|
PR DEBRIDE ASSOC OPEN FX/DISLOC SKIN/SUBQ
|
Professional
|
$822.54
|
|
|
Service Code
|
CPT 11010
|
| Hospital Charge Code |
z11010
|
| Min. Negotiated Rate |
$255.77 |
| Max. Negotiated Rate |
$616.90 |
| Rate for Payer: Aetna Medicare |
$255.77
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$470.62
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$470.62
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$294.14
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$281.35
|
| Rate for Payer: Cash Price |
$509.97
|
| Rate for Payer: Cash Price |
$509.97
|
| Rate for Payer: Coventry All Commercial |
$306.92
|
| Rate for Payer: Frontpath All Commercial |
$356.52
|
| Rate for Payer: Humana ChoiceCare |
$260.00
|
| Rate for Payer: Humana Medicare |
$255.77
|
| Rate for Payer: Lucent All Commercial |
$434.81
|
| Rate for Payer: Lutheran Preferred All Commercial |
$333.00
|
| Rate for Payer: PHCS All Commercial |
$616.90
|
| Rate for Payer: PHP All Commercial |
$349.35
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$255.77
|
| Rate for Payer: Signature Care EPO |
$446.25
|
| Rate for Payer: Signature Care PPO |
$446.25
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$307.00
|
| Rate for Payer: United Healthcare Commercial |
$309.78
|
| Rate for Payer: United Healthcare Medicare |
$255.77
|
|
|
PR DEBRIDE ASSOC OPEN FX/DISLO SKIN/MUS/BONE
|
Professional
|
$1,180.28
|
|
|
Service Code
|
CPT 11012
|
| Hospital Charge Code |
z11012
|
| Min. Negotiated Rate |
$382.62 |
| Max. Negotiated Rate |
$885.21 |
| Rate for Payer: Aetna Medicare |
$382.62
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$717.17
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$717.17
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$440.01
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$420.88
|
| Rate for Payer: Cash Price |
$731.77
|
| Rate for Payer: Cash Price |
$731.77
|
| Rate for Payer: Coventry All Commercial |
$459.14
|
| Rate for Payer: Frontpath All Commercial |
$540.46
|
| Rate for Payer: Humana ChoiceCare |
$411.71
|
| Rate for Payer: Humana Medicare |
$382.62
|
| Rate for Payer: Lucent All Commercial |
$650.45
|
| Rate for Payer: Lutheran Preferred All Commercial |
$497.00
|
| Rate for Payer: PHCS All Commercial |
$885.21
|
| Rate for Payer: PHP All Commercial |
$522.61
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$382.62
|
| Rate for Payer: Signature Care EPO |
$772.65
|
| Rate for Payer: Signature Care PPO |
$772.65
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$459.00
|
| Rate for Payer: United Healthcare Commercial |
$483.41
|
| Rate for Payer: United Healthcare Medicare |
$382.62
|
|
|
PR DEBRIDE MASTOID CAVITY,COMPLEX
|
Professional
|
$396.72
|
|
|
Service Code
|
CPT 69222
|
| Hospital Charge Code |
z69222
|
| Min. Negotiated Rate |
$128.30 |
| Max. Negotiated Rate |
$297.54 |
| Rate for Payer: Aetna Medicare |
$128.30
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$182.93
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$182.93
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$147.54
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$141.13
|
| Rate for Payer: Cash Price |
$245.97
|
| Rate for Payer: Cash Price |
$245.97
|
| Rate for Payer: Coventry All Commercial |
$153.96
|
| Rate for Payer: Frontpath All Commercial |
$173.73
|
| Rate for Payer: Humana ChoiceCare |
$139.60
|
| Rate for Payer: Humana Medicare |
$128.30
|
| Rate for Payer: Lucent All Commercial |
$218.11
|
| Rate for Payer: Lutheran Preferred All Commercial |
$205.00
|
| Rate for Payer: PHCS All Commercial |
$297.54
|
| Rate for Payer: PHP All Commercial |
$162.72
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$128.30
|
| Rate for Payer: Signature Care EPO |
$243.10
|
| Rate for Payer: Signature Care PPO |
$243.10
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$192.00
|
| Rate for Payer: United Healthcare Commercial |
$147.55
|
