|
PR AUDEO P90-RT BI
|
Professional
|
$5,000.00
|
|
|
Service Code
|
CPT V5261
|
| Hospital Charge Code |
zV5261BT
|
| Min. Negotiated Rate |
$3,750.00 |
| Max. Negotiated Rate |
$5,000.00 |
| Rate for Payer: Cash Price |
$3,100.00
|
| Rate for Payer: Cash Price |
$3,100.00
|
| Rate for Payer: PHCS All Commercial |
$3,750.00
|
| Rate for Payer: Signature Care EPO |
$5,000.00
|
| Rate for Payer: Signature Care PPO |
$5,000.00
|
| Rate for Payer: United Healthcare Commercial |
$5,000.00
|
|
|
PR AUDEO P90-RT MONO
|
Professional
|
$2,500.00
|
|
|
Service Code
|
CPT V5257
|
| Hospital Charge Code |
zV5257DG
|
| Min. Negotiated Rate |
$1,875.00 |
| Max. Negotiated Rate |
$2,500.00 |
| Rate for Payer: Cash Price |
$1,550.00
|
| Rate for Payer: Cash Price |
$1,550.00
|
| Rate for Payer: PHCS All Commercial |
$1,875.00
|
| Rate for Payer: Signature Care EPO |
$2,500.00
|
| Rate for Payer: Signature Care PPO |
$2,500.00
|
| Rate for Payer: United Healthcare Commercial |
$2,500.00
|
|
|
PR AUDIOMETRY, AIR & BONE
|
Professional
|
$78.02
|
|
|
Service Code
|
CPT 92553
|
| Hospital Charge Code |
z92553
|
| Min. Negotiated Rate |
$25.70 |
| Max. Negotiated Rate |
$67.97 |
| Rate for Payer: Aetna Medicare |
$39.98
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$25.70
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$25.70
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$45.98
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$43.98
|
| Rate for Payer: Cash Price |
$48.37
|
| Rate for Payer: Cash Price |
$48.37
|
| Rate for Payer: Coventry All Commercial |
$47.98
|
| Rate for Payer: Frontpath All Commercial |
$41.78
|
| Rate for Payer: Humana ChoiceCare |
$27.67
|
| Rate for Payer: Humana Medicare |
$39.98
|
| Rate for Payer: Lucent All Commercial |
$67.97
|
| Rate for Payer: Lutheran Preferred All Commercial |
$52.00
|
| Rate for Payer: PHCS All Commercial |
$58.52
|
| Rate for Payer: PHP All Commercial |
$56.56
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$39.98
|
| Rate for Payer: Signature Care EPO |
$31.64
|
| Rate for Payer: Signature Care PPO |
$31.64
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$48.00
|
| Rate for Payer: United Healthcare Commercial |
$31.84
|
| Rate for Payer: United Healthcare Medicare |
$39.98
|
|
|
PR AUDITORY FUNCTION, + 15 MIN
|
Professional
|
$40.92
|
|
|
Service Code
|
CPT 92621
|
| Hospital Charge Code |
z92621
|
| Min. Negotiated Rate |
$11.07 |
| Max. Negotiated Rate |
$30.69 |
| Rate for Payer: Aetna Medicare |
$17.89
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$11.07
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$11.07
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$20.57
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$19.68
|
| Rate for Payer: Cash Price |
$25.37
|
| Rate for Payer: Cash Price |
$25.37
|
| Rate for Payer: Coventry All Commercial |
$21.47
|
| Rate for Payer: Frontpath All Commercial |
$20.34
|
| Rate for Payer: Humana ChoiceCare |
$11.21
|
| Rate for Payer: Humana Medicare |
$17.89
|
| Rate for Payer: Lucent All Commercial |
$30.41
|
| Rate for Payer: Lutheran Preferred All Commercial |
$23.00
|
| Rate for Payer: PHCS All Commercial |
$30.69
|
| Rate for Payer: PHP All Commercial |
$25.30
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$17.89
|
| Rate for Payer: Signature Care EPO |
$18.39
|
| Rate for Payer: Signature Care PPO |
$18.39
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$21.00
|
| Rate for Payer: United Healthcare Commercial |
$20.19
|
| Rate for Payer: United Healthcare Medicare |
$17.89
|
|
|
PR AUDITORY FUNCTION, 60 MIN
|
Professional
|
$166.12
|
|
|
Service Code
|
CPT 92620
|
| Hospital Charge Code |
z92620
|
| Min. Negotiated Rate |
$42.84 |
| Max. Negotiated Rate |
$129.51 |
| Rate for Payer: Aetna Medicare |
$76.18
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$42.84
