|
| Rate for Payer: Cash Price |
$43.98
|
| Rate for Payer: Cash Price |
$43.98
|
| Rate for Payer: Frontpath All Commercial |
$24.59
|
| Rate for Payer: Humana ChoiceCare |
$24.88
|
| Rate for Payer: Lutheran Preferred All Commercial |
$24.00
|
| Rate for Payer: PHCS All Commercial |
$53.20
|
| Rate for Payer: PHP All Commercial |
$22.89
|
| Rate for Payer: Signature Care EPO |
$37.40
|
| Rate for Payer: Signature Care PPO |
$37.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$23.00
|
| Rate for Payer: United Healthcare Commercial |
$24.32
|
|
|
PR PREV MED CNSL&/RSK FCTR RDCTJ INDV APPROX 30 MIN
|
Professional
|
$116.08
|
|
|
Service Code
|
CPT 99402
|
| Hospital Charge Code |
z99402
|
| Min. Negotiated Rate |
$46.13 |
| Max. Negotiated Rate |
$87.06 |
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$82.10
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$82.10
|
| Rate for Payer: Cash Price |
$71.97
|
| Rate for Payer: Cash Price |
$71.97
|
| Rate for Payer: Frontpath All Commercial |
$50.27
|
| Rate for Payer: Humana ChoiceCare |
$50.17
|
| Rate for Payer: Lutheran Preferred All Commercial |
$48.00
|
| Rate for Payer: PHCS All Commercial |
$87.06
|
| Rate for Payer: PHP All Commercial |
$46.13
|
| Rate for Payer: Signature Care EPO |
$62.90
|
| Rate for Payer: Signature Care PPO |
$62.90
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$47.00
|
| Rate for Payer: United Healthcare Commercial |
$49.38
|
|
|
PR PRGRMG DEV EVAL 1 LEAD PM/LDLS PM 1 CAR CHMBR IP
|
Professional
|
$125.24
|
|
|
Service Code
|
CPT 93279
|
| Hospital Charge Code |
z93279
|
| Min. Negotiated Rate |
$64.19 |
| Max. Negotiated Rate |
$109.12 |
| Rate for Payer: Aetna Medicare |
$64.19
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$78.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$78.30
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$73.82
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$70.61
|
| Rate for Payer: Cash Price |
$77.65
|
| Rate for Payer: Cash Price |
$77.65
|
| Rate for Payer: Coventry All Commercial |
$77.03
|
| Rate for Payer: Frontpath All Commercial |
$73.61
|
| Rate for Payer: Humana ChoiceCare |
$71.42
|
| Rate for Payer: Humana Medicare |
$64.19
|
| Rate for Payer: Lucent All Commercial |
$109.12
|
| Rate for Payer: Lutheran Preferred All Commercial |
$103.00
|
| Rate for Payer: PHCS All Commercial |
$93.93
|
| Rate for Payer: PHP All Commercial |
$92.05
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$64.19
|
| Rate for Payer: Signature Care EPO |
$80.40
|
| Rate for Payer: Signature Care PPO |
$80.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$96.00
|
| Rate for Payer: United Healthcare Commercial |
$65.69
|
| Rate for Payer: United Healthcare Medicare |
$64.19
|
|
|
PR PRGRMG DEV EVAL IMPLANTABLE SUBQ LEAD DFB SYSTEM
|
Professional
|
$141.50
|
|
|
Service Code
|
CPT 93260
|
| Hospital Charge Code |
z93260
|
| Min. Negotiated Rate |
$72.52 |
| Max. Negotiated Rate |
$123.28 |
| Rate for Payer: Aetna Medicare |
$72.52
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$91.81
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$91.81
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$83.40
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$79.77
|
| Rate for Payer: Cash Price |
$87.73
|
| Rate for Payer: Cash Price |
$87.73
|
| Rate for Payer: Coventry All Commercial |
$87.02
|
| Rate for Payer: Frontpath All Commercial |
$83.09
|
| Rate for Payer: Humana ChoiceCare |
$87.25
|
| Rate for Payer: Humana Medicare |
$72.52
|
| Rate for Payer: Lucent All Commercial |
$123.28
|
| Rate for Payer: Lutheran Preferred All Commercial |
$116.00
|
| Rate for Payer: PHCS All Commercial |
$106.12
|
| Rate for Payer: PHP All Commercial |
$104.00
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$72.52
|
| Rate for Payer: Signature Care EPO |
$101.60
|
| Rate for Payer: Signature Care PPO |
$101.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$109.00
|
| Rate for Payer: United Healthcare Commercial |
