|
PR SKELTON STYLE #2
|
Professional
|
$80.00
|
|
|
Service Code
|
CPT V5264
|
| Hospital Charge Code |
zV5264H
|
| Min. Negotiated Rate |
$60.00 |
| Max. Negotiated Rate |
$80.00 |
| Rate for Payer: Cash Price |
$49.60
|
| Rate for Payer: PHCS All Commercial |
$60.00
|
| Rate for Payer: Signature Care EPO |
$80.00
|
| Rate for Payer: Signature Care PPO |
$80.00
|
|
|
PR SKIN TISSUE PROCEDURE UNLISTED
|
Professional
|
$0.01
|
|
|
Service Code
|
CPT 17999
|
| Hospital Charge Code |
z17999
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$0.01
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$0.01
|
|
|
PR SPECIAL REPORTS OR FORMS
|
Professional
|
$10.00
|
|
|
Service Code
|
CPT 99080
|
| Hospital Charge Code |
z99080
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$10.00 |
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$10.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$10.00
|
|
|
PR SPEECH AUDIOMETRY, COMPLETE
|
Professional
|
$76.22
|
|
|
Service Code
|
CPT 92556
|
| Hospital Charge Code |
z92556
|
| Min. Negotiated Rate |
$22.50 |
| Max. Negotiated Rate |
$66.40 |
| Rate for Payer: Aetna Medicare |
$39.06
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$22.50
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$22.50
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$44.92
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$42.97
|
| Rate for Payer: Cash Price |
$47.26
|
| Rate for Payer: Cash Price |
$47.26
|
| Rate for Payer: Coventry All Commercial |
$46.87
|
| Rate for Payer: Frontpath All Commercial |
$41.09
|
| Rate for Payer: Humana ChoiceCare |
$24.06
|
| Rate for Payer: Humana Medicare |
$39.06
|
| Rate for Payer: Lucent All Commercial |
$66.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$51.00
|
| Rate for Payer: PHCS All Commercial |
$57.16
|
| Rate for Payer: PHP All Commercial |
$55.25
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$39.06
|
| Rate for Payer: Signature Care EPO |
$31.11
|
| Rate for Payer: Signature Care PPO |
$31.11
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$47.00
|
| Rate for Payer: United Healthcare Commercial |
$27.28
|
| Rate for Payer: United Healthcare Medicare |
$39.06
|
|
|
PR SPEECH THRESHOLD AUDIOMETRY
|
Professional
|
$49.10
|
|
|
Service Code
|
CPT 92555
|
| Hospital Charge Code |
z92555
|
| Min. Negotiated Rate |
$16.04 |
| Max. Negotiated Rate |
$42.79 |
| Rate for Payer: Aetna Medicare |
$25.17
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$17.76
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$17.76
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$28.95
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$27.69
|
| Rate for Payer: Cash Price |
$30.44
|
| Rate for Payer: Cash Price |
$30.44
|
| Rate for Payer: Coventry All Commercial |
$30.20
|
| Rate for Payer: Frontpath All Commercial |
$26.14
|
| Rate for Payer: Humana ChoiceCare |
$16.04
|
| Rate for Payer: Humana Medicare |
$25.17
|
| Rate for Payer: Lucent All Commercial |
$42.79
|
| Rate for Payer: Lutheran Preferred All Commercial |
$33.00
|
| Rate for Payer: PHCS All Commercial |
$36.82
|
| Rate for Payer: PHP All Commercial |
$35.60
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$25.17
|
| Rate for Payer: Signature Care EPO |
$19.73
|
| Rate for Payer: Signature Care PPO |
$19.73
