|
PR DRESS/DEBRID LARGE BURN NO ANESTH
|
Professional
|
$355.50
|
|
|
Service Code
|
CPT 16030
|
| Hospital Charge Code |
z16030
|
| Min. Negotiated Rate |
$121.07 |
| Max. Negotiated Rate |
$266.62 |
| Rate for Payer: Aetna Medicare |
$121.07
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$205.21
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$205.21
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$139.23
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$133.18
|
| Rate for Payer: Cash Price |
$220.41
|
| Rate for Payer: Cash Price |
$220.41
|
| Rate for Payer: Coventry All Commercial |
$145.28
|
| Rate for Payer: Frontpath All Commercial |
$170.27
|
| Rate for Payer: Humana ChoiceCare |
$121.25
|
| Rate for Payer: Humana Medicare |
$121.07
|
| Rate for Payer: Lucent All Commercial |
$205.82
|
| Rate for Payer: Lutheran Preferred All Commercial |
$157.00
|
| Rate for Payer: PHCS All Commercial |
$266.62
|
| Rate for Payer: PHP All Commercial |
$165.36
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$121.07
|
| Rate for Payer: Signature Care EPO |
$175.95
|
| Rate for Payer: Signature Care PPO |
$175.95
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$145.00
|
| Rate for Payer: United Healthcare Commercial |
$143.30
|
| Rate for Payer: United Healthcare Medicare |
$121.07
|
|
|
PR DRESS/DEBRID MED BURN NO ANESTH
|
Professional
|
$284.36
|
|
|
Service Code
|
CPT 16025
|
| Hospital Charge Code |
z16025
|
| Min. Negotiated Rate |
$102.52 |
| Max. Negotiated Rate |
$213.27 |
| Rate for Payer: Aetna Medicare |
$102.52
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$149.76
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$149.76
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$117.90
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$112.77
|
| Rate for Payer: Cash Price |
$176.30
|
| Rate for Payer: Cash Price |
$176.30
|
| Rate for Payer: Coventry All Commercial |
$123.02
|
| Rate for Payer: Frontpath All Commercial |
$143.33
|
| Rate for Payer: Humana ChoiceCare |
$106.21
|
| Rate for Payer: Humana Medicare |
$102.52
|
| Rate for Payer: Lucent All Commercial |
$174.28
|
| Rate for Payer: Lutheran Preferred All Commercial |
$133.00
|
| Rate for Payer: PHCS All Commercial |
$213.27
|
| Rate for Payer: PHP All Commercial |
$140.02
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$102.52
|
| Rate for Payer: Signature Care EPO |
$150.45
|
| Rate for Payer: Signature Care PPO |
$150.45
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$123.00
|
| Rate for Payer: United Healthcare Commercial |
$126.20
|
| Rate for Payer: United Healthcare Medicare |
$102.52
|
|
|
PR DRESS/DEBRID SMALL BURN NO ANES
|
Professional
|
$154.92
|
|
|
Service Code
|
CPT 16020
|
| Hospital Charge Code |
z16020
|
| Min. Negotiated Rate |
$51.31 |
| Max. Negotiated Rate |
$116.19 |
| Rate for Payer: Aetna Medicare |
$51.31
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$99.41
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$99.41
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$59.01
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$56.44
|
| Rate for Payer: Cash Price |
$96.05
|
| Rate for Payer: Cash Price |
$96.05
|
| Rate for Payer: Coventry All Commercial |
$61.57
|
| Rate for Payer: Frontpath All Commercial |
$69.39
|
| Rate for Payer: Humana ChoiceCare |
$51.55
|
| Rate for Payer: Humana Medicare |
$51.31
|
| Rate for Payer: Lucent All Commercial |
$87.23
|
| Rate for Payer: Lutheran Preferred All Commercial |
$67.00
|
| Rate for Payer: PHCS All Commercial |
$116.19
|
| Rate for Payer: PHP All Commercial |
$70.08
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$51.31
|
| Rate for Payer: Signature Care EPO |
$85.85
|
| Rate for Payer: Signature Care PPO |
$85.85
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$62.00
|
| Rate for Payer: United Healthcare Commercial |
$61.40
|
| Rate for Payer: United Healthcare Medicare |
$51.31
|
|
|
PR DRESSING CHANGE,NOT FOR BURN
|
