|
PR CAST SUP SHT ARM ADULT FBRGL
|
Professional
|
$9.19
|
|
|
Service Code
|
CPT Q4010
|
| Hospital Charge Code |
zQ4010
|
| Min. Negotiated Rate |
$6.25 |
| Max. Negotiated Rate |
$19.67 |
| Rate for Payer: Cash Price |
$5.70
|
| Rate for Payer: Cash Price |
$5.70
|
| Rate for Payer: Humana ChoiceCare |
$19.67
|
| Rate for Payer: PHCS All Commercial |
$6.89
|
| Rate for Payer: PHP All Commercial |
$19.67
|
| Rate for Payer: Signature Care EPO |
$6.25
|
| Rate for Payer: Signature Care PPO |
$6.25
|
| Rate for Payer: United Healthcare Commercial |
$14.93
|
|
|
PR CAST SUP SHT ARM PED FBRGLAS
|
Professional
|
$5.62
|
|
|
Service Code
|
CPT Q4012
|
| Hospital Charge Code |
zQ4012
|
| Min. Negotiated Rate |
$3.82 |
| Max. Negotiated Rate |
$9.86 |
| Rate for Payer: Cash Price |
$3.48
|
| Rate for Payer: Cash Price |
$3.48
|
| Rate for Payer: Humana ChoiceCare |
$9.86
|
| Rate for Payer: PHCS All Commercial |
$4.22
|
| Rate for Payer: PHP All Commercial |
$9.86
|
| Rate for Payer: Signature Care EPO |
$3.82
|
| Rate for Payer: Signature Care PPO |
$3.82
|
| Rate for Payer: United Healthcare Commercial |
$7.46
|
|
|
PR CAST SUP SHT ARM SPLINT FBRG
|
Professional
|
$43.34
|
|
|
Service Code
|
CPT Q4022
|
| Hospital Charge Code |
zQ4022
|
| Min. Negotiated Rate |
$9.32 |
| Max. Negotiated Rate |
$32.50 |
| Rate for Payer: Cash Price |
$26.87
|
| Rate for Payer: Cash Price |
$26.87
|
| Rate for Payer: Humana ChoiceCare |
$12.29
|
| Rate for Payer: PHCS All Commercial |
$32.50
|
| Rate for Payer: PHP All Commercial |
$12.29
|
| Rate for Payer: Signature Care EPO |
$29.47
|
| Rate for Payer: Signature Care PPO |
$29.47
|
| Rate for Payer: United Healthcare Commercial |
$9.32
|
|
|
PR CAST SUP SHT ARM SPLNT PED F
|
Professional
|
$25.74
|
|
|
Service Code
|
CPT Q4024
|
| Hospital Charge Code |
zQ4024
|
| Min. Negotiated Rate |
$4.66 |
| Max. Negotiated Rate |
$19.30 |
| Rate for Payer: Cash Price |
$15.96
|
| Rate for Payer: Cash Price |
$15.96
|
| Rate for Payer: Humana ChoiceCare |
$6.15
|
| Rate for Payer: PHCS All Commercial |
$19.30
|
| Rate for Payer: PHP All Commercial |
$6.15
|
| Rate for Payer: Signature Care EPO |
$17.50
|
| Rate for Payer: Signature Care PPO |
$17.50
|
| Rate for Payer: United Healthcare Commercial |
$4.66
|
|
|
PR CAST SUP SHT LEG SPLNT FBRGL
|
Professional
|
$96.37
|
|
|
Service Code
|
CPT Q4046
|
| Hospital Charge Code |
zQ4046
|
| Min. Negotiated Rate |
$14.31 |
| Max. Negotiated Rate |
$72.28 |
| Rate for Payer: Cash Price |
$59.75
|
| Rate for Payer: Cash Price |
$59.75
|
| Rate for Payer: Humana ChoiceCare |
$18.86
|
| Rate for Payer: PHCS All Commercial |
$72.28
|
| Rate for Payer: PHP All Commercial |
$18.86
|
| Rate for Payer: Signature Care EPO |
$65.53
|
| Rate for Payer: Signature Care PPO |
$65.53
|
| Rate for Payer: United Healthcare Commercial |
$14.31
|
|
|
PR CAST SUP SHT LEG SPLNT PED F
|
Professional
|
$47.23
|
|
|
Service Code
|
CPT Q4048
|
| Hospital Charge Code |
zQ4048
|
| Min. Negotiated Rate |
$7.16 |
| Max. Negotiated Rate |
$35.42 |
| Rate for Payer: Cash Price |
$29.28
|
| Rate for Payer: Cash Price |
$29.28
|
| Rate for Payer: Humana ChoiceCare |
$9.44
|
| Rate for Payer: PHCS All Commercial |
$35.42
|
| Rate for Payer: PHP All Commercial |
$9.44
|
| Rate for Payer: Signature Care EPO |
$32.12
|
| Rate for Payer: Signature Care PPO |
$32.12
|
| Rate for Payer: United Healthcare Commercial |
