|
PR CONIZATION CERVIX,KNIFE/LASER
|
Professional
|
$647.00
|
|
|
Service Code
|
CPT 57520
|
| Hospital Charge Code |
z57520
|
| Min. Negotiated Rate |
$277.87 |
| Max. Negotiated Rate |
$485.25 |
| Rate for Payer: Aetna Medicare |
$277.87
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$414.11
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$414.11
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$319.55
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$305.66
|
| Rate for Payer: Cash Price |
$401.14
|
| Rate for Payer: Cash Price |
$401.14
|
| Rate for Payer: Coventry All Commercial |
$333.44
|
| Rate for Payer: Frontpath All Commercial |
$383.73
|
| Rate for Payer: Humana ChoiceCare |
$303.86
|
| Rate for Payer: Humana Medicare |
$277.87
|
| Rate for Payer: Lucent All Commercial |
$472.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$389.00
|
| Rate for Payer: PHCS All Commercial |
$485.25
|
| Rate for Payer: PHP All Commercial |
$357.84
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$277.87
|
| Rate for Payer: Signature Care EPO |
$433.50
|
| Rate for Payer: Signature Care PPO |
$433.50
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$361.00
|
| Rate for Payer: United Healthcare Commercial |
$305.53
|
| Rate for Payer: United Healthcare Medicare |
$277.87
|
|
|
PR CONIZATION CERVIX,LOOP ELECTRD
|
Professional
|
$555.76
|
|
|
Service Code
|
CPT 57522
|
| Hospital Charge Code |
z57522
|
| Min. Negotiated Rate |
$239.13 |
| Max. Negotiated Rate |
$416.82 |
| Rate for Payer: Aetna Medicare |
$239.13
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$338.73
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$338.73
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$275.00
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$263.04
|
| Rate for Payer: Cash Price |
$344.57
|
| Rate for Payer: Cash Price |
$344.57
|
| Rate for Payer: Coventry All Commercial |
$286.96
|
| Rate for Payer: Frontpath All Commercial |
$331.41
|
| Rate for Payer: Humana ChoiceCare |
$255.29
|
| Rate for Payer: Humana Medicare |
$239.13
|
| Rate for Payer: Lucent All Commercial |
$406.52
|
| Rate for Payer: Lutheran Preferred All Commercial |
$335.00
|
| Rate for Payer: PHCS All Commercial |
$416.82
|
| Rate for Payer: PHP All Commercial |
$307.96
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$239.13
|
| Rate for Payer: Signature Care EPO |
$374.00
|
| Rate for Payer: Signature Care PPO |
$374.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$311.00
|
| Rate for Payer: United Healthcare Commercial |
$271.11
|
| Rate for Payer: United Healthcare Medicare |
$239.13
|
|
|
PR CONT GLUC MNTR PHYSICIAN/QHP PROVIDED EQUIPTMENT
|
Professional
|
$260.28
|
|
|
Service Code
|
CPT 95250
|
| Hospital Charge Code |
z95250
|
| Min. Negotiated Rate |
$133.39 |
| Max. Negotiated Rate |
$226.76 |
| Rate for Payer: Aetna Medicare |
$133.39
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$153.40
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$146.73
|
| Rate for Payer: Cash Price |
$161.37
|
| Rate for Payer: Cash Price |
$161.37
|
| Rate for Payer: Coventry All Commercial |
$160.07
|
| Rate for Payer: Frontpath All Commercial |
$144.19
|
| Rate for Payer: Humana ChoiceCare |
$170.38
|
| Rate for Payer: Humana Medicare |
$133.39
|
| Rate for Payer: Lucent All Commercial |
$226.76
|
| Rate for Payer: PHCS All Commercial |
$195.21
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$133.39
|
| Rate for Payer: United Healthcare Commercial |
$147.19
|
| Rate for Payer: United Healthcare Medicare |
$133.39
|
|
|
PR CONTINUOUS GLUCOSE MONITORING ANALYSIS I&R
|
Professional
|
$64.40
|
|
|
Service Code
|
CPT 95251
|
| Hospital Charge Code |
z95251
|
| Min. Negotiated Rate |
$32.03 |
| Max. Negotiated Rate |
$56.12 |
| Rate for Payer: Aetna Medicare |
$33.01
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$37.96
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$36.31
|
| Rate for Payer: Cash Price |
$39.93
|
| Rate for Payer: Cash Price |
$39.93
|
| Rate for Payer: Coventry All Commercial |
$39.61
|
| Rate for Payer: Frontpath All Commercial |