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$42.84
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$87.61
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$83.80
|
| Rate for Payer: Cash Price |
$102.99
|
| Rate for Payer: Cash Price |
$102.99
|
| Rate for Payer: Coventry All Commercial |
$91.42
|
| Rate for Payer: Frontpath All Commercial |
$87.54
|
| Rate for Payer: Humana ChoiceCare |
$46.95
|
| Rate for Payer: Humana Medicare |
$76.18
|
| Rate for Payer: Lucent All Commercial |
$129.51
|
| Rate for Payer: Lutheran Preferred All Commercial |
$99.00
|
| Rate for Payer: PHCS All Commercial |
$124.59
|
| Rate for Payer: PHP All Commercial |
$107.77
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$76.18
|
| Rate for Payer: Signature Care EPO |
$77.32
|
| Rate for Payer: Signature Care PPO |
$77.32
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$91.00
|
| Rate for Payer: United Healthcare Commercial |
$86.91
|
| Rate for Payer: United Healthcare Medicare |
$76.18
|
|
|
PR BEHAV ASSMT W/SCORE & DOCD/STAND INSTRUMENT
|
Professional
|
$8.14
|
|
|
Service Code
|
CPT 96127
|
| Hospital Charge Code |
z96127
|
| Min. Negotiated Rate |
$4.11 |
| Max. Negotiated Rate |
$7.09 |
| Rate for Payer: Aetna Medicare |
$4.17
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$4.80
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$4.59
|
| Rate for Payer: Cash Price |
$5.05
|
| Rate for Payer: Cash Price |
$5.05
|
| Rate for Payer: Coventry All Commercial |
$5.00
|
| Rate for Payer: Frontpath All Commercial |
$4.94
|
| Rate for Payer: Humana ChoiceCare |
$4.87
|
| Rate for Payer: Humana Medicare |
$4.17
|
| Rate for Payer: Lucent All Commercial |
$7.09
|
| Rate for Payer: PHCS All Commercial |
$6.10
|
| Rate for Payer: PHP All Commercial |
$4.44
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$4.17
|
| Rate for Payer: Signature Care EPO |
$4.11
|
| Rate for Payer: Signature Care PPO |
$4.11
|
| Rate for Payer: United Healthcare Commercial |
$6.06
|
| Rate for Payer: United Healthcare Medicare |
$4.17
|
|
|
PR BEKESY AUDIOMETRY, DIAGNOSIS
|
Professional
|
$157.14
|
|
|
Service Code
|
CPT 92561
|
| Hospital Charge Code |
z92561
|
| Min. Negotiated Rate |
$27.80 |
| Max. Negotiated Rate |
$133.57 |
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$27.80
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$27.80
|
| Rate for Payer: Cash Price |
$97.43
|
| Rate for Payer: Cash Price |
$97.43
|
| Rate for Payer: Frontpath All Commercial |
$40.44
|
| Rate for Payer: Humana ChoiceCare |
$30.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$133.57
|
| Rate for Payer: PHCS All Commercial |
$117.86
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$94.28
|
|
|
PR BETAMETHASONE ACET&SOD PHOSP
|
Professional
|
$7.54
|
|
|
Service Code
|
CPT J0702
|
| Hospital Charge Code |
zJ0702
|
| Min. Negotiated Rate |
$6.94 |
| Max. Negotiated Rate |
$7.54 |
| Rate for Payer: Humana ChoiceCare |
$6.94
|
| Rate for Payer: PHP All Commercial |
$7.54
|
|
|
PR BINAURAL HEARING AID REPAIR/MODIFYING
|
Professional
|
$300.00
|
|
|
Service Code
|
CPT V5014
|
| Hospital Charge Code |
zV5014B
|
| Min. Negotiated Rate |
$73.21 |
| Max. Negotiated Rate |
$300.00 |
| Rate for Payer: Cash Price |
$186.00
|
| Rate for Payer: Cash Price |
$186.00
|
| Rate for Payer: Humana ChoiceCare |
$73.21
|
| Rate for Payer: PHCS All Commercial |
$225.00
|
| Rate for Payer: Signature Care EPO |
$300.00
|
| Rate for Payer: Signature Care PPO |
$300.00
|
| Rate for Payer: United Healthcare Commercial |
$125.40
|
|
|
PR BIOPSY BONE OPEN SUPERFICIAL
|
Professional
|
$256.38
|
|
|
Service Code
|
CPT 20240
|
| Hospital Charge Code |
z20240
|
| Min. Negotiated Rate |
$131.39 |
| Max. Negotiated Rate |
$250.65 |
| Rate for Payer: Aetna Medicare |
$131.39
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$151.10
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$144.53
