|
PR ELECTROCARDIOGRAM, COMPLETE
|
Professional
|
$26.32
|
|
|
Service Code
|
CPT 93000
|
| Hospital Charge Code |
z93000
|
| Min. Negotiated Rate |
$13.49 |
| Max. Negotiated Rate |
$33.23 |
| Rate for Payer: Aetna Medicare |
$13.49
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$24.45
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$24.45
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$15.51
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$14.84
|
| Rate for Payer: Cash Price |
$16.32
|
| Rate for Payer: Cash Price |
$16.32
|
| Rate for Payer: Coventry All Commercial |
$16.19
|
| Rate for Payer: Frontpath All Commercial |
$15.30
|
| Rate for Payer: Humana ChoiceCare |
$33.23
|
| Rate for Payer: Humana Medicare |
$13.49
|
| Rate for Payer: Lucent All Commercial |
$22.93
|
| Rate for Payer: Lutheran Preferred All Commercial |
$22.00
|
| Rate for Payer: PHCS All Commercial |
$19.74
|
| Rate for Payer: PHP All Commercial |
$19.35
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$13.49
|
| Rate for Payer: Signature Care EPO |
$22.73
|
| Rate for Payer: Signature Care PPO |
$22.73
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$20.00
|
| Rate for Payer: United Healthcare Commercial |
$24.20
|
| Rate for Payer: United Healthcare Medicare |
$13.49
|
|
|
PR ELECTROCARDIOGRAM REPORT
|
Professional
|
$15.16
|
|
|
Service Code
|
CPT 93010
|
| Hospital Charge Code |
z93010
|
| Min. Negotiated Rate |
$7.77 |
| Max. Negotiated Rate |
$13.45 |
| Rate for Payer: Aetna Medicare |
$7.77
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$8.67
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$8.67
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$8.94
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$8.55
|
| Rate for Payer: Cash Price |
$9.40
|
| Rate for Payer: Cash Price |
$9.40
|
| Rate for Payer: Coventry All Commercial |
$9.32
|
| Rate for Payer: Frontpath All Commercial |
$8.98
|
| Rate for Payer: Humana ChoiceCare |
$11.78
|
| Rate for Payer: Humana Medicare |
$7.77
|
| Rate for Payer: Lucent All Commercial |
$13.21
|
| Rate for Payer: Lutheran Preferred All Commercial |
$12.00
|
| Rate for Payer: PHCS All Commercial |
$11.37
|
| Rate for Payer: PHP All Commercial |
$11.15
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$7.77
|
| Rate for Payer: Signature Care EPO |
$13.45
|
| Rate for Payer: Signature Care PPO |
$13.45
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$12.00
|
| Rate for Payer: United Healthcare Commercial |
$10.84
|
| Rate for Payer: United Healthcare Medicare |
$7.77
|
|
|
PR ELECTROCARDIOGRAM, TRACING
|
Professional
|
$11.16
|
|
|
Service Code
|
CPT 93005
|
| Hospital Charge Code |
z93005
|
| Min. Negotiated Rate |
$5.72 |
| Max. Negotiated Rate |
$21.45 |
| Rate for Payer: Aetna Medicare |
$5.72
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$6.58
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$6.29
|
| Rate for Payer: Cash Price |
$6.92
|
| Rate for Payer: Cash Price |
$6.92
|
| Rate for Payer: Coventry All Commercial |
$6.86
|
| Rate for Payer: Frontpath All Commercial |
$6.32
|
| Rate for Payer: Humana ChoiceCare |
$21.45
|
| Rate for Payer: Humana Medicare |
$5.72
|
| Rate for Payer: Lucent All Commercial |
$9.72
|
| Rate for Payer: PHCS All Commercial |
$8.37
|
| Rate for Payer: PHP All Commercial |
$8.20
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$5.72
|
| Rate for Payer: Signature Care EPO |
$9.28
|
| Rate for Payer: Signature Care PPO |
$9.28
|
| Rate for Payer: United Healthcare Commercial |
$13.38
|
| Rate for Payer: United Healthcare Medicare |
$5.72
