|
PR COLONOSCOPY STOMA W/SUBMUCOSAL INJECTION
|
Professional
|
$770.36
|
|
|
Service Code
|
CPT 44404
|
| Hospital Charge Code |
z44404
|
| Min. Negotiated Rate |
$159.26 |
| Max. Negotiated Rate |
$577.77 |
| Rate for Payer: Aetna Medicare |
$159.26
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$183.15
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$175.19
|
| Rate for Payer: Cash Price |
$477.62
|
| Rate for Payer: Cash Price |
$477.62
|
| Rate for Payer: Coventry All Commercial |
$191.11
|
| Rate for Payer: Frontpath All Commercial |
$222.09
|
| Rate for Payer: Humana ChoiceCare |
$209.95
|
| Rate for Payer: Humana Medicare |
$159.26
|
| Rate for Payer: Lucent All Commercial |
$270.74
|
| Rate for Payer: PHCS All Commercial |
$577.77
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$159.26
|
| Rate for Payer: United Healthcare Commercial |
$220.25
|
| Rate for Payer: United Healthcare Medicare |
$159.26
|
|
|
PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE
|
Professional
|
$793.76
|
|
|
Service Code
|
CPT 45380
|
| Hospital Charge Code |
z45380
|
| Min. Negotiated Rate |
$186.07 |
| Max. Negotiated Rate |
$632.40 |
| Rate for Payer: Aetna Medicare |
$186.07
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$623.48
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$623.48
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$213.98
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$204.68
|
| Rate for Payer: Cash Price |
$492.13
|
| Rate for Payer: Cash Price |
$492.13
|
| Rate for Payer: Coventry All Commercial |
$223.28
|
| Rate for Payer: Frontpath All Commercial |
$257.97
|
| Rate for Payer: Humana ChoiceCare |
$279.39
|
| Rate for Payer: Humana Medicare |
$186.07
|
| Rate for Payer: Lucent All Commercial |
$316.32
|
| Rate for Payer: Lutheran Preferred All Commercial |
$279.00
|
| Rate for Payer: PHCS All Commercial |
$595.32
|
| Rate for Payer: PHP All Commercial |
$317.68
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$186.07
|
| Rate for Payer: Signature Care EPO |
$632.40
|
| Rate for Payer: Signature Care PPO |
$632.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$260.00
|
| Rate for Payer: United Healthcare Commercial |
$298.98
|
| Rate for Payer: United Healthcare Medicare |
$186.07
|
|
|
PR COLORECTAL SCRN; HI RISK IND
|
Professional
|
$909.50
|
|
|
Service Code
|
CPT G0105
|
| Hospital Charge Code |
zG0105
|
| Min. Negotiated Rate |
$145.31 |
| Max. Negotiated Rate |
$682.12 |
| Rate for Payer: Aetna Medicare |
$170.95
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$413.20
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$413.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$196.59
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$188.04
|
| Rate for Payer: Cash Price |
$563.89
|
| Rate for Payer: Cash Price |
$563.89
|
| Rate for Payer: Coventry All Commercial |
$205.14
|
| Rate for Payer: Humana ChoiceCare |
$145.31
|
| Rate for Payer: Humana Medicare |
$170.95
|
| Rate for Payer: Lucent All Commercial |
$290.62
|
| Rate for Payer: PHCS All Commercial |
$682.12
|
| Rate for Payer: PHP All Commercial |
$146.77
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$170.95
|
| Rate for Payer: Signature Care EPO |
$472.36
|
| Rate for Payer: Signature Care PPO |
$472.36
|
| Rate for Payer: United Healthcare Commercial |
$248.13
|
| Rate for Payer: United Healthcare Medicare |
$170.95
|
|
|
PR COLPORRHAPHY, SUTURE VAGINAL INJURY, NON-OB
|
Professional
|
$606.42
|
|
|
Service Code
|
CPT 57200
|
| Hospital Charge Code |
z57200
|
| Min. Negotiated Rate |
$299.65 |
| Max. Negotiated Rate |
$528.34 |
| Rate for Payer: Aetna Medicare |
$310.79
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$356.84
