|
PR RMVL TUN CTR VAD W/SUBQ PORT/PMP CTR/PRPH INSJ
|
Professional
|
$404.46
|
|
|
Service Code
|
CPT 36590
|
| Hospital Charge Code |
z36590
|
| Min. Negotiated Rate |
$174.87 |
| Max. Negotiated Rate |
$470.40 |
| Rate for Payer: Aetna Medicare |
$174.87
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$470.40
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$470.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$201.10
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$192.36
|
| Rate for Payer: Cash Price |
$250.77
|
| Rate for Payer: Cash Price |
$250.77
|
| Rate for Payer: Coventry All Commercial |
$209.84
|
| Rate for Payer: Frontpath All Commercial |
$247.04
|
| Rate for Payer: Humana ChoiceCare |
$249.76
|
| Rate for Payer: Humana Medicare |
$174.87
|
| Rate for Payer: Lucent All Commercial |
$297.28
|
| Rate for Payer: Lutheran Preferred All Commercial |
$280.00
|
| Rate for Payer: PHCS All Commercial |
$303.34
|
| Rate for Payer: PHP All Commercial |
$290.02
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$174.87
|
| Rate for Payer: Signature Care EPO |
$359.45
|
| Rate for Payer: Signature Care PPO |
$359.45
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$262.00
|
| Rate for Payer: United Healthcare Commercial |
$231.09
|
| Rate for Payer: United Healthcare Medicare |
$174.87
|
|
|
PR ROUT OB CARE,C-SEC,PREV C-SEC
|
Professional
|
$4,729.96
|
|
|
Service Code
|
CPT 59618
|
| Hospital Charge Code |
z59618
|
| Min. Negotiated Rate |
$1,787.81 |
| Max. Negotiated Rate |
$4,121.24 |
| Rate for Payer: Aetna Medicare |
$2,424.26
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,021.25
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,021.25
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,787.90
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,666.69
|
| Rate for Payer: Cash Price |
$2,932.58
|
| Rate for Payer: Cash Price |
$2,932.58
|
| Rate for Payer: Coventry All Commercial |
$2,909.11
|
| Rate for Payer: Frontpath All Commercial |
$3,460.15
|
| Rate for Payer: Humana ChoiceCare |
$1,787.81
|
| Rate for Payer: Humana Medicare |
$2,424.26
|
| Rate for Payer: Lucent All Commercial |
$4,121.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,394.00
|
| Rate for Payer: PHCS All Commercial |
$3,547.47
|
| Rate for Payer: PHP All Commercial |
$3,121.77
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,424.26
|
| Rate for Payer: Signature Care EPO |
$2,306.05
|
| Rate for Payer: Signature Care PPO |
$2,306.05
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,152.00
|
| Rate for Payer: United Healthcare Commercial |
$2,328.48
|
| Rate for Payer: United Healthcare Medicare |
$2,424.26
|
|
|
PR ROUT OB CARE,VAG DELIV,PREV C-SEC
|
Professional
|
$4,431.32
|
|
|
Service Code
|
CPT 59610
|
| Hospital Charge Code |
z59610
|
| Min. Negotiated Rate |
$1,574.45 |
| Max. Negotiated Rate |
$3,860.78 |
| Rate for Payer: Aetna Medicare |
$2,271.05
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,021.25
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,021.25
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,611.71
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,498.16
|
| Rate for Payer: Cash Price |
$2,747.42
|
| Rate for Payer: Cash Price |
$2,747.42
|
| Rate for Payer: Coventry All Commercial |
$2,725.26
|
| Rate for Payer: Frontpath All Commercial |
$3,242.23
|
| Rate for Payer: Humana ChoiceCare |
$1,574.45
|
| Rate for Payer: Humana Medicare |
$2,271.05
|
| Rate for Payer: Lucent All Commercial |
$3,860.78
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,179.00
|
| Rate for Payer: PHCS All Commercial |
$3,323.49
|
| Rate for Payer: PHP All Commercial |
$2,924.67
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,271.05
|
| Rate for Payer: Signature Care EPO |
$2,029.80
|
| Rate for Payer: Signature Care PPO |
$2,029.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,952.00
|
| Rate for Payer: United Healthcare Commercial |
$2,069.74
|
| Rate for Payer: United Healthcare Medicare |
$2,271.05
|
|
|
PR RPR AA HERNIA 1ST 3-10 CM REDUCIBLE