|
|
|
PR ELECTROCONVULSIVE THERAPY,1 SEIZ
|
Professional
|
$319.64
|
|
|
Service Code
|
CPT 90870
|
| Hospital Charge Code |
z90870
|
| Min. Negotiated Rate |
$74.66 |
| Max. Negotiated Rate |
$239.73 |
| Rate for Payer: Aetna Medicare |
$102.07
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$168.95
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$168.95
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$117.38
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$112.28
|
| Rate for Payer: Cash Price |
$198.18
|
| Rate for Payer: Cash Price |
$198.18
|
| Rate for Payer: Coventry All Commercial |
$122.48
|
| Rate for Payer: Frontpath All Commercial |
$116.64
|
| Rate for Payer: Humana ChoiceCare |
$74.66
|
| Rate for Payer: Humana Medicare |
$102.07
|
| Rate for Payer: Lucent All Commercial |
$173.52
|
| Rate for Payer: Lutheran Preferred All Commercial |
$133.00
|
| Rate for Payer: PHCS All Commercial |
$239.73
|
| Rate for Payer: PHP All Commercial |
$108.54
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$102.07
|
| Rate for Payer: Signature Care EPO |
$144.84
|
| Rate for Payer: Signature Care PPO |
$144.84
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$122.00
|
| Rate for Payer: United Healthcare Commercial |
$104.05
|
| Rate for Payer: United Healthcare Medicare |
$102.07
|
|
|
PR ELECTRODESSICATN,ANAL LESN(S)
|
Professional
|
$479.66
|
|
|
Service Code
|
CPT 46910
|
| Hospital Charge Code |
z46910
|
| Min. Negotiated Rate |
$125.43 |
| Max. Negotiated Rate |
$359.74 |
| Rate for Payer: Aetna Medicare |
$125.43
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$192.76
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$192.76
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$144.24
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$137.97
|
| Rate for Payer: Cash Price |
$297.39
|
| Rate for Payer: Cash Price |
$297.39
|
| Rate for Payer: Coventry All Commercial |
$150.52
|
| Rate for Payer: Frontpath All Commercial |
$174.29
|
| Rate for Payer: Humana ChoiceCare |
$131.69
|
| Rate for Payer: Humana Medicare |
$125.43
|
| Rate for Payer: Lucent All Commercial |
$213.23
|
| Rate for Payer: Lutheran Preferred All Commercial |
$188.00
|
| Rate for Payer: PHCS All Commercial |
$359.74
|
| Rate for Payer: PHP All Commercial |
$214.15
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$125.43
|
| Rate for Payer: Signature Care EPO |
$251.60
|
| Rate for Payer: Signature Care PPO |
$251.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$176.00
|
| Rate for Payer: United Healthcare Commercial |
$139.55
|
| Rate for Payer: United Healthcare Medicare |
$125.43
|
|
|
PR ELECTRO HEARINGAID TEST, BOTH
|
Professional
|
$100.00
|
|
|
Service Code
|
CPT 92595
|
| Hospital Charge Code |
z92595
|
| Min. Negotiated Rate |
$32.82 |
| Max. Negotiated Rate |
$85.00 |
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$40.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$40.00
|
| Rate for Payer: Cash Price |
$62.00
|
| Rate for Payer: Cash Price |
$62.00
|
| Rate for Payer: Frontpath All Commercial |
$47.23
|
| Rate for Payer: Humana ChoiceCare |
$32.82
|
| Rate for Payer: Lutheran Preferred All Commercial |
$85.00
|
| Rate for Payer: PHCS All Commercial |
$75.00
|
| Rate for Payer: Signature Care EPO |
$51.00
|
| Rate for Payer: Signature Care PPO |
$51.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$60.00
|
| Rate for Payer: United Healthcare Commercial |
$44.66
|
|
|
PR ELECTRO HEARING AID TEST, ONE
|
Professional
|
$50.00
|
|
|
Service Code
|
CPT 92594
|
| Hospital Charge Code |
z92594
|
| Min. Negotiated Rate |