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$356.84
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$357.41
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$341.87
|
| Rate for Payer: Cash Price |
$375.98
|
| Rate for Payer: Cash Price |
$375.98
|
| Rate for Payer: Coventry All Commercial |
$372.95
|
| Rate for Payer: Frontpath All Commercial |
$431.92
|
| Rate for Payer: Humana ChoiceCare |
$299.65
|
| Rate for Payer: Humana Medicare |
$310.79
|
| Rate for Payer: Lucent All Commercial |
$528.34
|
| Rate for Payer: Lutheran Preferred All Commercial |
$435.00
|
| Rate for Payer: PHCS All Commercial |
$454.82
|
| Rate for Payer: PHP All Commercial |
$400.23
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$310.79
|
| Rate for Payer: Signature Care EPO |
$337.45
|
| Rate for Payer: Signature Care PPO |
$337.45
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$404.00
|
| Rate for Payer: United Healthcare Commercial |
$331.41
|
| Rate for Payer: United Healthcare Medicare |
$310.79
|
|
|
PR COLPOSC,CERVIX W/ADJ VAG,W/BX & CURRETAG
|
Professional
|
$309.04
|
|
|
Service Code
|
CPT 57454
|
| Hospital Charge Code |
z57454
|
| Min. Negotiated Rate |
$123.81 |
| Max. Negotiated Rate |
$231.78 |
| Rate for Payer: Aetna Medicare |
$123.81
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$208.03
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$208.03
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$142.38
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$136.19
|
| Rate for Payer: Cash Price |
$191.60
|
| Rate for Payer: Cash Price |
$191.60
|
| Rate for Payer: Coventry All Commercial |
$148.57
|
| Rate for Payer: Frontpath All Commercial |
$174.54
|
| Rate for Payer: Humana ChoiceCare |
$154.92
|
| Rate for Payer: Humana Medicare |
$123.81
|
| Rate for Payer: Lucent All Commercial |
$210.48
|
| Rate for Payer: Lutheran Preferred All Commercial |
$173.00
|
| Rate for Payer: PHCS All Commercial |
$231.78
|
| Rate for Payer: PHP All Commercial |
$159.44
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$123.81
|
| Rate for Payer: Signature Care EPO |
$199.75
|
| Rate for Payer: Signature Care PPO |
$199.75
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$161.00
|
| Rate for Payer: United Healthcare Commercial |
$155.24
|
| Rate for Payer: United Healthcare Medicare |
$123.81
|
|
|
PR COLPOSCOPY,CERVIX W/ADJ VAGINA
|
Professional
|
$231.72
|
|
|
Service Code
|
CPT 57452
|
| Hospital Charge Code |
z57452
|
| Min. Negotiated Rate |
$84.49 |
| Max. Negotiated Rate |
$173.79 |
| Rate for Payer: Aetna Medicare |
$84.49
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$144.89
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$144.89
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$97.16
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$92.94
|
| Rate for Payer: Cash Price |
$143.67
|
| Rate for Payer: Cash Price |
$143.67
|
| Rate for Payer: Coventry All Commercial |
$101.39
|
| Rate for Payer: Frontpath All Commercial |
$117.49
|
| Rate for Payer: Humana ChoiceCare |
$100.53
|
| Rate for Payer: Humana Medicare |
$84.49
|
| Rate for Payer: Lucent All Commercial |
$143.63
|
| Rate for Payer: Lutheran Preferred All Commercial |
$118.00
|
| Rate for Payer: PHCS All Commercial |
$173.79
|
| Rate for Payer: PHP All Commercial |
$108.81
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$84.49
|
| Rate for Payer: Signature Care EPO |
$141.10
|
| Rate for Payer: Signature Care PPO |
$141.10
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$110.00
|
| Rate for Payer: United Healthcare Commercial |
$103.94
|
| Rate for Payer: United Healthcare Medicare |
$84.49
|
|
|
PR COLPOSCOPY,CERVIX W/ADJ VAGINA, CURETTAG
|
Professional
|
$278.12
|
|
|
Service Code
|
CPT 57456
|
| Hospital Charge Code |