|
Professional
|
$1,018.02
|
|
|
Service Code
|
CPT 49593
|
| Hospital Charge Code |
z49593
|
| Min. Negotiated Rate |
$521.89 |
| Max. Negotiated Rate |
$887.21 |
| Rate for Payer: Aetna Medicare |
$521.89
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$600.17
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$574.08
|
| Rate for Payer: Cash Price |
$631.17
|
| Rate for Payer: Cash Price |
$631.17
|
| Rate for Payer: Coventry All Commercial |
$626.27
|
| Rate for Payer: Humana ChoiceCare |
$521.89
|
| Rate for Payer: Humana Medicare |
$521.89
|
| Rate for Payer: Lucent All Commercial |
$887.21
|
| Rate for Payer: PHCS All Commercial |
$763.52
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$521.89
|
| Rate for Payer: United Healthcare Commercial |
$709.56
|
| Rate for Payer: United Healthcare Medicare |
$521.89
|
|
|
PR RPSG PREV IMPLTED PM/DFB R ATR/R VENTR ELECTRODE
|
Professional
|
$549.92
|
|
|
Service Code
|
CPT 33215
|
| Hospital Charge Code |
z33215
|
| Min. Negotiated Rate |
$281.84 |
| Max. Negotiated Rate |
$559.60 |
| Rate for Payer: Aetna Medicare |
$281.84
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$559.60
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$559.60
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$324.12
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$310.02
|
| Rate for Payer: Cash Price |
$340.95
|
| Rate for Payer: Cash Price |
$340.95
|
| Rate for Payer: Coventry All Commercial |
$338.21
|
| Rate for Payer: Frontpath All Commercial |
$405.03
|
| Rate for Payer: Humana ChoiceCare |
$385.84
|
| Rate for Payer: Humana Medicare |
$281.84
|
| Rate for Payer: Lucent All Commercial |
$479.13
|
| Rate for Payer: Lutheran Preferred All Commercial |
$451.00
|
| Rate for Payer: PHCS All Commercial |
$412.44
|
| Rate for Payer: PHP All Commercial |
$384.95
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$281.84
|
| Rate for Payer: Signature Care EPO |
$445.40
|
| Rate for Payer: Signature Care PPO |
$445.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$423.00
|
| Rate for Payer: United Healthcare Commercial |
$371.16
|
| Rate for Payer: United Healthcare Medicare |
$281.84
|
|
|
PR RV5 VACCINE 3 DOSE SCHEDULE LIVE FOR ORAL USE
|
Professional
|
$130.47
|
|
|
Service Code
|
CPT 90680
|
| Hospital Charge Code |
z90680
|
| Min. Negotiated Rate |
$87.50 |
| Max. Negotiated Rate |
$130.47 |
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$95.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$95.00
|
| Rate for Payer: Frontpath All Commercial |
$87.50
|
| Rate for Payer: Humana ChoiceCare |
$103.03
|
| Rate for Payer: Lutheran Preferred All Commercial |
$130.47
|
| Rate for Payer: PHP All Commercial |
$102.51
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$130.47
|
| Rate for Payer: United Healthcare Commercial |
$111.68
|
|
|
PR RX ECTOP PREG BY LAPAROSCOPE
|
Professional
|
$1,405.86
|
|
|
Service Code
|
CPT 59150
|
| Hospital Charge Code |
z59150
|
| Min. Negotiated Rate |
$693.79 |
| Max. Negotiated Rate |
$1,224.85 |
| Rate for Payer: Aetna Medicare |
$720.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,000.52
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,000.52
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$828.58
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$792.55
|
| Rate for Payer: Cash Price |
$871.63
|
| Rate for Payer: Cash Price |
$871.63
|
| Rate for Payer: Coventry All Commercial |
$864.60
|
| Rate for Payer: Frontpath All Commercial |
$1,030.99
|
| Rate for Payer: Humana ChoiceCare |
$693.79
|
| Rate for Payer: Humana Medicare |
$720.50
|
| Rate for Payer: Lucent All Commercial |
$1,224.85
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,009.00
|
| Rate for Payer: PHCS All Commercial |
$1,054.40
|
| Rate for Payer: PHP All Commercial |
$927.87
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$720.50
|
| Rate for Payer: Signature Care EPO |
$869.55
|
| Rate for Payer: Signature Care PPO |
$869.55
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$937.00
|