$7.16
|
|
|
PR CATH/INJECT HYSTEROSALPINGOGRAM
|
Professional
|
$448.10
|
|
|
Service Code
|
CPT 58340
|
| Hospital Charge Code |
z58340
|
| Min. Negotiated Rate |
$53.38 |
| Max. Negotiated Rate |
$336.08 |
| Rate for Payer: Aetna Medicare |
$53.38
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$202.65
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$202.65
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$61.39
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$58.72
|
| Rate for Payer: Cash Price |
$277.82
|
| Rate for Payer: Cash Price |
$277.82
|
| Rate for Payer: Coventry All Commercial |
$64.06
|
| Rate for Payer: Frontpath All Commercial |
$72.60
|
| Rate for Payer: Humana ChoiceCare |
$66.87
|
| Rate for Payer: Humana Medicare |
$53.38
|
| Rate for Payer: Lucent All Commercial |
$90.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$75.00
|
| Rate for Payer: PHCS All Commercial |
$336.08
|
| Rate for Payer: PHP All Commercial |
$68.74
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$53.38
|
| Rate for Payer: Signature Care EPO |
$201.46
|
| Rate for Payer: Signature Care PPO |
$201.46
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$69.00
|
| Rate for Payer: United Healthcare Commercial |
$66.94
|
| Rate for Payer: United Healthcare Medicare |
$53.38
|
|
|
PR CAUTERIZATION,CERVIX,ELECTRO/THERMAL
|
Professional
|
$306.72
|
|
|
Service Code
|
CPT 57510
|
| Hospital Charge Code |
z57510
|
| Min. Negotiated Rate |
$105.03 |
| Max. Negotiated Rate |
$230.04 |
| Rate for Payer: Aetna Medicare |
$105.03
|
| 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 |
$120.78
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$115.53
|
| Rate for Payer: Cash Price |
$190.17
|
| Rate for Payer: Cash Price |
$190.17
|
| Rate for Payer: Coventry All Commercial |
$126.04
|
| Rate for Payer: Frontpath All Commercial |
$146.74
|
| Rate for Payer: Humana ChoiceCare |
$130.47
|
| Rate for Payer: Humana Medicare |
$105.03
|
| Rate for Payer: Lucent All Commercial |
$178.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$147.00
|
| Rate for Payer: PHCS All Commercial |
$230.04
|
| Rate for Payer: PHP All Commercial |
$135.25
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$105.03
|
| Rate for Payer: Signature Care EPO |
$170.85
|
| Rate for Payer: Signature Care PPO |
$170.85
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$137.00
|
| Rate for Payer: United Healthcare Commercial |
$131.19
|
| Rate for Payer: United Healthcare Medicare |
$105.03
|
|
|
PR CAUTER TURBINATE MUCOSA,SUPERFICIAL
|
Professional
|
$401.78
|
|
|
Service Code
|
CPT 30801
|
| Hospital Charge Code |
z30801
|
| Min. Negotiated Rate |
$132.51 |
| Max. Negotiated Rate |
$301.34 |
| Rate for Payer: Aetna Medicare |
$143.55
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$214.58
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$214.58
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$165.08
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$157.90
|
| Rate for Payer: Cash Price |
$249.10
|
| Rate for Payer: Cash Price |
$249.10
|
| Rate for Payer: Coventry All Commercial |
$172.26
|
| Rate for Payer: Frontpath All Commercial |
$195.20
|
| Rate for Payer: Humana ChoiceCare |
$132.51
|
| Rate for Payer: Humana Medicare |
$143.55
|
| Rate for Payer: Lucent All Commercial |
$244.04