z57456
|
| Min. Negotiated Rate |
$94.07 |
| Max. Negotiated Rate |
$208.59 |
| Rate for Payer: Aetna Medicare |
$94.07
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$182.09
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$182.09
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$108.18
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$103.48
|
| Rate for Payer: Cash Price |
$172.43
|
| Rate for Payer: Cash Price |
$172.43
|
| Rate for Payer: Coventry All Commercial |
$112.88
|
| Rate for Payer: Frontpath All Commercial |
$132.00
|
| Rate for Payer: Humana ChoiceCare |
$119.22
|
| Rate for Payer: Humana Medicare |
$94.07
|
| Rate for Payer: Lucent All Commercial |
$159.92
|
| Rate for Payer: Lutheran Preferred All Commercial |
$132.00
|
| Rate for Payer: PHCS All Commercial |
$208.59
|
| Rate for Payer: PHP All Commercial |
$121.14
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$94.07
|
| Rate for Payer: Signature Care EPO |
$171.70
|
| Rate for Payer: Signature Care PPO |
$171.70
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$122.00
|
| Rate for Payer: United Healthcare Commercial |
$118.31
|
| Rate for Payer: United Healthcare Medicare |
$94.07
|
|
|
PR COLPOSCOPY,CERVIX W/ADJ VAGINA,W/BX
|
Professional
|
$294.92
|
|
|
Service Code
|
CPT 57455
|
| Hospital Charge Code |
z57455
|
| Min. Negotiated Rate |
$101.14 |
| Max. Negotiated Rate |
$221.19 |
| Rate for Payer: Aetna Medicare |
$101.14
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$193.35
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$193.35
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$116.31
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$111.25
|
| Rate for Payer: Cash Price |
$182.85
|
| Rate for Payer: Cash Price |
$182.85
|
| Rate for Payer: Coventry All Commercial |
$121.37
|
| Rate for Payer: Frontpath All Commercial |
$142.25
|
| Rate for Payer: Humana ChoiceCare |
$127.82
|
| Rate for Payer: Humana Medicare |
$101.14
|
| Rate for Payer: Lucent All Commercial |
$171.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$142.00
|
| Rate for Payer: PHCS All Commercial |
$221.19
|
| Rate for Payer: PHP All Commercial |
$130.24
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$101.14
|
| Rate for Payer: Signature Care EPO |
$181.90
|
| Rate for Payer: Signature Care PPO |
$181.90
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$131.00
|
| Rate for Payer: United Healthcare Commercial |
$126.83
|
| Rate for Payer: United Healthcare Medicare |
$101.14
|
|
|
PR COLPOSCOPY,CERVIX W/ADJ VAG,W/LOOP BX
|
Professional
|
$576.84
|
|
|
Service Code
|
CPT 57460
|
| Hospital Charge Code |
z57460
|
| Min. Negotiated Rate |
$148.38 |
| Max. Negotiated Rate |
$442.01 |
| Rate for Payer: Aetna Medicare |
$148.38
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$442.01
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$442.01
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$170.64
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$163.22
|
| Rate for Payer: Cash Price |
$357.64
|
| Rate for Payer: Cash Price |
$357.64
|
| Rate for Payer: Coventry All Commercial |
$178.06
|
| Rate for Payer: Frontpath All Commercial |
$206.88
|
| Rate for Payer: Humana ChoiceCare |
$187.49
|
| Rate for Payer: Humana Medicare |
$148.38
|
| Rate for Payer: Lucent All Commercial |
$252.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$208.00
|
| Rate for Payer: PHCS All Commercial |
$432.63
|
| Rate for Payer: PHP All Commercial |
$191.08
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$148.38
|
| Rate for Payer: Signature Care EPO |
$423.30
|
| Rate for Payer: Signature Care PPO |
$423.30
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$193.00
|