$20.63 |
| Max. Negotiated Rate |
$42.50 |
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$30.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$30.00
|
| Rate for Payer: Cash Price |
$31.00
|
| Rate for Payer: Cash Price |
$31.00
|
| Rate for Payer: Frontpath All Commercial |
$21.66
|
| Rate for Payer: Humana ChoiceCare |
$22.03
|
| Rate for Payer: Lutheran Preferred All Commercial |
$42.50
|
| Rate for Payer: PHCS All Commercial |
$37.50
|
| Rate for Payer: Signature Care EPO |
$34.00
|
| Rate for Payer: Signature Care PPO |
$34.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$30.00
|
| Rate for Payer: United Healthcare Commercial |
$20.63
|
|
|
PR EMERGENCY DEPARTMENT VISIT HIGH MDM
|
Professional
|
$325.26
|
|
|
Service Code
|
CPT 99285
|
| Hospital Charge Code |
z99285
|
| Min. Negotiated Rate |
$166.70 |
| Max. Negotiated Rate |
$288.75 |
| Rate for Payer: Aetna Medicare |
$166.70
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$237.74
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$237.74
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$191.70
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$183.37
|
| Rate for Payer: Cash Price |
$201.66
|
| Rate for Payer: Cash Price |
$201.66
|
| Rate for Payer: Coventry All Commercial |
$200.04
|
| Rate for Payer: Frontpath All Commercial |
$288.75
|
| Rate for Payer: Humana ChoiceCare |
$192.17
|
| Rate for Payer: Humana Medicare |
$166.70
|
| Rate for Payer: Lucent All Commercial |
$283.39
|
| Rate for Payer: Lutheran Preferred All Commercial |
$276.47
|
| Rate for Payer: PHCS All Commercial |
$243.94
|
| Rate for Payer: PHP All Commercial |
$167.51
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$166.70
|
| Rate for Payer: Signature Care EPO |
$267.75
|
| Rate for Payer: Signature Care PPO |
$267.75
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$195.16
|
| Rate for Payer: United Healthcare Commercial |
$255.55
|
| Rate for Payer: United Healthcare Medicare |
$166.70
|
|
|
PR EMERGENCY DEPARTMENT VISIT LOW MDM
|
Professional
|
$132.54
|
|
|
Service Code
|
CPT 99283
|
| Hospital Charge Code |
z99283
|
| Min. Negotiated Rate |
$67.92 |
| Max. Negotiated Rate |
$138.75 |
| Rate for Payer: Aetna Medicare |
$67.92
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$94.45
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$94.45
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$78.11
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$74.71
|
| Rate for Payer: Cash Price |
$82.17
|
| Rate for Payer: Cash Price |
$82.17
|
| Rate for Payer: Coventry All Commercial |
$81.50
|
| Rate for Payer: Frontpath All Commercial |
$138.75
|
| Rate for Payer: Humana ChoiceCare |
$78.63
|
| Rate for Payer: Humana Medicare |
$67.92
|
| Rate for Payer: Lucent All Commercial |
$115.46
|
| Rate for Payer: Lutheran Preferred All Commercial |
$112.66
|
| Rate for Payer: PHCS All Commercial |
$99.40
|
| Rate for Payer: PHP All Commercial |
$68.25
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$67.92
|
| Rate for Payer: Signature Care EPO |
$102.00
|
| Rate for Payer: Signature Care PPO |
$102.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$79.52
|
| Rate for Payer: United Healthcare Commercial |
$91.78
|
| Rate for Payer: United Healthcare Medicare |
$67.92
|
|
|
PR EMERGENCY DEPARTMENT VISIT MAY NOT REQ PHYS/QHP
|
Professional
|
$21.40
|
|
|
Service Code
|
CPT 99281
|
| Hospital Charge Code |
z99281
|
| Min. Negotiated Rate |
$10.97 |
| Max. Negotiated Rate |
$60.00 |
| Rate for Payer: Aetna Medicare |
$10.97