| Rate for Payer: United Healthcare Medicare |
$128.30
|
|
|
PR DEBRIDE MASTOID CAVITY,SIMPLE
|
Professional
|
$142.98
|
|
|
Service Code
|
CPT 69220
|
| Hospital Charge Code |
z69220
|
| Min. Negotiated Rate |
$47.96 |
| Max. Negotiated Rate |
$144.85 |
| Rate for Payer: Aetna Medicare |
$47.96
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$144.85
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$144.85
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$55.15
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$52.76
|
| Rate for Payer: Cash Price |
$88.65
|
| Rate for Payer: Cash Price |
$88.65
|
| Rate for Payer: Coventry All Commercial |
$57.55
|
| Rate for Payer: Frontpath All Commercial |
$65.35
|
| Rate for Payer: Humana ChoiceCare |
$63.85
|
| Rate for Payer: Humana Medicare |
$47.96
|
| Rate for Payer: Lucent All Commercial |
$81.53
|
| Rate for Payer: Lutheran Preferred All Commercial |
$77.00
|
| Rate for Payer: PHCS All Commercial |
$107.24
|
| Rate for Payer: PHP All Commercial |
$60.83
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$47.96
|
| Rate for Payer: Signature Care EPO |
$123.32
|
| Rate for Payer: Signature Care PPO |
$123.32
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$72.00
|
| Rate for Payer: United Healthcare Commercial |
$68.28
|
| Rate for Payer: United Healthcare Medicare |
$47.96
|
|
|
PR DEBRIDEMENT BONE 1ST 20 SQ CM/<
|
Professional
|
$563.18
|
|
|
Service Code
|
CPT 11044
|
| Hospital Charge Code |
z11044
|
| Min. Negotiated Rate |
$208.67 |
| Max. Negotiated Rate |
$422.38 |
| Rate for Payer: Aetna Medicare |
$208.67
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$377.75
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$377.75
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$239.97
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$229.54
|
| Rate for Payer: Cash Price |
$349.17
|
| Rate for Payer: Cash Price |
$349.17
|
| Rate for Payer: Coventry All Commercial |
$250.40
|
| Rate for Payer: Frontpath All Commercial |
$292.44
|
| Rate for Payer: Humana ChoiceCare |
$252.17
|
| Rate for Payer: Humana Medicare |
$208.67
|
| Rate for Payer: Lucent All Commercial |
$354.74
|
| Rate for Payer: Lutheran Preferred All Commercial |
$271.00
|
| Rate for Payer: PHCS All Commercial |
$422.38
|
| Rate for Payer: PHP All Commercial |
$285.02
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$208.67
|
| Rate for Payer: Signature Care EPO |
$310.25
|
| Rate for Payer: Signature Care PPO |
$310.25
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$250.00
|
| Rate for Payer: United Healthcare Commercial |
$347.96
|
| Rate for Payer: United Healthcare Medicare |
$208.67
|
|
|
PR DEBRIDEMENT MUSCLE &/FASCIA 1ST 20 SQ CM/<
|
Professional
|
$421.80
|
|
|
Service Code
|
CPT 11043
|
| Hospital Charge Code |
z11043
|
| Min. Negotiated Rate |
$142.70 |
| Max. Negotiated Rate |
$316.35 |
| Rate for Payer: Aetna Medicare |
$142.70
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$276.54
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$276.54
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$164.10
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$156.97
|
| Rate for Payer: Cash Price |
$261.52
|
| Rate for Payer: Cash Price |
$261.52
|
| Rate for Payer: Coventry All Commercial |
$171.24
|
| Rate for Payer: Frontpath All Commercial |
$199.15
|
| Rate for Payer: Humana ChoiceCare |
$184.75
|
| Rate for Payer: Humana Medicare |
$142.70
|
| Rate for Payer: Lucent All Commercial |
$242.59
|
| Rate for Payer: Lutheran Preferred All Commercial |
$186.00
|
| Rate for Payer: PHCS All Commercial |
$316.35
|
| Rate for Payer: PHP All Commercial |
$194.90
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$142.70
|
| Rate for Payer: Signature Care EPO |
$237.15
|
| Rate for Payer: Signature Care PPO |
$237.15
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$171.00
|
| Rate for Payer: United Healthcare Commercial |
$252.89
|
