|
PR BIOPSY TONGUE,POSTER 1/3
|
Professional
|
$344.12
|
|
|
Service Code
|
CPT 41105
|
| Hospital Charge Code |
z41105
|
| Min. Negotiated Rate |
$103.50 |
| Max. Negotiated Rate |
$258.09 |
| Rate for Payer: Aetna Medicare |
$103.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$144.90
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$144.90
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$119.02
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$113.85
|
| Rate for Payer: Cash Price |
$213.35
|
| Rate for Payer: Cash Price |
$213.35
|
| Rate for Payer: Coventry All Commercial |
$124.20
|
| Rate for Payer: Frontpath All Commercial |
$140.39
|
| Rate for Payer: Humana ChoiceCare |
$121.23
|
| Rate for Payer: Humana Medicare |
$103.50
|
| Rate for Payer: Lucent All Commercial |
$175.95
|
| Rate for Payer: Lutheran Preferred All Commercial |
$155.00
|
| Rate for Payer: PHCS All Commercial |
$258.09
|
| Rate for Payer: PHP All Commercial |
$176.71
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$103.50
|
| Rate for Payer: Signature Care EPO |
$214.20
|
| Rate for Payer: Signature Care PPO |
$214.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$145.00
|
| Rate for Payer: United Healthcare Commercial |
$120.16
|
| Rate for Payer: United Healthcare Medicare |
$103.50
|
|
|
PR BIOPSY VULVA/PERINEUM,ONE LESN
|
Professional
|
$176.58
|
|
|
Service Code
|
CPT 56605
|
| Hospital Charge Code |
z56605
|
| Min. Negotiated Rate |
$55.30 |
| Max. Negotiated Rate |
$132.44 |
| Rate for Payer: Aetna Medicare |
$55.30
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$112.58
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$112.58
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$63.60
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$60.83
|
| Rate for Payer: Cash Price |
$109.48
|
| Rate for Payer: Cash Price |
$109.48
|
| Rate for Payer: Coventry All Commercial |
$66.36
|
| Rate for Payer: Frontpath All Commercial |
$77.65
|
| Rate for Payer: Humana ChoiceCare |
$69.77
|
| Rate for Payer: Humana Medicare |
$55.30
|
| Rate for Payer: Lucent All Commercial |
$94.01
|
| Rate for Payer: Lutheran Preferred All Commercial |
$77.00
|
| Rate for Payer: PHCS All Commercial |
$132.44
|
| Rate for Payer: PHP All Commercial |
$71.22
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$55.30
|
| Rate for Payer: Signature Care EPO |
$107.10
|
| Rate for Payer: Signature Care PPO |
$107.10
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$72.00
|
| Rate for Payer: United Healthcare Commercial |
$69.24
|
| Rate for Payer: United Healthcare Medicare |
$55.30
|
|
|
PR BX/REMV,LYMPH NODE,DEEP AXILL
|
Professional
|
$788.90
|
|
|
Service Code
|
CPT 38525
|
| Hospital Charge Code |
z38525
|
| Min. Negotiated Rate |
$393.50 |
| Max. Negotiated Rate |
$687.33 |
| Rate for Payer: Aetna Medicare |
$404.31
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$393.50
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$393.50
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$464.96
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$444.74
|
| Rate for Payer: Cash Price |
$489.12
|
| Rate for Payer: Cash Price |
$489.12
|
| Rate for Payer: Coventry All Commercial |
$485.17
|
| Rate for Payer: Frontpath All Commercial |
$578.24
|
| Rate for Payer: Humana ChoiceCare |
$464.81
|
| Rate for Payer: Humana Medicare |
$404.31
|
| Rate for Payer: Lucent All Commercial |
$687.33
|
| Rate for Payer: Lutheran Preferred All Commercial |
$647.00
|
| Rate for Payer: PHCS All Commercial |
$591.68
|