Professional
|
$82.68
|
|
|
Service Code
|
CPT 15852
|
| Hospital Charge Code |
z15852
|
| Min. Negotiated Rate |
$42.38 |
| Max. Negotiated Rate |
$73.78 |
| Rate for Payer: Aetna Medicare |
$42.38
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$48.74
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$46.62
|
| Rate for Payer: Cash Price |
$51.26
|
| Rate for Payer: Cash Price |
$51.26
|
| Rate for Payer: Coventry All Commercial |
$50.86
|
| Rate for Payer: Frontpath All Commercial |
$61.44
|
| Rate for Payer: Humana ChoiceCare |
$45.41
|
| Rate for Payer: Humana Medicare |
$42.38
|
| Rate for Payer: Lucent All Commercial |
$72.05
|
| Rate for Payer: PHCS All Commercial |
$62.01
|
| Rate for Payer: PHP All Commercial |
$57.88
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$42.38
|
| Rate for Payer: Signature Care EPO |
$73.78
|
| Rate for Payer: Signature Care PPO |
$73.78
|
| Rate for Payer: United Healthcare Commercial |
$53.20
|
| Rate for Payer: United Healthcare Medicare |
$42.38
|
|
|
PR DTAP-HEPB-IPV VACCINE INTRAMUSCULAR
|
Professional
|
$112.94
|
|
|
Service Code
|
CPT 90723
|
| Hospital Charge Code |
z90723
|
| Min. Negotiated Rate |
$75.00 |
| Max. Negotiated Rate |
$112.94 |
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$91.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$91.00
|
| Rate for Payer: Frontpath All Commercial |
$75.00
|
| Rate for Payer: Humana ChoiceCare |
$112.94
|
| Rate for Payer: PHP All Commercial |
$99.05
|
| Rate for Payer: United Healthcare Commercial |
$110.38
|
|
|
PR DTAP IMMUNIZATION, IM, <7 YO
|
Professional
|
$50.05
|
|
|
Service Code
|
CPT 90700
|
| Hospital Charge Code |
z90700
|
| Min. Negotiated Rate |
$26.86 |
| Max. Negotiated Rate |
$50.05 |
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$35.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$35.00
|
| Rate for Payer: Frontpath All Commercial |
$26.86
|
| Rate for Payer: Humana ChoiceCare |
$30.39
|
| Rate for Payer: Lutheran Preferred All Commercial |
$50.05
|
| Rate for Payer: PHP All Commercial |
$29.73
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$50.05
|
|
|
PR DTAP-IPV/HIB VACCINE FOR INTRAMUSCULAR USE
|
Professional
|
$155.82
|
|
|
Service Code
|
CPT 90698
|
| Hospital Charge Code |
z90698
|
| Min. Negotiated Rate |
$90.20 |
| Max. Negotiated Rate |
$155.82 |
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$112.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$112.00
|
| Rate for Payer: Frontpath All Commercial |
$90.20
|
| Rate for Payer: Humana ChoiceCare |
$131.33
|
| Rate for Payer: Lutheran Preferred All Commercial |
$155.82
|
| Rate for Payer: PHP All Commercial |
$116.79
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$155.82
|
| Rate for Payer: United Healthcare Commercial |
$132.77
|
|
|
PR DTAP-IPV VACCINE CHILD 4-6 YRS FOR IM USE
|
Professional
|
$85.58
|
|
|
Service Code
|
CPT 90696
|
| Hospital Charge Code |
z90696
|
| Min. Negotiated Rate |
$60.00 |
| Max. Negotiated Rate |
$85.58 |
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$60.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$60.00
|
| Rate for Payer: Humana ChoiceCare |
$75.66
|
| Rate for Payer: Lutheran Preferred All Commercial |
$85.58
|
| Rate for Payer: PHP All Commercial |
$64.19
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$85.58
|
|
|
PR EAR AND THROAT EXAMINATION
|
Professional
|
$175.26
|
|
|
Service Code
|
CPT 92502
|
| Hospital Charge Code |
z92502
|
| Min. Negotiated Rate |
$89.82 |
| Max. Negotiated Rate |
$152.69 |
| Rate for Payer: Aetna Medicare |
$89.82
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$98.50
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$98.50
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$103.29
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$98.80
|
| Rate for Payer: Cash Price |
$108.66
|
| Rate for Payer: Cash Price |
$108.66
|
| Rate for Payer: Coventry All Commercial |
$107.78
|
| Rate for Payer: Frontpath All Commercial |