$35.97
|
| Rate for Payer: Humana ChoiceCare |
$32.03
|
| Rate for Payer: Humana Medicare |
$33.01
|
| Rate for Payer: Lucent All Commercial |
$56.12
|
| Rate for Payer: PHCS All Commercial |
$48.30
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$33.01
|
| Rate for Payer: United Healthcare Commercial |
$48.38
|
| Rate for Payer: United Healthcare Medicare |
$33.01
|
|
|
PR CONTROL THROAT BLEED,SIMPLE
|
Professional
|
$295.70
|
|
|
Service Code
|
CPT 42960
|
| Hospital Charge Code |
z42960
|
| Min. Negotiated Rate |
$151.54 |
| Max. Negotiated Rate |
$258.74 |
| Rate for Payer: Aetna Medicare |
$151.54
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$189.50
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$189.50
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$174.27
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$166.69
|
| Rate for Payer: Cash Price |
$183.33
|
| Rate for Payer: Cash Price |
$183.33
|
| Rate for Payer: Coventry All Commercial |
$181.85
|
| Rate for Payer: Frontpath All Commercial |
$208.34
|
| Rate for Payer: Humana ChoiceCare |
$190.42
|
| Rate for Payer: Humana Medicare |
$151.54
|
| Rate for Payer: Lucent All Commercial |
$257.62
|
| Rate for Payer: Lutheran Preferred All Commercial |
$227.00
|
| Rate for Payer: PHCS All Commercial |
$221.78
|
| Rate for Payer: PHP All Commercial |
$258.74
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$151.54
|
| Rate for Payer: Signature Care EPO |
$243.95
|
| Rate for Payer: Signature Care PPO |
$243.95
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$212.00
|
| Rate for Payer: United Healthcare Commercial |
$185.99
|
| Rate for Payer: United Healthcare Medicare |
$151.54
|
|
|
PR CONTROL THROAT BLEED,SURG INTERVENTN
|
Professional
|
$953.88
|
|
|
Service Code
|
CPT 42962
|
| Hospital Charge Code |
z42962
|
| Min. Negotiated Rate |
$488.87 |
| Max. Negotiated Rate |
$834.65 |
| Rate for Payer: Aetna Medicare |
$488.87
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$641.60
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$641.60
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$562.20
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$537.76
|
| Rate for Payer: Cash Price |
$591.41
|
| Rate for Payer: Cash Price |
$591.41
|
| Rate for Payer: Coventry All Commercial |
$586.64
|
| Rate for Payer: Frontpath All Commercial |
$664.64
|
| Rate for Payer: Humana ChoiceCare |
$578.63
|
| Rate for Payer: Humana Medicare |
$488.87
|
| Rate for Payer: Lucent All Commercial |
$831.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$733.00
|
| Rate for Payer: PHCS All Commercial |
$715.41
|
| Rate for Payer: PHP All Commercial |
$834.65
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$488.87
|
| Rate for Payer: Signature Care EPO |
$725.05
|
| Rate for Payer: Signature Care PPO |
$725.05
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$684.00
|
| Rate for Payer: United Healthcare Commercial |
$572.03
|
| Rate for Payer: United Healthcare Medicare |
$488.87
|
|
|
PR CORACO-ACROMIAL LIG RELEASE
|
Professional
|
$1,271.08
|
|
|
Service Code
|
CPT 23415
|
| Hospital Charge Code |
z23415
|
| Min. Negotiated Rate |
$651.27 |
| Max. Negotiated Rate |
$1,107.16 |
| Rate for Payer: Aetna Medicare |
$651.27
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$859.70
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$859.70
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$748.96
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$716.40
|
| Rate for Payer: Cash Price |
$788.07
|
| Rate for Payer: Cash Price |
$788.07
|
| Rate for Payer: Coventry All Commercial |
$781.52
|
| Rate for Payer: Frontpath All Commercial |
$906.76
|
| Rate for Payer: Humana ChoiceCare |
$784.59
|
| Rate for Payer: Humana Medicare |
$651.27
|
| Rate for Payer: Lucent All Commercial |
$1,107.16
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,042.00
|
| Rate for Payer: PHCS All Commercial |
$953.31
|
| Rate for Payer: PHP All Commercial |
$1,105.84
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$651.27
|
| Rate for Payer: Signature Care EPO |
$1,049.75
|
