|
PR PROFES SVC, IMMUNOTHER, SUBLINGUAL 3 MON
|
Professional
|
$318.00
|
|
|
Service Code
|
CPT 95165
|
| Hospital Charge Code |
z95165A
|
| Min. Negotiated Rate |
$3.12 |
| Max. Negotiated Rate |
$238.50 |
| 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 |
$197.16
|
| Rate for Payer: Cash Price |
$197.16
|
| 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 |
$238.50
|
| 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
|
|
|
PR PROFES SVC, IMMUNOTHER, SUBLINGUAL 6 MON
|
Professional
|
$399.60
|
|
|
Service Code
|
CPT 95165
|
| Hospital Charge Code |
z95165B
|
| Min. Negotiated Rate |
$3.12 |
| Max. Negotiated Rate |
$299.70 |
| 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 |
$247.75
|
| Rate for Payer: Cash Price |
$247.75
|
| 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 |
$299.70
|
| 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
|
|
|
PR PROGRAM EVAL IMPLANTABLE IN PERSN DUAL LD PACER
|
Professional
|
$147.02
|
|
|
Service Code
|
CPT 93280
|
| Hospital Charge Code |
z93280
|
| Min. Negotiated Rate |
$75.35 |
| Max. Negotiated Rate |
$128.10 |
| Rate for Payer: Aetna Medicare |
$75.35
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$92.81
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$92.81
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$86.65
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$82.88
|
| Rate for Payer: Cash Price |
$91.15
|
| Rate for Payer: Cash Price |
$91.15
|
| Rate for Payer: Coventry All Commercial |
$90.42
|
| Rate for Payer: Frontpath All Commercial |
$87.35
|
| Rate for Payer: Humana ChoiceCare |
$84.65
|
| Rate for Payer: Humana Medicare |
$75.35
|
| Rate for Payer: Lucent All Commercial |
$128.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$121.00
|
| Rate for Payer: PHCS All Commercial |
$110.26
|
| Rate for Payer: PHP All Commercial |
$108.07
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$75.35
|
| Rate for Payer: Signature Care EPO |
$95.31
|
| Rate for Payer: Signature Care PPO |
$95.31
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$113.00
|
| Rate for Payer: United Healthcare Commercial |
$77.86
|
| Rate for Payer: United Healthcare Medicare |
$75.35
|
|
|
PR PROGRAM EVAL IMPLANTABLE IN PRSN MULTI LD PACER
|
Professional
|
$156.56
|
|
|
Service Code
|
CPT 93281
|
| Hospital Charge Code |
z93281
|
| Min. Negotiated Rate |
$80.24 |
| Max. Negotiated Rate |
$136.41 |
| Rate for Payer: Aetna Medicare |
$80.24
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$108.50
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$108.50
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$92.28
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$88.26
|
| Rate for Payer: Cash Price |
$97.07
|
| Rate for Payer: Cash Price |
$97.07
|
| Rate for Payer: Coventry All Commercial |
$96.29
|
| Rate for Payer: Frontpath All Commercial |
$92.48
|
| Rate for Payer: Humana ChoiceCare |
$98.96
|
| Rate for Payer: Humana Medicare |
$80.24
|
| Rate for Payer: Lucent All Commercial |
$136.41
|
| Rate for Payer: Lutheran Preferred All Commercial |
$128.00
|
| Rate for Payer: PHCS All Commercial |
$117.42
|
| Rate for Payer: PHP All Commercial |
$115.07
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$80.24
|
| Rate for Payer: Signature Care EPO |
$111.06
|
| Rate for Payer: Signature Care PPO |
$111.06
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$120.00
|
| Rate for Payer: United Healthcare Commercial |
$91.03
|
| Rate for Payer: United Healthcare Medicare |
$80.24
|
|
|
PR PROLONGED OUTPATIENT E/M SERVICE EACH 15 MINUTES
|
Professional
|
$57.86
|
|
|
Service Code
|
CPT 99417
|
| Hospital Charge Code |
z99417
|
| Min. Negotiated Rate |
$24.52 |
| Max. Negotiated Rate |
$43.40 |
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$31.52
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$31.52
|
| Rate for Payer: Cash Price |
$35.87
|
| Rate for Payer: Cash Price |
$35.87
|