|
| Rate for Payer: Lutheran Preferred All Commercial |
$230.00
|
| Rate for Payer: PHCS All Commercial |
$301.34
|
| Rate for Payer: PHP All Commercial |
$196.07
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$143.55
|
| Rate for Payer: Signature Care EPO |
$183.76
|
| Rate for Payer: Signature Care PPO |
$183.76
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$215.00
|
| Rate for Payer: United Healthcare Commercial |
$138.56
|
| Rate for Payer: United Healthcare Medicare |
$143.55
|
|
|
PR CCM/BHI BY RHC/FQHC 20MIN MO
|
Professional
|
$133.54
|
|
|
Service Code
|
CPT G0511
|
| Hospital Charge Code |
zG0511
|
| Min. Negotiated Rate |
$34.71 |
| Max. Negotiated Rate |
$100.16 |
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$57.59
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$57.59
|
| Rate for Payer: Cash Price |
$82.79
|
| Rate for Payer: Cash Price |
$82.79
|
| Rate for Payer: Humana ChoiceCare |
$36.66
|
| Rate for Payer: PHCS All Commercial |
$100.16
|
| Rate for Payer: PHP All Commercial |
$43.34
|
| Rate for Payer: United Healthcare Commercial |
$34.71
|
|
|
PR CEFAZOLIN SODIUM INJECTION
|
Professional
|
$1.92
|
|
|
Service Code
|
CPT J0690
|
| Hospital Charge Code |
zJ0690
|
| Min. Negotiated Rate |
$0.73 |
| Max. Negotiated Rate |
$1.92 |
| Rate for Payer: Humana ChoiceCare |
$0.73
|
| Rate for Payer: PHP All Commercial |
$1.92
|
|
|
PR CEFTRIAXONE SODIUM INJECTION
|
Professional
|
$1.12
|
|
|
Service Code
|
CPT J0696
|
| Hospital Charge Code |
zJ0696
|
| Min. Negotiated Rate |
$0.53 |
| Max. Negotiated Rate |
$1.12 |
| Rate for Payer: Humana ChoiceCare |
$0.53
|
| Rate for Payer: PHP All Commercial |
$1.12
|
|
|
PR CESAREAN DELIVERY ONLY
|
Professional
|
$1,594.50
|
|
|
Service Code
|
CPT 59514
|
| Hospital Charge Code |
z59514
|
| Min. Negotiated Rate |
$817.19 |
| Max. Negotiated Rate |
$1,389.22 |
| Rate for Payer: Aetna Medicare |
$817.19
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$987.53
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$987.53
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$939.77
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$898.91
|
| Rate for Payer: Cash Price |
$988.59
|
| Rate for Payer: Cash Price |
$988.59
|
| Rate for Payer: Coventry All Commercial |
$980.63
|
| Rate for Payer: Frontpath All Commercial |
$1,183.39
|
| Rate for Payer: Humana ChoiceCare |
$881.00
|
| Rate for Payer: Humana Medicare |
$817.19
|
| Rate for Payer: Lucent All Commercial |
$1,389.22
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,144.00
|
| Rate for Payer: PHCS All Commercial |
$1,195.88
|
| Rate for Payer: PHP All Commercial |
$1,052.38
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$817.19
|
| Rate for Payer: Signature Care EPO |
$1,130.50
|
| Rate for Payer: Signature Care PPO |
$1,130.50
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,062.00
|
| Rate for Payer: United Healthcare Commercial |
$1,032.76
|
| Rate for Payer: United Healthcare Medicare |
$817.19
|
|
|
PR CESAREAN DELIVERY+POSTPARTUM CARE
|
Professional
|
$2,296.00
|
|
|
Service Code
|
CPT 59515
|
| Hospital Charge Code |
z59515
|
| Min. Negotiated Rate |
$994.75 |
| Max. Negotiated Rate |
$2,000.39 |
| Rate for Payer: Aetna Medicare |
$1,176.70
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,089.77
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,089.77