$102.31
|
| Rate for Payer: Humana ChoiceCare |
$112.51
|
| Rate for Payer: Humana Medicare |
$89.82
|
| Rate for Payer: Lucent All Commercial |
$152.69
|
| Rate for Payer: Lutheran Preferred All Commercial |
$117.00
|
| Rate for Payer: PHCS All Commercial |
$131.44
|
| Rate for Payer: PHP All Commercial |
$127.07
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$89.82
|
| Rate for Payer: Signature Care EPO |
$113.90
|
| Rate for Payer: Signature Care PPO |
$113.90
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$108.00
|
| Rate for Payer: United Healthcare Commercial |
$109.58
|
| Rate for Payer: United Healthcare Medicare |
$89.82
|
|
|
PR EAR MICROSCOPY EXAMINATION
|
Professional
|
$53.18
|
|
|
Service Code
|
CPT 92504
|
| Hospital Charge Code |
z92504
|
| Min. Negotiated Rate |
$9.04 |
| Max. Negotiated Rate |
$39.88 |
| Rate for Payer: Aetna Medicare |
$9.04
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$24.72
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$24.72
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$10.40
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$9.94
|
| Rate for Payer: Cash Price |
$32.97
|
| Rate for Payer: Cash Price |
$32.97
|
| Rate for Payer: Coventry All Commercial |
$10.85
|
| Rate for Payer: Frontpath All Commercial |
$10.05
|
| Rate for Payer: Humana ChoiceCare |
$11.79
|
| Rate for Payer: Humana Medicare |
$9.04
|
| Rate for Payer: Lucent All Commercial |
$15.37
|
| Rate for Payer: Lutheran Preferred All Commercial |
$12.00
|
| Rate for Payer: PHCS All Commercial |
$39.88
|
| Rate for Payer: PHP All Commercial |
$12.79
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$9.04
|
| Rate for Payer: Signature Care EPO |
$28.05
|
| Rate for Payer: Signature Care PPO |
$28.05
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$11.00
|
| Rate for Payer: United Healthcare Commercial |
$11.29
|
| Rate for Payer: United Healthcare Medicare |
$9.04
|
|
|
PR EAR MOLD/INSERT
|
Professional
|
$125.00
|
|
|
Service Code
|
CPT V5264
|
| Hospital Charge Code |
zV5264
|
| Min. Negotiated Rate |
$93.75 |
| Max. Negotiated Rate |
$125.00 |
| Rate for Payer: Cash Price |
$77.50
|
| Rate for Payer: PHCS All Commercial |
$93.75
|
| Rate for Payer: Signature Care EPO |
$125.00
|
| Rate for Payer: Signature Care PPO |
$125.00
|
|
|
PR EAR PLUGS
|
Professional
|
$400.00
|
|
|
Service Code
|
CPT V5267
|
| Hospital Charge Code |
zV5267C
|
| 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 ECG/SIGNAL-AVERAGED
|
Professional
|
$52.70
|
|
|
Service Code
|
CPT 93278
|
| Hospital Charge Code |
z93278
|
| Min. Negotiated Rate |
$27.01 |
| Max. Negotiated Rate |
$77.30 |
| Rate for Payer: Aetna Medicare |
$27.01
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$77.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$77.30
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$31.06
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$29.71
|
| Rate for Payer: Cash Price |
$32.67
|
| Rate for Payer: Cash Price |
$32.67
|
| Rate for Payer: Coventry All Commercial |
$32.41
|
| Rate for Payer: Frontpath All Commercial |
$30.50
|
| Rate for Payer: Humana ChoiceCare |
$73.90
|
| Rate for Payer: Humana Medicare |
$27.01
|
| Rate for Payer: Lucent All Commercial |
$45.92
|
| Rate for Payer: Lutheran Preferred All Commercial |
$43.00
|
| Rate for Payer: PHCS All Commercial |
$39.52
|
| Rate for Payer: PHP All Commercial |
$38.73
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$27.01
|
| Rate for Payer: Signature Care EPO |
$45.97
|
| Rate for Payer: Signature Care PPO |
$45.97
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$41.00
|
| Rate for Payer: United Healthcare Commercial |
$45.96
|
| Rate for Payer: United Healthcare Medicare |
$27.01
|
|
|
PR ECHO HEART XTHORACIC,COMPLETE W DOPPLER
|
Professional
|
$128.52
|
|
|
Service Code
|
CPT 93306
|
| Hospital Charge Code |
z93306
|
| Min. Negotiated Rate |
$96.39 |
| Max. Negotiated Rate |
$365.44 |
| Rate for Payer: Aetna Medicare |