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$33.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$33.30
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$12.62
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$12.07
|
| Rate for Payer: Cash Price |
$13.27
|
| Rate for Payer: Cash Price |
$13.27
|
| Rate for Payer: Coventry All Commercial |
$13.16
|
| Rate for Payer: Frontpath All Commercial |
$60.00
|
| Rate for Payer: Humana ChoiceCare |
$21.19
|
| Rate for Payer: Humana Medicare |
$10.97
|
| Rate for Payer: Lucent All Commercial |
$18.65
|
| Rate for Payer: Lutheran Preferred All Commercial |
$18.19
|
| Rate for Payer: PHCS All Commercial |
$16.05
|
| Rate for Payer: PHP All Commercial |
$11.02
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$10.97
|
| Rate for Payer: Signature Care EPO |
$26.35
|
| Rate for Payer: Signature Care PPO |
$26.35
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$12.84
|
| Rate for Payer: United Healthcare Commercial |
$30.44
|
| Rate for Payer: United Healthcare Medicare |
$10.97
|
|
|
PR EMERGENCY DEPARTMENT VISIT MODERATE MDM
|
Professional
|
$223.98
|
|
|
Service Code
|
CPT 99284
|
| Hospital Charge Code |
z99284
|
| Min. Negotiated Rate |
$114.79 |
| Max. Negotiated Rate |
$221.25 |
| Rate for Payer: Aetna Medicare |
$114.79
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$159.95
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$159.95
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$132.01
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$126.27
|
| Rate for Payer: Cash Price |
$138.87
|
| Rate for Payer: Cash Price |
$138.87
|
| Rate for Payer: Coventry All Commercial |
$137.75
|
| Rate for Payer: Frontpath All Commercial |
$221.25
|
| Rate for Payer: Humana ChoiceCare |
$122.83
|
| Rate for Payer: Humana Medicare |
$114.79
|
| Rate for Payer: Lucent All Commercial |
$195.14
|
| Rate for Payer: Lutheran Preferred All Commercial |
$190.38
|
| Rate for Payer: PHCS All Commercial |
$167.98
|
| Rate for Payer: PHP All Commercial |
$115.35
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$114.79
|
| Rate for Payer: Signature Care EPO |
$180.20
|
| Rate for Payer: Signature Care PPO |
$180.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$134.39
|
| Rate for Payer: United Healthcare Commercial |
$171.93
|
| Rate for Payer: United Healthcare Medicare |
$114.79
|
|
|
PR EMERGENCY DEPARTMENT VISIT STRAIGHTFORWARD MDM
|
Professional
|
$77.28
|
|
|
Service Code
|
CPT 99282
|
| Hospital Charge Code |
z99282
|
| Min. Negotiated Rate |
$34.99 |
| Max. Negotiated Rate |
$82.50 |
| Rate for Payer: Aetna Medicare |
$39.61
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$56.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$56.00
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$45.55
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$43.57
|
| Rate for Payer: Cash Price |
$47.91
|
| Rate for Payer: Cash Price |
$47.91
|
| Rate for Payer: Coventry All Commercial |
$47.53
|
| Rate for Payer: Frontpath All Commercial |
$82.50
|
| Rate for Payer: Humana ChoiceCare |
$34.99
|
| Rate for Payer: Humana Medicare |
$39.61
|
| Rate for Payer: Lucent All Commercial |
$67.34
|
| Rate for Payer: Lutheran Preferred All Commercial |
$65.69
|
| Rate for Payer: PHCS All Commercial |
$57.96
|
| Rate for Payer: PHP All Commercial |
$39.80
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$39.61
|
| Rate for Payer: Signature Care EPO |
$45.05
|
| Rate for Payer: Signature Care PPO |
$45.05
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$46.37
|
| Rate for Payer: United Healthcare Commercial |
$59.26
|
