|
PR FLUVIRIN VACC, 3 YRS & >, IM
|
Professional
|
$18.62
|
|
|
Service Code
|
CPT Q2037
|
| Hospital Charge Code |
zQ2037
|
| Min. Negotiated Rate |
$17.69 |
| Max. Negotiated Rate |
$18.62 |
| Rate for Payer: Humana ChoiceCare |
$17.69
|
| Rate for Payer: United Healthcare Commercial |
$18.62
|
|
|
PR FOOT/TOES SURGERY PROC UNLISTED
|
Professional
|
$508.53
|
|
|
Service Code
|
CPT 28899
|
| Hospital Charge Code |
z28899
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$432.25 |
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$0.01
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$0.01
|
| Rate for Payer: Cash Price |
$315.29
|
| Rate for Payer: Cash Price |
$315.29
|
| Rate for Payer: Lutheran Preferred All Commercial |
$432.25
|
| Rate for Payer: PHCS All Commercial |
$381.40
|
| Rate for Payer: Signature Care EPO |
$324.19
|
| Rate for Payer: Signature Care PPO |
$324.19
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$305.12
|
|
|
PR FOREARM/WRIST SURGERY UNLISTED
|
Professional
|
$805.13
|
|
|
Service Code
|
CPT 25999
|
| Hospital Charge Code |
z25999
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$684.36 |
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$0.01
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$0.01
|
| Rate for Payer: Cash Price |
$499.18
|
| Rate for Payer: Cash Price |
$499.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$684.36
|
| Rate for Payer: PHCS All Commercial |
$603.85
|
| Rate for Payer: Signature Care EPO |
$513.27
|
| Rate for Payer: Signature Care PPO |
$513.27
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$483.08
|
|
|
PR FORM SKIN PEDICLE FLAP FACE,GEN,HAND
|
Professional
|
$1,599.26
|
|
|
Service Code
|
CPT 15574
|
| Hospital Charge Code |
z15574
|
| Min. Negotiated Rate |
$662.03 |
| Max. Negotiated Rate |
$1,199.44 |
| Rate for Payer: Aetna Medicare |
$685.33
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$912.73
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$912.73
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$788.13
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$753.86
|
| Rate for Payer: Cash Price |
$991.54
|
| Rate for Payer: Cash Price |
$991.54
|
| Rate for Payer: Coventry All Commercial |
$822.40
|
| Rate for Payer: Frontpath All Commercial |
$948.52
|
| Rate for Payer: Humana ChoiceCare |
$662.03
|
| Rate for Payer: Humana Medicare |
$685.33
|
| Rate for Payer: Lucent All Commercial |
$1,165.06
|
| Rate for Payer: Lutheran Preferred All Commercial |
$891.00
|
| Rate for Payer: PHCS All Commercial |
$1,199.44
|
| Rate for Payer: PHP All Commercial |
$936.06
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$685.33
|
| Rate for Payer: Signature Care EPO |
$774.35
|
| Rate for Payer: Signature Care PPO |
$774.35
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$822.00
|
| Rate for Payer: United Healthcare Commercial |
$819.98
|
| Rate for Payer: United Healthcare Medicare |
$685.33
|
|
|
PR FREEING BOWEL ADHESION,ENTEROLYSIS
|
Professional
|
$1,943.32
|
|
|
Service Code
|
CPT 44005
|
| Hospital Charge Code |
z44005
|
| Min. Negotiated Rate |
$995.95 |
| Max. Negotiated Rate |
$1,700.41 |
| Rate for Payer: Aetna Medicare |
$995.95
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,079.60
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,079.60
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,145.34
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,095.54
|
| Rate for Payer: Cash Price |
$1,204.86
|
| Rate for Payer: Cash Price |
$1,204.86
|
