|
PR SELF-MEAS BP PT EDUCAJ/TRAING & DEV CALIBRATION
|
Professional
|
$26.10
|
|
|
Service Code
|
CPT 99473
|
| Hospital Charge Code |
z99473
|
| Min. Negotiated Rate |
$10.66 |
| Max. Negotiated Rate |
$19.69 |
| Rate for Payer: Aetna Medicare |
$11.58
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$13.32
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$12.74
|
| Rate for Payer: Cash Price |
$16.18
|
| Rate for Payer: Cash Price |
$16.18
|
| Rate for Payer: Coventry All Commercial |
$13.90
|
| Rate for Payer: Frontpath All Commercial |
$11.24
|
| Rate for Payer: Humana ChoiceCare |
$15.20
|
| Rate for Payer: Humana Medicare |
$11.58
|
| Rate for Payer: Lucent All Commercial |
$19.69
|
| Rate for Payer: PHCS All Commercial |
$19.58
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$11.58
|
| Rate for Payer: United Healthcare Commercial |
$10.66
|
| Rate for Payer: United Healthcare Medicare |
$11.58
|
|
|
PR SELF-MGMT EDUC & TRAIN, 1 PT, EA 30 MIN
|
Professional
|
$51.82
|
|
|
Service Code
|
CPT 98960
|
| Hospital Charge Code |
z98960
|
| Min. Negotiated Rate |
$27.18 |
| Max. Negotiated Rate |
$38.86 |
| Rate for Payer: Cash Price |
$32.13
|
| Rate for Payer: Cash Price |
$32.13
|
| Rate for Payer: Frontpath All Commercial |
$27.36
|
| Rate for Payer: Humana ChoiceCare |
$29.20
|
| Rate for Payer: PHCS All Commercial |
$38.86
|
| Rate for Payer: United Healthcare Commercial |
$27.18
|
|
|
PR SELF-MGMT EDUC/TRAIN, 2-4 PT, EA 30 MIN
|
Professional
|
$25.02
|
|
|
Service Code
|
CPT 98961
|
| Hospital Charge Code |
z98961
|
| Min. Negotiated Rate |
$12.82 |
| Max. Negotiated Rate |
$34.95 |
| Rate for Payer: Cash Price |
$15.51
|
| Rate for Payer: Cash Price |
$15.51
|
| Rate for Payer: Frontpath All Commercial |
$12.82
|
| Rate for Payer: Humana ChoiceCare |
$34.95
|
| Rate for Payer: PHCS All Commercial |
$18.76
|
| Rate for Payer: United Healthcare Commercial |
$13.10
|
|
|
PR SELF-MGMT EDUC/TRAIN, 5-8 PT, EA 30 MIN
|
Professional
|
$18.38
|
|
|
Service Code
|
CPT 98962
|
| Hospital Charge Code |
z98962
|
| Min. Negotiated Rate |
$9.63 |
| Max. Negotiated Rate |
$37.94 |
| Rate for Payer: Cash Price |
$11.40
|
| Rate for Payer: Cash Price |
$11.40
|
| Rate for Payer: Frontpath All Commercial |
$9.63
|
| Rate for Payer: Humana ChoiceCare |
$37.94
|
| Rate for Payer: PHCS All Commercial |
$13.78
|
| Rate for Payer: United Healthcare Commercial |
$9.79
|
|
|
PR SENSORINEURAL ACUITY TEST
|
Professional
|
$133.76
|
|
|
Service Code
|
CPT 92575
|
| Hospital Charge Code |
z92575
|
| Min. Negotiated Rate |
$11.80 |
| Max. Negotiated Rate |
$116.54 |
| Rate for Payer: Aetna Medicare |
$68.55
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$11.80
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$11.80
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$78.83
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$75.40
|
| Rate for Payer: Cash Price |
$82.93
|
| Rate for Payer: Cash Price |
$82.93
|
| Rate for Payer: Coventry All Commercial |
$82.26
|
| Rate for Payer: Frontpath All Commercial |
$72.22
|
| Rate for Payer: Humana ChoiceCare |
$12.44
|
| Rate for Payer: Humana Medicare |
$68.55
|
| Rate for Payer: Lucent All Commercial |
$116.54
|
| Rate for Payer: Lutheran Preferred All Commercial |
$89.00
|
| Rate for Payer: PHCS All Commercial |
$100.32
|
| Rate for Payer: PHP All Commercial |
$96.97
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$68.55
|
| Rate for Payer: Signature Care EPO |
$55.89
|
| Rate for Payer: Signature Care PPO |
$55.89
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$82.00
|
| Rate for Payer: United Healthcare Commercial |