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,353.20
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,294.37
|
| Rate for Payer: Cash Price |
$1,423.52
|
| Rate for Payer: Cash Price |
$1,423.52
|
| Rate for Payer: Coventry All Commercial |
$1,412.04
|
| Rate for Payer: Frontpath All Commercial |
$1,699.44
|
| Rate for Payer: Humana ChoiceCare |
$994.75
|
| Rate for Payer: Humana Medicare |
$1,176.70
|
| Rate for Payer: Lucent All Commercial |
$2,000.39
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,647.00
|
| Rate for Payer: PHCS All Commercial |
$1,722.00
|
| Rate for Payer: PHP All Commercial |
$1,515.36
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,176.70
|
| Rate for Payer: Signature Care EPO |
$1,278.40
|
| Rate for Payer: Signature Care PPO |
$1,278.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,530.00
|
| Rate for Payer: United Healthcare Commercial |
$1,217.84
|
| Rate for Payer: United Healthcare Medicare |
$1,176.70
|
|
|
PR CHEMICAL CAUTERIZATION OF GRANULATION TISSUE
|
Professional
|
$159.06
|
|
|
Service Code
|
CPT 17250
|
| Hospital Charge Code |
z17250
|
| Min. Negotiated Rate |
$31.61 |
| Max. Negotiated Rate |
$119.30 |
| Rate for Payer: Aetna Medicare |
$34.59
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$81.17
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$81.17
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$39.78
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$38.05
|
| Rate for Payer: Cash Price |
$98.62
|
| Rate for Payer: Cash Price |
$98.62
|
| Rate for Payer: Coventry All Commercial |
$41.51
|
| Rate for Payer: Frontpath All Commercial |
$47.87
|
| Rate for Payer: Humana ChoiceCare |
$31.61
|
| Rate for Payer: Humana Medicare |
$34.59
|
| Rate for Payer: Lucent All Commercial |
$58.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$45.00
|
| Rate for Payer: PHCS All Commercial |
$119.30
|
| Rate for Payer: PHP All Commercial |
$47.25
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$34.59
|
| Rate for Payer: Signature Care EPO |
$71.27
|
| Rate for Payer: Signature Care PPO |
$71.27
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$42.00
|
| Rate for Payer: United Healthcare Commercial |
$39.48
|
| Rate for Payer: United Healthcare Medicare |
$34.59
|
|
|
PR CHORIONIC GONADOTROPIN/1000U
|
Professional
|
$22.88
|
|
|
Service Code
|
CPT J0725
|
| Hospital Charge Code |
zJ0725
|
| Min. Negotiated Rate |
$10.23 |
| Max. Negotiated Rate |
$22.88 |
| Rate for Payer: Humana ChoiceCare |
$22.88
|
| Rate for Payer: PHP All Commercial |
$10.23
|
|
|
PR CHRONIC CARE MGMT SVC PHYS 1ST 30 MIN CAL MONTH
|
Professional
|
$157.14
|
|
|
Service Code
|
CPT 99491
|
| Hospital Charge Code |
z99491
|
| Min. Negotiated Rate |
$71.89 |
| Max. Negotiated Rate |
$122.21 |
| Rate for Payer: Aetna Medicare |
$71.89
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$79.65
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$79.65
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$82.67
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$79.08
|
| Rate for Payer: Cash Price |
$97.43
|
| Rate for Payer: Cash Price |
$97.43
|
| Rate for Payer: Coventry All Commercial |
$86.27
|
| Rate for Payer: Frontpath All Commercial |
$78.96
|
| Rate for Payer: Humana ChoiceCare |
$84.75
|
| Rate for Payer: Humana Medicare |
$71.89
|