| Rate for Payer: Signature Care PPO |
$1,049.75
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$977.00
|
| Rate for Payer: United Healthcare Commercial |
$750.98
|
| Rate for Payer: United Healthcare Medicare |
$651.27
|
|
|
PR CORRJ HLX VLGS BNCTY SESMDC DSTL METAR OSTEOT
|
Professional
|
$1,614.76
|
|
|
Service Code
|
CPT 28296
|
| Hospital Charge Code |
z28296
|
| Min. Negotiated Rate |
$484.59 |
| Max. Negotiated Rate |
$1,211.07 |
| Rate for Payer: Aetna Medicare |
$484.59
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$788.02
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$788.02
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$557.28
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$533.05
|
| Rate for Payer: Cash Price |
$1,001.15
|
| Rate for Payer: Cash Price |
$1,001.15
|
| Rate for Payer: Coventry All Commercial |
$581.51
|
| Rate for Payer: Frontpath All Commercial |
$656.32
|
| Rate for Payer: Humana ChoiceCare |
$637.77
|
| Rate for Payer: Humana Medicare |
$484.59
|
| Rate for Payer: Lucent All Commercial |
$823.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$775.00
|
| Rate for Payer: PHCS All Commercial |
$1,211.07
|
| Rate for Payer: PHP All Commercial |
$822.62
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$484.59
|
| Rate for Payer: Signature Care EPO |
$1,009.80
|
| Rate for Payer: Signature Care PPO |
$1,009.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$727.00
|
| Rate for Payer: United Healthcare Commercial |
$610.26
|
| Rate for Payer: United Healthcare Medicare |
$484.59
|
|
|
PR CPLX CHRONIC CARE MGMT SVC EA ADDL 30 MIN CAL MO
|
Professional
|
$129.16
|
|
|
Service Code
|
CPT 99489
|
| Hospital Charge Code |
z99489
|
| Min. Negotiated Rate |
$38.07 |
| Max. Negotiated Rate |
$96.87 |
| Rate for Payer: Aetna Medicare |
$47.67
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$38.07
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$38.07
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$54.82
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$52.44
|
| Rate for Payer: Cash Price |
$80.08
|
| Rate for Payer: Cash Price |
$80.08
|
| Rate for Payer: Coventry All Commercial |
$57.20
|
| Rate for Payer: Frontpath All Commercial |
$52.22
|
| Rate for Payer: Humana ChoiceCare |
$41.49
|
| Rate for Payer: Humana Medicare |
$47.67
|
| Rate for Payer: Lucent All Commercial |
$81.04
|
| Rate for Payer: Lutheran Preferred All Commercial |
$50.00
|
| Rate for Payer: PHCS All Commercial |
$96.87
|
| Rate for Payer: PHP All Commercial |
$47.90
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$47.67
|
| Rate for Payer: Signature Care EPO |
$56.05
|
| Rate for Payer: Signature Care PPO |
$56.05
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$49.00
|
| Rate for Payer: United Healthcare Commercial |
$43.26
|
| Rate for Payer: United Healthcare Medicare |
$47.67
|
|
|
PR CREATE EARDRUM OPENING,GEN ANESTH
|
Professional
|
$586.36
|
|
|
Service Code
|
CPT 69436
|
| Hospital Charge Code |
z69436
|
| Min. Negotiated Rate |
$150.25 |
| Max. Negotiated Rate |
$439.77 |
| Rate for Payer: Aetna Medicare |
$150.25
|
| Rate for Payer: Aetna Medicare |
$150.25
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$193.70
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$193.70
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$193.70
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$193.70
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$172.79
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$172.79
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$165.28
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$165.28
|
| Rate for Payer: Cash Price |
$363.54
|
| Rate for Payer: Cash Price |
$363.54
|
| Rate for Payer: Cash Price |
$181.77
|
| Rate for Payer: Cash Price |
$181.77
|
| Rate for Payer: Coventry All Commercial |
$180.30
|
| Rate for Payer: Coventry All Commercial |
$180.30
|
| Rate for Payer: Frontpath All Commercial |
$204.02
|
| Rate for Payer: Frontpath All Commercial |
$204.02
|
| Rate for Payer: Humana ChoiceCare |
$173.12
|
| Rate for Payer: Humana ChoiceCare |