$39.03
|
| Rate for Payer: United Healthcare Medicare |
$68.55
|
|
|
PR SGMDSC FLX DIRED SBMCSL NJX ANY SBST
|
Professional
|
$532.16
|
|
|
Service Code
|
CPT 45335
|
| Hospital Charge Code |
z45335
|
| Min. Negotiated Rate |
$61.88 |
| Max. Negotiated Rate |
$399.12 |
| Rate for Payer: Aetna Medicare |
$61.88
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$71.16
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$68.07
|
| Rate for Payer: Cash Price |
$329.94
|
| Rate for Payer: Cash Price |
$329.94
|
| Rate for Payer: Coventry All Commercial |
$74.26
|
| Rate for Payer: Frontpath All Commercial |
$84.32
|
| Rate for Payer: Humana ChoiceCare |
$96.77
|
| Rate for Payer: Humana Medicare |
$61.88
|
| Rate for Payer: Lucent All Commercial |
$105.20
|
| Rate for Payer: PHCS All Commercial |
$399.12
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$61.88
|
| Rate for Payer: United Healthcare Commercial |
$103.98
|
| Rate for Payer: United Healthcare Medicare |
$61.88
|
|
|
PR SGMDSC FLX RMVL TUM POLYP/OTH LES SNARE TQ
|
Professional
|
$546.70
|
|
|
Service Code
|
CPT 45338
|
| Hospital Charge Code |
z45338
|
| Min. Negotiated Rate |
$111.32 |
| Max. Negotiated Rate |
$410.02 |
| Rate for Payer: Aetna Medicare |
$111.32
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$128.02
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$122.45
|
| Rate for Payer: Cash Price |
$338.95
|
| Rate for Payer: Cash Price |
$338.95
|
| Rate for Payer: Coventry All Commercial |
$133.58
|
| Rate for Payer: Frontpath All Commercial |
$154.64
|
| Rate for Payer: Humana ChoiceCare |
$151.00
|
| Rate for Payer: Humana Medicare |
$111.32
|
| Rate for Payer: Lucent All Commercial |
$189.24
|
| Rate for Payer: PHCS All Commercial |
$410.02
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$111.32
|
| Rate for Payer: United Healthcare Commercial |
$161.95
|
| Rate for Payer: United Healthcare Medicare |
$111.32
|
|
|
PR SHAV SKIN LES <0.5 CM FACE,FACIAL
|
Professional
|
$213.26
|
|
|
Service Code
|
CPT 11310
|
| Hospital Charge Code |
z11310
|
| Min. Negotiated Rate |
$39.31 |
| Max. Negotiated Rate |
$159.94 |
| Rate for Payer: Aetna Medicare |
$42.92
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$49.36
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$47.21
|
| Rate for Payer: Cash Price |
$132.22
|
| Rate for Payer: Cash Price |
$132.22
|
| Rate for Payer: Coventry All Commercial |
$51.50
|
| Rate for Payer: Frontpath All Commercial |
$58.49
|
| Rate for Payer: Humana ChoiceCare |
$39.31
|
| Rate for Payer: Humana Medicare |
$42.92
|
| Rate for Payer: Lucent All Commercial |
$72.96
|
| Rate for Payer: PHCS All Commercial |
$159.94
|
| Rate for Payer: PHP All Commercial |
$58.62
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$42.92
|
| Rate for Payer: Signature Care EPO |
$93.59
|
| Rate for Payer: Signature Care PPO |
$93.59
|
| Rate for Payer: United Healthcare Commercial |
$47.65
|
| Rate for Payer: United Healthcare Medicare |
$42.92
|
|
|
PR SHAV SKIN LES <0.5 CM REMAINDER BODY
|
Professional
|
$194.24
|
|
|
Service Code
|
CPT 11305
|
| Hospital Charge Code |
z11305
|
| Min. Negotiated Rate |
$35.65 |
| Max. Negotiated Rate |
$145.68 |
| Rate for Payer: Lucent All Commercial |
$60.60
|
| Rate for Payer: PHCS All Commercial |
$145.68
|
| Rate for Payer: Aetna Medicare |
$35.65
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$41.00
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$39.22
|
| Rate for Payer: Cash Price |
$120.43
|
| Rate for Payer: Cash Price |
$120.43
|
| Rate for Payer: Coventry All Commercial |
$42.78
|
| Rate for Payer: Frontpath All Commercial |