|
| Rate for Payer: Cash Price |
$158.96
|
| Rate for Payer: Cash Price |
$158.96
|
| Rate for Payer: Coventry All Commercial |
$157.67
|
| Rate for Payer: Frontpath All Commercial |
$183.20
|
| Rate for Payer: Humana ChoiceCare |
$250.65
|
| Rate for Payer: Humana Medicare |
$131.39
|
| Rate for Payer: Lucent All Commercial |
$223.36
|
| Rate for Payer: PHCS All Commercial |
$192.28
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$131.39
|
| Rate for Payer: United Healthcare Commercial |
$249.04
|
| Rate for Payer: United Healthcare Medicare |
$131.39
|
|
|
PR BIOPSY BONE TROCAR/NEEDLE SUPERFICIAL
|
Professional
|
$431.88
|
|
|
Service Code
|
CPT 20220
|
| Hospital Charge Code |
z20220
|
| Min. Negotiated Rate |
$82.42 |
| Max. Negotiated Rate |
$323.91 |
| Rate for Payer: Aetna Medicare |
$82.42
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$94.78
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$90.66
|
| Rate for Payer: Cash Price |
$267.77
|
| Rate for Payer: Cash Price |
$267.77
|
| Rate for Payer: Coventry All Commercial |
$98.90
|
| Rate for Payer: Frontpath All Commercial |
$111.93
|
| Rate for Payer: Humana ChoiceCare |
$88.22
|
| Rate for Payer: Humana Medicare |
$82.42
|
| Rate for Payer: Lucent All Commercial |
$140.11
|
| Rate for Payer: PHCS All Commercial |
$323.91
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$82.42
|
| Rate for Payer: United Healthcare Commercial |
$89.63
|
| Rate for Payer: United Healthcare Medicare |
$82.42
|
|
|
PR BIOPSY CERVIX, 1 OR MORE, OR EXCISION OF LESION
|
Professional
|
$281.68
|
|
|
Service Code
|
CPT 57500
|
| Hospital Charge Code |
z57500
|
| Min. Negotiated Rate |
$69.65 |
| Max. Negotiated Rate |
$211.26 |
| Rate for Payer: Aetna Medicare |
$69.65
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$178.17
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$178.17
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$80.10
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$76.62
|
| Rate for Payer: Cash Price |
$174.64
|
| Rate for Payer: Cash Price |
$174.64
|
| Rate for Payer: Coventry All Commercial |
$83.58
|
| Rate for Payer: Frontpath All Commercial |
$97.10
|
| Rate for Payer: Humana ChoiceCare |
$70.63
|
| Rate for Payer: Humana Medicare |
$69.65
|
| Rate for Payer: Lucent All Commercial |
$118.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$98.00
|
| Rate for Payer: PHCS All Commercial |
$211.26
|
| Rate for Payer: PHP All Commercial |
$89.70
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$69.65
|
| Rate for Payer: Signature Care EPO |
$172.55
|
| Rate for Payer: Signature Care PPO |
$172.55
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$91.00
|
| Rate for Payer: United Healthcare Commercial |
$84.24
|
| Rate for Payer: United Healthcare Medicare |
$69.65
|
|
|
PR BIOPSY/EXCISION, LYMPH NODE(S)
|
Professional
|
$607.44
|
|
|
Service Code
|
CPT 38500
|
| Hospital Charge Code |
z38500
|
| Min. Negotiated Rate |
$234.45 |
| Max. Negotiated Rate |
$455.58 |
| Rate for Payer: Aetna Medicare |
$234.45
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$270.02
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$270.02
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$269.62
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$257.90
|
| Rate for Payer: Cash Price |
$376.61
|
| Rate for Payer: Cash Price |
$376.61
|
| Rate for Payer: Coventry All Commercial |
$281.34
|
| Rate for Payer: Frontpath All Commercial |
$334.66
|
| Rate for Payer: Humana ChoiceCare |
$289.17
|
| Rate for Payer: Humana Medicare |
$234.45
|
| Rate for Payer: Lucent All Commercial |
$398.56
|
| Rate for Payer: Lutheran Preferred All Commercial |
$375.00
|
| Rate for Payer: PHCS All Commercial |
$455.58
|
| Rate for Payer: PHP All Commercial |
$320.22
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$234.45
|