| Rate for Payer: United Healthcare Medicare |
$142.70
|
|
|
PR DEBRIDEMENT MUSCLE &/FASCIA EA ADDL 20 SQ CM
|
Professional
|
$131.30
|
|
|
Service Code
|
CPT 11046
|
| Hospital Charge Code |
z11046
|
| Min. Negotiated Rate |
$36.00 |
| Max. Negotiated Rate |
$98.48 |
| Rate for Payer: Aetna Medicare |
$50.31
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$58.32
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$58.32
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$57.86
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$55.34
|
| Rate for Payer: Cash Price |
$81.41
|
| Rate for Payer: Cash Price |
$81.41
|
| Rate for Payer: Coventry All Commercial |
$60.37
|
| Rate for Payer: Frontpath All Commercial |
$72.60
|
| Rate for Payer: Humana ChoiceCare |
$36.00
|
| Rate for Payer: Humana Medicare |
$50.31
|
| Rate for Payer: Lucent All Commercial |
$85.53
|
| Rate for Payer: Lutheran Preferred All Commercial |
$65.00
|
| Rate for Payer: PHCS All Commercial |
$98.48
|
| Rate for Payer: PHP All Commercial |
$68.72
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$50.31
|
| Rate for Payer: Signature Care EPO |
$58.85
|
| Rate for Payer: Signature Care PPO |
$58.85
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$60.00
|
| Rate for Payer: United Healthcare Commercial |
$47.21
|
| Rate for Payer: United Healthcare Medicare |
$50.31
|
|
|
PR DEBRIDEMENT OF NAIL(S), 1-5
|
Professional
|
$59.76
|
|
|
Service Code
|
CPT 11720
|
| Hospital Charge Code |
z11720
|
| Min. Negotiated Rate |
$13.65 |
| Max. Negotiated Rate |
$44.82 |
| Rate for Payer: Aetna Medicare |
$13.65
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$15.70
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$15.02
|
| Rate for Payer: Cash Price |
$37.05
|
| Rate for Payer: Cash Price |
$37.05
|
| Rate for Payer: Coventry All Commercial |
$16.38
|
| Rate for Payer: Frontpath All Commercial |
$19.24
|
| Rate for Payer: Humana ChoiceCare |
$16.91
|
| Rate for Payer: Humana Medicare |
$13.65
|
| Rate for Payer: Lucent All Commercial |
$23.20
|
| Rate for Payer: PHCS All Commercial |
$44.82
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$13.65
|
| Rate for Payer: United Healthcare Commercial |
$19.24
|
| Rate for Payer: United Healthcare Medicare |
$13.65
|
|
|
PR DEBRIDEMENT OF NAILS, 6 OR MORE
|
Professional
|
$81.54
|
|
|
Service Code
|
CPT 11721
|
| Hospital Charge Code |
z11721
|
| Min. Negotiated Rate |
$22.65 |
| Max. Negotiated Rate |
$61.16 |
| Rate for Payer: Aetna Medicare |
$22.65
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$26.05
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$24.92
|
| Rate for Payer: Cash Price |
$50.55
|
| Rate for Payer: Cash Price |
$50.55
|
| Rate for Payer: Coventry All Commercial |
$27.18
|
| Rate for Payer: Frontpath All Commercial |
$31.19
|
| Rate for Payer: Humana ChoiceCare |
$28.83
|
| Rate for Payer: Humana Medicare |
$22.65
|
| Rate for Payer: Lucent All Commercial |
$38.50
|
| Rate for Payer: PHCS All Commercial |
$61.16
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$22.65
|
| Rate for Payer: United Healthcare Commercial |
$32.86
|
| Rate for Payer: United Healthcare Medicare |
$22.65
|
|
|
PR DEBRIDEMENT OPEN WOUND FIRST 20 SQ CM/<
|
Professional
|
$184.12
|
|
|
Service Code
|
CPT 97597
|
| Hospital Charge Code |
z97597
|
| Min. Negotiated Rate |
$30.61 |
| Max. Negotiated Rate |
$138.09 |
| Rate for Payer: Aetna Medicare |
$33.85
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$94.25
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$94.25
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$38.93
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$37.24
|
| Rate for Payer: Cash Price |
$114.15
|
| Rate for Payer: Cash Price |
$114.15
|
| Rate for Payer: Coventry All Commercial |
$40.62
|
| Rate for Payer: Frontpath All Commercial |
$39.88
|
| Rate for Payer: Humana ChoiceCare |
$47.06
|
| Rate for Payer: Humana Medicare |