$49.79
|
| Rate for Payer: Humana ChoiceCare |
$35.82
|
| Rate for Payer: Humana Medicare |
$35.65
|
| Rate for Payer: PHP All Commercial |
$48.69
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$35.65
|
| Rate for Payer: Signature Care EPO |
$86.31
|
| Rate for Payer: Signature Care PPO |
$86.31
|
| Rate for Payer: United Healthcare Commercial |
$41.61
|
| Rate for Payer: United Healthcare Medicare |
$35.65
|
|
|
PR SHAV SKIN LES < 0.5 CM TRUNK,ARM,LEG
|
Professional
|
$185.24
|
|
|
Service Code
|
CPT 11300
|
| Hospital Charge Code |
z11300
|
| Min. Negotiated Rate |
$27.03 |
| Max. Negotiated Rate |
$138.93 |
| Rate for Payer: Aetna Medicare |
$31.96
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$36.75
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$35.16
|
| Rate for Payer: Cash Price |
$114.85
|
| Rate for Payer: Cash Price |
$114.85
|
| Rate for Payer: Coventry All Commercial |
$38.35
|
| Rate for Payer: Frontpath All Commercial |
$43.99
|
| Rate for Payer: Humana ChoiceCare |
$27.03
|
| Rate for Payer: Humana Medicare |
$31.96
|
| Rate for Payer: Lucent All Commercial |
$54.33
|
| Rate for Payer: PHCS All Commercial |
$138.93
|
| Rate for Payer: PHP All Commercial |
$43.65
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$31.96
|
| Rate for Payer: Signature Care EPO |
$81.88
|
| Rate for Payer: Signature Care PPO |
$81.88
|
| Rate for Payer: United Healthcare Commercial |
$32.91
|
| Rate for Payer: United Healthcare Medicare |
$31.96
|
|
|
PR SHAV SKIN LES 0.6-1.0 CM TRUNK,ARM,LEG
|
Professional
|
$223.48
|
|
|
Service Code
|
CPT 11301
|
| Hospital Charge Code |
z11301
|
| Min. Negotiated Rate |
$45.92 |
| Max. Negotiated Rate |
$167.61 |
| Rate for Payer: Aetna Medicare |
$48.16
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$92.12
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$92.12
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$55.38
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$52.98
|
| Rate for Payer: Cash Price |
$138.56
|
| Rate for Payer: Cash Price |
$138.56
|
| Rate for Payer: Coventry All Commercial |
$57.79
|
| Rate for Payer: Frontpath All Commercial |
$65.46
|
| Rate for Payer: Humana ChoiceCare |
$45.92
|
| Rate for Payer: Humana Medicare |
$48.16
|
| Rate for Payer: Lucent All Commercial |
$81.87
|
| Rate for Payer: Lutheran Preferred All Commercial |
$63.00
|
| Rate for Payer: PHCS All Commercial |
$167.61
|
| Rate for Payer: PHP All Commercial |
$65.78
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$48.16
|
| Rate for Payer: Signature Care EPO |
$98.39
|
| Rate for Payer: Signature Care PPO |
$98.39
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$58.00
|
| Rate for Payer: United Healthcare Commercial |
$55.95
|
| Rate for Payer: United Healthcare Medicare |
$48.16
|
|
|
PR SHAV SKIN LES 1.1-2.0 CM REMAINDER BODY
|
Professional
|
$256.00
|
|
|
Service Code
|
CPT 11307
|
| Hospital Charge Code |
z11307
|
| Min. Negotiated Rate |
$59.27 |
| Max. Negotiated Rate |
$192.00 |
| Rate for Payer: Aetna Medicare |
$59.27
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$68.16
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$65.20
|
| Rate for Payer: Cash Price |
$158.72
|
| Rate for Payer: Cash Price |
$158.72
|
| Rate for Payer: Coventry All Commercial |
$71.12
|
| Rate for Payer: Frontpath All Commercial |
$81.17
|
| Rate for Payer: Humana ChoiceCare |
$61.18
|
| Rate for Payer: Humana Medicare |
$59.27
|
| Rate for Payer: Lucent All Commercial |
$100.76
|
| Rate for Payer: PHCS All Commercial |
$192.00
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$59.27
|