| Rate for Payer: Coventry All Commercial |
$1,195.14
|
| Rate for Payer: Frontpath All Commercial |
$1,445.21
|
| Rate for Payer: Humana ChoiceCare |
$1,054.26
|
| Rate for Payer: Humana Medicare |
$995.95
|
| Rate for Payer: Lucent All Commercial |
$1,693.12
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,494.00
|
| Rate for Payer: PHCS All Commercial |
$1,457.49
|
| Rate for Payer: PHP All Commercial |
$1,700.41
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$995.95
|
| Rate for Payer: Signature Care EPO |
$1,326.85
|
| Rate for Payer: Signature Care PPO |
$1,326.85
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,394.00
|
| Rate for Payer: United Healthcare Commercial |
$1,170.19
|
| Rate for Payer: United Healthcare Medicare |
$995.95
|
|
|
PR FTH/GF FR W/DIR CLSR F/C/C/M/N/AX/G/H/F 20SQCM/<
|
Professional
|
$1,694.84
|
|
|
Service Code
|
CPT 15240
|
| Hospital Charge Code |
z15240
|
| Min. Negotiated Rate |
$631.07 |
| Max. Negotiated Rate |
$1,271.13 |
| Rate for Payer: Aetna Medicare |
$741.11
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$925.61
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$925.61
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$852.28
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$815.22
|
| Rate for Payer: Cash Price |
$1,050.80
|
| Rate for Payer: Cash Price |
$1,050.80
|
| Rate for Payer: Coventry All Commercial |
$889.33
|
| Rate for Payer: Frontpath All Commercial |
$1,006.54
|
| Rate for Payer: Humana ChoiceCare |
$631.07
|
| Rate for Payer: Humana Medicare |
$741.11
|
| Rate for Payer: Lucent All Commercial |
$1,259.89
|
| Rate for Payer: Lutheran Preferred All Commercial |
$963.00
|
| Rate for Payer: PHCS All Commercial |
$1,271.13
|
| Rate for Payer: PHP All Commercial |
$1,012.25
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$741.11
|
| Rate for Payer: Signature Care EPO |
$788.80
|
| Rate for Payer: Signature Care PPO |
$788.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$889.00
|
| Rate for Payer: United Healthcare Commercial |
$846.64
|
| Rate for Payer: United Healthcare Medicare |
$741.11
|
|
|
PR FTH/GFT FREE W/DIRECT CLOSURE N/E/E/L 20 SQ CM/<
|
Professional
|
$1,827.32
|
|
|
Service Code
|
CPT 15260
|
| Hospital Charge Code |
z15260
|
| Min. Negotiated Rate |
$687.17 |
| Max. Negotiated Rate |
$1,370.49 |
| Rate for Payer: Aetna Medicare |
$790.48
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$896.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$896.30
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$909.05
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$869.53
|
| Rate for Payer: Cash Price |
$1,132.94
|
| Rate for Payer: Cash Price |
$1,132.94
|
| Rate for Payer: Coventry All Commercial |
$948.58
|
| Rate for Payer: Frontpath All Commercial |
$1,068.78
|
| Rate for Payer: Humana ChoiceCare |
$687.17
|
| Rate for Payer: Humana Medicare |
$790.48
|
| Rate for Payer: Lucent All Commercial |
$1,343.82
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,028.00
|
| Rate for Payer: PHCS All Commercial |
$1,370.49
|
| Rate for Payer: PHP All Commercial |
$1,079.69
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$790.48
|
| Rate for Payer: Signature Care EPO |
$816.85
|
| Rate for Payer: Signature Care PPO |
$816.85
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$949.00
|
| Rate for Payer: United Healthcare Commercial |
$919.10
|
| Rate for Payer: United Healthcare Medicare |
$790.48
|
|
|
PR FULL ROUT OBSTE CARE,CESAREAN DELIV
|
Professional
|
$4,683.82
|
|
|
Service Code
|
CPT 59510