| Rate for Payer: United Healthcare Commercial |
$186.43
|
| Rate for Payer: United Healthcare Medicare |
$148.38
|
|
|
PR COLPOSCOPY,CERVIX W/ADJ VAG,W/LOOP CONIZ
|
Professional
|
$643.16
|
|
|
Service Code
|
CPT 57461
|
| Hospital Charge Code |
z57461
|
| Min. Negotiated Rate |
$170.63 |
| Max. Negotiated Rate |
$487.53 |
| Rate for Payer: Aetna Medicare |
$170.63
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$487.53
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$487.53
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$196.22
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$187.69
|
| Rate for Payer: Cash Price |
$398.76
|
| Rate for Payer: Cash Price |
$398.76
|
| Rate for Payer: Coventry All Commercial |
$204.76
|
| Rate for Payer: Frontpath All Commercial |
$241.02
|
| Rate for Payer: Humana ChoiceCare |
$219.07
|
| Rate for Payer: Humana Medicare |
$170.63
|
| Rate for Payer: Lucent All Commercial |
$290.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$239.00
|
| Rate for Payer: PHCS All Commercial |
$482.37
|
| Rate for Payer: PHP All Commercial |
$219.74
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$170.63
|
| Rate for Payer: Signature Care EPO |
$464.95
|
| Rate for Payer: Signature Care PPO |
$464.95
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$222.00
|
| Rate for Payer: United Healthcare Commercial |
$215.79
|
| Rate for Payer: United Healthcare Medicare |
$170.63
|
|
|
PR COLPOSCOPY,ENTIRE VAGINA
|
Professional
|
$241.96
|
|
|
Service Code
|
CPT 57420
|
| Hospital Charge Code |
z57420
|
| Min. Negotiated Rate |
$83.25 |
| Max. Negotiated Rate |
$181.47 |
| Rate for Payer: Aetna Medicare |
$83.25
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$153.70
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$153.70
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$95.74
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$91.58
|
| Rate for Payer: Cash Price |
$150.02
|
| Rate for Payer: Cash Price |
$150.02
|
| Rate for Payer: Coventry All Commercial |
$99.90
|
| Rate for Payer: Frontpath All Commercial |
$116.32
|
| Rate for Payer: Humana ChoiceCare |
$101.53
|
| Rate for Payer: Humana Medicare |
$83.25
|
| Rate for Payer: Lucent All Commercial |
$141.52
|
| Rate for Payer: Lutheran Preferred All Commercial |
$117.00
|
| Rate for Payer: PHCS All Commercial |
$181.47
|
| Rate for Payer: PHP All Commercial |
$107.21
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$83.25
|
| Rate for Payer: Signature Care EPO |
$145.35
|
| Rate for Payer: Signature Care PPO |
$145.35
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$108.00
|
| Rate for Payer: United Healthcare Commercial |
$102.51
|
| Rate for Payer: United Healthcare Medicare |
$83.25
|
|
|
PR COLPOSCOPY,ENTIRE VAGINA,W/BIOPSY(S)
|
Professional
|
$324.24
|
|
|
Service Code
|
CPT 57421
|
| Hospital Charge Code |
z57421
|
| Min. Negotiated Rate |
$112.76 |
| Max. Negotiated Rate |
$243.18 |
| Rate for Payer: Aetna Medicare |
$112.76
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$211.46
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$211.46
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$129.67
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$124.04
|
| Rate for Payer: Cash Price |
$201.03
|
| Rate for Payer: Cash Price |
$201.03
|
| Rate for Payer: Coventry All Commercial |
$135.31
|
| Rate for Payer: Frontpath All Commercial |
$158.51
|
| Rate for Payer: Humana ChoiceCare |
$141.34
|
| Rate for Payer: Humana Medicare |
$112.76
|
| Rate for Payer: Lucent All Commercial |
$191.69
|
| Rate for Payer: Lutheran Preferred All Commercial |
$158.00
|
| Rate for Payer: PHCS All Commercial |
$243.18
|
| Rate for Payer: PHP All Commercial |
$145.21
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$112.76