$173.12
|
| Rate for Payer: Humana Medicare |
$150.25
|
| Rate for Payer: Humana Medicare |
$150.25
|
| Rate for Payer: Lucent All Commercial |
$255.42
|
| Rate for Payer: Lucent All Commercial |
$255.42
|
| Rate for Payer: Lutheran Preferred All Commercial |
$240.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$240.00
|
| Rate for Payer: PHCS All Commercial |
$219.88
|
| Rate for Payer: PHCS All Commercial |
$439.77
|
| Rate for Payer: PHP All Commercial |
$190.57
|
| Rate for Payer: PHP All Commercial |
$190.57
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$150.25
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$150.25
|
| Rate for Payer: Signature Care EPO |
$200.60
|
| Rate for Payer: Signature Care EPO |
$200.60
|
| Rate for Payer: Signature Care PPO |
$200.60
|
| Rate for Payer: Signature Care PPO |
$200.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$225.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$225.00
|
| Rate for Payer: United Healthcare Commercial |
$177.59
|
| Rate for Payer: United Healthcare Commercial |
$177.59
|
| Rate for Payer: United Healthcare Medicare |
$150.25
|
| Rate for Payer: United Healthcare Medicare |
$150.25
|
|
|
PR CREATE EARDRUM OPENING,LOCAL ANESTH
|
Professional
|
$370.94
|
|
|
Service Code
|
CPT 69433
|
| Hospital Charge Code |
z69433
|
| Min. Negotiated Rate |
$124.35 |
| Max. Negotiated Rate |
$278.20 |
| Rate for Payer: Aetna Medicare |
$124.35
|
| Rate for Payer: Aetna Medicare |
$124.35
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$213.89
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$213.89
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$213.89
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$213.89
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$143.00
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$143.00
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$136.78
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$136.78
|
| Rate for Payer: Cash Price |
$229.98
|
| Rate for Payer: Cash Price |
$229.98
|
| Rate for Payer: Cash Price |
$459.97
|
| Rate for Payer: Cash Price |
$459.97
|
| Rate for Payer: Coventry All Commercial |
$149.22
|
| Rate for Payer: Coventry All Commercial |
$149.22
|
| Rate for Payer: Frontpath All Commercial |
$167.71
|
| Rate for Payer: Frontpath All Commercial |
$167.71
|
| Rate for Payer: Humana ChoiceCare |
$128.48
|
| Rate for Payer: Humana ChoiceCare |
$128.48
|
| Rate for Payer: Humana Medicare |
$124.35
|
| Rate for Payer: Humana Medicare |
$124.35
|
| Rate for Payer: Lucent All Commercial |
$211.40
|
| Rate for Payer: Lucent All Commercial |
$211.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$199.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$199.00
|
| Rate for Payer: PHCS All Commercial |
$556.41
|
| Rate for Payer: PHCS All Commercial |
$278.20
|
| Rate for Payer: PHP All Commercial |
$157.71
|
| Rate for Payer: PHP All Commercial |
$157.71
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$124.35
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$124.35
|
| Rate for Payer: Signature Care EPO |
$217.60
|
| Rate for Payer: Signature Care EPO |
$217.60
|
| Rate for Payer: Signature Care PPO |
$217.60
|
| Rate for Payer: Signature Care PPO |
$217.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$187.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$187.00
|
| Rate for Payer: United Healthcare Commercial |
$139.58
|
| Rate for Payer: United Healthcare Commercial |
$139.58
|
| Rate for Payer: United Healthcare Medicare |
$124.35
|
| Rate for Payer: United Healthcare Medicare |
$124.35
|
|
|
PR CRITICAL CARE, ADDL 30 MIN
|
Professional
|
$220.74
|
|
|
Service Code
|
CPT 99292
|
| Hospital Charge Code |
z99292
|
| Min. Negotiated Rate |
$99.59 |
| Max. Negotiated Rate |
$187.63 |
| Rate for Payer: Aetna Medicare |
$101.40
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$161.67
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$161.67
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$116.61
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$111.54
|