| Rate for Payer: United Healthcare Commercial |
$74.39
|
| Rate for Payer: United Healthcare Medicare |
$59.27
|
|
|
PR SHAV SKIN LES 1.1-2.0 CM TRUNK,ARM,LEG
|
Professional
|
$251.78
|
|
|
Service Code
|
CPT 11302
|
| Hospital Charge Code |
z11302
|
| Min. Negotiated Rate |
$56.18 |
| Max. Negotiated Rate |
$188.84 |
| Rate for Payer: Aetna Medicare |
$56.18
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$64.61
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$61.80
|
| Rate for Payer: Cash Price |
$156.10
|
| Rate for Payer: Cash Price |
$156.10
|
| Rate for Payer: Coventry All Commercial |
$67.42
|
| Rate for Payer: Frontpath All Commercial |
$76.88
|
| Rate for Payer: Humana ChoiceCare |
$56.41
|
| Rate for Payer: Humana Medicare |
$56.18
|
| Rate for Payer: Lucent All Commercial |
$95.51
|
| Rate for Payer: PHCS All Commercial |
$188.84
|
| Rate for Payer: PHP All Commercial |
$76.74
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$56.18
|
| Rate for Payer: Signature Care EPO |
$111.28
|
| Rate for Payer: Signature Care PPO |
$111.28
|
| Rate for Payer: United Healthcare Commercial |
$69.38
|
| Rate for Payer: United Healthcare Medicare |
$56.18
|
|
|
PR SHLDR ARTHROSCOP,PART ACROMIOPLAS
|
Professional
|
$308.74
|
|
|
Service Code
|
CPT 29826
|
| Hospital Charge Code |
z29826
|
| Min. Negotiated Rate |
$158.23 |
| Max. Negotiated Rate |
$940.30 |
| Rate for Payer: Aetna Medicare |
$158.23
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$940.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$940.30
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$181.96
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$174.05
|
| Rate for Payer: Cash Price |
$191.42
|
| Rate for Payer: Cash Price |
$191.42
|
| Rate for Payer: Coventry All Commercial |
$189.88
|
| Rate for Payer: Frontpath All Commercial |
$226.11
|
| Rate for Payer: Humana ChoiceCare |
$720.18
|
| Rate for Payer: Humana Medicare |
$158.23
|
| Rate for Payer: Lucent All Commercial |
$268.99
|
| Rate for Payer: Lutheran Preferred All Commercial |
$253.00
|
| Rate for Payer: PHCS All Commercial |
$231.56
|
| Rate for Payer: PHP All Commercial |
$268.61
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$158.23
|
| Rate for Payer: Signature Care EPO |
$272.32
|
| Rate for Payer: Signature Care PPO |
$272.32
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$237.00
|
| Rate for Payer: United Healthcare Commercial |
$725.91
|
| Rate for Payer: United Healthcare Medicare |
$158.23
|
|
|
PR SHLDR ARTHROSCOP,SURG,CAPSULORRHAPHY
|
Professional
|
$1,915.64
|
|
|
Service Code
|
CPT 29806
|
| Hospital Charge Code |
z29806
|
| Min. Negotiated Rate |
$981.77 |
| Max. Negotiated Rate |
$1,669.01 |
| Rate for Payer: Aetna Medicare |
$981.77
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,299.60
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,299.60
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,129.04
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,079.95
|
| Rate for Payer: Cash Price |
$1,187.70
|
| Rate for Payer: Cash Price |
$1,187.70
|
| Rate for Payer: Coventry All Commercial |
$1,178.12
|
| Rate for Payer: Frontpath All Commercial |
$1,375.22
|
| Rate for Payer: Humana ChoiceCare |
$1,116.50
|
| Rate for Payer: Humana Medicare |
$981.77
|
| Rate for Payer: Lucent All Commercial |
$1,669.01
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,571.00
|
| Rate for Payer: PHCS All Commercial |
$1,436.73
|
| Rate for Payer: PHP All Commercial |
$1,666.61
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$981.77
|
| Rate for Payer: Signature Care EPO |
$1,483.25
|