| Rate for Payer: PHP All Commercial |
$552.23
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$404.31
|
| Rate for Payer: Signature Care EPO |
$499.80
|
| Rate for Payer: Signature Care PPO |
$499.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$606.00
|
| Rate for Payer: United Healthcare Commercial |
$451.91
|
| Rate for Payer: United Healthcare Medicare |
$404.31
|
|
|
PR BX/REMV,LYMPH NODE,DEEP CERV
|
Professional
|
$960.52
|
|
|
Service Code
|
CPT 38510
|
| Hospital Charge Code |
z38510
|
| Min. Negotiated Rate |
$388.54 |
| Max. Negotiated Rate |
$720.39 |
| Rate for Payer: Aetna Medicare |
$388.54
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$486.60
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$486.60
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$446.82
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$427.39
|
| Rate for Payer: Cash Price |
$595.52
|
| Rate for Payer: Cash Price |
$595.52
|
| Rate for Payer: Coventry All Commercial |
$466.25
|
| Rate for Payer: Frontpath All Commercial |
$547.03
|
| Rate for Payer: Humana ChoiceCare |
$489.41
|
| Rate for Payer: Humana Medicare |
$388.54
|
| Rate for Payer: Lucent All Commercial |
$660.52
|
| Rate for Payer: Lutheran Preferred All Commercial |
$622.00
|
| Rate for Payer: PHCS All Commercial |
$720.39
|
| Rate for Payer: PHP All Commercial |
$530.69
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$388.54
|
| Rate for Payer: Signature Care EPO |
$627.30
|
| Rate for Payer: Signature Care PPO |
$627.30
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$583.00
|
| Rate for Payer: United Healthcare Commercial |
$456.80
|
| Rate for Payer: United Healthcare Medicare |
$388.54
|
|
|
PR BX,VULVA/PERINEUM,ADDL LESION
|
Professional
|
$70.22
|
|
|
Service Code
|
CPT 56606
|
| Hospital Charge Code |
z56606
|
| Min. Negotiated Rate |
$27.35 |
| Max. Negotiated Rate |
$54.33 |
| Rate for Payer: Aetna Medicare |
$27.35
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$54.33
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$54.33
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$31.45
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$30.08
|
| Rate for Payer: Cash Price |
$43.54
|
| Rate for Payer: Cash Price |
$43.54
|
| Rate for Payer: Coventry All Commercial |
$32.82
|
| Rate for Payer: Frontpath All Commercial |
$38.21
|
| Rate for Payer: Humana ChoiceCare |
$34.57
|
| Rate for Payer: Humana Medicare |
$27.35
|
| Rate for Payer: Lucent All Commercial |
$46.50
|
| Rate for Payer: Lutheran Preferred All Commercial |
$38.00
|
| Rate for Payer: PHCS All Commercial |
$52.66
|
| Rate for Payer: PHP All Commercial |
$35.22
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$27.35
|
| Rate for Payer: Signature Care EPO |
$51.00
|
| Rate for Payer: Signature Care PPO |
$51.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$36.00
|
| Rate for Payer: United Healthcare Commercial |
$34.14
|
| Rate for Payer: United Healthcare Medicare |
$27.35
|
|
|
PR CANALITH REPOSITIONING PROCEDURE, PER DAY
|
Professional
|
$80.96
|
|
|
Service Code
|
CPT 95992
|
| Hospital Charge Code |
z95992
|
| Min. Negotiated Rate |
$34.70 |
| Max. Negotiated Rate |
$60.72 |
| Rate for Payer: Aetna Medicare |
$34.70
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$41.76
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$41.76
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$39.90
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$38.17
|
| Rate for Payer: Cash Price |
$50.20
|
| Rate for Payer: Cash Price |