| Rate for Payer: United Healthcare Commercial |
$855.01
|
| Rate for Payer: United Healthcare Medicare |
$720.50
|
|
|
PR RX ECTOP PREG BY SCOPE,RMV TUBE/OVRY
|
Professional
|
$1,375.78
|
|
|
Service Code
|
CPT 59151
|
| Hospital Charge Code |
z59151
|
| Min. Negotiated Rate |
$688.21 |
| Max. Negotiated Rate |
$1,198.65 |
| Rate for Payer: Aetna Medicare |
$705.09
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$992.19
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$992.19
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$810.85
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$775.60
|
| Rate for Payer: Cash Price |
$852.98
|
| Rate for Payer: Cash Price |
$852.98
|
| Rate for Payer: Coventry All Commercial |
$846.11
|
| Rate for Payer: Frontpath All Commercial |
$1,008.63
|
| Rate for Payer: Humana ChoiceCare |
$688.21
|
| Rate for Payer: Humana Medicare |
$705.09
|
| Rate for Payer: Lucent All Commercial |
$1,198.65
|
| Rate for Payer: Lutheran Preferred All Commercial |
$987.00
|
| Rate for Payer: PHCS All Commercial |
$1,031.84
|
| Rate for Payer: PHP All Commercial |
$908.02
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$705.09
|
| Rate for Payer: Signature Care EPO |
$867.85
|
| Rate for Payer: Signature Care PPO |
$867.85
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$917.00
|
| Rate for Payer: United Healthcare Commercial |
$835.63
|
| Rate for Payer: United Healthcare Medicare |
$705.09
|
|
|
PR RX ECTOP PREG,UTER WALL,PART HYSTREC
|
Professional
|
$1,594.04
|
|
|
Service Code
|
CPT 59136
|
| Hospital Charge Code |
z59136
|
| Min. Negotiated Rate |
$777.75 |
| Max. Negotiated Rate |
$1,389.07 |
| Rate for Payer: Aetna Medicare |
$817.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,121.42
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,121.42
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$939.66
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$898.81
|
| Rate for Payer: Cash Price |
$988.30
|
| Rate for Payer: Cash Price |
$988.30
|
| Rate for Payer: Coventry All Commercial |
$980.52
|
| Rate for Payer: Frontpath All Commercial |
$1,171.64
|
| Rate for Payer: Humana ChoiceCare |
$777.75
|
| Rate for Payer: Humana Medicare |
$817.10
|
| Rate for Payer: Lucent All Commercial |
$1,389.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,144.00
|
| Rate for Payer: PHCS All Commercial |
$1,195.53
|
| Rate for Payer: PHP All Commercial |
$1,052.06
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$817.10
|
| Rate for Payer: Signature Care EPO |
$999.60
|
| Rate for Payer: Signature Care PPO |
$999.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,062.00
|
| Rate for Payer: United Healthcare Commercial |
$976.01
|
| Rate for Payer: United Healthcare Medicare |
$817.10
|
|
|
PR SARSCOV2 VACCINE 10MCG/0.2ML TRIS-SUCROSE IM USE
|
Professional
|
$0.01
|
|
|
Service Code
|
CPT 91307
|
| Hospital Charge Code |
z91307
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Humana ChoiceCare |
$0.01
|
| Rate for Payer: United Healthcare Commercial |
$0.01
|
|
|
PR SARSCOV2 VACCINE 30MCG/0.3ML TRIS-SUCROSE IM USE
|
Professional
|
$0.01
|
|
|
Service Code
|
CPT 91305
|
| Hospital Charge Code |
z91305
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Humana ChoiceCare |
$0.01
|
| Rate for Payer: United Healthcare Commercial |
$0.01
|
|
|
PR SARSCOV2 VACCINE 3MCG/0.2ML TRIS-SUCROSE IM USE
|
Professional
|
$0.01
|
|
|
Service Code
|
CPT 91308
|
| Hospital Charge Code |
z91308
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Humana ChoiceCare |
$0.01
|
| Rate for Payer: United Healthcare Commercial |
$0.01
|
|
|
PR SARSCOV2 VACCINE BIVALENT 10 MCG/0.2 ML IM USE
|
Professional
|
$0.01
|
|
|
Service Code
|
CPT 91315
|
| Hospital Charge Code |
z91315
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Humana ChoiceCare |
$0.01
|
| Rate for Payer: United Healthcare Commercial |
$0.01
|
|
|
PR SARSCOV2 VACCINE BIVALENT 30 MCG/0.3 ML IM USE
|
Professional
|
$0.01
|
|
|
Service Code
|
CPT 91312
|
| Hospital Charge Code |
z91312