$33.85
|
| Rate for Payer: Lucent All Commercial |
$57.54
|
| Rate for Payer: Lutheran Preferred All Commercial |
$44.00
|
| Rate for Payer: PHCS All Commercial |
$138.09
|
| Rate for Payer: PHP All Commercial |
$33.02
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$33.85
|
| Rate for Payer: Signature Care EPO |
$81.58
|
| Rate for Payer: Signature Care PPO |
$81.58
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$41.00
|
| Rate for Payer: United Healthcare Commercial |
$30.61
|
| Rate for Payer: United Healthcare Medicare |
$33.85
|
|
|
PR DEBRIDEMENT OPN WND EA ADDL 20 SQ CM/PRT THEREOF
|
Professional
|
$81.92
|
|
|
Service Code
|
CPT 97598
|
| Hospital Charge Code |
z97598
|
| Min. Negotiated Rate |
$23.16 |
| Max. Negotiated Rate |
$61.44 |
| Rate for Payer: Aetna Medicare |
$23.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$26.63
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$25.48
|
| Rate for Payer: Cash Price |
$50.79
|
| Rate for Payer: Cash Price |
$50.79
|
| Rate for Payer: Coventry All Commercial |
$27.79
|
| Rate for Payer: Frontpath All Commercial |
$27.85
|
| Rate for Payer: Humana ChoiceCare |
$60.31
|
| Rate for Payer: Humana Medicare |
$23.16
|
| Rate for Payer: Lucent All Commercial |
$39.37
|
| Rate for Payer: PHCS All Commercial |
$61.44
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$23.16
|
| Rate for Payer: United Healthcare Commercial |
$40.86
|
| Rate for Payer: United Healthcare Medicare |
$23.16
|
|
|
PR DEBRIDEMENT SUBCUTANEOUS TISSUE 1ST 20 SQ CM/<
|
Professional
|
$235.00
|
|
|
Service Code
|
CPT 11042
|
| Hospital Charge Code |
z11042
|
| Min. Negotiated Rate |
$51.99 |
| Max. Negotiated Rate |
$176.25 |
| Rate for Payer: Aetna Medicare |
$55.92
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$132.44
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$132.44
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$64.31
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$61.51
|
| Rate for Payer: Cash Price |
$145.70
|
| Rate for Payer: Cash Price |
$145.70
|
| Rate for Payer: Coventry All Commercial |
$67.10
|
| Rate for Payer: Frontpath All Commercial |
$77.22
|
| Rate for Payer: Humana ChoiceCare |
$59.70
|
| Rate for Payer: Humana Medicare |
$55.92
|
| Rate for Payer: Lucent All Commercial |
$95.06
|
| Rate for Payer: Lutheran Preferred All Commercial |
$73.00
|
| Rate for Payer: PHCS All Commercial |
$176.25
|
| Rate for Payer: PHP All Commercial |
$76.37
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$55.92
|
| Rate for Payer: Signature Care EPO |
$103.89
|
| Rate for Payer: Signature Care PPO |
$103.89
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$67.00
|
| Rate for Payer: United Healthcare Commercial |
$51.99
|
| Rate for Payer: United Healthcare Medicare |
$55.92
|
|
|
PR DEBRIDEMENT SUBCUTANEOUS TISSUE EA ADDL 20 SQ CM
|
Professional
|
$72.32
|
|
|
Service Code
|
CPT 11045
|
| Hospital Charge Code |
z11045
|
| Min. Negotiated Rate |
$16.87 |
| Max. Negotiated Rate |
$54.24 |
| Rate for Payer: Aetna Medicare |
$23.48
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$38.38
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$38.38
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$27.00
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$25.83
|
| Rate for Payer: Cash Price |
$44.84
|
| Rate for Payer: Cash Price |
$44.84
|
| Rate for Payer: Coventry All Commercial |
$28.18
|
| Rate for Payer: Frontpath All Commercial |
$34.32
|
| Rate for Payer: Humana ChoiceCare |
$16.87
|
| Rate for Payer: Humana Medicare |
$23.48
|
| Rate for Payer: Lucent All Commercial |
$39.92
|
| Rate for Payer: Lutheran Preferred All Commercial |
$31.00
|
| Rate for Payer: PHCS All Commercial |
$54.24
|
| Rate for Payer: PHP All Commercial |
$32.07
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$23.48
|
| Rate for Payer: Signature Care EPO |
$33.30
|
| Rate for Payer: Signature Care PPO |
$33.30