| Rate for Payer: United Healthcare Medicare |
$39.61
|
|
|
PR ENDOCERVICAL CURETTAGE
|
Professional
|
$284.04
|
|
|
Service Code
|
CPT 57505
|
| Hospital Charge Code |
z57505
|
| Min. Negotiated Rate |
$97.45 |
| Max. Negotiated Rate |
$213.03 |
| Rate for Payer: Aetna Medicare |
$102.35
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$134.12
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$134.12
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$117.70
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$112.58
|
| Rate for Payer: Cash Price |
$176.10
|
| Rate for Payer: Cash Price |
$176.10
|
| Rate for Payer: Coventry All Commercial |
$122.82
|
| Rate for Payer: Frontpath All Commercial |
$140.60
|
| Rate for Payer: Humana ChoiceCare |
$97.45
|
| Rate for Payer: Humana Medicare |
$102.35
|
| Rate for Payer: Lucent All Commercial |
$174.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$143.00
|
| Rate for Payer: PHCS All Commercial |
$213.03
|
| Rate for Payer: PHP All Commercial |
$131.80
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$102.35
|
| Rate for Payer: Signature Care EPO |
$126.65
|
| Rate for Payer: Signature Care PPO |
$126.65
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$133.00
|
| Rate for Payer: United Healthcare Commercial |
$100.78
|
| Rate for Payer: United Healthcare Medicare |
$102.35
|
|
|
PR ENDOMET BIOPSY DONE W/COLPOSCOPY
|
Professional
|
$90.82
|
|
|
Service Code
|
CPT 58110
|
| Hospital Charge Code |
z58110
|
| Min. Negotiated Rate |
$37.29 |
| Max. Negotiated Rate |
$68.12 |
| Rate for Payer: Aetna Medicare |
$37.29
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$59.13
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$59.13
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$42.88
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$41.02
|
| Rate for Payer: Cash Price |
$56.31
|
| Rate for Payer: Cash Price |
$56.31
|
| Rate for Payer: Coventry All Commercial |
$44.75
|
| Rate for Payer: Frontpath All Commercial |
$52.87
|
| Rate for Payer: Humana ChoiceCare |
$48.33
|
| Rate for Payer: Humana Medicare |
$37.29
|
| Rate for Payer: Lucent All Commercial |
$63.39
|
| Rate for Payer: Lutheran Preferred All Commercial |
$52.00
|
| Rate for Payer: PHCS All Commercial |
$68.12
|
| Rate for Payer: PHP All Commercial |
$48.02
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$37.29
|
| Rate for Payer: Signature Care EPO |
$57.80
|
| Rate for Payer: Signature Care PPO |
$57.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$48.00
|
| Rate for Payer: United Healthcare Commercial |
$47.49
|
| Rate for Payer: United Healthcare Medicare |
$37.29
|
|
|
PR ENTEROSCOPY > 2ND PRTN ILEUM CONTROL BLEEDING
|
Professional
|
$695.90
|
|
|
Service Code
|
CPT 44378
|
| Hospital Charge Code |
z44378
|
| Min. Negotiated Rate |
$356.65 |
| Max. Negotiated Rate |
$606.30 |
| Rate for Payer: Aetna Medicare |
$356.65
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$410.15
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$392.32
|
| Rate for Payer: Cash Price |
$431.46
|
| Rate for Payer: Cash Price |
$431.46
|
| Rate for Payer: Coventry All Commercial |
$427.98
|
| Rate for Payer: Frontpath All Commercial |
$495.83
|
| Rate for Payer: Humana ChoiceCare |
$444.24
|
| Rate for Payer: Humana Medicare |
$356.65
|
| Rate for Payer: Lucent All Commercial |
$606.30
|
| Rate for Payer: PHCS All Commercial |
$521.92
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$356.65
|
| Rate for Payer: United Healthcare Commercial |
$476.99
|
| Rate for Payer: United Healthcare Medicare |
$356.65
|
|
|