$50.20
|
| Rate for Payer: Coventry All Commercial |
$41.64
|
| Rate for Payer: Frontpath All Commercial |
$39.95
|
| Rate for Payer: Humana ChoiceCare |
$46.67
|
| Rate for Payer: Humana Medicare |
$34.70
|
| Rate for Payer: Lucent All Commercial |
$58.99
|
| Rate for Payer: Lutheran Preferred All Commercial |
$45.00
|
| Rate for Payer: PHCS All Commercial |
$60.72
|
| Rate for Payer: PHP All Commercial |
$55.86
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$34.70
|
| Rate for Payer: Signature Care EPO |
$45.21
|
| Rate for Payer: Signature Care PPO |
$45.21
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$42.00
|
| Rate for Payer: United Healthcare Commercial |
$44.70
|
| Rate for Payer: United Healthcare Medicare |
$34.70
|
|
|
PR CANAL OTICON RIC STYLE #86
|
Professional
|
$80.00
|
|
|
Service Code
|
CPT V5264
|
| Hospital Charge Code |
zV5264L
|
| 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 CANAL POWER RECÂ STYLE #88
|
Professional
|
$80.00
|
|
|
Service Code
|
CPT V5264
|
| Hospital Charge Code |
zV5264N
|
| 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 CANAL SIEMENS RIC STYLE #87
|
Professional
|
$80.00
|
|
|
Service Code
|
CPT V5264
|
| Hospital Charge Code |
zV5264M
|
| 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 CANAL STYLE #4
|
Professional
|
$80.00
|
|
|
Service Code
|
CPT V5264
|
| Hospital Charge Code |
zV5264I
|
| 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 CARDIAC STRESS TST,INTERP/REPT ONLY
|
Professional
|
$26.18
|
|
|
Service Code
|
CPT 93018
|
| Hospital Charge Code |
z93018
|
| Min. Negotiated Rate |
$13.41 |
| Max. Negotiated Rate |
$24.60 |
| Rate for Payer: Aetna Medicare |
$13.41
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$24.60
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$24.60
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$15.42
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$14.75
|
| Rate for Payer: Cash Price |
$16.23
|
| Rate for Payer: Cash Price |
$16.23
|
| Rate for Payer: Coventry All Commercial |
$16.09
|
| Rate for Payer: Frontpath All Commercial |
$15.66
|
| Rate for Payer: Humana ChoiceCare |
$20.81
|
| Rate for Payer: Humana Medicare |
$13.41
|
| Rate for Payer: Lucent All Commercial |
$22.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$21.00
|
| Rate for Payer: PHCS All Commercial |
$19.64
|
| Rate for Payer: PHP All Commercial |
$19.24
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$13.41
|
| Rate for Payer: Signature Care EPO |
$23.75
|
| Rate for Payer: Signature Care PPO |
$23.75
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$20.00
|
| Rate for Payer: United Healthcare Commercial |
$19.59
|
| Rate for Payer: United Healthcare Medicare |
$13.41
|
|
|
PR CARDIOVERSION ELECTIVE ARRHYTHMIA EXTERNAL
|
Professional
|
$285.16
|
|
|
Service Code
|
CPT 92960
|
| Hospital Charge Code |
z92960
|
| Min. Negotiated Rate |
$102.00 |
| Max. Negotiated Rate |
$251.74 |
| Rate for Payer: Aetna Medicare |
$102.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$239.93
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$239.93
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$117.30
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$112.20
|
| Rate for Payer: Cash Price |
$176.80
|
| Rate for Payer: Cash Price |
$176.80
|
| Rate for Payer: Coventry All Commercial |
$122.40
|
| Rate for Payer: Frontpath All Commercial |
$117.41
|
| Rate for Payer: Humana ChoiceCare |
$172.05
|
| Rate for Payer: Humana Medicare |
$102.00
|
| Rate for Payer: Lucent All Commercial |