| Rate for Payer: Lucent All Commercial |
$122.21
|
| Rate for Payer: Lutheran Preferred All Commercial |
$75.00
|
| Rate for Payer: PHCS All Commercial |
$117.86
|
| Rate for Payer: PHP All Commercial |
$72.24
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$71.89
|
| Rate for Payer: Signature Care EPO |
$82.95
|
| Rate for Payer: Signature Care PPO |
$82.95
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$74.00
|
| Rate for Payer: United Healthcare Commercial |
$84.42
|
| Rate for Payer: United Healthcare Medicare |
$71.89
|
|
|
PR CHRONIC CARE MGMT SVCS STAFF 1ST 20 MIN CAL MO
|
Professional
|
$115.30
|
|
|
Service Code
|
CPT 99490
|
| Hospital Charge Code |
z99490
|
| Min. Negotiated Rate |
$33.27 |
| Max. Negotiated Rate |
$86.48 |
| Rate for Payer: Aetna Medicare |
$47.98
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$49.65
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$49.65
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$55.18
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$52.78
|
| Rate for Payer: Cash Price |
$71.49
|
| Rate for Payer: Cash Price |
$71.49
|
| Rate for Payer: Coventry All Commercial |
$57.58
|
| Rate for Payer: Frontpath All Commercial |
$52.55
|
| Rate for Payer: Humana ChoiceCare |
$33.49
|
| Rate for Payer: Humana Medicare |
$47.98
|
| Rate for Payer: Lucent All Commercial |
$81.57
|
| Rate for Payer: Lutheran Preferred All Commercial |
$50.00
|
| Rate for Payer: PHCS All Commercial |
$86.48
|
| Rate for Payer: PHP All Commercial |
$48.21
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$47.98
|
| Rate for Payer: Signature Care EPO |
$51.03
|
| Rate for Payer: Signature Care PPO |
$51.03
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$49.00
|
| Rate for Payer: United Healthcare Commercial |
$33.27
|
| Rate for Payer: United Healthcare Medicare |
$47.98
|
|
|
PR CHRONIC CARE MGMT SVC STAF EA ADDL 20 MIN CAL MO
|
Professional
|
$87.30
|
|
|
Service Code
|
CPT 99439
|
| Hospital Charge Code |
z99439
|
| Min. Negotiated Rate |
$28.42 |
| Max. Negotiated Rate |
$65.48 |
| Rate for Payer: Aetna Medicare |
$33.32
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$35.19
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$35.19
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$38.32
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$36.65
|
| Rate for Payer: Cash Price |
$54.13
|
| Rate for Payer: Cash Price |
$54.13
|
| Rate for Payer: Coventry All Commercial |
$39.98
|
| Rate for Payer: Frontpath All Commercial |
$37.02
|
| Rate for Payer: Humana ChoiceCare |
$28.42
|
| Rate for Payer: Humana Medicare |
$33.32
|
| Rate for Payer: Lucent All Commercial |
$56.64
|
| Rate for Payer: Lutheran Preferred All Commercial |
$35.00
|
| Rate for Payer: PHCS All Commercial |
$65.48
|
| Rate for Payer: PHP All Commercial |
$33.48
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$33.32
|
| Rate for Payer: Signature Care EPO |
$38.48
|
| Rate for Payer: Signature Care PPO |
$38.48
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$34.00
|
| Rate for Payer: United Healthcare Commercial |
$29.36
|
| Rate for Payer: United Healthcare Medicare |
$33.32
|
|
|
PR CIRCUMCISION NEONATE
|
Professional
|
$402.00
|
|
|
Service Code
|
CPT 54160
|
| Hospital Charge Code |
z54160
|
| Min. Negotiated Rate |
$135.94 |
| Max. Negotiated Rate |
$333.83 |
| Rate for Payer: Aetna Medicare |