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Humana ChoiceCare |
$0.01
|
| Rate for Payer: United Healthcare Commercial |
$0.01
|
|
|
PR SARSCOV2 VACCINE BIVALENT 3 MCG/0.2 ML IM USE
|
Professional
|
$0.01
|
|
|
Service Code
|
CPT 91317
|
| Hospital Charge Code |
z91317
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Humana ChoiceCare |
$0.01
|
| Rate for Payer: United Healthcare Commercial |
$0.01
|
|
|
PR SARSCOV2 VACCINE DIL RECON 30 MCG/0.3 ML IM USE
|
Professional
|
$0.01
|
|
|
Service Code
|
CPT 91300
|
| Hospital Charge Code |
z91300
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Humana ChoiceCare |
$0.01
|
| Rate for Payer: United Healthcare Commercial |
$0.01
|
|
|
PR SBSQ HOSPITAL IP/OBS CARE HIGH MDM 50 MINUTES
|
Professional
|
$220.96
|
|
|
Service Code
|
CPT 99233
|
| Hospital Charge Code |
z99233
|
| Min. Negotiated Rate |
$76.07 |
| Max. Negotiated Rate |
$192.52 |
| Rate for Payer: Aetna Medicare |
$113.25
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$105.51
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$105.51
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$130.24
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$124.58
|
| Rate for Payer: Cash Price |
$137.00
|
| Rate for Payer: Cash Price |
$137.00
|
| Rate for Payer: Coventry All Commercial |
$135.90
|
| Rate for Payer: Frontpath All Commercial |
$104.44
|
| Rate for Payer: Humana ChoiceCare |
$76.07
|
| Rate for Payer: Humana Medicare |
$113.25
|
| Rate for Payer: Lucent All Commercial |
$192.52
|
| Rate for Payer: Lutheran Preferred All Commercial |
$119.00
|
| Rate for Payer: PHCS All Commercial |
$165.72
|
| Rate for Payer: PHP All Commercial |
$113.80
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$113.25
|
| Rate for Payer: Signature Care EPO |
$85.80
|
| Rate for Payer: Signature Care PPO |
$85.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$117.00
|
| Rate for Payer: United Healthcare Commercial |
$97.61
|
| Rate for Payer: United Healthcare Medicare |
$113.25
|
|
|
PR SBSQ HOSPITAL IP/OBS CARE MOD MDM 35 MINUTES
|
Professional
|
$146.86
|
|
|
Service Code
|
CPT 99232
|
| Hospital Charge Code |
z99232
|
| Min. Negotiated Rate |
$53.54 |
| Max. Negotiated Rate |
$127.94 |
| Rate for Payer: Aetna Medicare |
$75.26
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$73.21
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$73.21
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$86.55
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$82.79
|
| Rate for Payer: Cash Price |
$91.05
|
| Rate for Payer: Cash Price |
$91.05
|
| Rate for Payer: Coventry All Commercial |
$90.31
|
| Rate for Payer: Frontpath All Commercial |
$72.70
|
| Rate for Payer: Humana ChoiceCare |
$53.54
|
| Rate for Payer: Humana Medicare |
$75.26
|
| Rate for Payer: Lucent All Commercial |
$127.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$79.00
|
| Rate for Payer: PHCS All Commercial |
$110.14
|
| Rate for Payer: PHP All Commercial |
$75.63
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$75.26
|
| Rate for Payer: Signature Care EPO |
$59.61
|
| Rate for Payer: Signature Care PPO |
$59.61
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$78.00
|
| Rate for Payer: United Healthcare Commercial |
$68.15
|
| Rate for Payer: United Healthcare Medicare |
$75.26
|
|
|
PR SBSQ HOSPITAL IP/OBS CARE SF/LOW MDM 25 MINUTES
|
Professional
|
$91.54
|
|
|
Service Code
|
CPT 99231
|
| Hospital Charge Code |
z99231
|
| Min. Negotiated Rate |
$32.65 |
| Max. Negotiated Rate |
$79.76 |
| Rate for Payer: Aetna Medicare |
$46.92
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$41.16
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$41.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$53.96
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$51.61
|
| Rate for Payer: Cash Price |
$56.75
|
| Rate for Payer: Cash Price |
$56.75
|
| Rate for Payer: Coventry All Commercial |
$56.30
|
| Rate for Payer: Frontpath All Commercial |
$39.63
|
| Rate for Payer: Humana ChoiceCare |
$32.65
|