$80.79
|
| Rate for Payer: United Healthcare Medicare |
$72.52
|
|
|
PR PRGRMG DEV EVAL SCRMS PHYS/QHP IN PERSON
|
Professional
|
$111.82
|
|
|
Service Code
|
CPT 93285
|
| Hospital Charge Code |
z93285
|
| Min. Negotiated Rate |
$56.51 |
| Max. Negotiated Rate |
$97.43 |
| Rate for Payer: Aetna Medicare |
$57.31
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$67.36
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$67.36
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$65.91
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$63.04
|
| Rate for Payer: Cash Price |
$69.33
|
| Rate for Payer: Cash Price |
$69.33
|
| Rate for Payer: Coventry All Commercial |
$68.77
|
| Rate for Payer: Frontpath All Commercial |
$66.23
|
| Rate for Payer: Humana ChoiceCare |
$61.44
|
| Rate for Payer: Humana Medicare |
$57.31
|
| Rate for Payer: Lucent All Commercial |
$97.43
|
| Rate for Payer: Lutheran Preferred All Commercial |
$92.00
|
| Rate for Payer: PHCS All Commercial |
$83.86
|
| Rate for Payer: PHP All Commercial |
$82.19
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$57.31
|
| Rate for Payer: Signature Care EPO |
$68.56
|
| Rate for Payer: Signature Care PPO |
$68.56
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$86.00
|
| Rate for Payer: United Healthcare Commercial |
$56.51
|
| Rate for Payer: United Healthcare Medicare |
$57.31
|
|
|
PR PRGRMG EVAL IMPLANTABLE IN PERSON MULTI LEAD DFB
|
Professional
|
$197.46
|
|
|
Service Code
|
CPT 93284
|
| Hospital Charge Code |
z93284
|
| Min. Negotiated Rate |
$101.20 |
| Max. Negotiated Rate |
$172.04 |
| Rate for Payer: Aetna Medicare |
$101.20
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$143.25
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$143.25
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$116.38
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$111.32
|
| Rate for Payer: Cash Price |
$122.43
|
| Rate for Payer: Cash Price |
$122.43
|
| Rate for Payer: Coventry All Commercial |
$121.44
|
| Rate for Payer: Frontpath All Commercial |
$116.05
|
| Rate for Payer: Humana ChoiceCare |
$130.65
|
| Rate for Payer: Humana Medicare |
$101.20
|
| Rate for Payer: Lucent All Commercial |
$172.04
|
| Rate for Payer: Lutheran Preferred All Commercial |
$162.00
|
| Rate for Payer: PHCS All Commercial |
$148.10
|
| Rate for Payer: PHP All Commercial |
$145.14
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$101.20
|
| Rate for Payer: Signature Care EPO |
$146.71
|
| Rate for Payer: Signature Care PPO |
$146.71
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$152.00
|
| Rate for Payer: United Healthcare Commercial |
$120.18
|
| Rate for Payer: United Healthcare Medicare |
$101.20
|
|
|
PR PRGRMG EVAL IMPLANTABLE IN PRSN DUAL LEAD DFB
|
Professional
|
$183.02
|
|
|
Service Code
|
CPT 93283
|
| Hospital Charge Code |
z93283
|
| Min. Negotiated Rate |
$93.80 |
| Max. Negotiated Rate |
$159.46 |
| Rate for Payer: Aetna Medicare |
$93.80
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$122.15
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$122.15
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$107.87
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$103.18
|
| Rate for Payer: Cash Price |
$113.47
|
| Rate for Payer: Cash Price |
$113.47
|
| Rate for Payer: Coventry All Commercial |
$112.56
|
| Rate for Payer: Frontpath All Commercial |
$107.72
|
| Rate for Payer: Humana ChoiceCare |
$111.41
|
| Rate for Payer: Humana Medicare |
$93.80
|
| Rate for Payer: Lucent All Commercial |
$159.46
|
| Rate for Payer: Lutheran Preferred All Commercial |
$150.00
|
| Rate for Payer: PHCS All Commercial |
$137.26
|
| Rate for Payer: PHP All Commercial |
$134.52
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$93.80
|
| Rate for Payer: Signature Care EPO |
$125.43
|
| Rate for Payer: Signature Care PPO |
$125.43
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$141.00
|
| Rate for Payer: United Healthcare Commercial |