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$30.00
|
| Rate for Payer: United Healthcare Commercial |
$17.64
|
| Rate for Payer: United Healthcare Medicare |
$25.17
|
|
|
PR SPLINT FINGER FOAM 3 INCH
|
Professional
|
$4.77
|
|
|
Service Code
|
CPT L3927
|
| Hospital Charge Code |
zL3927A
|
| Min. Negotiated Rate |
$3.58 |
| Max. Negotiated Rate |
$31.05 |
| Rate for Payer: Cash Price |
$2.96
|
| Rate for Payer: Cash Price |
$2.96
|
| Rate for Payer: Humana ChoiceCare |
$31.05
|
| Rate for Payer: PHCS All Commercial |
$3.58
|
| Rate for Payer: Signature Care EPO |
$4.77
|
| Rate for Payer: Signature Care PPO |
$4.77
|
| Rate for Payer: United Healthcare Commercial |
$24.52
|
|
|
PR SPLINT FINGER FOAM 6 INCH
|
Professional
|
$2.41
|
|
|
Service Code
|
CPT L3927
|
| Hospital Charge Code |
zL3927B
|
| Min. Negotiated Rate |
$1.81 |
| Max. Negotiated Rate |
$31.05 |
| Rate for Payer: Cash Price |
$1.49
|
| Rate for Payer: Cash Price |
$1.49
|
| Rate for Payer: Humana ChoiceCare |
$31.05
|
| Rate for Payer: PHCS All Commercial |
$1.81
|
| Rate for Payer: Signature Care EPO |
$2.41
|
| Rate for Payer: Signature Care PPO |
$2.41
|
| Rate for Payer: United Healthcare Commercial |
$24.52
|
|
|
PR SPLINT FINGER FOAM MED
|
Professional
|
$4.20
|
|
|
Service Code
|
CPT L3927
|
| Hospital Charge Code |
zL3927C
|
| Min. Negotiated Rate |
$3.15 |
| Max. Negotiated Rate |
$31.05 |
| Rate for Payer: Cash Price |
$2.60
|
| Rate for Payer: Cash Price |
$2.60
|
| Rate for Payer: Humana ChoiceCare |
$31.05
|
| Rate for Payer: PHCS All Commercial |
$3.15
|
| Rate for Payer: Signature Care EPO |
$4.20
|
| Rate for Payer: Signature Care PPO |
$4.20
|
| Rate for Payer: United Healthcare Commercial |
$24.52
|
|
|
PR SPLINT FINGER FOAM XLG
|
Professional
|
$2.59
|
|
|
Service Code
|
CPT L3927
|
| Hospital Charge Code |
zL3927D
|
| Min. Negotiated Rate |
$1.94 |
| Max. Negotiated Rate |
$31.05 |
| Rate for Payer: Cash Price |
$1.61
|
| Rate for Payer: Cash Price |
$1.61
|
| Rate for Payer: Humana ChoiceCare |
$31.05
|
| Rate for Payer: PHCS All Commercial |
$1.94
|
| Rate for Payer: Signature Care EPO |
$2.59
|
| Rate for Payer: Signature Care PPO |
$2.59
|
| Rate for Payer: United Healthcare Commercial |
$24.52
|
|
|
PR SPLINT FINGER STAX #2
|
Professional
|
$5.15
|
|
|
Service Code
|
CPT Q4049
|
| Hospital Charge Code |
zQ4049A
|
| Min. Negotiated Rate |
$1.62 |
| Max. Negotiated Rate |
$3.86 |
| Rate for Payer: Cash Price |
$3.19
|
| Rate for Payer: Cash Price |
$3.19
|
| Rate for Payer: Humana ChoiceCare |
$2.13
|
| Rate for Payer: PHCS All Commercial |
$3.86
|
| Rate for Payer: Signature Care EPO |
$3.50
|
| Rate for Payer: Signature Care PPO |
$3.50
|
| Rate for Payer: United Healthcare Commercial |
$1.62
|
|
|
PR SPLINT FINGER STAX #3
|
Professional
|
$5.15
|
|
|
Service Code
|
CPT Q4049
|
| Hospital Charge Code |
zQ4049B
|
| Min. Negotiated Rate |
$1.62 |
| Max. Negotiated Rate |
$3.86 |
| Rate for Payer: Cash Price |
$3.19
|
| Rate for Payer: Cash Price |
$3.19
|
| Rate for Payer: Humana ChoiceCare |
$2.13
|
| Rate for Payer: PHCS All Commercial |
$3.86
|
| Rate for Payer: Signature Care EPO |
$3.50
|
| Rate for Payer: Signature Care PPO |
$3.50
|
| Rate for Payer: United Healthcare Commercial |
$1.62
|
|
|
PR SPLINT FINGER STAX #4
|
Professional
|
$5.15
|
|
|
Service Code
|
CPT Q4049
|
| Hospital Charge Code |
zQ4049C
|