| Rate for Payer: Signature Care EPO |
$391.00
|
| Rate for Payer: Signature Care PPO |
$391.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$352.00
|
| Rate for Payer: United Healthcare Commercial |
$268.83
|
| Rate for Payer: United Healthcare Medicare |
$234.45
|
|
|
PR BIOPSY, NAIL UNIT (SEP PROC)
|
Professional
|
$225.54
|
|
|
Service Code
|
CPT 11755
|
| Hospital Charge Code |
z11755
|
| Min. Negotiated Rate |
$57.55 |
| Max. Negotiated Rate |
$169.16 |
| Rate for Payer: Aetna Medicare |
$57.55
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$66.18
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$63.30
|
| Rate for Payer: Cash Price |
$139.83
|
| Rate for Payer: Cash Price |
$139.83
|
| Rate for Payer: Coventry All Commercial |
$69.06
|
| Rate for Payer: Frontpath All Commercial |
$78.40
|
| Rate for Payer: Humana ChoiceCare |
$78.40
|
| Rate for Payer: Humana Medicare |
$57.55
|
| Rate for Payer: Lucent All Commercial |
$97.84
|
| Rate for Payer: PHCS All Commercial |
$169.16
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$57.55
|
| Rate for Payer: United Healthcare Commercial |
$94.29
|
| Rate for Payer: United Healthcare Medicare |
$57.55
|
|
|
PR BIOPSY OF BREAST, INCISIONAL
|
Professional
|
$594.96
|
|
|
Service Code
|
CPT 19101
|
| Hospital Charge Code |
z19101
|
| Min. Negotiated Rate |
$192.88 |
| Max. Negotiated Rate |
$446.22 |
| Rate for Payer: Aetna Medicare |
$205.51
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$403.79
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$403.79
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$236.34
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$226.06
|
| Rate for Payer: Cash Price |
$368.88
|
| Rate for Payer: Cash Price |
$368.88
|
| Rate for Payer: Coventry All Commercial |
$246.61
|
| Rate for Payer: Frontpath All Commercial |
$293.29
|
| Rate for Payer: Humana ChoiceCare |
$192.88
|
| Rate for Payer: Humana Medicare |
$205.51
|
| Rate for Payer: Lucent All Commercial |
$349.37
|
| Rate for Payer: Lutheran Preferred All Commercial |
$267.00
|
| Rate for Payer: PHCS All Commercial |
$446.22
|
| Rate for Payer: PHP All Commercial |
$280.70
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$205.51
|
| Rate for Payer: Signature Care EPO |
$318.75
|
| Rate for Payer: Signature Care PPO |
$318.75
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$247.00
|
| Rate for Payer: United Healthcare Commercial |
$230.95
|
| Rate for Payer: United Healthcare Medicare |
$205.51
|
|
|
PR BIOPSY OF EXT AUDITORY CANAL
|
Professional
|
$265.98
|
|
|
Service Code
|
CPT 69105
|
| Hospital Charge Code |
z69105
|
| Min. Negotiated Rate |
$59.45 |
| Max. Negotiated Rate |
$199.48 |
| Rate for Payer: Aetna Medicare |
$59.45
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$145.75
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$145.75
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$68.37
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$65.40
|
| Rate for Payer: Cash Price |
$164.91
|
| Rate for Payer: Cash Price |
$164.91
|
| Rate for Payer: Coventry All Commercial |
$71.34
|
| Rate for Payer: Frontpath All Commercial |
$79.79
|
| Rate for Payer: Humana ChoiceCare |
$66.21
|
| Rate for Payer: Humana Medicare |
$59.45
|
| Rate for Payer: Lucent All Commercial |
$101.06
|
| Rate for Payer: Lutheran Preferred All Commercial |
$95.00
|
| Rate for Payer: PHCS All Commercial |
$199.48
|
| Rate for Payer: PHP All Commercial |
$75.39
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$59.45
|
| Rate for Payer: Signature Care EPO |
$147.90
|
| Rate for Payer: Signature Care PPO |
$147.90
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$89.00
|
| Rate for Payer: United Healthcare Commercial |
$70.43
|
| Rate for Payer: United Healthcare Medicare |
$59.45
|
|
|
PR BIOPSY OF EXTERNAL EAR
|
Professional
|
$176.56
|
|
|
Service Code
|
CPT 69100
|