| Rate for Payer: Cash Price |
$136.86
|
| Rate for Payer: Cash Price |
$136.86
|
| Rate for Payer: Coventry All Commercial |
$121.68
|
| Rate for Payer: Frontpath All Commercial |
$141.13
|
| Rate for Payer: Humana ChoiceCare |
$99.59
|
| Rate for Payer: Humana Medicare |
$101.40
|
| Rate for Payer: Lucent All Commercial |
$172.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$187.63
|
| Rate for Payer: PHCS All Commercial |
$165.56
|
| Rate for Payer: PHP All Commercial |
$101.89
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$101.40
|
| Rate for Payer: Signature Care EPO |
$148.75
|
| Rate for Payer: Signature Care PPO |
$148.75
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$132.44
|
| Rate for Payer: United Healthcare Commercial |
$171.55
|
| Rate for Payer: United Healthcare Medicare |
$101.40
|
|
|
PR CRITICAL CARE, E/M 30-74 MINUTES
|
Professional
|
$504.10
|
|
|
Service Code
|
CPT 99291
|
| Hospital Charge Code |
z99291
|
| Min. Negotiated Rate |
$198.63 |
| Max. Negotiated Rate |
$428.48 |
| Rate for Payer: Aetna Medicare |
$202.16
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$298.08
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$298.08
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$232.48
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$222.38
|
| Rate for Payer: Cash Price |
$312.54
|
| Rate for Payer: Cash Price |
$312.54
|
| Rate for Payer: Coventry All Commercial |
$242.59
|
| Rate for Payer: Frontpath All Commercial |
$280.96
|
| Rate for Payer: Humana ChoiceCare |
$198.63
|
| Rate for Payer: Humana Medicare |
$202.16
|
| Rate for Payer: Lucent All Commercial |
$343.67
|
| Rate for Payer: Lutheran Preferred All Commercial |
$428.48
|
| Rate for Payer: PHCS All Commercial |
$378.08
|
| Rate for Payer: PHP All Commercial |
$203.15
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$202.16
|
| Rate for Payer: Signature Care EPO |
$318.75
|
| Rate for Payer: Signature Care PPO |
$318.75
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$302.46
|
| Rate for Payer: United Healthcare Commercial |
$378.17
|
| Rate for Payer: United Healthcare Medicare |
$202.16
|
|
|
PR C-SEC ONLY,PREV C-SEC
|
Professional
|
$1,645.28
|
|
|
Service Code
|
CPT 59620
|
| Hospital Charge Code |
z59620
|
| Min. Negotiated Rate |
$843.37 |
| Max. Negotiated Rate |
$1,433.73 |
| Rate for Payer: Aetna Medicare |
$843.37
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,072.59
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,072.59
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$969.88
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$927.71
|
| Rate for Payer: Cash Price |
$1,020.07
|
| Rate for Payer: Cash Price |
$1,020.07
|
| Rate for Payer: Coventry All Commercial |
$1,012.04
|
| Rate for Payer: Frontpath All Commercial |
$1,224.40
|
| Rate for Payer: Humana ChoiceCare |
$964.74
|
| Rate for Payer: Humana Medicare |
$843.37
|
| Rate for Payer: Lucent All Commercial |
$1,433.73
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,181.00
|
| Rate for Payer: PHCS All Commercial |
$1,233.96
|
| Rate for Payer: PHP All Commercial |
$1,085.89
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$843.37
|
| Rate for Payer: Signature Care EPO |
$1,237.60
|
| Rate for Payer: Signature Care PPO |
$1,237.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,096.00
|
| Rate for Payer: United Healthcare Commercial |
$1,133.75
|
| Rate for Payer: United Healthcare Medicare |
$843.37
|
|
|
PR C-SEC+POSTPARTUM CARE,PREV C-SEC
|
Professional
|
$2,382.00
|
|
|
Service Code
|
CPT 59622
|
| Hospital Charge Code |
z59622
|
| Min. Negotiated Rate |
$1,087.79 |
| Max. Negotiated Rate |
$2,075.04 |
| Rate for Payer: Aetna Medicare |
$1,220.61
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,164.12
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,164.12
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,403.70
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,342.67
|
| Rate for Payer: Cash Price |
$1,476.84
|
| Rate for Payer: Cash Price |
$1,476.84
|
| Rate for Payer: Coventry All Commercial |
$1,464.73
|