|
| Rate for Payer: Signature Care EPO |
$198.05
|
| Rate for Payer: Signature Care PPO |
$198.05
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$147.00
|
| Rate for Payer: United Healthcare Commercial |
$140.00
|
| Rate for Payer: United Healthcare Medicare |
$112.76
|
|
|
PR COLPOSCOPY,VULVA
|
Professional
|
$228.72
|
|
|
Service Code
|
CPT 56820
|
| Hospital Charge Code |
z56820
|
| Min. Negotiated Rate |
$78.63 |
| Max. Negotiated Rate |
$171.54 |
| Rate for Payer: Aetna Medicare |
$78.63
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$146.36
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$146.36
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$90.42
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$86.49
|
| Rate for Payer: Cash Price |
$141.81
|
| Rate for Payer: Cash Price |
$141.81
|
| Rate for Payer: Coventry All Commercial |
$94.36
|
| Rate for Payer: Frontpath All Commercial |
$110.18
|
| Rate for Payer: Humana ChoiceCare |
$96.10
|
| Rate for Payer: Humana Medicare |
$78.63
|
| Rate for Payer: Lucent All Commercial |
$133.67
|
| Rate for Payer: Lutheran Preferred All Commercial |
$110.00
|
| Rate for Payer: PHCS All Commercial |
$171.54
|
| Rate for Payer: PHP All Commercial |
$101.25
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$78.63
|
| Rate for Payer: Signature Care EPO |
$138.55
|
| Rate for Payer: Signature Care PPO |
$138.55
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$102.00
|
| Rate for Payer: United Healthcare Commercial |
$96.49
|
| Rate for Payer: United Healthcare Medicare |
$78.63
|
|
|
PR COLPOSCOPY,VULVA,W/BIOPSY(S)
|
Professional
|
$306.16
|
|
|
Service Code
|
CPT 56821
|
| Hospital Charge Code |
z56821
|
| Min. Negotiated Rate |
$105.36 |
| Max. Negotiated Rate |
$229.62 |
| Rate for Payer: Aetna Medicare |
$105.36
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$198.73
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$198.73
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$121.16
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$115.90
|
| Rate for Payer: Cash Price |
$189.82
|
| Rate for Payer: Cash Price |
$189.82
|
| Rate for Payer: Coventry All Commercial |
$126.43
|
| Rate for Payer: Frontpath All Commercial |
$148.40
|
| Rate for Payer: Humana ChoiceCare |
$132.29
|
| Rate for Payer: Humana Medicare |
$105.36
|
| Rate for Payer: Lucent All Commercial |
$179.11
|
| Rate for Payer: Lutheran Preferred All Commercial |
$147.00
|
| Rate for Payer: PHCS All Commercial |
$229.62
|
| Rate for Payer: PHP All Commercial |
$135.68
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$105.36
|
| Rate for Payer: Signature Care EPO |
$186.15
|
| Rate for Payer: Signature Care PPO |
$186.15
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$137.00
|
| Rate for Payer: United Healthcare Commercial |
$131.04
|
| Rate for Payer: United Healthcare Medicare |
$105.36
|
|
|
PR COLSC FLEXIBLE W/CONTROL BLEEDING ANY METHOD
|
Professional
|
$1,218.70
|
|
|
Service Code
|
CPT 45382
|
| Hospital Charge Code |
z45382
|
| Min. Negotiated Rate |
$240.24 |
| Max. Negotiated Rate |
$914.02 |
| Rate for Payer: Aetna Medicare |
$240.24
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$821.19
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$821.19
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$276.28
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$264.26
|
| Rate for Payer: Cash Price |
$755.59
|
| Rate for Payer: Cash Price |
$755.59
|
| Rate for Payer: Coventry All Commercial |
$288.29
|
| Rate for Payer: Frontpath All Commercial |
$334.39
|
| Rate for Payer: Humana ChoiceCare |
$355.78
|
| Rate for Payer: Humana Medicare |
$240.24
|
| Rate for Payer: Lucent All Commercial |
$408.41
|