$102.48
|
| Rate for Payer: United Healthcare Medicare |
$93.80
|
|
|
PR PRGRMNG DEV EVAL IMPLANTABLE IN PERSN 1 LD DFB
|
Professional
|
$149.34
|
|
|
Service Code
|
CPT 93282
|
| Hospital Charge Code |
z93282
|
| Min. Negotiated Rate |
$76.53 |
| Max. Negotiated Rate |
$130.10 |
| Rate for Payer: Aetna Medicare |
$76.53
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$100.22
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$100.22
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$88.01
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$84.18
|
| Rate for Payer: Cash Price |
$92.59
|
| Rate for Payer: Cash Price |
$92.59
|
| Rate for Payer: Coventry All Commercial |
$91.84
|
| Rate for Payer: Frontpath All Commercial |
$88.31
|
| Rate for Payer: Humana ChoiceCare |
$91.41
|
| Rate for Payer: Humana Medicare |
$76.53
|
| Rate for Payer: Lucent All Commercial |
$130.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$122.00
|
| Rate for Payer: PHCS All Commercial |
$112.00
|
| Rate for Payer: PHP All Commercial |
$109.76
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$76.53
|
| Rate for Payer: Signature Care EPO |
$102.92
|
| Rate for Payer: Signature Care PPO |
$102.92
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$115.00
|
| Rate for Payer: United Healthcare Commercial |
$84.08
|
| Rate for Payer: United Healthcare Medicare |
$76.53
|
|
|
PR PROCTOSIGMOIDOSCOPY,RIGID,DIAGNOS
|
Professional
|
$234.36
|
|
|
Service Code
|
CPT 45300
|
| Hospital Charge Code |
z45300
|
| Min. Negotiated Rate |
$29.54 |
| Max. Negotiated Rate |
$175.77 |
| Rate for Payer: Aetna Medicare |
$44.79
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$111.52
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$111.52
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$51.51
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$49.27
|
| Rate for Payer: Cash Price |
$145.30
|
| Rate for Payer: Cash Price |
$145.30
|
| Rate for Payer: Coventry All Commercial |
$53.75
|
| Rate for Payer: Frontpath All Commercial |
$61.53
|
| Rate for Payer: Humana ChoiceCare |
$29.54
|
| Rate for Payer: Humana Medicare |
$44.79
|
| Rate for Payer: Lucent All Commercial |
$76.14
|
| Rate for Payer: Lutheran Preferred All Commercial |
$67.00
|
| Rate for Payer: PHCS All Commercial |
$175.77
|
| Rate for Payer: PHP All Commercial |
$76.46
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$44.79
|
| Rate for Payer: Signature Care EPO |
$103.93
|
| Rate for Payer: Signature Care PPO |
$103.93
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$63.00
|
| Rate for Payer: United Healthcare Commercial |
$54.53
|
| Rate for Payer: United Healthcare Medicare |
$44.79
|
|
|
PR PROFES SVC,IMMUNOTHER,SINGLE/MULT AGS
|
Professional
|
$27.18
|
|
|
Service Code
|
CPT 95165
|
| Hospital Charge Code |
z95165
|
| Min. Negotiated Rate |
$3.12 |
| Max. Negotiated Rate |
$20.38 |
| Rate for Payer: Aetna Medicare |
$3.12
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$9.54
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$9.54
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$3.59
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3.43
|
| Rate for Payer: Cash Price |
$16.85
|
| Rate for Payer: Cash Price |
$16.85
|
| Rate for Payer: Coventry All Commercial |
$3.74
|
| Rate for Payer: Frontpath All Commercial |
$3.21
|
| Rate for Payer: Humana ChoiceCare |
$11.85
|
| Rate for Payer: Humana Medicare |
$3.12
|
| Rate for Payer: Lucent All Commercial |
$5.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4.00
|
| Rate for Payer: PHCS All Commercial |
$20.38
|
| Rate for Payer: PHP All Commercial |
$3.50
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$3.12
|
| Rate for Payer: Signature Care EPO |
$12.22
|
| Rate for Payer: Signature Care PPO |
$12.22
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4.00
|
| Rate for Payer: United Healthcare Commercial |
$3.80
|
| Rate for Payer: United Healthcare Medicare |
$3.12
|
|