|
| Hospital Charge Code |
z59510
|
| Min. Negotiated Rate |
$1,689.44 |
| Max. Negotiated Rate |
$4,080.26 |
| Rate for Payer: Aetna Medicare |
$2,400.15
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,200.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,200.00
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,760.17
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,640.16
|
| Rate for Payer: Cash Price |
$2,903.97
|
| Rate for Payer: Cash Price |
$2,903.97
|
| Rate for Payer: Coventry All Commercial |
$2,880.18
|
| Rate for Payer: Frontpath All Commercial |
$3,422.49
|
| Rate for Payer: Humana ChoiceCare |
$1,689.44
|
| Rate for Payer: Humana Medicare |
$2,400.15
|
| Rate for Payer: Lucent All Commercial |
$4,080.26
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,360.00
|
| Rate for Payer: PHCS All Commercial |
$3,512.86
|
| Rate for Payer: PHP All Commercial |
$3,091.32
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,400.15
|
| Rate for Payer: Signature Care EPO |
$2,177.70
|
| Rate for Payer: Signature Care PPO |
$2,177.70
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,120.00
|
| Rate for Payer: United Healthcare Commercial |
$2,225.69
|
| Rate for Payer: United Healthcare Medicare |
$2,400.15
|
|
|
PR FULL ROUT OBSTE CARE,VAGINAL DELIV
|
Professional
|
$4,262.28
|
|
|
Service Code
|
CPT 59400
|
| Hospital Charge Code |
z59400
|
| Min. Negotiated Rate |
$1,490.71 |
| Max. Negotiated Rate |
$3,713.24 |
| Rate for Payer: Aetna Medicare |
$2,184.26
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,200.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,200.00
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,511.90
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,402.69
|
| Rate for Payer: Cash Price |
$2,642.61
|
| Rate for Payer: Cash Price |
$2,642.61
|
| Rate for Payer: Coventry All Commercial |
$2,621.11
|
| Rate for Payer: Frontpath All Commercial |
$3,092.42
|
| Rate for Payer: Humana ChoiceCare |
$1,490.71
|
| Rate for Payer: Humana Medicare |
$2,184.26
|
| Rate for Payer: Lucent All Commercial |
$3,713.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,058.00
|
| Rate for Payer: PHCS All Commercial |
$3,196.71
|
| Rate for Payer: PHP All Commercial |
$2,813.11
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,184.26
|
| Rate for Payer: Signature Care EPO |
$1,922.70
|
| Rate for Payer: Signature Care PPO |
$1,922.70
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,840.00
|
| Rate for Payer: United Healthcare Commercial |
$1,965.55
|
| Rate for Payer: United Healthcare Medicare |
$2,184.26
|
|
|
PR FULL SHELL STYLE #6
|
Professional
|
$80.00
|
|
|
Service Code
|
CPT V5264
|
| Hospital Charge Code |
zV5264J
|
| 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 FUSION FINGER TENDONS,DIP JT STABIL
|
Professional
|
$1,198.72
|
|
|
Service Code
|
CPT 26474
|
| Hospital Charge Code |
z26474
|
| Min. Negotiated Rate |
$614.35 |
| Max. Negotiated Rate |
$1,044.40 |
| Rate for Payer: Aetna Medicare |
$614.35
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$706.50
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$675.78
|
| Rate for Payer: Cash Price |
$743.21
|
| Rate for Payer: Cash Price |
$743.21
|
| Rate for Payer: Coventry All Commercial |
$737.22
|
| Rate for Payer: Frontpath All Commercial |
$844.61
|
| Rate for Payer: Humana ChoiceCare |
$698.00
|
| Rate for Payer: Humana Medicare |
$614.35
|
| Rate for Payer: Lucent All Commercial |
$1,044.40
|
| Rate for Payer: PHCS All Commercial |
$899.04
|