| Min. Negotiated Rate |
$1.62 |
| Max. Negotiated Rate |
$3.86 |
| Rate for Payer: Cash Price |
$3.19
|
| Rate for Payer: Cash Price |
$3.19
|
| Rate for Payer: Humana ChoiceCare |
$2.13
|
| Rate for Payer: PHCS All Commercial |
$3.86
|
| Rate for Payer: Signature Care EPO |
$3.50
|
| Rate for Payer: Signature Care PPO |
$3.50
|
| Rate for Payer: United Healthcare Commercial |
$1.62
|
|
|
PR SPLINT FINGER STAX #5
|
Professional
|
$5.15
|
|
|
Service Code
|
CPT Q4049
|
| Hospital Charge Code |
zQ4049D
|
| Min. Negotiated Rate |
$1.62 |
| Max. Negotiated Rate |
$3.86 |
| Rate for Payer: Cash Price |
$3.19
|
| Rate for Payer: Cash Price |
$3.19
|
| Rate for Payer: Humana ChoiceCare |
$2.13
|
| Rate for Payer: PHCS All Commercial |
$3.86
|
| Rate for Payer: Signature Care EPO |
$3.50
|
| Rate for Payer: Signature Care PPO |
$3.50
|
| Rate for Payer: United Healthcare Commercial |
$1.62
|
|
|
PR SPLINT FINGER STAX # 5 1/2
|
Professional
|
$5.15
|
|
|
Service Code
|
CPT Q4049
|
| Hospital Charge Code |
zQ4049G
|
| Min. Negotiated Rate |
$1.62 |
| Max. Negotiated Rate |
$3.86 |
| Rate for Payer: Cash Price |
$3.19
|
| Rate for Payer: Cash Price |
$3.19
|
| Rate for Payer: Humana ChoiceCare |
$2.13
|
| Rate for Payer: PHCS All Commercial |
$3.86
|
| Rate for Payer: Signature Care EPO |
$3.50
|
| Rate for Payer: Signature Care PPO |
$3.50
|
| Rate for Payer: United Healthcare Commercial |
$1.62
|
|
|
PR SPLINT FINGER STAX #6
|
Professional
|
$5.15
|
|
|
Service Code
|
CPT Q4049
|
| Hospital Charge Code |
zQ4049E
|
| Min. Negotiated Rate |
$1.62 |
| Max. Negotiated Rate |
$3.86 |
| Rate for Payer: Cash Price |
$3.19
|
| Rate for Payer: Cash Price |
$3.19
|
| Rate for Payer: Humana ChoiceCare |
$2.13
|
| Rate for Payer: PHCS All Commercial |
$3.86
|
| Rate for Payer: Signature Care EPO |
$3.50
|
| Rate for Payer: Signature Care PPO |
$3.50
|
| Rate for Payer: United Healthcare Commercial |
$1.62
|
|
|
PR SPLINT FINGER STAX #7
|
Professional
|
$5.15
|
|
|
Service Code
|
CPT Q4049
|
| Hospital Charge Code |
zQ4049F
|
| Min. Negotiated Rate |
$1.62 |
| Max. Negotiated Rate |
$3.86 |
| Rate for Payer: Cash Price |
$3.19
|
| Rate for Payer: Cash Price |
$3.19
|
| Rate for Payer: Humana ChoiceCare |
$2.13
|
| Rate for Payer: PHCS All Commercial |
$3.86
|
| Rate for Payer: Signature Care EPO |
$3.50
|
| Rate for Payer: Signature Care PPO |
$3.50
|
| Rate for Payer: United Healthcare Commercial |
$1.62
|
|
|
PR SPLIT GRFT,HEAD,FAC,HAND,FEET <100 SQCM
|
Professional
|
$1,538.54
|
|
|
Service Code
|
CPT 15120
|
| Hospital Charge Code |
z15120
|
| Min. Negotiated Rate |
$641.24 |
| Max. Negotiated Rate |
$1,153.90 |
| Rate for Payer: Aetna Medicare |
$641.24
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$949.01
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$949.01
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$737.43
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$705.36
|
| Rate for Payer: Cash Price |
$953.89
|
| Rate for Payer: Cash Price |
$953.89
|
| Rate for Payer: Coventry All Commercial |
$769.49
|
| Rate for Payer: Frontpath All Commercial |
$886.89
|
| Rate for Payer: Humana ChoiceCare |
$659.13
|
| Rate for Payer: Humana Medicare |
$641.24
|
| Rate for Payer: Lucent All Commercial |
$1,090.11
|
| Rate for Payer: Lutheran Preferred All Commercial |
$834.00
|
| Rate for Payer: PHCS All Commercial |