$173.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$163.00
|
| Rate for Payer: PHCS All Commercial |
$213.87
|
| Rate for Payer: PHP All Commercial |
$146.28
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$102.00
|
| Rate for Payer: Signature Care EPO |
$251.74
|
| Rate for Payer: Signature Care PPO |
$251.74
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$153.00
|
| Rate for Payer: United Healthcare Commercial |
$160.44
|
| Rate for Payer: United Healthcare Medicare |
$102.00
|
|
|
PR CARE AFTER DELIVERY ONLY
|
Professional
|
$190.00
|
|
|
Service Code
|
CPT 59430
|
| Hospital Charge Code |
z59430
|
| Min. Negotiated Rate |
$121.26 |
| Max. Negotiated Rate |
$276.50 |
| Rate for Payer: Aetna Medicare |
$162.65
|
| Rate for Payer: Aetna Medicare |
$162.65
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$132.90
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$132.90
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$132.90
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$132.90
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$187.05
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$187.05
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$178.92
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$178.92
|
| Rate for Payer: Cash Price |
$293.87
|
| Rate for Payer: Cash Price |
$117.80
|
| Rate for Payer: Cash Price |
$293.87
|
| Rate for Payer: Cash Price |
$117.80
|
| Rate for Payer: Coventry All Commercial |
$195.18
|
| Rate for Payer: Coventry All Commercial |
$195.18
|
| Rate for Payer: Frontpath All Commercial |
$234.38
|
| Rate for Payer: Frontpath All Commercial |
$234.38
|
| Rate for Payer: Humana ChoiceCare |
$121.26
|
| Rate for Payer: Humana ChoiceCare |
$121.26
|
| Rate for Payer: Humana Medicare |
$162.65
|
| Rate for Payer: Humana Medicare |
$162.65
|
| Rate for Payer: Lucent All Commercial |
$276.50
|
| Rate for Payer: Lucent All Commercial |
$276.50
|
| Rate for Payer: Lutheran Preferred All Commercial |
$228.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$228.00
|
| Rate for Payer: PHCS All Commercial |
$355.48
|
| Rate for Payer: PHCS All Commercial |
$142.50
|
| Rate for Payer: PHP All Commercial |
$209.46
|
| Rate for Payer: PHP All Commercial |
$209.46
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$162.65
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$162.65
|
| Rate for Payer: Signature Care EPO |
$208.00
|
| Rate for Payer: Signature Care EPO |
$208.00
|
| Rate for Payer: Signature Care PPO |
$208.00
|
| Rate for Payer: Signature Care PPO |
$208.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$211.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$211.00
|
| Rate for Payer: United Healthcare Commercial |
$142.23
|
| Rate for Payer: United Healthcare Commercial |
$142.23
|
| Rate for Payer: United Healthcare Medicare |
$162.65
|
| Rate for Payer: United Healthcare Medicare |
$162.65
|
|
|
PR CAREGIVER HLTH RISK ASSMT SCORE DOC STND INSTRM
|
Professional
|
$4.82
|
|
|
Service Code
|
CPT 96161
|
| Hospital Charge Code |
z96161
|
| Min. Negotiated Rate |
$2.47 |
| Max. Negotiated Rate |
$5.38 |
| Rate for Payer: Aetna Medicare |
$2.47
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2.84
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2.72
|
| Rate for Payer: Cash Price |
$2.99
|
| Rate for Payer: Cash Price |
$2.99
|
| Rate for Payer: Coventry All Commercial |
$2.96
|
| Rate for Payer: Frontpath All Commercial |
$2.63
|
| Rate for Payer: Humana ChoiceCare |
$5.17
|
| Rate for Payer: Humana Medicare |