| Hospital Charge Code |
z69100
|
| Min. Negotiated Rate |
$43.88 |
| Max. Negotiated Rate |
$132.42 |
| Rate for Payer: Aetna Medicare |
$43.88
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$117.32
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$117.32
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$50.46
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$48.27
|
| Rate for Payer: Cash Price |
$109.47
|
| Rate for Payer: Cash Price |
$109.47
|
| Rate for Payer: Coventry All Commercial |
$52.66
|
| Rate for Payer: Frontpath All Commercial |
$59.76
|
| Rate for Payer: Humana ChoiceCare |
$49.35
|
| Rate for Payer: Humana Medicare |
$43.88
|
| Rate for Payer: Lucent All Commercial |
$74.60
|
| Rate for Payer: Lutheran Preferred All Commercial |
$70.00
|
| Rate for Payer: PHCS All Commercial |
$132.42
|
| Rate for Payer: PHP All Commercial |
$55.65
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$43.88
|
| Rate for Payer: Signature Care EPO |
$119.85
|
| Rate for Payer: Signature Care PPO |
$119.85
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$66.00
|
| Rate for Payer: United Healthcare Commercial |
$54.30
|
| Rate for Payer: United Healthcare Medicare |
$43.88
|
|
|
PR BIOPSY OF FLOOR OF MOUTH
|
Professional
|
$308.78
|
|
|
Service Code
|
CPT 41108
|
| Hospital Charge Code |
z41108
|
| Min. Negotiated Rate |
$85.70 |
| Max. Negotiated Rate |
$231.58 |
| Rate for Payer: Aetna Medicare |
$85.70
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$195.61
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$195.61
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$98.56
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$94.27
|
| Rate for Payer: Cash Price |
$191.44
|
| Rate for Payer: Cash Price |
$191.44
|
| Rate for Payer: Coventry All Commercial |
$102.84
|
| Rate for Payer: Frontpath All Commercial |
$114.70
|
| Rate for Payer: Humana ChoiceCare |
$96.05
|
| Rate for Payer: Humana Medicare |
$85.70
|
| Rate for Payer: Lucent All Commercial |
$145.69
|
| Rate for Payer: Lutheran Preferred All Commercial |
$129.00
|
| Rate for Payer: PHCS All Commercial |
$231.58
|
| Rate for Payer: PHP All Commercial |
$146.32
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$85.70
|
| Rate for Payer: Signature Care EPO |
$178.50
|
| Rate for Payer: Signature Care PPO |
$178.50
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$120.00
|
| Rate for Payer: United Healthcare Commercial |
$96.46
|
| Rate for Payer: United Healthcare Medicare |
$85.70
|
|
|
PR BIOPSY OF LIP
|
Professional
|
$225.40
|
|
|
Service Code
|
CPT 40490
|
| Hospital Charge Code |
z40490
|
| Min. Negotiated Rate |
$65.19 |
| Max. Negotiated Rate |
$183.34 |
| Rate for Payer: Aetna Medicare |
$65.19
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$183.34
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$183.34
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$74.97
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$71.71
|
| Rate for Payer: Cash Price |
$139.75
|
| Rate for Payer: Cash Price |
$139.75
|
| Rate for Payer: Coventry All Commercial |
$78.23
|
| Rate for Payer: Frontpath All Commercial |
$88.23
|
| Rate for Payer: Humana ChoiceCare |
$81.41
|
| Rate for Payer: Humana Medicare |
$65.19
|
| Rate for Payer: Lucent All Commercial |
$110.82
|
| Rate for Payer: Lutheran Preferred All Commercial |
$98.00
|
| Rate for Payer: PHCS All Commercial |
$169.05
|
| Rate for Payer: PHP All Commercial |
$111.30
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$65.19
|
| Rate for Payer: Signature Care EPO |
$169.15
|
| Rate for Payer: Signature Care PPO |
$169.15
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$91.00
|
| Rate for Payer: United Healthcare Commercial |
$82.01
|
| Rate for Payer: United Healthcare Medicare |
$65.19
|
|
|
PR BIOPSY OF MOUTH LESION
|
Professional
|
$309.92
|
|
|
Service Code