$1,153.90
|
| Rate for Payer: PHP All Commercial |
$875.84
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$641.24
|
| Rate for Payer: Signature Care EPO |
$848.30
|
| Rate for Payer: Signature Care PPO |
$848.30
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$769.00
|
| Rate for Payer: United Healthcare Commercial |
$841.21
|
| Rate for Payer: United Healthcare Medicare |
$641.24
|
|
|
PR SPLIT GRFT TRUNK,ARM,LEG <100 SQCM
|
Professional
|
$1,573.86
|
|
|
Service Code
|
CPT 15100
|
| Hospital Charge Code |
z15100
|
| Min. Negotiated Rate |
$632.93 |
| Max. Negotiated Rate |
$1,180.40 |
| Rate for Payer: Aetna Medicare |
$661.81
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$872.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$872.30
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$761.08
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$727.99
|
| Rate for Payer: Cash Price |
$975.79
|
| Rate for Payer: Cash Price |
$975.79
|
| Rate for Payer: Coventry All Commercial |
$794.17
|
| Rate for Payer: Frontpath All Commercial |
$923.18
|
| Rate for Payer: Humana ChoiceCare |
$632.93
|
| Rate for Payer: Humana Medicare |
$661.81
|
| Rate for Payer: Lucent All Commercial |
$1,125.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$860.00
|
| Rate for Payer: PHCS All Commercial |
$1,180.40
|
| Rate for Payer: PHP All Commercial |
$903.94
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$661.81
|
| Rate for Payer: Signature Care EPO |
$888.25
|
| Rate for Payer: Signature Care PPO |
$888.25
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$794.00
|
| Rate for Payer: United Healthcare Commercial |
$766.28
|
| Rate for Payer: United Healthcare Medicare |
$661.81
|
|
|
PR STAGGERED SPONDAIC WORD TEST
|
Professional
|
$84.64
|
|
|
Service Code
|
CPT 92572
|
| Hospital Charge Code |
z92572
|
| Min. Negotiated Rate |
$3.60 |
| Max. Negotiated Rate |
$73.75 |
| Rate for Payer: Aetna Medicare |
$43.38
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$3.60
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3.60
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$49.89
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$47.72
|
| Rate for Payer: Cash Price |
$52.48
|
| Rate for Payer: Cash Price |
$52.48
|
| Rate for Payer: Coventry All Commercial |
$52.06
|
| Rate for Payer: Frontpath All Commercial |
$42.12
|
| Rate for Payer: Humana ChoiceCare |
$3.81
|
| Rate for Payer: Humana Medicare |
$43.38
|
| Rate for Payer: Lucent All Commercial |
$73.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$56.00
|
| Rate for Payer: PHCS All Commercial |
$63.48
|
| Rate for Payer: PHP All Commercial |
$61.37
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$43.38
|
| Rate for Payer: Signature Care EPO |
$31.91
|
| Rate for Payer: Signature Care PPO |
$31.91
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$52.00
|
| Rate for Payer: United Healthcare Commercial |
$19.31
|
| Rate for Payer: United Healthcare Medicare |
$43.38
|
|
|
PR STENGER TEST, PURE TONE
|
Professional
|
$35.86
|
|
|
Service Code
|
CPT 92565
|
| Hospital Charge Code |
z92565
|
| Min. Negotiated Rate |
$13.91 |
| Max. Negotiated Rate |
$31.23 |
| Rate for Payer: Aetna Medicare |
$18.37
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$15.70
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$15.70