| Rate for Payer: Frontpath All Commercial |
$31.17
|
| Rate for Payer: Humana ChoiceCare |
$30.58
|
| Rate for Payer: Lutheran Preferred All Commercial |
$30.00
|
| Rate for Payer: PHCS All Commercial |
$43.40
|
| Rate for Payer: PHP All Commercial |
$28.86
|
| Rate for Payer: Signature Care EPO |
$24.52
|
| Rate for Payer: Signature Care PPO |
$24.52
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$30.00
|
| Rate for Payer: United Healthcare Commercial |
$33.62
|
|
|
PR PROLONGED SVC OUTPATIENT SETTING 1ST HOUR
|
Professional
|
$242.10
|
|
|
Service Code
|
CPT 99354
|
| Hospital Charge Code |
z99354
|
| Min. Negotiated Rate |
$96.89 |
| Max. Negotiated Rate |
$205.78 |
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$125.90
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$125.90
|
| Rate for Payer: Cash Price |
$150.10
|
| Rate for Payer: Cash Price |
$150.10
|
| Rate for Payer: Frontpath All Commercial |
$122.43
|
| Rate for Payer: Humana ChoiceCare |
$96.89
|
| Rate for Payer: Lutheran Preferred All Commercial |
$205.78
|
| Rate for Payer: PHCS All Commercial |
$181.58
|
| Rate for Payer: Signature Care EPO |
$102.89
|
| Rate for Payer: Signature Care PPO |
$102.89
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$145.26
|
|
|
PR PROLONG INPT EVAL ADD15 M
|
Professional
|
$57.24
|
|
|
Service Code
|
CPT G0316
|
| Hospital Charge Code |
zG0316
|
| Min. Negotiated Rate |
$29.03 |
| Max. Negotiated Rate |
$49.35 |
| Rate for Payer: Aetna Medicare |
$29.03
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$33.38
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$31.93
|
| Rate for Payer: Cash Price |
$35.49
|
| Rate for Payer: Cash Price |
$35.49
|
| Rate for Payer: Coventry All Commercial |
$34.84
|
| Rate for Payer: Humana Medicare |
$29.03
|
| Rate for Payer: Lucent All Commercial |
$49.35
|
| Rate for Payer: PHCS All Commercial |
$42.93
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$29.03
|
| Rate for Payer: United Healthcare Commercial |
$32.70
|
| Rate for Payer: United Healthcare Medicare |
$29.03
|
|
|
PR PROLONG OUTPT/OFFICE VIS
|
Professional
|
$61.24
|
|
|
Service Code
|
CPT G2212
|
| Hospital Charge Code |
zG2212
|
| Min. Negotiated Rate |
$25.20 |
| Max. Negotiated Rate |
$50.40 |
| Rate for Payer: Aetna Medicare |
$29.65
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$34.10
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$32.62
|
| Rate for Payer: Cash Price |
$37.97
|
| Rate for Payer: Cash Price |
$37.97
|
| Rate for Payer: Coventry All Commercial |
$35.58
|
| Rate for Payer: Humana ChoiceCare |
$25.20
|
| Rate for Payer: Humana Medicare |
$29.65
|
| Rate for Payer: Lucent All Commercial |
$50.40
|
| Rate for Payer: PHCS All Commercial |
$45.93
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$29.65
|
| Rate for Payer: United Healthcare Commercial |
$33.62
|
| Rate for Payer: United Healthcare Medicare |
$29.65
|
|
|
PR PROMETHAZINE HCL INJECTION
|
Professional
|
$3.60
|
|
|
Service Code
|
CPT J2550
|
| Hospital Charge Code |
zJ2550
|
| Min. Negotiated Rate |
$3.22 |
| Max. Negotiated Rate |
$3.60 |
| Rate for Payer: Humana ChoiceCare |
$3.22
|
| Rate for Payer: PHP All Commercial |
$3.60
|
|
|
PR PRQ SKEL FIXATION CARP/MTCRPL FX DISLOCATE THUMB
|
Professional
|
$887.50
|
|
|
Service Code
|
CPT 26650
|
| Hospital Charge Code |
z26650
|
| Min. Negotiated Rate |
$454.85 |
| Max. Negotiated Rate |
$773.24 |
| Rate for Payer: Aetna Medicare |
$454.85
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$568.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$568.00
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$523.08
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$500.34
|
| Rate for Payer: Cash Price |
$550.25
|
| Rate for Payer: Cash Price |
$550.25
|
| Rate for Payer: Coventry All Commercial |
$545.82
|
| Rate for Payer: Frontpath All Commercial |
$621.04
|
| Rate for Payer: Humana ChoiceCare |
$532.59
|
| Rate for Payer: Humana Medicare |