PR ENTEROSCOPY > 2ND PRTN W/CONTROL BLEEDING
|
Professional
|
$434.64
|
|
|
Service Code
|
CPT 44366
|
| Hospital Charge Code |
z44366
|
| Min. Negotiated Rate |
$222.75 |
| Max. Negotiated Rate |
$378.68 |
| Rate for Payer: Aetna Medicare |
$222.75
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$256.16
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$245.02
|
| Rate for Payer: Cash Price |
$269.48
|
| Rate for Payer: Cash Price |
$269.48
|
| Rate for Payer: Coventry All Commercial |
$267.30
|
| Rate for Payer: Frontpath All Commercial |
$307.61
|
| Rate for Payer: Humana ChoiceCare |
$277.44
|
| Rate for Payer: Humana Medicare |
$222.75
|
| Rate for Payer: Lucent All Commercial |
$378.68
|
| Rate for Payer: PHCS All Commercial |
$325.98
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$222.75
|
| Rate for Payer: United Healthcare Commercial |
$300.95
|
| Rate for Payer: United Healthcare Medicare |
$222.75
|
|
|
PR ENTEROSCOPY > 2ND PRTN W/RMVL FOREIGN BODY
|
Professional
|
$346.94
|
|
|
Service Code
|
CPT 44363
|
| Hospital Charge Code |
z44363
|
| Min. Negotiated Rate |
$177.81 |
| Max. Negotiated Rate |
$302.28 |
| Rate for Payer: Aetna Medicare |
$177.81
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$204.48
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$195.59
|
| Rate for Payer: Cash Price |
$215.10
|
| Rate for Payer: Cash Price |
$215.10
|
| Rate for Payer: Coventry All Commercial |
$213.37
|
| Rate for Payer: Frontpath All Commercial |
$246.87
|
| Rate for Payer: Humana ChoiceCare |
$220.38
|
| Rate for Payer: Humana Medicare |
$177.81
|
| Rate for Payer: Lucent All Commercial |
$302.28
|
| Rate for Payer: PHCS All Commercial |
$260.20
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$177.81
|
| Rate for Payer: United Healthcare Commercial |
$237.06
|
| Rate for Payer: United Healthcare Medicare |
$177.81
|
|
|
PR ENTEROSCOPY > 2ND PRTN W/RMVL LESION SNARE
|
Professional
|
$370.08
|
|
|
Service Code
|
CPT 44364
|
| Hospital Charge Code |
z44364
|
| Min. Negotiated Rate |
$189.66 |
| Max. Negotiated Rate |
$322.42 |
| Rate for Payer: Aetna Medicare |
$189.66
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$218.11
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$208.63
|
| Rate for Payer: Cash Price |
$229.45
|
| Rate for Payer: Cash Price |
$229.45
|
| Rate for Payer: Coventry All Commercial |
$227.59
|
| Rate for Payer: Frontpath All Commercial |
$262.68
|
| Rate for Payer: Humana ChoiceCare |
$235.79
|
| Rate for Payer: Humana Medicare |
$189.66
|
| Rate for Payer: Lucent All Commercial |
$322.42
|
| Rate for Payer: PHCS All Commercial |
$277.56
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$189.66
|
| Rate for Payer: United Healthcare Commercial |
$255.33
|
| Rate for Payer: United Healthcare Medicare |
$189.66
|
|
|
PR EPHYS EVAL PACG CVDFB LDS INITIAL IMPLAN/REPLACE
|
Professional
|
$313.00
|
|
|
Service Code
|
CPT 93640
|
| Hospital Charge Code |
z93640
|
| Min. Negotiated Rate |
$187.80 |
| Max. Negotiated Rate |
$632.50 |
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$632.50
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$632.50
|
| Rate for Payer: Cash Price |
$194.06
|
| Rate for Payer: Cash Price |
$194.06
|
| Rate for Payer: Frontpath All Commercial |
$413.67
|
| Rate for Payer: Humana ChoiceCare |
$594.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$266.05
|
| Rate for Payer: PHCS All Commercial |
$234.75
|
| Rate for Payer: Signature Care EPO |
$329.06
|
| Rate for Payer: Signature Care PPO |
$329.06
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$187.80