| Rate for Payer: PHP All Commercial |
$1,042.89
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$614.35
|
| Rate for Payer: Signature Care EPO |
$956.79
|
| Rate for Payer: Signature Care PPO |
$956.79
|
| Rate for Payer: United Healthcare Commercial |
$614.85
|
| Rate for Payer: United Healthcare Medicare |
$614.35
|
|
|
PR FUSION MC-P JT
|
Professional
|
$1,351.46
|
|
|
Service Code
|
CPT 26850
|
| Hospital Charge Code |
z26850
|
| Min. Negotiated Rate |
$692.62 |
| Max. Negotiated Rate |
$1,177.45 |
| Rate for Payer: Aetna Medicare |
$692.62
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$750.40
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$750.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$796.51
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$761.88
|
| Rate for Payer: Cash Price |
$837.91
|
| Rate for Payer: Cash Price |
$837.91
|
| Rate for Payer: Coventry All Commercial |
$831.14
|
| Rate for Payer: Frontpath All Commercial |
$953.08
|
| Rate for Payer: Humana ChoiceCare |
$808.17
|
| Rate for Payer: Humana Medicare |
$692.62
|
| Rate for Payer: Lucent All Commercial |
$1,177.45
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,108.00
|
| Rate for Payer: PHCS All Commercial |
$1,013.60
|
| Rate for Payer: PHP All Commercial |
$1,175.77
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$692.62
|
| Rate for Payer: Signature Care EPO |
$1,099.46
|
| Rate for Payer: Signature Care PPO |
$1,099.46
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,039.00
|
| Rate for Payer: United Healthcare Commercial |
$731.29
|
| Rate for Payer: United Healthcare Medicare |
$692.62
|
|
|
PR GASTROSTOMY,OPEN,W/O TUBE CNSTR
|
Professional
|
$1,258.10
|
|
|
Service Code
|
CPT 43830
|
| Hospital Charge Code |
z43830
|
| Min. Negotiated Rate |
$631.30 |
| Max. Negotiated Rate |
$1,100.84 |
| Rate for Payer: Aetna Medicare |
$644.78
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$631.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$631.30
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$741.50
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$709.26
|
| Rate for Payer: Cash Price |
$780.02
|
| Rate for Payer: Cash Price |
$780.02
|
| Rate for Payer: Coventry All Commercial |
$773.74
|
| Rate for Payer: Frontpath All Commercial |
$927.59
|
| Rate for Payer: Humana ChoiceCare |
$655.91
|
| Rate for Payer: Humana Medicare |
$644.78
|
| Rate for Payer: Lucent All Commercial |
$1,096.13
|
| Rate for Payer: Lutheran Preferred All Commercial |
$967.00
|
| Rate for Payer: PHCS All Commercial |
$943.58
|
| Rate for Payer: PHP All Commercial |
$1,100.84
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$644.78
|
| Rate for Payer: Signature Care EPO |
$822.80
|
| Rate for Payer: Signature Care PPO |
$822.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$903.00
|
| Rate for Payer: United Healthcare Commercial |
$734.03
|
| Rate for Payer: United Healthcare Medicare |
$644.78
|
|
|
PR GASTROSTOMY,OPEN,W/TUBE CNSTR
|
Professional
|
$1,859.12
|
|
|
Service Code
|
CPT 43832
|
| Hospital Charge Code |
z43832
|
| Min. Negotiated Rate |
$952.79 |
| Max. Negotiated Rate |
$1,626.72 |
| Rate for Payer: Aetna Medicare |
$952.79
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$963.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$963.30
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,095.71
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,048.07
|
| Rate for Payer: Cash Price |
$1,152.65
|
| Rate for Payer: Cash Price |
$1,152.65
|
| Rate for Payer: Coventry All Commercial |