$184.13
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$365.44
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$365.44
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$211.75
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$202.54
|
| Rate for Payer: Cash Price |
$79.68
|
| Rate for Payer: Cash Price |
$79.68
|
| Rate for Payer: Coventry All Commercial |
$220.96
|
| Rate for Payer: Frontpath All Commercial |
$211.07
|
| Rate for Payer: Humana ChoiceCare |
$214.20
|
| Rate for Payer: Humana Medicare |
$184.13
|
| Rate for Payer: Lucent All Commercial |
$313.02
|
| Rate for Payer: Lutheran Preferred All Commercial |
$295.00
|
| Rate for Payer: PHCS All Commercial |
$96.39
|
| Rate for Payer: PHP All Commercial |
$264.51
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$184.13
|
| Rate for Payer: Signature Care EPO |
$135.06
|
| Rate for Payer: Signature Care PPO |
$135.06
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$276.00
|
| Rate for Payer: United Healthcare Commercial |
$306.58
|
| Rate for Payer: United Healthcare Medicare |
$184.13
|
|
|
PR ECHO HEART XTHORACIC,COMPLETE, W/O DOPPLER
|
Professional
|
$81.36
|
|
|
Service Code
|
CPT 93307
|
| Hospital Charge Code |
z93307
|
| Min. Negotiated Rate |
$61.02 |
| Max. Negotiated Rate |
$260.60 |
| Rate for Payer: Aetna Medicare |
$128.15
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$260.60
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$260.60
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$147.37
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$140.96
|
| Rate for Payer: Cash Price |
$50.44
|
| Rate for Payer: Cash Price |
$50.44
|
| Rate for Payer: Coventry All Commercial |
$153.78
|
| Rate for Payer: Frontpath All Commercial |
$147.70
|
| Rate for Payer: Humana ChoiceCare |
$151.31
|
| Rate for Payer: Humana Medicare |
$128.15
|
| Rate for Payer: Lucent All Commercial |
$217.86
|
| Rate for Payer: Lutheran Preferred All Commercial |
$205.00
|
| Rate for Payer: PHCS All Commercial |
$61.02
|
| Rate for Payer: PHP All Commercial |
$183.79
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$128.15
|
| Rate for Payer: Signature Care EPO |
$85.52
|
| Rate for Payer: Signature Care PPO |
$85.52
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$192.00
|
| Rate for Payer: United Healthcare Commercial |
$202.88
|
| Rate for Payer: United Healthcare Medicare |
$128.15
|
|
|
PR ECHO HEART XTHORACIC,LIMITED
|
Professional
|
$46.52
|
|
|
Service Code
|
CPT 93308
|
| Hospital Charge Code |
z93308
|
| Min. Negotiated Rate |
$34.89 |
| Max. Negotiated Rate |
$156.01 |
| Rate for Payer: Aetna Medicare |
$91.77
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$138.80
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$138.80
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$105.54
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$100.95
|
| Rate for Payer: Cash Price |
$28.84
|
| Rate for Payer: Cash Price |
$28.84
|
| Rate for Payer: Coventry All Commercial |
$110.12
|
| Rate for Payer: Frontpath All Commercial |
$104.14
|
| Rate for Payer: Humana ChoiceCare |
$106.02
|
| Rate for Payer: Humana Medicare |
$91.77
|
| Rate for Payer: Lucent All Commercial |
$156.01
|
| Rate for Payer: Lutheran Preferred All Commercial |
$147.00
|
| Rate for Payer: PHCS All Commercial |
$34.89
|
| Rate for Payer: PHP All Commercial |
$131.61
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$91.77
|
| Rate for Payer: Signature Care EPO |
$48.54
|
| Rate for Payer: Signature Care PPO |
$48.54
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$138.00
|
| Rate for Payer: United Healthcare Commercial |
$128.10
|
| Rate for Payer: United Healthcare Medicare |
$91.77
|
|
|
PR ECHO HEART XTHORACIC, STRESS/REST
|
Professional
|
$128.52
|
|
|
Service Code
|
CPT 93350
|
| Hospital Charge Code |
z93350
|
| Min. Negotiated Rate |
$96.39 |
| Max. Negotiated Rate |
$296.72 |
| Rate for Payer: Aetna Medicare |
$174.54