$454.85
|
| Rate for Payer: Lucent All Commercial |
$773.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$728.00
|
| Rate for Payer: PHCS All Commercial |
$665.62
|
| Rate for Payer: PHP All Commercial |
$772.13
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$454.85
|
| Rate for Payer: Signature Care EPO |
$718.25
|
| Rate for Payer: Signature Care PPO |
$718.25
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$682.00
|
| Rate for Payer: United Healthcare Commercial |
$497.75
|
| Rate for Payer: United Healthcare Medicare |
$454.85
|
|
|
PR PSYCHIATRIC DIAGNOSTIC EVALUATION
|
Professional
|
$330.54
|
|
|
Service Code
|
CPT 90791
|
| Hospital Charge Code |
z90791
|
| Min. Negotiated Rate |
$92.50 |
| Max. Negotiated Rate |
$250.72 |
| Rate for Payer: Aetna Medicare |
$147.48
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$155.31
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$155.31
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$169.60
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$162.23
|
| Rate for Payer: Cash Price |
$204.93
|
| Rate for Payer: Cash Price |
$204.93
|
| Rate for Payer: Coventry All Commercial |
$176.98
|
| Rate for Payer: Frontpath All Commercial |
$168.20
|
| Rate for Payer: Humana ChoiceCare |
$92.50
|
| Rate for Payer: Humana Medicare |
$147.48
|
| Rate for Payer: Lucent All Commercial |
$250.72
|
| Rate for Payer: Lutheran Preferred All Commercial |
$192.00
|
| Rate for Payer: PHCS All Commercial |
$247.90
|
| Rate for Payer: PHP All Commercial |
$156.83
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$147.48
|
| Rate for Payer: Signature Care EPO |
$166.72
|
| Rate for Payer: Signature Care PPO |
$166.72
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$177.00
|
| Rate for Payer: United Healthcare Commercial |
$151.14
|
| Rate for Payer: United Healthcare Medicare |
$147.48
|
|
|
PR PSYCHIATRIC DIAGNOSTIC EVAL W/MEDICAL SERVICES
|
Professional
|
$368.66
|
|
|
Service Code
|
CPT 90792
|
| Hospital Charge Code |
z90792
|
| Min. Negotiated Rate |
$95.64 |
| Max. Negotiated Rate |
$283.41 |
| Rate for Payer: Aetna Medicare |
$166.71
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$165.87
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$165.87
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$191.72
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$183.38
|
| Rate for Payer: Cash Price |
$228.57
|
| Rate for Payer: Cash Price |
$228.57
|
| Rate for Payer: Coventry All Commercial |
$200.05
|
| Rate for Payer: Frontpath All Commercial |
$191.50
|
| Rate for Payer: Humana ChoiceCare |
$95.64
|
| Rate for Payer: Humana Medicare |
$166.71
|
| Rate for Payer: Lucent All Commercial |
$283.41
|
| Rate for Payer: Lutheran Preferred All Commercial |
$217.00
|
| Rate for Payer: PHCS All Commercial |
$276.50
|
| Rate for Payer: PHP All Commercial |
$177.28
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$166.71
|
| Rate for Payer: Signature Care EPO |
$163.34
|
| Rate for Payer: Signature Care PPO |
$163.34
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$200.00
|
| Rate for Payer: United Healthcare Commercial |
$156.29
|
| Rate for Payer: United Healthcare Medicare |
$166.71
|
|
|
PR PSYCHOANALYSIS
|
Professional
|
$178.68
|
|
|
Service Code
|
CPT 90845
|
| Hospital Charge Code |
z90845
|
| Min. Negotiated Rate |
$70.78 |
| Max. Negotiated Rate |
$138.89 |
| Rate for Payer: Aetna Medicare |
$81.70
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$79.70
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$79.70
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$93.96
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$89.87
|
| Rate for Payer: Cash Price |
$110.78
|
| Rate for Payer: Cash Price |
$110.78
|
| Rate for Payer: Coventry All Commercial |
$98.04
|
| Rate for Payer: Frontpath All Commercial |
$94.46
|
| Rate for Payer: Humana ChoiceCare |
$70.78
|
| Rate for Payer: Humana Medicare |
$81.70