$1,143.35
|
| Rate for Payer: Frontpath All Commercial |
$1,382.76
|
| Rate for Payer: Humana ChoiceCare |
$1,027.66
|
| Rate for Payer: Humana Medicare |
$952.79
|
| Rate for Payer: Lucent All Commercial |
$1,619.74
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,429.00
|
| Rate for Payer: PHCS All Commercial |
$1,394.34
|
| Rate for Payer: PHP All Commercial |
$1,626.72
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$952.79
|
| Rate for Payer: Signature Care EPO |
$1,289.45
|
| Rate for Payer: Signature Care PPO |
$1,289.45
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,334.00
|
| Rate for Payer: United Healthcare Commercial |
$1,131.66
|
| Rate for Payer: United Healthcare Medicare |
$952.79
|
|
|
PR GEL-ONE
|
Professional
|
$1,104.00
|
|
|
Service Code
|
CPT J7326
|
| Hospital Charge Code |
zJ7326
|
| Min. Negotiated Rate |
$517.39 |
| Max. Negotiated Rate |
$1,104.00 |
| Rate for Payer: Humana ChoiceCare |
$517.39
|
| Rate for Payer: PHP All Commercial |
$1,104.00
|
|
|
PR GROUP PSYCHOTHERAPY
|
Professional
|
$50.48
|
|
|
Service Code
|
CPT 90853
|
| Hospital Charge Code |
z90853
|
| Min. Negotiated Rate |
$22.79 |
| Max. Negotiated Rate |
$38.74 |
| Rate for Payer: Aetna Medicare |
$22.79
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$31.64
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$31.64
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$26.21
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$25.07
|
| Rate for Payer: Cash Price |
$31.30
|
| Rate for Payer: Cash Price |
$31.30
|
| Rate for Payer: Coventry All Commercial |
$27.35
|
| Rate for Payer: Frontpath All Commercial |
$26.07
|
| Rate for Payer: Humana ChoiceCare |
$24.64
|
| Rate for Payer: Humana Medicare |
$22.79
|
| Rate for Payer: Lucent All Commercial |
$38.74
|
| Rate for Payer: Lutheran Preferred All Commercial |
$30.00
|
| Rate for Payer: PHCS All Commercial |
$37.86
|
| Rate for Payer: PHP All Commercial |
$24.23
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$22.79
|
| Rate for Payer: Signature Care EPO |
$34.85
|
| Rate for Payer: Signature Care PPO |
$34.85
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$27.00
|
| Rate for Payer: United Healthcare Commercial |
$35.56
|
| Rate for Payer: United Healthcare Medicare |
$22.79
|
|
|
PR HALF SHELL STYLE #8
|
Professional
|
$80.00
|
|
|
Service Code
|
CPT V5264
|
| Hospital Charge Code |
zV5264K
|
| 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 HAND/FINGER SURGERY UNLISTED
|
Professional
|
$1,187.00
|
|
|
Service Code
|
CPT 26989
|
| Hospital Charge Code |
z26989
|
| Min. Negotiated Rate |
$890.25 |
| Max. Negotiated Rate |
$890.25 |
| Rate for Payer: Cash Price |
$735.94
|
| Rate for Payer: PHCS All Commercial |
$890.25
|
|
|
PR HEARING AID BATTERY PK 6 CELL
|
Professional
|
$5.00
|
|
|
Service Code
|
CPT V5266
|
| Hospital Charge Code |
zV5266A
|
| Min. Negotiated Rate |
$3.75 |
| Max. Negotiated Rate |
$5.00 |
| Rate for Payer: Cash Price |
$3.10
|
| Rate for Payer: PHCS All Commercial |
$3.75
|
| Rate for Payer: Signature Care EPO |
$5.00
|
| Rate for Payer: Signature Care PPO |
$5.00
|
|
|
PR HEARING AID CHECK, BOTH EARS
|
Professional
|
$100.00
|
|
|
Service Code
|
CPT 92593
|
| Hospital Charge Code |
z92593
|
| Min. Negotiated Rate |
$30.00 |
| Max. Negotiated Rate |
$85.00 |
| 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 |
$62.00
|
| Rate for Payer: Cash Price |
$62.00
|
| Rate for Payer: Frontpath All Commercial |
$37.76
|
| Rate for Payer: Humana ChoiceCare |
$30.12
|