| Rate for Payer: Signature Care PPO |
$1,483.25
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,473.00
|
| Rate for Payer: United Healthcare Commercial |
$1,159.10
|
| Rate for Payer: United Healthcare Medicare |
$981.77
|
|
|
PR SHLDR ARTHROSCOP,SURG,DIS CLAVICULECTOMY
|
Professional
|
$1,232.72
|
|
|
Service Code
|
CPT 29824
|
| Hospital Charge Code |
z29824
|
| Min. Negotiated Rate |
$631.77 |
| Max. Negotiated Rate |
$1,074.01 |
| Rate for Payer: Aetna Medicare |
$631.77
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$792.10
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$792.10
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$726.54
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$694.95
|
| Rate for Payer: Cash Price |
$764.29
|
| Rate for Payer: Cash Price |
$764.29
|
| Rate for Payer: Coventry All Commercial |
$758.12
|
| Rate for Payer: Frontpath All Commercial |
$877.28
|
| Rate for Payer: Humana ChoiceCare |
$685.41
|
| Rate for Payer: Humana Medicare |
$631.77
|
| Rate for Payer: Lucent All Commercial |
$1,074.01
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,011.00
|
| Rate for Payer: PHCS All Commercial |
$924.54
|
| Rate for Payer: PHP All Commercial |
$1,072.46
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$631.77
|
| Rate for Payer: Signature Care EPO |
$907.80
|
| Rate for Payer: Signature Care PPO |
$907.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$948.00
|
| Rate for Payer: United Healthcare Commercial |
$722.38
|
| Rate for Payer: United Healthcare Medicare |
$631.77
|
|
|
PR SHLDR ARTHROSCOP,SURG,REPAIR,SLAP LESION
|
Professional
|
$1,873.60
|
|
|
Service Code
|
CPT 29807
|
| Hospital Charge Code |
z29807
|
| Min. Negotiated Rate |
$960.54 |
| Max. Negotiated Rate |
$1,632.92 |
| Rate for Payer: Aetna Medicare |
$960.54
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,264.90
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,264.90
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,104.62
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,056.59
|
| Rate for Payer: Cash Price |
$1,161.63
|
| Rate for Payer: Cash Price |
$1,161.63
|
| Rate for Payer: Coventry All Commercial |
$1,152.65
|
| Rate for Payer: Frontpath All Commercial |
$1,340.94
|
| Rate for Payer: Humana ChoiceCare |
$1,087.73
|
| Rate for Payer: Humana Medicare |
$960.54
|
| Rate for Payer: Lucent All Commercial |
$1,632.92
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,537.00
|
| Rate for Payer: PHCS All Commercial |
$1,405.20
|
| Rate for Payer: PHP All Commercial |
$1,630.03
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$960.54
|
| Rate for Payer: Signature Care EPO |
$1,445.85
|
| Rate for Payer: Signature Care PPO |
$1,445.85
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,441.00
|
| Rate for Payer: United Healthcare Commercial |
$1,128.71
|
| Rate for Payer: United Healthcare Medicare |
$960.54
|
|
|
PR SHLDR ARTHROSCOP,SURG,W/ROTAT CUFF REPR
|
Professional
|
$1,935.56
|
|
|
Service Code
|
CPT 29827
|
| Hospital Charge Code |
z29827
|
| Min. Negotiated Rate |
$991.97 |
| Max. Negotiated Rate |
$1,686.35 |
| Rate for Payer: Aetna Medicare |
$991.97
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,294.10
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,294.10
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,140.77
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,091.17
|
| Rate for Payer: Cash Price |
$1,200.05
|
| Rate for Payer: Cash Price |
$1,200.05
|
| Rate for Payer: Coventry All Commercial |
$1,190.36
|
| Rate for Payer: Frontpath All Commercial |
$1,388.40
|
| Rate for Payer: Humana ChoiceCare |