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$28.00
|
| Rate for Payer: United Healthcare Commercial |
$22.15
|
| Rate for Payer: United Healthcare Medicare |
$23.48
|
|
|
PR DEEP INCIS FOOT BONE INFECTN
|
Professional
|
$1,054.80
|
|
|
Service Code
|
CPT 28005
|
| Hospital Charge Code |
z28005
|
| Min. Negotiated Rate |
$540.59 |
| Max. Negotiated Rate |
$919.00 |
| Rate for Payer: Aetna Medicare |
$540.59
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$621.68
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$594.65
|
| Rate for Payer: Cash Price |
$653.98
|
| Rate for Payer: Cash Price |
$653.98
|
| Rate for Payer: Coventry All Commercial |
$648.71
|
| Rate for Payer: Frontpath All Commercial |
$737.19
|
| Rate for Payer: Humana ChoiceCare |
$640.29
|
| Rate for Payer: Humana Medicare |
$540.59
|
| Rate for Payer: Lucent All Commercial |
$919.00
|
| Rate for Payer: PHCS All Commercial |
$791.10
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$540.59
|
| Rate for Payer: United Healthcare Commercial |
$685.26
|
| Rate for Payer: United Healthcare Medicare |
$540.59
|
|
|
PR DEEP INCIS SHLDR BONE CORTEX
|
Professional
|
$1,306.14
|
|
|
Service Code
|
CPT 23040
|
| Hospital Charge Code |
z23040
|
| Min. Negotiated Rate |
$669.40 |
| Max. Negotiated Rate |
$1,137.98 |
| Rate for Payer: Aetna Medicare |
$669.40
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$957.70
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$957.70
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$769.81
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$736.34
|
| Rate for Payer: Cash Price |
$809.81
|
| Rate for Payer: Cash Price |
$809.81
|
| Rate for Payer: Coventry All Commercial |
$803.28
|
| Rate for Payer: Frontpath All Commercial |
$934.51
|
| Rate for Payer: Humana ChoiceCare |
$743.36
|
| Rate for Payer: Humana Medicare |
$669.40
|
| Rate for Payer: Lucent All Commercial |
$1,137.98
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,071.00
|
| Rate for Payer: PHCS All Commercial |
$979.60
|
| Rate for Payer: PHP All Commercial |
$1,136.35
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$669.40
|
| Rate for Payer: Signature Care EPO |
$995.35
|
| Rate for Payer: Signature Care PPO |
$995.35
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,004.00
|
| Rate for Payer: United Healthcare Commercial |
$774.51
|
| Rate for Payer: United Healthcare Medicare |
$669.40
|
|
|
PR DEFENDEAR CONCERT STYLE #49
|
Professional
|
$80.00
|
|
|
Service Code
|
CPT V5264
|
| Hospital Charge Code |
zV5264G
|
| 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 DEFENDEAR HUNTER DIGITAL
|
Professional
|
$1,895.00
|
|
|
Service Code
|
CPT V5264
|
| Hospital Charge Code |
zV5264B
|
| Min. Negotiated Rate |
$1,421.25 |
| Max. Negotiated Rate |
$1,895.00 |
| Rate for Payer: Cash Price |
$1,174.90
|
| Rate for Payer: PHCS All Commercial |
$1,421.25
|
| Rate for Payer: Signature Care EPO |
$1,895.00
|
| Rate for Payer: Signature Care PPO |
$1,895.00
|
|
|
PR DEFENDEAR HUNTER PASSIVE #39
|
Professional
|
$80.00
|
|
|
Service Code
|
CPT V5264
|
| Hospital Charge Code |
zV5264C
|
| 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 DEFENDEAR MOTORSPORT #4RT
|
Professional
|
$80.00
|
|
|
Service Code
|
CPT V5264
|
| Hospital Charge Code |
zV5264D
|
| 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 DEFENDEAR SLEEP STYLE #40-4
|
Professional
|
$80.00
|
|
|
Service Code
|
CPT V5264
|
| Hospital Charge Code |
zV5264E
|
| 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 DEFENDEAR SOLID STYLE #40
|
Professional
|
$80.00
|
|
|
Service Code
|
CPT V5264
|
| Hospital Charge Code |
zV5264F
|
| 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 DELIVER PLACENTA
|
Professional
|
$159.16
|
|
|
Service Code
|
CPT 59414
|
| Hospital Charge Code |
z59414
|
| Min. Negotiated Rate |
$81.57 |
| Max. Negotiated Rate |
$138.67 |
| Rate for Payer: Aetna Medicare |
$81.57