| Rate for Payer: Frontpath All Commercial |
$1,761.18
|
| Rate for Payer: Humana ChoiceCare |
$1,087.79
|
| Rate for Payer: Humana Medicare |
$1,220.61
|
| Rate for Payer: Lucent All Commercial |
$2,075.04
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,709.00
|
| Rate for Payer: PHCS All Commercial |
$1,786.50
|
| Rate for Payer: PHP All Commercial |
$1,572.12
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,220.61
|
| Rate for Payer: Signature Care EPO |
$1,397.40
|
| Rate for Payer: Signature Care PPO |
$1,397.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,587.00
|
| Rate for Payer: United Healthcare Commercial |
$1,320.06
|
| Rate for Payer: United Healthcare Medicare |
$1,220.61
|
|
|
PR CTRL NOSEBLEED,ANTER,COMPLEX
|
Professional
|
$449.72
|
|
|
Service Code
|
CPT 30903
|
| Hospital Charge Code |
z30903
|
| Min. Negotiated Rate |
$72.12 |
| Max. Negotiated Rate |
$337.29 |
| Rate for Payer: Aetna Medicare |
$72.12
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$187.10
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$187.10
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$82.94
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$79.33
|
| Rate for Payer: Cash Price |
$278.83
|
| Rate for Payer: Cash Price |
$278.83
|
| Rate for Payer: Coventry All Commercial |
$86.54
|
| Rate for Payer: Frontpath All Commercial |
$101.30
|
| Rate for Payer: Humana ChoiceCare |
$94.38
|
| Rate for Payer: Humana Medicare |
$72.12
|
| Rate for Payer: Lucent All Commercial |
$122.60
|
| Rate for Payer: Lutheran Preferred All Commercial |
$115.00
|
| Rate for Payer: PHCS All Commercial |
$337.29
|
| Rate for Payer: PHP All Commercial |
$98.50
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$72.12
|
| Rate for Payer: Signature Care EPO |
$224.40
|
| Rate for Payer: Signature Care PPO |
$224.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$108.00
|
| Rate for Payer: United Healthcare Commercial |
$91.98
|
| Rate for Payer: United Healthcare Medicare |
$72.12
|
|
|
PR CTRL NOSEBLEED,ANTER,SIMPLE
|
Professional
|
$287.12
|
|
|
Service Code
|
CPT 30901
|
| Hospital Charge Code |
z30901
|
| Min. Negotiated Rate |
$52.68 |
| Max. Negotiated Rate |
$215.34 |
| Rate for Payer: Aetna Medicare |
$52.68
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$120.10
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$120.10
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$60.58
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$57.95
|
| Rate for Payer: Cash Price |
$178.01
|
| Rate for Payer: Cash Price |
$178.01
|
| Rate for Payer: Coventry All Commercial |
$63.22
|
| Rate for Payer: Frontpath All Commercial |
$74.45
|
| Rate for Payer: Humana ChoiceCare |
$71.27
|
| Rate for Payer: Humana Medicare |
$52.68
|
| Rate for Payer: Lucent All Commercial |
$89.56
|
| Rate for Payer: Lutheran Preferred All Commercial |
$84.00
|
| Rate for Payer: PHCS All Commercial |
$215.34
|
| Rate for Payer: PHP All Commercial |
$71.96
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$52.68
|
| Rate for Payer: Signature Care EPO |
$135.15
|
| Rate for Payer: Signature Care PPO |
$135.15
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$79.00
|
| Rate for Payer: United Healthcare Commercial |
$70.76
|
| Rate for Payer: United Healthcare Medicare |
$52.68
|
|
|
PR CTRL NOSEBLEED,POST,W/PACKS &/OR CAUT
|
Professional
|
$642.42
|
|
|
Service Code
|
CPT 30905
|
| Hospital Charge Code |
z30905
|
| Min. Negotiated Rate |
$98.32 |
| Max. Negotiated Rate |
$481.82 |
| Rate for Payer: Aetna Medicare |
$98.32
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$232.08
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$232.08
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$113.07
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$108.15
|
| Rate for Payer: Cash Price |
$398.30
|
| Rate for Payer: Cash Price |
$398.30
|
| Rate for Payer: Coventry All Commercial |
$117.98
|
| Rate for Payer: Frontpath All Commercial |
$138.22
|
| Rate for Payer: Humana ChoiceCare |
$125.83
|
| Rate for Payer: Humana Medicare |
$98.32
|
| Rate for Payer: Lucent All Commercial |