|
CPT 40808
|
| Hospital Charge Code |
z40808
|
| Min. Negotiated Rate |
$83.20 |
| Max. Negotiated Rate |
$232.44 |
| Rate for Payer: Aetna Medicare |
$83.20
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$194.44
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$194.44
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$95.68
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$91.52
|
| Rate for Payer: Cash Price |
$192.15
|
| Rate for Payer: Cash Price |
$192.15
|
| Rate for Payer: Coventry All Commercial |
$99.84
|
| Rate for Payer: Frontpath All Commercial |
$110.15
|
| Rate for Payer: Humana ChoiceCare |
$106.35
|
| Rate for Payer: Humana Medicare |
$83.20
|
| Rate for Payer: Lucent All Commercial |
$141.44
|
| Rate for Payer: Lutheran Preferred All Commercial |
$125.00
|
| Rate for Payer: PHCS All Commercial |
$232.44
|
| Rate for Payer: PHP All Commercial |
$142.05
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$83.20
|
| Rate for Payer: Signature Care EPO |
$177.65
|
| Rate for Payer: Signature Care PPO |
$177.65
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$116.00
|
| Rate for Payer: United Healthcare Commercial |
$112.69
|
| Rate for Payer: United Healthcare Medicare |
$83.20
|
|
|
PR BIOPSY OF UTERUS LINING
|
Professional
|
$185.96
|
|
|
Service Code
|
CPT 58100
|
| Hospital Charge Code |
z58100
|
| Min. Negotiated Rate |
$58.88 |
| Max. Negotiated Rate |
$148.32 |
| Rate for Payer: Aetna Medicare |
$58.88
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$148.32
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$148.32
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$67.71
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$64.77
|
| Rate for Payer: Cash Price |
$115.30
|
| Rate for Payer: Cash Price |
$115.30
|
| Rate for Payer: Coventry All Commercial |
$70.66
|
| Rate for Payer: Frontpath All Commercial |
$83.59
|
| Rate for Payer: Humana ChoiceCare |
$100.25
|
| Rate for Payer: Humana Medicare |
$58.88
|
| Rate for Payer: Lucent All Commercial |
$100.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$82.00
|
| Rate for Payer: PHCS All Commercial |
$139.47
|
| Rate for Payer: PHP All Commercial |
$75.83
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$58.88
|
| Rate for Payer: Signature Care EPO |
$138.55
|
| Rate for Payer: Signature Care PPO |
$138.55
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$77.00
|
| Rate for Payer: United Healthcare Commercial |
$99.91
|
| Rate for Payer: United Healthcare Medicare |
$58.88
|
|
|
PR BIOPSY OF VAGINA,EXTENSIVE
|
Professional
|
$324.12
|
|
|
Service Code
|
CPT 57105
|
| Hospital Charge Code |
z57105
|
| Min. Negotiated Rate |
$135.85 |
| Max. Negotiated Rate |
$243.09 |
| Rate for Payer: Aetna Medicare |
$137.40
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$180.62
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$180.62
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$158.01
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$151.14
|
| Rate for Payer: Cash Price |
$200.95
|
| Rate for Payer: Cash Price |
$200.95
|
| Rate for Payer: Coventry All Commercial |
$164.88
|
| Rate for Payer: Frontpath All Commercial |
$188.50
|
| Rate for Payer: Humana ChoiceCare |
$135.85
|
| Rate for Payer: Humana Medicare |
$137.40
|
| Rate for Payer: Lucent All Commercial |
$233.58
|
| Rate for Payer: Lutheran Preferred All Commercial |
$192.00
|
| Rate for Payer: PHCS All Commercial |
$243.09
|
| Rate for Payer: PHP All Commercial |
$176.95
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$137.40
|
| Rate for Payer: Signature Care EPO |
$176.80
|
| Rate for Payer: Signature Care PPO |
$176.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$179.00
|
| Rate for Payer: United Healthcare Commercial |
$139.19
|
| Rate for Payer: United Healthcare Medicare |
$137.40
|
|
|
PR BIOPSY OF VAGINA,SIMPLE
|