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$125.47
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$125.47
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$93.81
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$89.73
|
| Rate for Payer: Cash Price |
$98.68
|
| Rate for Payer: Cash Price |
$98.68
|
| Rate for Payer: Coventry All Commercial |
$97.88
|
| Rate for Payer: Frontpath All Commercial |
$117.31
|
| Rate for Payer: Humana ChoiceCare |
$89.27
|
| Rate for Payer: Humana Medicare |
$81.57
|
| Rate for Payer: Lucent All Commercial |
$138.67
|
| Rate for Payer: Lutheran Preferred All Commercial |
$114.00
|
| Rate for Payer: PHCS All Commercial |
$119.37
|
| Rate for Payer: PHP All Commercial |
$105.05
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$81.57
|
| Rate for Payer: Signature Care EPO |
$113.90
|
| Rate for Payer: Signature Care PPO |
$113.90
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$106.00
|
| Rate for Payer: United Healthcare Commercial |
$103.95
|
| Rate for Payer: United Healthcare Medicare |
$81.57
|
|
|
PR DEMO &/OR EVAL,PT USE,AEROSOL DEVICE
|
Professional
|
$30.44
|
|
|
Service Code
|
CPT 94664
|
| Hospital Charge Code |
z94664
|
| Min. Negotiated Rate |
$15.60 |
| Max. Negotiated Rate |
$26.52 |
| Rate for Payer: Aetna Medicare |
$15.60
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$23.70
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$23.70
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$17.94
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$17.16
|
| Rate for Payer: Cash Price |
$18.87
|
| Rate for Payer: Cash Price |
$18.87
|
| Rate for Payer: Coventry All Commercial |
$18.72
|
| Rate for Payer: Frontpath All Commercial |
$17.45
|
| Rate for Payer: Humana ChoiceCare |
$15.76
|
| Rate for Payer: Humana Medicare |
$15.60
|
| Rate for Payer: Lucent All Commercial |
$26.52
|
| Rate for Payer: Lutheran Preferred All Commercial |
$20.00
|
| Rate for Payer: PHCS All Commercial |
$22.83
|
| Rate for Payer: PHP All Commercial |
$20.54
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$15.60
|
| Rate for Payer: Signature Care EPO |
$17.00
|
| Rate for Payer: Signature Care PPO |
$17.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$19.00
|
| Rate for Payer: United Healthcare Commercial |
$16.39
|
| Rate for Payer: United Healthcare Medicare |
$15.60
|
|
|
PR DENOSUMAB INJECTION
|
Professional
|
$23.63
|
|
|
Service Code
|
CPT J0897
|
| Hospital Charge Code |
zJ0897
|
| Min. Negotiated Rate |
$23.07 |
| Max. Negotiated Rate |
$23.63 |
| Rate for Payer: Humana ChoiceCare |
$23.07
|
| Rate for Payer: PHP All Commercial |
$23.63
|
|
|
PR DESTR PENIS LESN,EXTENSIVE
|
Professional
|
$407.02
|
|
|
Service Code
|
CPT 54065
|
| Hospital Charge Code |
z54065
|
| Min. Negotiated Rate |
$161.05 |
| Max. Negotiated Rate |
$305.26 |
| Rate for Payer: Aetna Medicare |
$161.05
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$254.04
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$254.04
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$185.21
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$177.16
|
| Rate for Payer: Cash Price |
$252.35
|
| Rate for Payer: Cash Price |
$252.35
|
| Rate for Payer: Coventry All Commercial |
$193.26
|
| Rate for Payer: Frontpath All Commercial |
$216.66
|
| Rate for Payer: Humana ChoiceCare |
$172.70
|
| Rate for Payer: Humana Medicare |
$161.05
|
| Rate for Payer: Lucent All Commercial |
$273.78
|
| Rate for Payer: Lutheran Preferred All Commercial |
$225.00
|
| Rate for Payer: PHCS All Commercial |
$305.26
|
| Rate for Payer: PHP All Commercial |
$207.40
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$161.05
|
| Rate for Payer: Signature Care EPO |
$186.15
|
| Rate for Payer: Signature Care PPO |
$186.15
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$209.00
|
| Rate for Payer: United Healthcare Commercial |
$189.25
|
| Rate for Payer: United Healthcare Medicare |
$161.05
|
|