|
| Rate for Payer: Lucent All Commercial |
$138.89
|
| Rate for Payer: Lutheran Preferred All Commercial |
$106.00
|
| Rate for Payer: PHCS All Commercial |
$134.01
|
| Rate for Payer: PHP All Commercial |
$86.88
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$81.70
|
| Rate for Payer: Signature Care EPO |
$98.60
|
| Rate for Payer: Signature Care PPO |
$98.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$98.00
|
| Rate for Payer: United Healthcare Commercial |
$97.93
|
| Rate for Payer: United Healthcare Medicare |
$81.70
|
|
|
PR PSYCHOTHERAPY COMPLEX INTERACTIVE
|
Professional
|
$28.16
|
|
|
Service Code
|
CPT 90785
|
| Hospital Charge Code |
z90785
|
| Min. Negotiated Rate |
$3.71 |
| Max. Negotiated Rate |
$21.91 |
| Rate for Payer: Aetna Medicare |
$12.89
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$4.77
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4.77
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$14.82
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$14.18
|
| Rate for Payer: Cash Price |
$17.46
|
| Rate for Payer: Cash Price |
$17.46
|
| Rate for Payer: Coventry All Commercial |
$15.47
|
| Rate for Payer: Frontpath All Commercial |
$14.37
|
| Rate for Payer: Humana ChoiceCare |
$3.71
|
| Rate for Payer: Humana Medicare |
$12.89
|
| Rate for Payer: Lucent All Commercial |
$21.91
|
| Rate for Payer: Lutheran Preferred All Commercial |
$17.00
|
| Rate for Payer: PHCS All Commercial |
$21.12
|
| Rate for Payer: PHP All Commercial |
$13.70
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$12.89
|
| Rate for Payer: Signature Care EPO |
$12.22
|
| Rate for Payer: Signature Care PPO |
$12.22
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$15.00
|
| Rate for Payer: United Healthcare Commercial |
$6.06
|
| Rate for Payer: United Healthcare Medicare |
$12.89
|
|
|
PR PSYCHOTHERAPY FOR CRISIS EACH ADDL 30 MINUTES
|
Professional
|
$131.22
|
|
|
Service Code
|
CPT 90840
|
| Hospital Charge Code |
z90840
|
| Min. Negotiated Rate |
$50.75 |
| Max. Negotiated Rate |
$114.65 |
| Rate for Payer: Aetna Medicare |
$60.45
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$64.98
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$64.98
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$69.52
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$66.50
|
| Rate for Payer: Cash Price |
$81.36
|
| Rate for Payer: Cash Price |
$81.36
|
| Rate for Payer: Coventry All Commercial |
$72.54
|
| Rate for Payer: Frontpath All Commercial |
$70.37
|
| Rate for Payer: Humana ChoiceCare |
$50.75
|
| Rate for Payer: Humana Medicare |
$60.45
|
| Rate for Payer: Lucent All Commercial |
$102.76
|
| Rate for Payer: Lutheran Preferred All Commercial |
$79.00
|
| Rate for Payer: PHCS All Commercial |
$98.42
|
| Rate for Payer: PHP All Commercial |
$64.29
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$60.45
|
| Rate for Payer: Signature Care EPO |
$58.07
|
| Rate for Payer: Signature Care PPO |
$58.07
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$73.00
|
| Rate for Payer: United Healthcare Commercial |
$114.65
|
| Rate for Payer: United Healthcare Medicare |
$60.45
|
|
|
PR PSYCHOTHERAPY FOR CRISIS INITIAL 60 MINUTES
|
Professional
|
$266.72
|
|
|
Service Code
|
CPT 90839
|
| Hospital Charge Code |
z90839
|
| Min. Negotiated Rate |
$105.62 |
| Max. Negotiated Rate |
$221.39 |
| Rate for Payer: Aetna Medicare |
$121.88
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$129.95
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$129.95
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$140.16
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$134.07
|
| Rate for Payer: Cash Price |
$165.37
|
| Rate for Payer: Cash Price |
$165.37
|
| Rate for Payer: Coventry All Commercial |
$146.26
|
| Rate for Payer: Frontpath All Commercial |
$139.44
|
| Rate for Payer: Humana ChoiceCare |
$105.62
|
| Rate for Payer: Humana Medicare |
$121.88
|
| Rate for Payer: Lucent All Commercial |