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$149.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$149.30
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$200.72
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$191.99
|
| Rate for Payer: Cash Price |
$79.68
|
| Rate for Payer: Cash Price |
$79.68
|
| Rate for Payer: Coventry All Commercial |
$209.45
|
| Rate for Payer: Frontpath All Commercial |
$200.64
|
| Rate for Payer: Humana ChoiceCare |
$202.70
|
| Rate for Payer: Humana Medicare |
$174.54
|
| Rate for Payer: Lucent All Commercial |
$296.72
|
| Rate for Payer: Lutheran Preferred All Commercial |
$279.00
|
| Rate for Payer: PHCS All Commercial |
$96.39
|
| Rate for Payer: PHP All Commercial |
$250.32
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$174.54
|
| Rate for Payer: Signature Care EPO |
$135.06
|
| Rate for Payer: Signature Care PPO |
$135.06
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$262.00
|
| Rate for Payer: United Healthcare Commercial |
$245.75
|
| Rate for Payer: United Healthcare Medicare |
$174.54
|
|
|
PR ECHO R-T 2D W/PROBE PLACEMENT ONLY
|
Professional
|
$20.84
|
|
|
Service Code
|
CPT 93313
|
| Hospital Charge Code |
z93313
|
| Min. Negotiated Rate |
$10.68 |
| Max. Negotiated Rate |
$60.07 |
| Rate for Payer: Aetna Medicare |
$10.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$12.28
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$11.75
|
| Rate for Payer: Cash Price |
$12.92
|
| Rate for Payer: Cash Price |
$12.92
|
| Rate for Payer: Coventry All Commercial |
$12.82
|
| Rate for Payer: Frontpath All Commercial |
$12.46
|
| Rate for Payer: Humana ChoiceCare |
$60.07
|
| Rate for Payer: Humana Medicare |
$10.68
|
| Rate for Payer: Lucent All Commercial |
$18.16
|
| Rate for Payer: PHCS All Commercial |
$15.63
|
| Rate for Payer: PHP All Commercial |
$15.31
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$10.68
|
| Rate for Payer: Signature Care EPO |
$18.50
|
| Rate for Payer: Signature Care PPO |
$18.50
|
| Rate for Payer: United Healthcare Commercial |
$50.24
|
| Rate for Payer: United Healthcare Medicare |
$10.68
|
|
|
PR ECHO TRANSESOPHAG CONGEN PROBE PLCMT IMGNG I&R
|
Professional
|
$235.82
|
|
|
Service Code
|
CPT 93315
|
| Hospital Charge Code |
z93315
|
| Min. Negotiated Rate |
$141.49 |
| Max. Negotiated Rate |
$575.12 |
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$369.70
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$369.70
|
| Rate for Payer: Cash Price |
$146.21
|
| Rate for Payer: Cash Price |
$146.21
|
| Rate for Payer: Frontpath All Commercial |
$575.12
|
| Rate for Payer: Humana ChoiceCare |
$266.68
|
| Rate for Payer: Lutheran Preferred All Commercial |
$200.45
|
| Rate for Payer: PHCS All Commercial |
$176.86
|
| Rate for Payer: Signature Care EPO |
$245.76
|
| Rate for Payer: Signature Care PPO |
$245.76
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$141.49
|
| Rate for Payer: United Healthcare Commercial |
$364.98
|
|
|
PR ECHO TRANSESOPHAG IMAGE ACQUISJ INTERP&REPORT
|
Professional
|
$163.36
|
|
|
Service Code
|
CPT 93317
|
| Hospital Charge Code |
z93317
|
| Min. Negotiated Rate |
$98.02 |
| Max. Negotiated Rate |
$317.40 |
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$301.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$301.30
|
| Rate for Payer: Cash Price |
$101.28
|
| Rate for Payer: Cash Price |
$101.28
|
| Rate for Payer: Frontpath All Commercial |
$182.87
|
| Rate for Payer: Humana ChoiceCare |
$305.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$138.86
|
| Rate for Payer: PHCS All Commercial |
$122.52
|
| Rate for Payer: Signature Care EPO |
$171.60
|
| Rate for Payer: Signature Care PPO |
$171.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$98.02
|
| Rate for Payer: United Healthcare Commercial |
$317.40
|
|
|
PR ECHO TRANSESOPHAG R-T 2D W/PRB IMG ACQUISJ I&R
|
Professional
|
$199.16
|
|
|
Service Code
|
CPT 93312
|
| Hospital Charge Code |
z93312
|
| Min. Negotiated Rate |
$149.37 |