Professional
|
$188.92
|
|
|
Service Code
|
CPT 57100
|
| Hospital Charge Code |
z57100
|
| Min. Negotiated Rate |
$60.70 |
| Max. Negotiated Rate |
$141.69 |
| Rate for Payer: Aetna Medicare |
$60.70
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$118.46
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$118.46
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$69.80
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$66.77
|
| Rate for Payer: Cash Price |
$117.13
|
| Rate for Payer: Cash Price |
$117.13
|
| Rate for Payer: Coventry All Commercial |
$72.84
|
| Rate for Payer: Frontpath All Commercial |
$86.01
|
| Rate for Payer: Humana ChoiceCare |
$75.20
|
| Rate for Payer: Humana Medicare |
$60.70
|
| Rate for Payer: Lucent All Commercial |
$103.19
|
| Rate for Payer: Lutheran Preferred All Commercial |
$85.00
|
| Rate for Payer: PHCS All Commercial |
$141.69
|
| Rate for Payer: PHP All Commercial |
$78.17
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$60.70
|
| Rate for Payer: Signature Care EPO |
$112.20
|
| Rate for Payer: Signature Care PPO |
$112.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$79.00
|
| Rate for Payer: United Healthcare Commercial |
$74.85
|
| Rate for Payer: United Healthcare Medicare |
$60.70
|
|
|
PR BIOPSY OROPHARYNX
|
Professional
|
$290.64
|
|
|
Service Code
|
CPT 42800
|
| Hospital Charge Code |
z42800
|
| Min. Negotiated Rate |
$109.44 |
| Max. Negotiated Rate |
$217.98 |
| Rate for Payer: Aetna Medicare |
$109.44
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$144.50
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$144.50
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$125.86
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$120.38
|
| Rate for Payer: Cash Price |
$180.20
|
| Rate for Payer: Cash Price |
$180.20
|
| Rate for Payer: Coventry All Commercial |
$131.33
|
| Rate for Payer: Frontpath All Commercial |
$147.73
|
| Rate for Payer: Humana ChoiceCare |
$122.76
|
| Rate for Payer: Humana Medicare |
$109.44
|
| Rate for Payer: Lucent All Commercial |
$186.05
|
| Rate for Payer: Lutheran Preferred All Commercial |
$164.00
|
| Rate for Payer: PHCS All Commercial |
$217.98
|
| Rate for Payer: PHP All Commercial |
$186.84
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$109.44
|
| Rate for Payer: Signature Care EPO |
$199.75
|
| Rate for Payer: Signature Care PPO |
$199.75
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$153.00
|
| Rate for Payer: United Healthcare Commercial |
$121.59
|
| Rate for Payer: United Healthcare Medicare |
$109.44
|
|
|
PR BIOPSY TONGUE,ANTER 2/3
|
Professional
|
$343.82
|
|
|
Service Code
|
CPT 41100
|
| Hospital Charge Code |
z41100
|
| Min. Negotiated Rate |
$100.88 |
| Max. Negotiated Rate |
$257.86 |
| Rate for Payer: Aetna Medicare |
$100.88
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$252.83
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$252.83
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$116.01
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$110.97
|
| Rate for Payer: Cash Price |
$213.17
|
| Rate for Payer: Cash Price |
$213.17
|
| Rate for Payer: Coventry All Commercial |
$121.06
|
| Rate for Payer: Frontpath All Commercial |
$137.31
|
| Rate for Payer: Humana ChoiceCare |
$135.27
|
| Rate for Payer: Humana Medicare |
$100.88
|
| Rate for Payer: Lucent All Commercial |
$171.50
|
| Rate for Payer: Lutheran Preferred All Commercial |
$151.00
|
| Rate for Payer: PHCS All Commercial |
$257.86
|
| Rate for Payer: PHP All Commercial |
$172.24
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$100.88
|
| Rate for Payer: Signature Care EPO |
$231.20
|
| Rate for Payer: Signature Care PPO |
$231.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$141.00
|
| Rate for Payer: United Healthcare Commercial |
$118.45
|
| Rate for Payer: United Healthcare Medicare |
$100.88
|
|