$207.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$158.00
|
| Rate for Payer: PHCS All Commercial |
$200.04
|
| Rate for Payer: PHP All Commercial |
$129.61
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$121.88
|
| Rate for Payer: Signature Care EPO |
$151.11
|
| Rate for Payer: Signature Care PPO |
$151.11
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$146.00
|
| Rate for Payer: United Healthcare Commercial |
$221.39
|
| Rate for Payer: United Healthcare Medicare |
$121.88
|
|
|
PR PSYCHOTHERAPY W/PATIENT 30 MINUTES
|
Professional
|
$143.18
|
|
|
Service Code
|
CPT 90832
|
| Hospital Charge Code |
z90832
|
| Min. Negotiated Rate |
$38.86 |
| Max. Negotiated Rate |
$110.57 |
| Rate for Payer: Aetna Medicare |
$65.04
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$65.72
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$65.72
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$74.80
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$71.54
|
| Rate for Payer: Cash Price |
$88.77
|
| Rate for Payer: Cash Price |
$88.77
|
| Rate for Payer: Coventry All Commercial |
$78.05
|
| Rate for Payer: Frontpath All Commercial |
$75.27
|
| Rate for Payer: Humana ChoiceCare |
$38.86
|
| Rate for Payer: Humana Medicare |
$65.04
|
| Rate for Payer: Lucent All Commercial |
$110.57
|
| Rate for Payer: Lutheran Preferred All Commercial |
$85.00
|
| Rate for Payer: PHCS All Commercial |
$107.38
|
| Rate for Payer: PHP All Commercial |
$69.17
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$65.04
|
| Rate for Payer: Signature Care EPO |
$69.45
|
| Rate for Payer: Signature Care PPO |
$69.45
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$78.00
|
| Rate for Payer: United Healthcare Commercial |
$63.50
|
| Rate for Payer: United Healthcare Medicare |
$65.04
|
|
|
PR PSYCHOTHERAPY W/PATIENT 45 MINUTES
|
Professional
|
$189.16
|
|
|
Service Code
|
CPT 90834
|
| Hospital Charge Code |
z90834
|
| Min. Negotiated Rate |
$58.35 |
| Max. Negotiated Rate |
$146.42 |
| Rate for Payer: Aetna Medicare |
$86.13
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$90.84
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$90.84
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$99.05
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$94.74
|
| Rate for Payer: Cash Price |
$117.28
|
| Rate for Payer: Cash Price |
$117.28
|
| Rate for Payer: Coventry All Commercial |
$103.36
|
| Rate for Payer: Frontpath All Commercial |
$99.10
|
| Rate for Payer: Humana ChoiceCare |
$58.35
|
| Rate for Payer: Humana Medicare |
$86.13
|
| Rate for Payer: Lucent All Commercial |
$146.42
|
| Rate for Payer: Lutheran Preferred All Commercial |
$112.00
|
| Rate for Payer: PHCS All Commercial |
$141.87
|
| Rate for Payer: PHP All Commercial |
$91.60
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$86.13
|
| Rate for Payer: Signature Care EPO |
$90.24
|
| Rate for Payer: Signature Care PPO |
$90.24
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$103.00
|
| Rate for Payer: United Healthcare Commercial |
$95.38
|
| Rate for Payer: United Healthcare Medicare |
$86.13
|
|
|
PR PSYCHOTHERAPY W/PATIENT 60 MINUTES
|
Professional
|
$278.60
|
|
|
Service Code
|
CPT 90837
|
| Hospital Charge Code |
z90837
|
| Min. Negotiated Rate |
$87.99 |
| Max. Negotiated Rate |
$215.44 |
| Rate for Payer: Aetna Medicare |
$126.73
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$133.86
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$133.86
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$145.74
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$139.40
|
| Rate for Payer: Cash Price |
$172.73
|
| Rate for Payer: Cash Price |
$172.73
|
| Rate for Payer: Coventry All Commercial |
$152.08
|
| Rate for Payer: Frontpath All Commercial |
$145.18
|
| Rate for Payer: Humana ChoiceCare |
$87.99
|
| Rate for Payer: Humana Medicare |
$126.73
|
| Rate for Payer: Lucent All Commercial |
$215.44