| Rate for Payer: Lutheran Preferred All Commercial |
$85.00
|
| Rate for Payer: PHCS All Commercial |
$75.00
|
| Rate for Payer: Signature Care EPO |
$46.75
|
| Rate for Payer: Signature Care PPO |
$46.75
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$60.00
|
| Rate for Payer: United Healthcare Commercial |
$35.85
|
|
|
PR HEARING AID CHECK, ONE EAR
|
Professional
|
$50.00
|
|
|
Service Code
|
CPT 92592
|
| Hospital Charge Code |
z92592
|
| Min. Negotiated Rate |
$19.93 |
| Max. Negotiated Rate |
$42.50 |
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$20.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$20.00
|
| Rate for Payer: Cash Price |
$31.00
|
| Rate for Payer: Cash Price |
$31.00
|
| Rate for Payer: Frontpath All Commercial |
$22.70
|
| Rate for Payer: Humana ChoiceCare |
$19.93
|
| Rate for Payer: Lutheran Preferred All Commercial |
$42.50
|
| Rate for Payer: PHCS All Commercial |
$37.50
|
| Rate for Payer: Signature Care EPO |
$31.45
|
| Rate for Payer: Signature Care PPO |
$31.45
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$30.00
|
| Rate for Payer: United Healthcare Commercial |
$21.90
|
|
|
PR HEARING AID EXAM, BOTH EARS
|
Professional
|
$350.00
|
|
|
Service Code
|
CPT 92591
|
| Hospital Charge Code |
z92591
|
| Min. Negotiated Rate |
$68.35 |
| Max. Negotiated Rate |
$297.50 |
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$110.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$110.00
|
| Rate for Payer: Cash Price |
$217.00
|
| Rate for Payer: Cash Price |
$217.00
|
| Rate for Payer: Frontpath All Commercial |
$73.10
|
| Rate for Payer: Humana ChoiceCare |
$68.35
|
| Rate for Payer: Lutheran Preferred All Commercial |
$297.50
|
| Rate for Payer: PHCS All Commercial |
$262.50
|
| Rate for Payer: Signature Care EPO |
$106.25
|
| Rate for Payer: Signature Care PPO |
$106.25
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$210.00
|
| Rate for Payer: United Healthcare Commercial |
$69.58
|
|
|
PR HEARING AID EXAM, ONE EAR
|
Professional
|
$250.00
|
|
|
Service Code
|
CPT 92590
|
| Hospital Charge Code |
z92590
|
| Min. Negotiated Rate |
$45.48 |
| Max. Negotiated Rate |
$212.50 |
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$70.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$70.00
|
| Rate for Payer: Cash Price |
$155.00
|
| Rate for Payer: Cash Price |
$155.00
|
| Rate for Payer: Frontpath All Commercial |
$57.33
|
| Rate for Payer: Humana ChoiceCare |
$45.48
|
| Rate for Payer: Lutheran Preferred All Commercial |
$212.50
|
| Rate for Payer: PHCS All Commercial |
$187.50
|
| Rate for Payer: Signature Care EPO |
$70.55
|
| Rate for Payer: Signature Care PPO |
$70.55
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$150.00
|
| Rate for Payer: United Healthcare Commercial |
$54.34
|
|
|
PR HEARING AID MONAURAL BTE
|
Professional
|
$1,000.00
|
|
|
Service Code
|
CPT V5181
|
| Hospital Charge Code |
zV5181
|
| Min. Negotiated Rate |
$750.00 |
| Max. Negotiated Rate |
$848.84 |
| Rate for Payer: Cash Price |
$620.00
|
| Rate for Payer: Cash Price |
$620.00
|
| Rate for Payer: PHCS All Commercial |
$750.00
|
| Rate for Payer: United Healthcare Commercial |
$848.84
|
|
|
PR HEARING AID SAVER ITEM# 50551
|
Professional
|
$20.00
|
|
|
Service Code
|
CPT V5267
|
| Hospital Charge Code |
zV5267G
|
| Min. Negotiated Rate |
$15.00 |
| Max. Negotiated Rate |
$20.00 |
| Rate for Payer: Cash Price |
$12.40
|
| Rate for Payer: PHCS All Commercial |
$15.00
|
| Rate for Payer: Signature Care EPO |
$20.00
|
| Rate for Payer: Signature Care PPO |
$20.00
|
|