| Rate for Payer: Lutheran Preferred All Commercial |
$360.00
|
| Rate for Payer: PHCS All Commercial |
$914.02
|
| Rate for Payer: PHP All Commercial |
$410.17
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$240.24
|
| Rate for Payer: Signature Care EPO |
$844.90
|
| Rate for Payer: Signature Care PPO |
$844.90
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$336.00
|
| Rate for Payer: United Healthcare Commercial |
$382.20
|
| Rate for Payer: United Healthcare Medicare |
$240.24
|
|
|
PR COLSC FLEXIBLE W/TRANSENDOSCOPIC BALLOON DILAT
|
Professional
|
$1,116.38
|
|
|
Service Code
|
CPT 45386
|
| Hospital Charge Code |
z45386
|
| Min. Negotiated Rate |
$196.14 |
| Max. Negotiated Rate |
$986.85 |
| Rate for Payer: Aetna Medicare |
$196.14
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$714.40
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$714.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$225.56
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$215.75
|
| Rate for Payer: Cash Price |
$692.16
|
| Rate for Payer: Cash Price |
$692.16
|
| Rate for Payer: Coventry All Commercial |
$235.37
|
| Rate for Payer: Frontpath All Commercial |
$272.18
|
| Rate for Payer: Humana ChoiceCare |
$288.60
|
| Rate for Payer: Humana Medicare |
$196.14
|
| Rate for Payer: Lucent All Commercial |
$333.44
|
| Rate for Payer: Lutheran Preferred All Commercial |
$294.00
|
| Rate for Payer: PHCS All Commercial |
$837.28
|
| Rate for Payer: PHP All Commercial |
$334.87
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$196.14
|
| Rate for Payer: Signature Care EPO |
$986.85
|
| Rate for Payer: Signature Care PPO |
$986.85
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$275.00
|
| Rate for Payer: United Healthcare Commercial |
$305.13
|
| Rate for Payer: United Healthcare Medicare |
$196.14
|
|
|
PR COLSC FLX WITH DIRECTED SUBMUCOSAL NJX ANY SBST
|
Professional
|
$810.30
|
|
|
Service Code
|
CPT 45381
|
| Hospital Charge Code |
z45381
|
| Min. Negotiated Rate |
$185.91 |
| Max. Negotiated Rate |
$714.40 |
| Rate for Payer: Aetna Medicare |
$185.91
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$714.40
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$714.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$213.80
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$204.50
|
| Rate for Payer: Cash Price |
$502.39
|
| Rate for Payer: Cash Price |
$502.39
|
| Rate for Payer: Coventry All Commercial |
$223.09
|
| Rate for Payer: Frontpath All Commercial |
$257.97
|
| Rate for Payer: Humana ChoiceCare |
$263.82
|
| Rate for Payer: Humana Medicare |
$185.91
|
| Rate for Payer: Lucent All Commercial |
$316.05
|
| Rate for Payer: Lutheran Preferred All Commercial |
$279.00
|
| Rate for Payer: PHCS All Commercial |
$607.72
|
| Rate for Payer: PHP All Commercial |
$317.40
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$185.91
|
| Rate for Payer: Signature Care EPO |
$674.90
|
| Rate for Payer: Signature Care PPO |
$674.90
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$260.00
|
| Rate for Payer: United Healthcare Commercial |
$283.09
|
| Rate for Payer: United Healthcare Medicare |
$185.91
|
|
|
PR COLSC FLX W/REMOVAL LESION BY HOT BX FORCEPS
|
Professional
|
$891.82
|
|
|
Service Code
|
CPT 45384
|
| Hospital Charge Code |
z45384
|
| Min. Negotiated Rate |
$210.09 |
| Max. Negotiated Rate |
$668.86 |
| Rate for Payer: Aetna Medicare |
$210.09
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$613.70
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$613.70
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$241.60
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$231.10
|
| Rate for Payer: Cash Price |
$552.93
|
| Rate for Payer: Cash Price |
$552.93
|