$167.14
|
| Rate for Payer: Lutheran Preferred All Commercial |
$157.00
|
| Rate for Payer: PHCS All Commercial |
$481.82
|
| Rate for Payer: PHP All Commercial |
$134.30
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$98.32
|
| Rate for Payer: Signature Care EPO |
$286.45
|
| Rate for Payer: Signature Care PPO |
$286.45
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$147.00
|
| Rate for Payer: United Healthcare Commercial |
$118.24
|
| Rate for Payer: United Healthcare Medicare |
$98.32
|
|
|
PR CUSTOM FIT EARPIECE SPECIAL
|
Professional
|
$80.00
|
|
|
Service Code
|
CPT V5264
|
| Hospital Charge Code |
zV5264A
|
| 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 CV STRS TST XERS&/OR RX CONT ECG W/O I&R
|
Professional
|
$39.70
|
|
|
Service Code
|
CPT 93016
|
| Hospital Charge Code |
z93016
|
| Min. Negotiated Rate |
$20.35 |
| Max. Negotiated Rate |
$35.50 |
| Rate for Payer: Aetna Medicare |
$20.35
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$34.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$34.00
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$23.40
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$22.38
|
| Rate for Payer: Cash Price |
$24.61
|
| Rate for Payer: Cash Price |
$24.61
|
| Rate for Payer: Coventry All Commercial |
$24.42
|
| Rate for Payer: Frontpath All Commercial |
$23.53
|
| Rate for Payer: Humana ChoiceCare |
$31.56
|
| Rate for Payer: Humana Medicare |
$20.35
|
| Rate for Payer: Lucent All Commercial |
$34.60
|
| Rate for Payer: Lutheran Preferred All Commercial |
$33.00
|
| Rate for Payer: PHCS All Commercial |
$29.78
|
| Rate for Payer: PHP All Commercial |
$29.18
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$20.35
|
| Rate for Payer: Signature Care EPO |
$35.50
|
| Rate for Payer: Signature Care PPO |
$35.50
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$31.00
|
| Rate for Payer: United Healthcare Commercial |
$29.51
|
| Rate for Payer: United Healthcare Medicare |
$20.35
|
|
|
PR DBRDMT EXTENSV ECZMT/INFCT SKIN UP 10% BDY SURF
|
Professional
|
$106.58
|
|
|
Service Code
|
CPT 11000
|
| Hospital Charge Code |
z11000
|
| Min. Negotiated Rate |
$25.92 |
| Max. Negotiated Rate |
$79.94 |
| Rate for Payer: Aetna Medicare |
$25.92
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$56.09
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$56.09
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$29.81
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$28.51
|
| Rate for Payer: Cash Price |
$66.08
|
| Rate for Payer: Cash Price |
$66.08
|
| Rate for Payer: Coventry All Commercial |
$31.10
|
| Rate for Payer: Frontpath All Commercial |
$36.02
|
| Rate for Payer: Humana ChoiceCare |
$31.45
|
| Rate for Payer: Humana Medicare |
$25.92
|
| Rate for Payer: Lucent All Commercial |
$44.06
|
| Rate for Payer: Lutheran Preferred All Commercial |
$34.00
|
| Rate for Payer: PHCS All Commercial |
$79.94
|
| Rate for Payer: PHP All Commercial |
$35.40
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$25.92
|
| Rate for Payer: Signature Care EPO |
$48.45
|
| Rate for Payer: Signature Care PPO |
$48.45
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$31.00
|
| Rate for Payer: United Healthcare Commercial |
$36.39
|
| Rate for Payer: United Healthcare Medicare |
$25.92
|
|
|
PR DBRDMT SKN SBQ T/M/F NECRO INFCTJ XTRNL GENT&PER
|
Professional
|
$1,016.72
|
|
|
Service Code
|
CPT 11004
|
| Hospital Charge Code |
z11004
|
| Min. Negotiated Rate |
$521.07 |
| Max. Negotiated Rate |
$885.82 |
| Rate for Payer: Aetna Medicare |
$521.07
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$697.87
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$697.87
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$599.23
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$573.18
|
| Rate for Payer: Cash Price |
$630.37
|
| Rate for Payer: Cash Price |
$630.37
|
| Rate for Payer: Coventry All Commercial |
$625.28
|
| Rate for Payer: Frontpath All Commercial |
$748.51
|
| Rate for Payer: Humana ChoiceCare |
$536.04
|
| Rate for Payer: Humana Medicare |
$521.07
|
| Rate for Payer: Lucent All Commercial |