| Rate for Payer: Humana Medicare |
$46.92
|
| Rate for Payer: Lucent All Commercial |
$79.76
|
| Rate for Payer: Lutheran Preferred All Commercial |
$49.00
|
| Rate for Payer: PHCS All Commercial |
$68.66
|
| Rate for Payer: PHP All Commercial |
$47.15
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$46.92
|
| Rate for Payer: Signature Care EPO |
$35.70
|
| Rate for Payer: Signature Care PPO |
$35.70
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$48.00
|
| Rate for Payer: United Healthcare Commercial |
$37.80
|
| Rate for Payer: United Healthcare Medicare |
$46.92
|
|
|
PR SBSQ NURSING FACILITY CARE HIGH MDM 45 MINUTES
|
Professional
|
$283.88
|
|
|
Service Code
|
CPT 99310
|
| Hospital Charge Code |
z99310
|
| Min. Negotiated Rate |
$99.95 |
| Max. Negotiated Rate |
$247.32 |
| Rate for Payer: Aetna Medicare |
$145.48
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$99.95
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$99.95
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$167.30
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$160.03
|
| Rate for Payer: Cash Price |
$176.01
|
| Rate for Payer: Cash Price |
$176.01
|
| Rate for Payer: Coventry All Commercial |
$174.58
|
| Rate for Payer: Frontpath All Commercial |
$135.11
|
| Rate for Payer: Humana ChoiceCare |
$101.27
|
| Rate for Payer: Humana Medicare |
$145.48
|
| Rate for Payer: Lucent All Commercial |
$247.32
|
| Rate for Payer: Lutheran Preferred All Commercial |
$153.00
|
| Rate for Payer: PHCS All Commercial |
$212.91
|
| Rate for Payer: PHP All Commercial |
$146.19
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$145.48
|
| Rate for Payer: Signature Care EPO |
$110.90
|
| Rate for Payer: Signature Care PPO |
$110.90
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$150.00
|
| Rate for Payer: United Healthcare Commercial |
$120.71
|
| Rate for Payer: United Healthcare Medicare |
$145.48
|
|
|
PR SBSQ NURSING FACILITY CARE LOW MDM 20 MINUTES
|
Professional
|
$137.28
|
|
|
Service Code
|
CPT 99308
|
| Hospital Charge Code |
z99308
|
| Min. Negotiated Rate |
$56.25 |
| Max. Negotiated Rate |
$119.61 |
| Rate for Payer: Aetna Medicare |
$70.36
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$56.71
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$56.71
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$80.91
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$77.40
|
| Rate for Payer: Cash Price |
$85.11
|
| Rate for Payer: Cash Price |
$85.11
|
| Rate for Payer: Coventry All Commercial |
$84.43
|
| Rate for Payer: Frontpath All Commercial |
$69.61
|
| Rate for Payer: Humana ChoiceCare |
$57.47
|
| Rate for Payer: Humana Medicare |
$70.36
|
| Rate for Payer: Lucent All Commercial |
$119.61
|
| Rate for Payer: Lutheran Preferred All Commercial |
$74.00
|
| Rate for Payer: PHCS All Commercial |
$102.96
|
| Rate for Payer: PHP All Commercial |
$70.70
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$70.36
|
| Rate for Payer: Signature Care EPO |
$56.25
|
| Rate for Payer: Signature Care PPO |
$56.25
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$72.00
|
| Rate for Payer: United Healthcare Commercial |
$61.52
|
| Rate for Payer: United Healthcare Medicare |
$70.36
|
|
|
PR SBSQ NURSING FACILITY CARE MOD MDM 30 MINUTES
|
Professional
|
$197.58
|
|
|
Service Code
|
CPT 99309
|
| Hospital Charge Code |
z99309
|
| Min. Negotiated Rate |
$74.80 |
| Max. Negotiated Rate |
$172.14 |
| Rate for Payer: Aetna Medicare |
$101.26
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$79.90
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$79.90
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$116.45
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$111.39
|
| Rate for Payer: Cash Price |
$122.50
|
| Rate for Payer: Cash Price |
$122.50
|
| Rate for Payer: Coventry All Commercial |
$121.51
|
| Rate for Payer: Frontpath All Commercial |
$91.59
|
| Rate for Payer: Humana ChoiceCare |
$80.96
|
| Rate for Payer: Humana Medicare |
$101.26
|
| Rate for Payer: Lucent All Commercial |
$172.14
|