$135.94
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$333.83
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$333.83
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$156.33
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$149.53
|
| Rate for Payer: Cash Price |
$249.24
|
| Rate for Payer: Cash Price |
$249.24
|
| Rate for Payer: Coventry All Commercial |
$163.13
|
| Rate for Payer: Frontpath All Commercial |
$186.82
|
| Rate for Payer: Humana ChoiceCare |
$170.74
|
| Rate for Payer: Humana Medicare |
$135.94
|
| Rate for Payer: Lucent All Commercial |
$231.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$190.00
|
| Rate for Payer: PHCS All Commercial |
$301.50
|
| Rate for Payer: PHP All Commercial |
$175.07
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$135.94
|
| Rate for Payer: Signature Care EPO |
$178.06
|
| Rate for Payer: Signature Care PPO |
$178.06
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$177.00
|
| Rate for Payer: United Healthcare Commercial |
$178.68
|
| Rate for Payer: United Healthcare Medicare |
$135.94
|
|
|
PR CIRCUMCISION W/CLAMP/OTH DEV W/BLOCK
|
Professional
|
$271.42
|
|
|
Service Code
|
CPT 54150
|
| Hospital Charge Code |
z54150
|
| Min. Negotiated Rate |
$90.02 |
| Max. Negotiated Rate |
$268.82 |
| Rate for Payer: Aetna Medicare |
$90.02
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$268.82
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$268.82
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$103.52
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$99.02
|
| Rate for Payer: Cash Price |
$168.28
|
| Rate for Payer: Cash Price |
$168.28
|
| Rate for Payer: Coventry All Commercial |
$108.02
|
| Rate for Payer: Frontpath All Commercial |
$126.13
|
| Rate for Payer: Humana ChoiceCare |
$120.90
|
| Rate for Payer: Humana Medicare |
$90.02
|
| Rate for Payer: Lucent All Commercial |
$153.03
|
| Rate for Payer: Lutheran Preferred All Commercial |
$126.00
|
| Rate for Payer: PHCS All Commercial |
$203.56
|
| Rate for Payer: PHP All Commercial |
$115.93
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$90.02
|
| Rate for Payer: Signature Care EPO |
$128.35
|
| Rate for Payer: Signature Care PPO |
$128.35
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$117.00
|
| Rate for Payer: United Healthcare Commercial |
$121.03
|
| Rate for Payer: United Healthcare Medicare |
$90.02
|
|
|
PR CLEANING SPRAY
|
Professional
|
$400.00
|
|
|
Service Code
|
CPT V5267
|
| Hospital Charge Code |
zV5267B
|
| Min. Negotiated Rate |
$300.00 |
| Max. Negotiated Rate |
$400.00 |
| Rate for Payer: Cash Price |
$248.00
|
| Rate for Payer: PHCS All Commercial |
$300.00
|
| Rate for Payer: Signature Care EPO |
$400.00
|
| Rate for Payer: Signature Care PPO |
$400.00
|
|
|
PR CLOSED RX ACETABULAR FX
|
Professional
|
$764.76
|
|
|
Service Code
|
CPT 27220
|
| Hospital Charge Code |
z27220
|
| Min. Negotiated Rate |
$386.08 |
| Max. Negotiated Rate |
$666.33 |
| Rate for Payer: Aetna Medicare |
$386.08
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$585.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$585.30
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$443.99
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$424.69
|
| Rate for Payer: Cash Price |
$474.15
|
| Rate for Payer: Cash Price |
$474.15
|