|
| Rate for Payer: United Healthcare Commercial |
$529.93
|
|
|
PR EPHYS EVAL PACG CVDFB LDS W/TSTG OF PULSE GEN
|
Professional
|
$547.94
|
|
|
Service Code
|
CPT 93641
|
| Hospital Charge Code |
z93641
|
| Min. Negotiated Rate |
$328.76 |
| Max. Negotiated Rate |
$830.50 |
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$830.50
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$830.50
|
| Rate for Payer: Cash Price |
$339.72
|
| Rate for Payer: Cash Price |
$339.72
|
| Rate for Payer: Frontpath All Commercial |
$642.64
|
| Rate for Payer: Humana ChoiceCare |
$767.28
|
| Rate for Payer: Lutheran Preferred All Commercial |
$465.75
|
| Rate for Payer: PHCS All Commercial |
$410.96
|
| Rate for Payer: Signature Care EPO |
$573.28
|
| Rate for Payer: Signature Care PPO |
$573.28
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$328.76
|
| Rate for Payer: United Healthcare Commercial |
$682.89
|
|
|
PR EPI AUTOGRFT FACE/NCK/HND/FT/GEN <100 SQCM
|
Professional
|
$1,462.74
|
|
|
Service Code
|
CPT 15115
|
| Hospital Charge Code |
z15115
|
| Min. Negotiated Rate |
$643.15 |
| Max. Negotiated Rate |
$1,097.06 |
| Rate for Payer: Aetna Medicare |
$643.15
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$845.27
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$845.27
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$739.62
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$707.46
|
| Rate for Payer: Cash Price |
$906.90
|
| Rate for Payer: Cash Price |
$906.90
|
| Rate for Payer: Coventry All Commercial |
$771.78
|
| Rate for Payer: Frontpath All Commercial |
$893.68
|
| Rate for Payer: Humana ChoiceCare |
$643.83
|
| Rate for Payer: Humana Medicare |
$643.15
|
| Rate for Payer: Lucent All Commercial |
$1,093.36
|
| Rate for Payer: Lutheran Preferred All Commercial |
$836.00
|
| Rate for Payer: PHCS All Commercial |
$1,097.06
|
| Rate for Payer: PHP All Commercial |
$878.44
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$643.15
|
| Rate for Payer: Signature Care EPO |
$788.80
|
| Rate for Payer: Signature Care PPO |
$788.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$772.00
|
| Rate for Payer: United Healthcare Commercial |
$819.45
|
| Rate for Payer: United Healthcare Medicare |
$643.15
|
|
|
PR EPISIOTOMY/VAG RPR OTH/THN ATTENDING
|
Professional
|
$413.28
|
|
|
Service Code
|
CPT 59300
|
| Hospital Charge Code |
z59300
|
| Min. Negotiated Rate |
$132.77 |
| Max. Negotiated Rate |
$309.96 |
| Rate for Payer: Aetna Medicare |
$132.77
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$252.58
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$252.58
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$152.69
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$146.05
|
| Rate for Payer: Cash Price |
$256.23
|
| Rate for Payer: Cash Price |
$256.23
|
| Rate for Payer: Coventry All Commercial |
$159.32
|
| Rate for Payer: Frontpath All Commercial |
$189.85
|
| Rate for Payer: Humana ChoiceCare |
$133.71
|
| Rate for Payer: Humana Medicare |
$132.77
|
| Rate for Payer: Lucent All Commercial |
$225.71
|
| Rate for Payer: Lutheran Preferred All Commercial |
$186.00
|
| Rate for Payer: PHCS All Commercial |
$309.96
|
| Rate for Payer: PHP All Commercial |
$170.99
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$132.77
|
| Rate for Payer: Signature Care EPO |
$225.25
|
| Rate for Payer: Signature Care PPO |
$225.25
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$173.00
|
| Rate for Payer: United Healthcare Commercial |
$165.01
|
| Rate for Payer: United Healthcare Medicare |
$132.77
|
|
|