$2.47
|
| Rate for Payer: Lucent All Commercial |
$4.20
|
| Rate for Payer: PHCS All Commercial |
$3.62
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2.47
|
| Rate for Payer: United Healthcare Commercial |
$5.38
|
| Rate for Payer: United Healthcare Medicare |
$2.47
|
|
|
PR CA SCREEN;PELVIC/BREAST EXAM
|
Professional
|
$89.00
|
|
|
Service Code
|
CPT G0101
|
| Hospital Charge Code |
zG0101
|
| Min. Negotiated Rate |
$25.64 |
| Max. Negotiated Rate |
$66.75 |
| Rate for Payer: Aetna Medicare |
$25.64
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$41.50
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$41.50
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$29.49
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$28.20
|
| Rate for Payer: Cash Price |
$55.18
|
| Rate for Payer: Cash Price |
$55.18
|
| Rate for Payer: Coventry All Commercial |
$30.77
|
| Rate for Payer: Humana ChoiceCare |
$30.97
|
| Rate for Payer: Humana Medicare |
$25.64
|
| Rate for Payer: Lucent All Commercial |
$43.59
|
| Rate for Payer: PHCS All Commercial |
$66.75
|
| Rate for Payer: PHP All Commercial |
$35.77
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$25.64
|
| Rate for Payer: Signature Care EPO |
$54.19
|
| Rate for Payer: Signature Care PPO |
$54.19
|
| Rate for Payer: United Healthcare Commercial |
$41.11
|
| Rate for Payer: United Healthcare Medicare |
$25.64
|
|
|
PR CAST SUP LNG ARM SPLINT FBRG
|
Professional
|
$94.79
|
|
|
Service Code
|
CPT Q4018
|
| Hospital Charge Code |
zQ4018
|
| Min. Negotiated Rate |
$11.13 |
| Max. Negotiated Rate |
$71.09 |
| Rate for Payer: Cash Price |
$58.77
|
| Rate for Payer: Cash Price |
$58.77
|
| Rate for Payer: Humana ChoiceCare |
$14.66
|
| Rate for Payer: PHCS All Commercial |
$71.09
|
| Rate for Payer: PHP All Commercial |
$14.66
|
| Rate for Payer: Signature Care EPO |
$64.46
|
| Rate for Payer: Signature Care PPO |
$64.46
|
| Rate for Payer: United Healthcare Commercial |
$11.13
|
|
|
PR CAST SUP LNG ARM SPLNT PED F
|
Professional
|
$56.38
|
|
|
Service Code
|
CPT Q4020
|
| Hospital Charge Code |
zQ4020
|
| Min. Negotiated Rate |
$5.57 |
| Max. Negotiated Rate |
$42.28 |
| Rate for Payer: Cash Price |
$34.96
|
| Rate for Payer: Cash Price |
$34.96
|
| Rate for Payer: Humana ChoiceCare |
$7.36
|
| Rate for Payer: PHCS All Commercial |
$42.28
|
| Rate for Payer: PHP All Commercial |
$7.36
|
| Rate for Payer: Signature Care EPO |
$38.34
|
| Rate for Payer: Signature Care PPO |
$38.34
|
| Rate for Payer: United Healthcare Commercial |
$5.57
|
|
|
PR CAST SUP LNG LEG PED FBRGLS
|
Professional
|
$16.17
|
|
|
Service Code
|
CPT Q4032
|
| Hospital Charge Code |
zQ4032
|
| Min. Negotiated Rate |
$11.00 |
| Max. Negotiated Rate |
$38.44 |
| Rate for Payer: Cash Price |
$10.03
|
| Rate for Payer: Cash Price |
$10.03
|
| Rate for Payer: Humana ChoiceCare |
$38.44
|
| Rate for Payer: PHCS All Commercial |
$12.13
|
| Rate for Payer: PHP All Commercial |
$38.44
|
| Rate for Payer: Signature Care EPO |
$11.00
|
| Rate for Payer: Signature Care PPO |
$11.00
|
| Rate for Payer: United Healthcare Commercial |
$29.14
|
|
|
PR CAST SUP LNG LEG SPLNT FBRGL
|
Professional
|
$153.76
|
|
|
Service Code
|
CPT Q4042
|
| Hospital Charge Code |
zQ4042
|
| Min. Negotiated Rate |
$26.15 |
| Max. Negotiated Rate |
$115.32 |
| Rate for Payer: Cash Price |
$95.33
|
| Rate for Payer: Cash Price |
$95.33
|
| Rate for Payer: Humana ChoiceCare |
$34.49
|
| Rate for Payer: PHCS All Commercial |
$115.32
|
| Rate for Payer: PHP All Commercial |
$34.49
|