| Rate for Payer: Coventry All Commercial |
$463.30
|
| Rate for Payer: Frontpath All Commercial |
$536.60
|
| Rate for Payer: Humana ChoiceCare |
$513.22
|
| Rate for Payer: Humana Medicare |
$386.08
|
| Rate for Payer: Lucent All Commercial |
$656.34
|
| Rate for Payer: Lutheran Preferred All Commercial |
$618.00
|
| Rate for Payer: PHCS All Commercial |
$573.57
|
| Rate for Payer: PHP All Commercial |
$655.39
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$386.08
|
| Rate for Payer: Signature Care EPO |
$666.33
|
| Rate for Payer: Signature Care PPO |
$666.33
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$579.00
|
| Rate for Payer: United Healthcare Commercial |
$554.51
|
| Rate for Payer: United Healthcare Medicare |
$386.08
|
|
|
PR CLOSED RX A-C JT DISLOC
|
Professional
|
$445.78
|
|
|
Service Code
|
CPT 23540
|
| Hospital Charge Code |
z23540
|
| Min. Negotiated Rate |
$196.62 |
| Max. Negotiated Rate |
$383.66 |
| Rate for Payer: Aetna Medicare |
$225.68
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$344.58
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$344.58
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$259.53
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$248.25
|
| Rate for Payer: Cash Price |
$276.38
|
| Rate for Payer: Cash Price |
$276.38
|
| Rate for Payer: Coventry All Commercial |
$270.82
|
| Rate for Payer: Frontpath All Commercial |
$303.88
|
| Rate for Payer: Humana ChoiceCare |
$196.62
|
| Rate for Payer: Humana Medicare |
$225.68
|
| Rate for Payer: Lucent All Commercial |
$383.66
|
| Rate for Payer: Lutheran Preferred All Commercial |
$361.00
|
| Rate for Payer: PHCS All Commercial |
$334.34
|
| Rate for Payer: PHP All Commercial |
$383.63
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$225.68
|
| Rate for Payer: Signature Care EPO |
$362.59
|
| Rate for Payer: Signature Care PPO |
$362.59
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$339.00
|
| Rate for Payer: United Healthcare Commercial |
$218.23
|
| Rate for Payer: United Healthcare Medicare |
$225.68
|
|
|
PR CLOSED RX BIG TOE FRACTURE
|
Professional
|
$261.60
|
|
|
Service Code
|
CPT 28490
|
| Hospital Charge Code |
z28490
|
| Min. Negotiated Rate |
$115.12 |
| Max. Negotiated Rate |
$201.16 |
| Rate for Payer: Aetna Medicare |
$118.33
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$129.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$129.00
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$136.08
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$130.16
|
| Rate for Payer: Cash Price |
$162.19
|
| Rate for Payer: Cash Price |
$162.19
|
| Rate for Payer: Coventry All Commercial |
$142.00
|
| Rate for Payer: Frontpath All Commercial |
$157.52
|
| Rate for Payer: Humana ChoiceCare |
$115.12
|
| Rate for Payer: Humana Medicare |
$118.33
|
| Rate for Payer: Lucent All Commercial |
$201.16
|
| Rate for Payer: Lutheran Preferred All Commercial |
$189.00
|
| Rate for Payer: PHCS All Commercial |
$196.20
|
| Rate for Payer: PHP All Commercial |
$200.87
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$118.33
|
| Rate for Payer: Signature Care EPO |
$186.15
|
| Rate for Payer: Signature Care PPO |
$186.15
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$177.00
|
| Rate for Payer: United Healthcare Commercial |
$122.15
|
| Rate for Payer: United Healthcare Medicare |
$118.33
|
|