| Rate for Payer: Coventry All Commercial |
$252.11
|
| Rate for Payer: Frontpath All Commercial |
$296.01
|
| Rate for Payer: Humana ChoiceCare |
$295.48
|
| Rate for Payer: Humana Medicare |
$210.09
|
| Rate for Payer: Lucent All Commercial |
$357.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$315.00
|
| Rate for Payer: PHCS All Commercial |
$668.86
|
| Rate for Payer: PHP All Commercial |
$358.68
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$210.09
|
| Rate for Payer: Signature Care EPO |
$628.15
|
| Rate for Payer: Signature Care PPO |
$628.15
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$294.00
|
| Rate for Payer: United Healthcare Commercial |
$310.69
|
| Rate for Payer: United Healthcare Medicare |
$210.09
|
|
|
PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ
|
Professional
|
$830.86
|
|
|
Service Code
|
CPT 45385
|
| Hospital Charge Code |
z45385
|
| Min. Negotiated Rate |
$235.65 |
| Max. Negotiated Rate |
$716.55 |
| Rate for Payer: Aetna Medicare |
$235.65
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$704.10
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$704.10
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$271.00
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$259.22
|
| Rate for Payer: Cash Price |
$515.13
|
| Rate for Payer: Cash Price |
$515.13
|
| Rate for Payer: Coventry All Commercial |
$282.78
|
| Rate for Payer: Frontpath All Commercial |
$328.29
|
| Rate for Payer: Humana ChoiceCare |
$332.57
|
| Rate for Payer: Humana Medicare |
$235.65
|
| Rate for Payer: Lucent All Commercial |
$400.60
|
| Rate for Payer: Lutheran Preferred All Commercial |
$353.00
|
| Rate for Payer: PHCS All Commercial |
$623.14
|
| Rate for Payer: PHP All Commercial |
$402.33
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$235.65
|
| Rate for Payer: Signature Care EPO |
$716.55
|
| Rate for Payer: Signature Care PPO |
$716.55
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$330.00
|
| Rate for Payer: United Healthcare Commercial |
$354.99
|
| Rate for Payer: United Healthcare Medicare |
$235.65
|
|
|
PR COMBINED VACCINE,MMR+VARICELLA,SUB-Q
|
Professional
|
$367.32
|
|
|
Service Code
|
CPT 90710
|
| Hospital Charge Code |
z90710
|
| Min. Negotiated Rate |
$252.00 |
| Max. Negotiated Rate |
$367.32 |
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$252.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$252.00
|
| Rate for Payer: Frontpath All Commercial |
$290.74
|
| Rate for Payer: Humana ChoiceCare |
$309.53
|
| Rate for Payer: Lutheran Preferred All Commercial |
$367.32
|
| Rate for Payer: PHP All Commercial |
$288.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$367.32
|
| Rate for Payer: United Healthcare Commercial |
$314.24
|
|
|
PR COMM SVCS BY RHC/FQHC 5 MIN
|
Professional
|
$25.00
|
|
|
Service Code
|
CPT G0071
|
| Hospital Charge Code |
zG0071
|
| Min. Negotiated Rate |
$11.69 |
| Max. Negotiated Rate |
$23.79 |
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$13.03
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$13.03
|
| Rate for Payer: Cash Price |
$15.50
|
| Rate for Payer: Cash Price |
$15.50
|
| Rate for Payer: Humana ChoiceCare |
$19.01
|
| Rate for Payer: PHCS All Commercial |
$18.75
|
| Rate for Payer: PHP All Commercial |
$23.79
|
| Rate for Payer: United Healthcare Commercial |
$11.69
|
|
|
PR COMPLEX CHRONIC CARE MGMT SVC 1ST 60 MIN CAL MO
|
Professional
|
$243.92
|
|
|
Service Code
|
CPT 99487
|
| Hospital Charge Code |
z99487
|
| Min. Negotiated Rate |
$75.85 |
| Max. Negotiated Rate |
$182.94 |
| Rate for Payer: Aetna Medicare |
$86.42
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$75.85
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$75.85
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$99.38