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$21.13
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$20.21
|
| Rate for Payer: Cash Price |
$22.23
|
| Rate for Payer: Cash Price |
$22.23
|
| Rate for Payer: Coventry All Commercial |
$22.04
|
| Rate for Payer: Frontpath All Commercial |
$19.54
|
| Rate for Payer: Humana ChoiceCare |
$16.84
|
| Rate for Payer: Humana Medicare |
$18.37
|
| Rate for Payer: Lucent All Commercial |
$31.23
|
| Rate for Payer: Lutheran Preferred All Commercial |
$24.00
|
| Rate for Payer: PHCS All Commercial |
$26.90
|
| Rate for Payer: PHP All Commercial |
$25.99
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$18.37
|
| Rate for Payer: Signature Care EPO |
$17.00
|
| Rate for Payer: Signature Care PPO |
$17.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$22.00
|
| Rate for Payer: United Healthcare Commercial |
$13.91
|
| Rate for Payer: United Healthcare Medicare |
$18.37
|
|
|
PR STENGER TEST, SPEECH
|
Professional
|
$36.46
|
|
|
Service Code
|
CPT 92577
|
| Hospital Charge Code |
z92577
|
| Min. Negotiated Rate |
$14.66 |
| Max. Negotiated Rate |
$31.76 |
| Rate for Payer: Aetna Medicare |
$18.68
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$28.20
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$28.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$21.48
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$20.55
|
| Rate for Payer: Cash Price |
$22.61
|
| Rate for Payer: Cash Price |
$22.61
|
| Rate for Payer: Coventry All Commercial |
$22.42
|
| Rate for Payer: Frontpath All Commercial |
$19.18
|
| Rate for Payer: Humana ChoiceCare |
$30.28
|
| Rate for Payer: Humana Medicare |
$18.68
|
| Rate for Payer: Lucent All Commercial |
$31.76
|
| Rate for Payer: Lutheran Preferred All Commercial |
$24.00
|
| Rate for Payer: PHCS All Commercial |
$27.34
|
| Rate for Payer: PHP All Commercial |
$26.43
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$18.68
|
| Rate for Payer: Signature Care EPO |
$14.66
|
| Rate for Payer: Signature Care PPO |
$14.66
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$22.00
|
| Rate for Payer: United Healthcare Commercial |
$18.86
|
| Rate for Payer: United Healthcare Medicare |
$18.68
|
|
|
PR STRAPPING OF TOES
|
Professional
|
$35.22
|
|
|
Service Code
|
CPT 29550
|
| Hospital Charge Code |
z29550
|
| Min. Negotiated Rate |
$10.65 |
| Max. Negotiated Rate |
$36.15 |
| Rate for Payer: Aetna Medicare |
$10.65
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$36.15
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$36.15
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$12.25
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$11.72
|
| Rate for Payer: Cash Price |
$21.84
|
| Rate for Payer: Cash Price |
$21.84
|
| Rate for Payer: Coventry All Commercial |
$12.78
|
| Rate for Payer: Frontpath All Commercial |
$14.69
|
| Rate for Payer: Humana ChoiceCare |
$32.74
|
| Rate for Payer: Humana Medicare |
$10.65
|
| Rate for Payer: Lucent All Commercial |
$18.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$17.00
|
| Rate for Payer: PHCS All Commercial |
$26.42
|
| Rate for Payer: PHP All Commercial |
$18.07
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$10.65
|
| Rate for Payer: Signature Care EPO |
$30.62
|
| Rate for Payer: Signature Care PPO |
$30.62