| Max. Negotiated Rate |
$379.80 |
| Rate for Payer: Aetna Medicare |
$223.41
|
| Rate for Payer: Aetna Medicare |
$223.41
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$338.40
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$338.40
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$338.40
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$338.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$256.92
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$256.92
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$245.75
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$245.75
|
| Rate for Payer: Cash Price |
$146.79
|
| Rate for Payer: Cash Price |
$123.48
|
| Rate for Payer: Cash Price |
$146.79
|
| Rate for Payer: Cash Price |
$123.48
|
| Rate for Payer: Coventry All Commercial |
$268.09
|
| Rate for Payer: Coventry All Commercial |
$268.09
|
| Rate for Payer: Frontpath All Commercial |
$256.53
|
| Rate for Payer: Frontpath All Commercial |
$256.53
|
| Rate for Payer: Humana ChoiceCare |
$259.85
|
| Rate for Payer: Humana ChoiceCare |
$259.85
|
| Rate for Payer: Humana Medicare |
$223.41
|
| Rate for Payer: Humana Medicare |
$223.41
|
| Rate for Payer: Lucent All Commercial |
$379.80
|
| Rate for Payer: Lucent All Commercial |
$379.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$357.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$357.00
|
| Rate for Payer: PHCS All Commercial |
$149.37
|
| Rate for Payer: PHCS All Commercial |
$177.57
|
| Rate for Payer: PHP All Commercial |
$320.40
|
| Rate for Payer: PHP All Commercial |
$320.40
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$223.41
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$223.41
|
| Rate for Payer: Signature Care EPO |
$248.56
|
| Rate for Payer: Signature Care EPO |
$248.56
|
| Rate for Payer: Signature Care PPO |
$248.56
|
| Rate for Payer: Signature Care PPO |
$248.56
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$335.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$335.00
|
| Rate for Payer: United Healthcare Commercial |
$376.53
|
| Rate for Payer: United Healthcare Commercial |
$376.53
|
| Rate for Payer: United Healthcare Medicare |
$223.41
|
| Rate for Payer: United Healthcare Medicare |
$223.41
|
|
|
PR ECHO TTHRC R-T 2D W/WO M-MODE REST&STRS CONT ECG
|
Professional
|
$154.34
|
|
|
Service Code
|
CPT 93351
|
| Hospital Charge Code |
z93351
|
| Min. Negotiated Rate |
$115.76 |
| Max. Negotiated Rate |
$380.93 |
| Rate for Payer: Aetna Medicare |
$217.74
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$380.93
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$380.93
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$250.40
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$239.51
|
| Rate for Payer: Cash Price |
$95.69
|
| Rate for Payer: Cash Price |
$95.69
|
| Rate for Payer: Coventry All Commercial |
$261.29
|
| Rate for Payer: Frontpath All Commercial |
$249.14
|
| Rate for Payer: Humana ChoiceCare |
$250.50
|
| Rate for Payer: Humana Medicare |
$217.74
|
| Rate for Payer: Lucent All Commercial |
$370.16
|
| Rate for Payer: Lutheran Preferred All Commercial |
$348.00
|
| Rate for Payer: PHCS All Commercial |
$115.76
|
| Rate for Payer: PHP All Commercial |
$312.27
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$217.74
|
| Rate for Payer: Signature Care EPO |
$162.00
|
| Rate for Payer: Signature Care PPO |
$162.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$327.00
|
| Rate for Payer: United Healthcare Commercial |
$294.66
|
| Rate for Payer: United Healthcare Medicare |
$217.74
|
|
|
PR ECHO XTHORACIC,CONG ANOM,COMPLETE
|
Professional
|
$114.92
|
|
|
Service Code
|
CPT 93303
|
| Hospital Charge Code |
z93303
|
| Min. Negotiated Rate |
$86.19 |
| Max. Negotiated Rate |
$350.51 |
| Rate for Payer: Aetna Medicare |
$206.18
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$279.80
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$279.80
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$237.11