| Rate for Payer: Signature Care EPO |
$104.56
|
| Rate for Payer: Signature Care PPO |
$104.56
|
| Rate for Payer: United Healthcare Commercial |
$26.15
|
|
|
PR CAST SUP LNG LEG SPLNT PED F
|
Professional
|
$67.07
|
|
|
Service Code
|
CPT Q4044
|
| Hospital Charge Code |
zQ4044
|
| Min. Negotiated Rate |
$13.08 |
| Max. Negotiated Rate |
$50.30 |
| Rate for Payer: Cash Price |
$41.58
|
| Rate for Payer: Cash Price |
$41.58
|
| Rate for Payer: Humana ChoiceCare |
$17.27
|
| Rate for Payer: PHCS All Commercial |
$50.30
|
| Rate for Payer: PHP All Commercial |
$17.27
|
| Rate for Payer: Signature Care EPO |
$45.61
|
| Rate for Payer: Signature Care PPO |
$45.61
|
| Rate for Payer: United Healthcare Commercial |
$13.08
|
|
|
PR CAST SUP LONG ARM ADULT FBRG
|
Professional
|
$13.10
|
|
|
Service Code
|
CPT Q4006
|
| Hospital Charge Code |
zQ4006
|
| Min. Negotiated Rate |
$8.91 |
| Max. Negotiated Rate |
$29.51 |
| Rate for Payer: Cash Price |
$8.12
|
| Rate for Payer: Cash Price |
$8.12
|
| Rate for Payer: Humana ChoiceCare |
$29.51
|
| Rate for Payer: PHCS All Commercial |
$9.82
|
| Rate for Payer: PHP All Commercial |
$29.51
|
| Rate for Payer: Signature Care EPO |
$8.91
|
| Rate for Payer: Signature Care PPO |
$8.91
|
| Rate for Payer: United Healthcare Commercial |
$22.38
|
|
|
PR CAST SUP LONG ARM PED FBRGLS
|
Professional
|
$9.19
|
|
|
Service Code
|
CPT Q4008
|
| Hospital Charge Code |
zQ4008
|
| Min. Negotiated Rate |
$6.25 |
| Max. Negotiated Rate |
$14.75 |
| Rate for Payer: Cash Price |
$5.70
|
| Rate for Payer: Cash Price |
$5.70
|
| Rate for Payer: Humana ChoiceCare |
$14.75
|
| Rate for Payer: PHCS All Commercial |
$6.89
|
| Rate for Payer: PHP All Commercial |
$14.75
|
| Rate for Payer: Signature Care EPO |
$6.25
|
| Rate for Payer: Signature Care PPO |
$6.25
|
| Rate for Payer: United Healthcare Commercial |
$11.19
|
|
|
PR CAST SUP LONG LEG FIBERGLASS
|
Professional
|
$28.23
|
|
|
Service Code
|
CPT Q4030
|
| Hospital Charge Code |
zQ4030
|
| Min. Negotiated Rate |
$19.20 |
| Max. Negotiated Rate |
$76.87 |
| Rate for Payer: Cash Price |
$17.50
|
| Rate for Payer: Cash Price |
$17.50
|
| Rate for Payer: Humana ChoiceCare |
$76.87
|
| Rate for Payer: PHCS All Commercial |
$21.17
|
| Rate for Payer: PHP All Commercial |
$76.87
|
| Rate for Payer: Signature Care EPO |
$19.20
|
| Rate for Payer: Signature Care PPO |
$19.20
|
| Rate for Payer: United Healthcare Commercial |
$58.29
|
|
|
PR CAST SUP SHRT LEG FIBERGLASS
|
Professional
|
$14.96
|
|
|
Service Code
|
CPT Q4038
|
| Hospital Charge Code |
zQ4038
|
| Min. Negotiated Rate |
$10.17 |
| Max. Negotiated Rate |
$41.62 |
| Rate for Payer: Cash Price |
$9.28
|
| Rate for Payer: Cash Price |
$9.28
|
| Rate for Payer: Humana ChoiceCare |
$41.62
|
| Rate for Payer: PHCS All Commercial |
$11.22
|
| Rate for Payer: PHP All Commercial |
$41.62
|
| Rate for Payer: Signature Care EPO |
$10.17
|
| Rate for Payer: Signature Care PPO |
$10.17
|
| Rate for Payer: United Healthcare Commercial |
$31.57
|
|
|
PR CAST SUP SHRT LEG PED FBRGLS
|
Professional
|
$12.00
|
|
|
Service Code
|
CPT Q4040
|
| Hospital Charge Code |
zQ4040
|
| Min. Negotiated Rate |
$8.16 |
| Max. Negotiated Rate |
$20.81 |
| Rate for Payer: Cash Price |
$7.44
|
| Rate for Payer: Cash Price |
$7.44
|
| Rate for Payer: Humana ChoiceCare |
$20.81
|
| Rate for Payer: PHCS All Commercial |
$9.00
|
| Rate for Payer: PHP All Commercial |
$20.81
|
| Rate for Payer: Signature Care EPO |
$8.16
|
| Rate for Payer: Signature Care PPO |
$8.16
|
| Rate for Payer: United Healthcare Commercial |
$15.78
|
|