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$16.00
|
| Rate for Payer: United Healthcare Commercial |
$34.81
|
| Rate for Payer: United Healthcare Medicare |
$10.65
|
|
|
PR STRAPPING UNNA BOOT
|
Professional
|
$115.06
|
|
|
Service Code
|
CPT 29580
|
| Hospital Charge Code |
z29580
|
| Min. Negotiated Rate |
$24.70 |
| Max. Negotiated Rate |
$86.30 |
| Rate for Payer: Aetna Medicare |
$24.70
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$65.05
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$65.05
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$28.40
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$27.17
|
| Rate for Payer: Cash Price |
$71.34
|
| Rate for Payer: Cash Price |
$71.34
|
| Rate for Payer: Coventry All Commercial |
$29.64
|
| Rate for Payer: Frontpath All Commercial |
$35.26
|
| Rate for Payer: Humana ChoiceCare |
$40.07
|
| Rate for Payer: Humana Medicare |
$24.70
|
| Rate for Payer: Lucent All Commercial |
$41.99
|
| Rate for Payer: Lutheran Preferred All Commercial |
$40.00
|
| Rate for Payer: PHCS All Commercial |
$86.30
|
| Rate for Payer: PHP All Commercial |
$41.94
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$24.70
|
| Rate for Payer: Signature Care EPO |
$69.70
|
| Rate for Payer: Signature Care PPO |
$69.70
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$37.00
|
| Rate for Payer: United Healthcare Commercial |
$40.76
|
| Rate for Payer: United Healthcare Medicare |
$24.70
|
|
|
PR SUB GRFT F/S/N/H/F/G/M/D />100SCM 1ST 100SCM
|
Professional
|
$625.62
|
|
|
Service Code
|
CPT 15277
|
| Hospital Charge Code |
z15277
|
| Min. Negotiated Rate |
$203.75 |
| Max. Negotiated Rate |
$469.22 |
| Rate for Payer: Aetna Medicare |
$206.72
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$237.73
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$227.39
|
| Rate for Payer: Cash Price |
$387.88
|
| Rate for Payer: Cash Price |
$387.88
|
| Rate for Payer: Coventry All Commercial |
$248.06
|
| Rate for Payer: Frontpath All Commercial |
$293.92
|
| Rate for Payer: Humana ChoiceCare |
$203.75
|
| Rate for Payer: Humana Medicare |
$206.72
|
| Rate for Payer: Lucent All Commercial |
$351.42
|
| Rate for Payer: PHCS All Commercial |
$469.22
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$206.72
|
| Rate for Payer: United Healthcare Commercial |
$269.10
|
| Rate for Payer: United Healthcare Medicare |
$206.72
|
|
|
PR SUB GRFT F/S/N/H/F/G/M/D /<100SCM /<1ST 25 SCM
|
Professional
|
$290.82
|
|
|
Service Code
|
CPT 15275
|
| Hospital Charge Code |
z15275
|
| Min. Negotiated Rate |
$87.61 |
| Max. Negotiated Rate |
$218.12 |
| Rate for Payer: Aetna Medicare |
$87.61
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$100.75
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$96.37
|
| Rate for Payer: Cash Price |
$180.31
|
| Rate for Payer: Cash Price |
$180.31
|
| Rate for Payer: Coventry All Commercial |
$105.13
|
| Rate for Payer: Frontpath All Commercial |
$121.33
|
| Rate for Payer: Humana ChoiceCare |
$95.46
|
| Rate for Payer: Humana Medicare |
$87.61
|
| Rate for Payer: Lucent All Commercial |
$148.94
|
| Rate for Payer: PHCS All Commercial |
$218.12
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$87.61
|
| Rate for Payer: United Healthcare Commercial |
$126.05
|
| Rate for Payer: United Healthcare Medicare |
$87.61
|
|