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$226.80
|
| Rate for Payer: Cash Price |
$71.25
|
| Rate for Payer: Cash Price |
$71.25
|
| Rate for Payer: Coventry All Commercial |
$247.42
|
| Rate for Payer: Frontpath All Commercial |
$236.89
|
| Rate for Payer: Humana ChoiceCare |
$245.11
|
| Rate for Payer: Humana Medicare |
$206.18
|
| Rate for Payer: Lucent All Commercial |
$350.51
|
| Rate for Payer: Lutheran Preferred All Commercial |
$330.00
|
| Rate for Payer: PHCS All Commercial |
$86.19
|
| Rate for Payer: PHP All Commercial |
$295.69
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$206.18
|
| Rate for Payer: Signature Care EPO |
$120.54
|
| Rate for Payer: Signature Care PPO |
$120.54
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$309.00
|
| Rate for Payer: United Healthcare Commercial |
$251.31
|
| Rate for Payer: United Healthcare Medicare |
$206.18
|
|
|
PR ECHO XTHORACIC,CONG ANOM,LIMITED
|
Professional
|
$67.12
|
|
|
Service Code
|
CPT 93304
|
| Hospital Charge Code |
z93304
|
| Min. Negotiated Rate |
$50.34 |
| Max. Negotiated Rate |
$246.38 |
| Rate for Payer: Aetna Medicare |
$144.93
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$151.10
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$151.10
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$166.67
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$159.42
|
| Rate for Payer: Cash Price |
$41.61
|
| Rate for Payer: Cash Price |
$41.61
|
| Rate for Payer: Coventry All Commercial |
$173.92
|
| Rate for Payer: Frontpath All Commercial |
$166.60
|
| Rate for Payer: Humana ChoiceCare |
$171.79
|
| Rate for Payer: Humana Medicare |
$144.93
|
| Rate for Payer: Lucent All Commercial |
$246.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$232.00
|
| Rate for Payer: PHCS All Commercial |
$50.34
|
| Rate for Payer: PHP All Commercial |
$207.85
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$144.93
|
| Rate for Payer: Signature Care EPO |
$70.02
|
| Rate for Payer: Signature Care PPO |
$70.02
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$217.00
|
| Rate for Payer: United Healthcare Commercial |
$155.40
|
| Rate for Payer: United Healthcare Medicare |
$144.93
|
|
|
PREDNISOLONE 15 MG/5 ML ORAL SOLN
|
Facility
IP
|
$300.96
|
|
|
Service Code
|
HCPCS J7510
|
| Hospital Charge Code |
11117
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$225.72 |
| Max. Negotiated Rate |
$279.89 |
| Rate for Payer: Aetna Commercial |
$260.03
|
| Rate for Payer: Aetna Commercial |
$6.32
|
| Rate for Payer: Cash Price |
$4.54
|
| Rate for Payer: Cash Price |
$186.60
|
| Rate for Payer: Cigna All Commercial |
$259.73
|
| Rate for Payer: Cigna All Commercial |
$6.31
|
| Rate for Payer: CORVEL All Commercial |
$279.89
|
| Rate for Payer: CORVEL All Commercial |
$6.80
|
| Rate for Payer: Coventry All Commercial |
$6.44
|
| Rate for Payer: Coventry All Commercial |
$264.84
|
| Rate for Payer: Encore All Commercial |
$6.73
|
| Rate for Payer: Encore All Commercial |
$277.03
|
| Rate for Payer: Frontpath All Commercial |
$6.73
|
| Rate for Payer: Frontpath All Commercial |
$276.88
|
| Rate for Payer: Humana ChoiceCare |
$6.32
|
| Rate for Payer: Humana ChoiceCare |
$259.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6.58
|
| Rate for Payer: Lutheran Preferred All Commercial |
$270.86
|
| Rate for Payer: PHCS All Commercial |
$225.72
|
| Rate for Payer: PHCS All Commercial |
$5.49
|
| Rate for Payer: PHP All Commercial |
$228.25
|
| Rate for Payer: PHP All Commercial |
$5.55
|
| Rate for Payer: Sagamore Health Network All Products |
$232.34
|
| Rate for Payer: Sagamore Health Network All Products |
$5.65
|
| Rate for Payer: Signature Care EPO |
$249.80
|
| Rate for Payer: Signature Care EPO |
$6.07
|
| Rate for Payer: Signature Care PPO |
$6.44
|
| Rate for Payer: Signature Care PPO |
$264.84
|
| Rate for Payer: United Healthcare Commercial |
$237.16
|
| Rate for Payer: United Healthcare Commercial |
$5.76
|
|