$1,177.59
|
| Rate for Payer: Humana Medicare |
$991.97
|
| Rate for Payer: Lucent All Commercial |
$1,686.35
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,587.00
|
| Rate for Payer: PHCS All Commercial |
$1,451.67
|
| Rate for Payer: PHP All Commercial |
$1,683.93
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$991.97
|
| Rate for Payer: Signature Care EPO |
$1,557.20
|
| Rate for Payer: Signature Care PPO |
$1,557.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,488.00
|
| Rate for Payer: United Healthcare Commercial |
$1,188.68
|
| Rate for Payer: United Healthcare Medicare |
$991.97
|
|
|
PR SHORT ARM CAST, ADULT
|
Professional
|
$36.92
|
|
|
Service Code
|
CPT Q4050
|
| Hospital Charge Code |
zQ4050C
|
| Min. Negotiated Rate |
$25.11 |
| Max. Negotiated Rate |
$27.69 |
| Rate for Payer: Cash Price |
$22.89
|
| Rate for Payer: PHCS All Commercial |
$27.69
|
| Rate for Payer: Signature Care EPO |
$25.11
|
| Rate for Payer: Signature Care PPO |
$25.11
|
|
|
PR SHORT ARM CAST, PEDIATRIC
|
Professional
|
$18.36
|
|
|
Service Code
|
CPT Q4050
|
| Hospital Charge Code |
zQ4050D
|
| Min. Negotiated Rate |
$12.48 |
| Max. Negotiated Rate |
$13.77 |
| Rate for Payer: Cash Price |
$11.38
|
| Rate for Payer: PHCS All Commercial |
$13.77
|
| Rate for Payer: Signature Care EPO |
$12.48
|
| Rate for Payer: Signature Care PPO |
$12.48
|
|
|
PR SHORT LEG CAST, ADULT
|
Professional
|
$40.92
|
|
|
Service Code
|
CPT Q4050
|
| Hospital Charge Code |
zQ4050G
|
| Min. Negotiated Rate |
$27.83 |
| Max. Negotiated Rate |
$30.69 |
| Rate for Payer: Cash Price |
$25.37
|
| Rate for Payer: PHCS All Commercial |
$30.69
|
| Rate for Payer: Signature Care EPO |
$27.83
|
| Rate for Payer: Signature Care PPO |
$27.83
|
|
|
PR SHORT LEG CAST, PEDIATRIC
|
Professional
|
$36.92
|
|
|
Service Code
|
CPT Q4050
|
| Hospital Charge Code |
zQ4050H
|
| Min. Negotiated Rate |
$25.11 |
| Max. Negotiated Rate |
$27.69 |
| Rate for Payer: Cash Price |
$22.89
|
| Rate for Payer: PHCS All Commercial |
$27.69
|
| Rate for Payer: Signature Care EPO |
$25.11
|
| Rate for Payer: Signature Care PPO |
$25.11
|
|
|
PR SIG 3BX MOTION PX BTE HA BI
|
Professional
|
$2,000.00
|
|
|
Service Code
|
CPT V5261
|
| Hospital Charge Code |
zV5261Z
|
| Min. Negotiated Rate |
$1,500.00 |
| Max. Negotiated Rate |
$5,000.00 |
| Rate for Payer: Cash Price |
$1,240.00
|
| Rate for Payer: Cash Price |
$1,240.00
|
| Rate for Payer: PHCS All Commercial |
$1,500.00
|
| Rate for Payer: Signature Care EPO |
$2,000.00
|
| Rate for Payer: Signature Care PPO |
$2,000.00
|
| Rate for Payer: United Healthcare Commercial |
$5,000.00
|
|
|
PR SIG 3BX MOTION PX BTE HA MON
|
Professional
|
$1,000.00
|
|
|
Service Code
|
CPT V5257
|
| Hospital Charge Code |
zV5257Z
|
| Min. Negotiated Rate |
$750.00 |
| Max. Negotiated Rate |
$2,500.00 |
| Rate for Payer: Cash Price |
$620.00
|
| Rate for Payer: Cash Price |
$620.00
|
| Rate for Payer: PHCS All Commercial |
$750.00
|
| Rate for Payer: Signature Care EPO |
$1,000.00
|
| Rate for Payer: Signature Care PPO |
$1,000.00
|
| Rate for Payer: United Healthcare Commercial |
$2,500.00
|
|
|
PR SIG 3NX MOTION CHARGE & GO BI
|
Professional
|
$2,000.00
|
|
|
Service Code
|
CPT V5261
|
| Hospital Charge Code |
zV5261BA
|
| Min. Negotiated Rate |
$1,500.00 |
| Max. Negotiated Rate |
$5,000.00 |
| Rate for Payer: Cash Price |
$1,240.00
|
| Rate for Payer: Cash Price |
$1,240.00
|
| Rate for Payer: PHCS All Commercial |
$1,500.00
|
| Rate for Payer: Signature Care EPO |
$2,000.00
|
| Rate for Payer: Signature Care PPO |
$2,000.00
|
| Rate for Payer: United Healthcare Commercial |
$5,000.00
|
|