| Rate for Payer: Lutheran Preferred All Commercial |
$106.00
|
| Rate for Payer: PHCS All Commercial |
$148.18
|
| Rate for Payer: PHP All Commercial |
$101.76
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$101.26
|
| Rate for Payer: Signature Care EPO |
$74.80
|
| Rate for Payer: Signature Care PPO |
$74.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$104.00
|
| Rate for Payer: United Healthcare Commercial |
$81.62
|
| Rate for Payer: United Healthcare Medicare |
$101.26
|
|
|
PR SBSQ NURSING FACILITY CARE SF MDM 10 MINUTES
|
Professional
|
$73.44
|
|
|
Service Code
|
CPT 99307
|
| Hospital Charge Code |
z99307
|
| Min. Negotiated Rate |
$34.13 |
| Max. Negotiated Rate |
$63.99 |
| Rate for Payer: Aetna Medicare |
$37.64
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$34.13
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$34.13
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$43.29
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$41.40
|
| Rate for Payer: Cash Price |
$45.53
|
| Rate for Payer: Cash Price |
$45.53
|
| Rate for Payer: Coventry All Commercial |
$45.17
|
| Rate for Payer: Frontpath All Commercial |
$44.11
|
| Rate for Payer: Humana ChoiceCare |
$34.58
|
| Rate for Payer: Humana Medicare |
$37.64
|
| Rate for Payer: Lucent All Commercial |
$63.99
|
| Rate for Payer: Lutheran Preferred All Commercial |
$40.00
|
| Rate for Payer: PHCS All Commercial |
$55.08
|
| Rate for Payer: PHP All Commercial |
$37.82
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$37.64
|
| Rate for Payer: Signature Care EPO |
$36.44
|
| Rate for Payer: Signature Care PPO |
$36.44
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$39.00
|
| Rate for Payer: United Healthcare Commercial |
$40.24
|
| Rate for Payer: United Healthcare Medicare |
$37.64
|
|
|
PR SECONDARY CLOSURE SURG WOUND/DEHSN XTNSV/COMP
|
Professional
|
$1,442.38
|
|
|
Service Code
|
CPT 13160
|
| Hospital Charge Code |
z13160
|
| Min. Negotiated Rate |
$668.38 |
| Max. Negotiated Rate |
$1,256.67 |
| Rate for Payer: Aetna Medicare |
$739.22
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$772.90
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$772.90
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$850.10
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$813.14
|
| Rate for Payer: Cash Price |
$894.28
|
| Rate for Payer: Cash Price |
$894.28
|
| Rate for Payer: Coventry All Commercial |
$887.06
|
| Rate for Payer: Frontpath All Commercial |
$1,031.85
|
| Rate for Payer: Humana ChoiceCare |
$668.38
|
| Rate for Payer: Humana Medicare |
$739.22
|
| Rate for Payer: Lucent All Commercial |
$1,256.67
|
| Rate for Payer: Lutheran Preferred All Commercial |
$961.00
|
| Rate for Payer: PHCS All Commercial |
$1,081.78
|
| Rate for Payer: PHP All Commercial |
$1,009.66
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$739.22
|
| Rate for Payer: Signature Care EPO |
$742.05
|
| Rate for Payer: Signature Care PPO |
$742.05
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$887.00
|
| Rate for Payer: United Healthcare Commercial |
$872.94
|
| Rate for Payer: United Healthcare Medicare |
$739.22
|
|
|
PR SELF-MEAS BP 2 READG 1 MIN APART BID 30 DAY PD
|
Professional
|
$34.34
|
|
|
Service Code
|
CPT 99474
|
| Hospital Charge Code |
z99474
|
| Min. Negotiated Rate |
$8.42 |
| Max. Negotiated Rate |
$25.76 |
| Rate for Payer: Aetna Medicare |
$8.42
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$9.68
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$9.26
|
| Rate for Payer: Cash Price |
$21.29
|
| Rate for Payer: Cash Price |
$21.29
|
| Rate for Payer: Coventry All Commercial |
$10.10
|
| Rate for Payer: Frontpath All Commercial |
$9.17
|
| Rate for Payer: Humana ChoiceCare |
$13.10
|
| Rate for Payer: Humana Medicare |
$8.42
|
| Rate for Payer: Lucent All Commercial |
$14.31
|
| Rate for Payer: PHCS All Commercial |
$25.76
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$8.42
|
| Rate for Payer: United Healthcare Commercial |
$9.12
|
| Rate for Payer: United Healthcare Medicare |
$8.42
|
|