|
| Rate for Payer: Lutheran Preferred All Commercial |
$165.00
|
| Rate for Payer: PHCS All Commercial |
$208.95
|
| Rate for Payer: PHP All Commercial |
$134.77
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$126.73
|
| Rate for Payer: Signature Care EPO |
$132.22
|
| Rate for Payer: Signature Care PPO |
$132.22
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$152.00
|
| Rate for Payer: United Healthcare Commercial |
$143.80
|
| Rate for Payer: United Healthcare Medicare |
$126.73
|
|
|
PR PSYCHOTHERAPY W/PATIENT W/E&M SRVCS 30 MIN
|
Professional
|
$130.58
|
|
|
Service Code
|
CPT 90833
|
| Hospital Charge Code |
z90833
|
| Min. Negotiated Rate |
$24.73 |
| Max. Negotiated Rate |
$102.22 |
| Rate for Payer: Aetna Medicare |
$60.13
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$24.73
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$24.73
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$69.15
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$66.14
|
| Rate for Payer: Cash Price |
$80.96
|
| Rate for Payer: Cash Price |
$80.96
|
| Rate for Payer: Coventry All Commercial |
$72.16
|
| Rate for Payer: Frontpath All Commercial |
$69.40
|
| Rate for Payer: Humana ChoiceCare |
$32.51
|
| Rate for Payer: Humana Medicare |
$60.13
|
| Rate for Payer: Lucent All Commercial |
$102.22
|
| Rate for Payer: Lutheran Preferred All Commercial |
$78.00
|
| Rate for Payer: PHCS All Commercial |
$97.94
|
| Rate for Payer: PHP All Commercial |
$63.95
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$60.13
|
| Rate for Payer: Signature Care EPO |
$58.06
|
| Rate for Payer: Signature Care PPO |
$58.06
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$72.00
|
| Rate for Payer: United Healthcare Commercial |
$53.13
|
| Rate for Payer: United Healthcare Medicare |
$60.13
|
|
|
PR PSYCHOTHERAPY W/PATIENT W/E&M SRVCS 45 MIN
|
Professional
|
$165.48
|
|
|
Service Code
|
CPT 90836
|
| Hospital Charge Code |
z90836
|
| Min. Negotiated Rate |
$27.89 |
| Max. Negotiated Rate |
$129.49 |
| Rate for Payer: Aetna Medicare |
$76.17
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$27.89
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$27.89
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$87.60
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$83.79
|
| Rate for Payer: Cash Price |
$102.60
|
| Rate for Payer: Cash Price |
$102.60
|
| Rate for Payer: Coventry All Commercial |
$91.40
|
| Rate for Payer: Frontpath All Commercial |
$87.47
|
| Rate for Payer: Humana ChoiceCare |
$53.25
|
| Rate for Payer: Humana Medicare |
$76.17
|
| Rate for Payer: Lucent All Commercial |
$129.49
|
| Rate for Payer: Lutheran Preferred All Commercial |
$99.00
|
| Rate for Payer: PHCS All Commercial |
$124.11
|
| Rate for Payer: PHP All Commercial |
$81.00
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$76.17
|
| Rate for Payer: Signature Care EPO |
$75.44
|
| Rate for Payer: Signature Care PPO |
$75.44
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$91.00
|
| Rate for Payer: United Healthcare Commercial |
$87.00
|
| Rate for Payer: United Healthcare Medicare |
$76.17
|
|
|
PR PSYCHOTHERAPY W/PATIENT W/E&M SRVCS 60 MIN
|
Professional
|
$218.76
|
|
|
Service Code
|
CPT 90838
|
| Hospital Charge Code |
z90838
|
| Min. Negotiated Rate |
$41.37 |
| Max. Negotiated Rate |
$171.70 |
| Rate for Payer: Aetna Medicare |
$101.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$41.37
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$41.37
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$116.15
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$111.10
|
| Rate for Payer: Cash Price |
$135.63
|
| Rate for Payer: Cash Price |
$135.63
|
| Rate for Payer: Coventry All Commercial |
$121.20
|
| Rate for Payer: Frontpath All Commercial |
$115.67
|
| Rate for Payer: Humana ChoiceCare |
$85.46
|
| Rate for Payer: Humana Medicare |
$101.00
|
| Rate for Payer: Lucent All Commercial |
$171.70