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$95.06
|
| Rate for Payer: Cash Price |
$151.23
|
| Rate for Payer: Cash Price |
$151.23
|
| Rate for Payer: Coventry All Commercial |
$103.70
|
| Rate for Payer: Frontpath All Commercial |
$94.44
|
| Rate for Payer: Humana ChoiceCare |
$82.64
|
| Rate for Payer: Humana Medicare |
$86.42
|
| Rate for Payer: Lucent All Commercial |
$146.91
|
| Rate for Payer: Lutheran Preferred All Commercial |
$91.00
|
| Rate for Payer: PHCS All Commercial |
$182.94
|
| Rate for Payer: PHP All Commercial |
$86.84
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$86.42
|
| Rate for Payer: Signature Care EPO |
$106.63
|
| Rate for Payer: Signature Care PPO |
$106.63
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$89.00
|
| Rate for Payer: United Healthcare Commercial |
$86.16
|
| Rate for Payer: United Healthcare Medicare |
$86.42
|
|
|
PR COMPLEX E/M VISIT ADD ON
|
Professional
|
$31.76
|
|
|
Service Code
|
CPT G2211
|
| Hospital Charge Code |
zG2211
|
| Min. Negotiated Rate |
$17.82 |
| Max. Negotiated Rate |
$23.82 |
| Rate for Payer: Cash Price |
$19.69
|
| Rate for Payer: Cash Price |
$19.69
|
| Rate for Payer: PHCS All Commercial |
$23.82
|
| Rate for Payer: United Healthcare Commercial |
$17.82
|
|
|
PR COMPREHENSIVE HEARING TEST
|
Professional
|
$69.22
|
|
|
Service Code
|
CPT 92557
|
| Hospital Charge Code |
z92557
|
| Min. Negotiated Rate |
$30.53 |
| Max. Negotiated Rate |
$51.92 |
| Rate for Payer: Aetna Medicare |
$30.53
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$47.10
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$47.10
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$35.11
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$33.58
|
| Rate for Payer: Cash Price |
$42.92
|
| Rate for Payer: Cash Price |
$42.92
|
| Rate for Payer: Coventry All Commercial |
$36.64
|
| Rate for Payer: Frontpath All Commercial |
$35.28
|
| Rate for Payer: Humana ChoiceCare |
$50.12
|
| Rate for Payer: Humana Medicare |
$30.53
|
| Rate for Payer: Lucent All Commercial |
$51.90
|
| Rate for Payer: Lutheran Preferred All Commercial |
$40.00
|
| Rate for Payer: PHCS All Commercial |
$51.92
|
| Rate for Payer: PHP All Commercial |
$43.19
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$30.53
|
| Rate for Payer: Signature Care EPO |
$51.00
|
| Rate for Payer: Signature Care PPO |
$51.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$37.00
|
| Rate for Payer: United Healthcare Commercial |
$49.33
|
| Rate for Payer: United Healthcare Medicare |
$30.53
|
|
|
PR CONDITIONING PLAY AUDIOMETRY
|
Professional
|
$147.30
|
|
|
Service Code
|
CPT 92582
|
| Hospital Charge Code |
z92582
|
| Min. Negotiated Rate |
$28.20 |
| Max. Negotiated Rate |
$128.33 |
| Rate for Payer: Aetna Medicare |
$75.49
|
| 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 |
$86.81
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$83.04
|
| Rate for Payer: Cash Price |
$91.33
|
| Rate for Payer: Cash Price |
$91.33
|
| Rate for Payer: Coventry All Commercial |
$90.59
|
| Rate for Payer: Frontpath All Commercial |
$79.38
|
| Rate for Payer: Humana ChoiceCare |
$30.49
|
| Rate for Payer: Humana Medicare |
$75.49
|
| Rate for Payer: Lucent All Commercial |
$128.33
|
| Rate for Payer: Lutheran Preferred All Commercial |
$98.00
|
| Rate for Payer: PHCS All Commercial |
$110.48
|
| Rate for Payer: PHP All Commercial |
$106.79
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$75.49
|
| Rate for Payer: Signature Care EPO |
$60.10
|
| Rate for Payer: Signature Care PPO |
$60.10
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$91.00
|
| Rate for Payer: United Healthcare Commercial |
$45.49
|
| Rate for Payer: United Healthcare Medicare |
$75.49
|
|