$885.82
|
| Rate for Payer: Lutheran Preferred All Commercial |
$677.00
|
| Rate for Payer: PHCS All Commercial |
$762.54
|
| Rate for Payer: PHP All Commercial |
$711.70
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$521.07
|
| Rate for Payer: Signature Care EPO |
$602.65
|
| Rate for Payer: Signature Care PPO |
$602.65
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$625.00
|
| Rate for Payer: United Healthcare Commercial |
$652.33
|
| Rate for Payer: United Healthcare Medicare |
$521.07
|
|
|
PR DBRDMT SKN SUBQ T/M/F NECRO INFCTJ ABDL WALL
|
Professional
|
$1,367.50
|
|
|
Service Code
|
CPT 11005
|
| Hospital Charge Code |
z11005
|
| Min. Negotiated Rate |
$700.69 |
| Max. Negotiated Rate |
$1,191.17 |
| Rate for Payer: Signature Care PPO |
$818.55
|
| Rate for Payer: Aetna Medicare |
$700.69
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$950.66
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$950.66
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$805.79
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$770.76
|
| Rate for Payer: Cash Price |
$847.85
|
| Rate for Payer: Cash Price |
$847.85
|
| Rate for Payer: Coventry All Commercial |
$840.83
|
| Rate for Payer: Frontpath All Commercial |
$1,025.09
|
| Rate for Payer: Humana ChoiceCare |
$728.54
|
| Rate for Payer: Humana Medicare |
$700.69
|
| Rate for Payer: Lucent All Commercial |
$1,191.17
|
| Rate for Payer: Lutheran Preferred All Commercial |
$911.00
|
| Rate for Payer: PHCS All Commercial |
$1,025.62
|
| Rate for Payer: PHP All Commercial |
$957.25
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$700.69
|
| Rate for Payer: Signature Care EPO |
$818.55
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$841.00
|
| Rate for Payer: United Healthcare Commercial |
$851.25
|
| Rate for Payer: United Healthcare Medicare |
$700.69
|
|
|
PR D&C AFTER DELIVERY
|
Professional
|
$492.56
|
|
|
Service Code
|
CPT 59160
|
| Hospital Charge Code |
z59160
|
| Min. Negotiated Rate |
$172.17 |
| Max. Negotiated Rate |
$369.42 |
| Rate for Payer: Aetna Medicare |
$172.17
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$325.51
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$325.51
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$198.00
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$189.39
|
| Rate for Payer: Cash Price |
$305.39
|
| Rate for Payer: Cash Price |
$305.39
|
| Rate for Payer: Coventry All Commercial |
$206.60
|
| Rate for Payer: Frontpath All Commercial |
$244.58
|
| Rate for Payer: Humana ChoiceCare |
$186.75
|
| Rate for Payer: Humana Medicare |
$172.17
|
| Rate for Payer: Lucent All Commercial |
$292.69
|
| Rate for Payer: Lutheran Preferred All Commercial |
$241.00
|
| Rate for Payer: PHCS All Commercial |
$369.42
|
| Rate for Payer: PHP All Commercial |
$221.73
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$172.17
|
| Rate for Payer: Signature Care EPO |
$291.55
|
| Rate for Payer: Signature Care PPO |
$291.55
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$224.00
|
| Rate for Payer: United Healthcare Commercial |
$200.79
|
| Rate for Payer: United Healthcare Medicare |
$172.17
|
|
|
PR DEBRIDE ASSOC OPEN FX/DISLOC SKIN/MUSCLE
|
Professional
|
$901.02
|
|
|
Service Code
|
CPT 11011
|
| Hospital Charge Code |
z11011
|
| Min. Negotiated Rate |
$272.22 |
| Max. Negotiated Rate |
$675.76 |
| Rate for Payer: Aetna Medicare |
$272.22
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$313.05
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$299.44
|
| Rate for Payer: Cash Price |
$558.63
|
| Rate for Payer: Cash Price |
$558.63
|
| Rate for Payer: Coventry All Commercial |
$326.66
|
| Rate for Payer: Frontpath All Commercial |
$385.64
|
| Rate for Payer: Humana ChoiceCare |
$280.13
|
| Rate for Payer: Humana Medicare |
$272.22
|
| Rate for Payer: Lucent All Commercial |
$462.77
|
| Rate for Payer: PHCS All Commercial |
$675.76
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$272.22
|
| Rate for Payer: United Healthcare Commercial |
$334.16
|
| Rate for Payer: United Healthcare Medicare |
$272.22
|
|