|
| Rate for Payer: Lutheran Preferred All Commercial |
$131.00
|
| Rate for Payer: PHCS All Commercial |
$164.07
|
| Rate for Payer: PHP All Commercial |
$107.40
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$101.00
|
| Rate for Payer: Signature Care EPO |
$121.80
|
| Rate for Payer: Signature Care PPO |
$121.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$121.00
|
| Rate for Payer: United Healthcare Commercial |
$139.64
|
| Rate for Payer: United Healthcare Medicare |
$101.00
|
|
|
PR PUNCH BIOPSY SKIN EA SEP/ADDITIONAL LESION
|
Professional
|
$108.14
|
|
|
Service Code
|
CPT 11105
|
| Hospital Charge Code |
z11105
|
| Min. Negotiated Rate |
$23.93 |
| Max. Negotiated Rate |
$81.10 |
| Rate for Payer: Aetna Medicare |
$23.93
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$27.52
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$26.32
|
| Rate for Payer: Cash Price |
$67.05
|
| Rate for Payer: Cash Price |
$67.05
|
| Rate for Payer: Coventry All Commercial |
$28.72
|
| Rate for Payer: Frontpath All Commercial |
$32.97
|
| Rate for Payer: Humana ChoiceCare |
$25.98
|
| Rate for Payer: Humana Medicare |
$23.93
|
| Rate for Payer: Lucent All Commercial |
$40.68
|
| Rate for Payer: PHCS All Commercial |
$81.10
|
| Rate for Payer: PHP All Commercial |
$32.69
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$23.93
|
| Rate for Payer: Signature Care EPO |
$57.61
|
| Rate for Payer: Signature Care PPO |
$57.61
|
| Rate for Payer: United Healthcare Commercial |
$33.09
|
| Rate for Payer: United Healthcare Medicare |
$23.93
|
|
|
PR PUNCH BIOPSY SKIN SINGLE LESION
|
Professional
|
$229.70
|
|
|
Service Code
|
CPT 11104
|
| Hospital Charge Code |
z11104
|
| Min. Negotiated Rate |
$43.94 |
| Max. Negotiated Rate |
$172.28 |
| Rate for Payer: Aetna Medicare |
$43.94
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$50.53
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$48.33
|
| Rate for Payer: Cash Price |
$142.41
|
| Rate for Payer: Cash Price |
$142.41
|
| Rate for Payer: Coventry All Commercial |
$52.73
|
| Rate for Payer: Frontpath All Commercial |
$60.26
|
| Rate for Payer: Humana ChoiceCare |
$47.64
|
| Rate for Payer: Humana Medicare |
$43.94
|
| Rate for Payer: Lucent All Commercial |
$74.70
|
| Rate for Payer: PHCS All Commercial |
$172.28
|
| Rate for Payer: PHP All Commercial |
$60.01
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$43.94
|
| Rate for Payer: Signature Care EPO |
$117.21
|
| Rate for Payer: Signature Care PPO |
$117.21
|
| Rate for Payer: United Healthcare Commercial |
$60.68
|
| Rate for Payer: United Healthcare Medicare |
$43.94
|
|
|
PR PUNCTURE ASPIRATION ABSCESS HEMATOMA BULLA/CYST
|
Professional
|
$237.38
|
|
|
Service Code
|
CPT 10160
|
| Hospital Charge Code |
z10160
|
| Min. Negotiated Rate |
$84.87 |
| Max. Negotiated Rate |
$178.04 |
| Rate for Payer: Signature Care PPO |
$104.81
|
| Rate for Payer: Aetna Medicare |
$90.17
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$93.94
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$93.94
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$103.70
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$99.19
|
| Rate for Payer: Cash Price |
$147.18
|
| Rate for Payer: Cash Price |
$147.18
|
| Rate for Payer: Coventry All Commercial |
$108.20
|
| Rate for Payer: Frontpath All Commercial |
$120.63
|
| Rate for Payer: Humana ChoiceCare |
$84.87
|
| Rate for Payer: Humana Medicare |
$90.17
|
| Rate for Payer: Lucent All Commercial |
$153.29
|
| Rate for Payer: Lutheran Preferred All Commercial |
$117.00
|
| Rate for Payer: PHCS All Commercial |
$178.04
|
| Rate for Payer: PHP All Commercial |
$123.16
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$90.17
|
| Rate for Payer: Signature Care EPO |
$104.81
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$108.00
|
| Rate for Payer: United Healthcare Commercial |
$103.06
|
| Rate for Payer: United Healthcare Medicare |
$90.17
|
|