PR ESOPHAGOGASTRODUODENOSCOPY SUBMUCOSAL INJECTION
|
Professional
|
$733.94
|
|
|
Service Code
|
CPT 43236
|
| Hospital Charge Code |
z43236
|
| Min. Negotiated Rate |
$127.94 |
| Max. Negotiated Rate |
$550.46 |
| Rate for Payer: Aetna Medicare |
$127.94
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$501.10
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$501.10
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$147.13
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$140.73
|
| Rate for Payer: Cash Price |
$455.04
|
| Rate for Payer: Cash Price |
$455.04
|
| Rate for Payer: Coventry All Commercial |
$153.53
|
| Rate for Payer: Frontpath All Commercial |
$176.51
|
| Rate for Payer: Humana ChoiceCare |
$186.76
|
| Rate for Payer: Humana Medicare |
$127.94
|
| Rate for Payer: Lucent All Commercial |
$217.50
|
| Rate for Payer: Lutheran Preferred All Commercial |
$192.00
|
| Rate for Payer: PHCS All Commercial |
$550.46
|
| Rate for Payer: PHP All Commercial |
$218.43
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$127.94
|
| Rate for Payer: Signature Care EPO |
$504.05
|
| Rate for Payer: Signature Care PPO |
$504.05
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$179.00
|
| Rate for Payer: United Healthcare Commercial |
$202.70
|
| Rate for Payer: United Healthcare Medicare |
$127.94
|
|
|
PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC
|
Professional
|
$526.46
|
|
|
Service Code
|
CPT 43235
|
| Hospital Charge Code |
z43235
|
| Min. Negotiated Rate |
$113.60 |
| Max. Negotiated Rate |
$406.30 |
| Rate for Payer: Aetna Medicare |
$113.60
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$302.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$302.00
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$130.64
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$124.96
|
| Rate for Payer: Cash Price |
$326.41
|
| Rate for Payer: Cash Price |
$326.41
|
| Rate for Payer: Coventry All Commercial |
$136.32
|
| Rate for Payer: Frontpath All Commercial |
$157.68
|
| Rate for Payer: Humana ChoiceCare |
$154.10
|
| Rate for Payer: Humana Medicare |
$113.60
|
| Rate for Payer: Lucent All Commercial |
$193.12
|
| Rate for Payer: Lutheran Preferred All Commercial |
$170.00
|
| Rate for Payer: PHCS All Commercial |
$394.84
|
| Rate for Payer: PHP All Commercial |
$193.95
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$113.60
|
| Rate for Payer: Signature Care EPO |
$406.30
|
| Rate for Payer: Signature Care PPO |
$406.30
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$159.00
|
| Rate for Payer: United Healthcare Commercial |
$166.69
|
| Rate for Payer: United Healthcare Medicare |
$113.60
|
|
|
PR ESOPHAGOSCOPY FLEXIBLE REMOVAL FOREIGN BODY
|
Professional
|
$517.50
|
|
|
Service Code
|
CPT 43215
|
| Hospital Charge Code |
z43215
|
| Min. Negotiated Rate |
$130.01 |
| Max. Negotiated Rate |
$388.12 |
| Rate for Payer: Aetna Medicare |
$130.01
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$149.51
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$143.01
|
| Rate for Payer: Cash Price |
$320.85
|
| Rate for Payer: Cash Price |
$320.85
|
| Rate for Payer: Coventry All Commercial |
$156.01
|
| Rate for Payer: Frontpath All Commercial |
$183.01
|
| Rate for Payer: Humana ChoiceCare |
$171.61
|
| Rate for Payer: Humana Medicare |
$130.01
|
| Rate for Payer: Lucent All Commercial |
$221.02
|
| Rate for Payer: PHCS All Commercial |
$388.12
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$130.01
|
| Rate for Payer: United Healthcare Commercial |
$176.55
|
| Rate for Payer: United Healthcare Medicare |
$130.01
|
|
