|
PR HEARING AID WARRANTY DEDUCTIBLE
|
Professional
|
$300.00
|
|
|
Service Code
|
CPT V5014
|
| Hospital Charge Code |
zV5014W
|
| Min. Negotiated Rate |
$73.21 |
| Max. Negotiated Rate |
$300.00 |
| Rate for Payer: Cash Price |
$186.00
|
| Rate for Payer: Cash Price |
$186.00
|
| Rate for Payer: Humana ChoiceCare |
$73.21
|
| Rate for Payer: PHCS All Commercial |
$225.00
|
| Rate for Payer: Signature Care EPO |
$300.00
|
| Rate for Payer: Signature Care PPO |
$300.00
|
| Rate for Payer: United Healthcare Commercial |
$125.40
|
|
|
PR HEART/LUNG RESUSCITATION (CPR)
|
Professional
|
$599.28
|
|
|
Service Code
|
CPT 92950
|
| Hospital Charge Code |
z92950
|
| Min. Negotiated Rate |
$172.54 |
| Max. Negotiated Rate |
$449.46 |
| Rate for Payer: Aetna Medicare |
$172.54
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$269.50
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$269.50
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$198.42
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$189.79
|
| Rate for Payer: Cash Price |
$371.55
|
| Rate for Payer: Cash Price |
$371.55
|
| Rate for Payer: Coventry All Commercial |
$207.05
|
| Rate for Payer: Frontpath All Commercial |
$203.34
|
| Rate for Payer: Humana ChoiceCare |
$246.74
|
| Rate for Payer: Humana Medicare |
$172.54
|
| Rate for Payer: Lucent All Commercial |
$293.32
|
| Rate for Payer: Lutheran Preferred All Commercial |
$276.00
|
| Rate for Payer: PHCS All Commercial |
$449.46
|
| Rate for Payer: PHP All Commercial |
$247.44
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$172.54
|
| Rate for Payer: Signature Care EPO |
$282.20
|
| Rate for Payer: Signature Care PPO |
$282.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$259.00
|
| Rate for Payer: United Healthcare Commercial |
$213.19
|
| Rate for Payer: United Healthcare Medicare |
$172.54
|
|
|
PR HEMORRHOIDECTOMY,INT/EXT, 2+ COLUMNS/GROUPS
|
Professional
|
$874.36
|
|
|
Service Code
|
CPT 46260
|
| Hospital Charge Code |
z46260
|
| Min. Negotiated Rate |
$434.64 |
| Max. Negotiated Rate |
$765.06 |
| Rate for Payer: Aetna Medicare |
$448.11
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$636.90
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$636.90
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$515.33
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$492.92
|
| Rate for Payer: Cash Price |
$542.10
|
| Rate for Payer: Cash Price |
$542.10
|
| Rate for Payer: Coventry All Commercial |
$537.73
|
| Rate for Payer: Frontpath All Commercial |
$630.20
|
| Rate for Payer: Humana ChoiceCare |
$434.64
|
| Rate for Payer: Humana Medicare |
$448.11
|
| Rate for Payer: Lucent All Commercial |
$761.79
|
| Rate for Payer: Lutheran Preferred All Commercial |
$672.00
|
| Rate for Payer: PHCS All Commercial |
$655.77
|
| Rate for Payer: PHP All Commercial |
$765.06
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$448.11
|
| Rate for Payer: Signature Care EPO |
$556.75
|
| Rate for Payer: Signature Care PPO |
$556.75
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$627.00
|
| Rate for Payer: United Healthcare Commercial |
$481.33
|
| Rate for Payer: United Healthcare Medicare |
$448.11
|
|
|
PR HEPA VACCINE 2 DOSE SCHEDULE PED/ADOLESC IM USE
|
Professional
|
$51.32
|
|
|
Service Code
|
CPT 90633
|
| Hospital Charge Code |
z90633
|
| Min. Negotiated Rate |
$37.00 |
| Max. Negotiated Rate |
$51.32 |
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$37.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$37.00
|
| Rate for Payer: Frontpath All Commercial |
$37.58
|
| Rate for Payer: Humana ChoiceCare |
$39.59
|
| Rate for Payer: Lutheran Preferred All Commercial |
$51.32
|
| Rate for Payer: PHP All Commercial |
$39.46
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$51.32
|
| Rate for Payer: United Healthcare Commercial |
$41.29
|
|
|
PR HEPB VACCINE ADULT 3 DOSE SCHEDULE FOR IM USE
|
Professional
|
$80.03
|
|
|
Service Code
|
CPT 90746
|
| Hospital Charge Code |
z90746
|
| Min. Negotiated Rate |
$70.38 |
| Max. Negotiated Rate |
$80.03 |
| Rate for Payer: Frontpath All Commercial |
$77.42
|
| Rate for Payer: Humana ChoiceCare |
$70.38
|
| Rate for Payer: PHP All Commercial |
$70.74
|
| Rate for Payer: United Healthcare Commercial |
$80.03
|
|
|
PR HEPB VACCINE PED/ADOLESC 3 DOSE SCHEDULE IM
|
Professional
|
$36.89
|
|
|
Service Code
|
CPT 90744
|
| Hospital Charge Code |
z90744
|
| Min. Negotiated Rate |
$28.76 |
| Max. Negotiated Rate |
$36.89 |
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$28.76
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$28.76
|
| Rate for Payer: Frontpath All Commercial |
$31.63
|
| Rate for Payer: Humana ChoiceCare |
$29.89
|
| Rate for Payer: Lutheran Preferred All Commercial |
$36.89
|
| Rate for Payer: PHP All Commercial |
$28.97
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$36.89
|
| Rate for Payer: United Healthcare Commercial |
$32.67
|
|
|
PR HFO WITHOUT JOINTS PRE CST
|
Professional
|
$10.76
|
|
|
Service Code
|
CPT L3923
|
| Hospital Charge Code |
zL3923
|
| Min. Negotiated Rate |
$8.07 |
| Max. Negotiated Rate |
$86.71 |
| Rate for Payer: Cash Price |
$6.67
|
| Rate for Payer: Cash Price |
$6.67
|
| Rate for Payer: Humana ChoiceCare |
$85.70
|
| Rate for Payer: PHCS All Commercial |
$8.07
|
| Rate for Payer: PHP All Commercial |
$86.71
|
| Rate for Payer: Signature Care EPO |
$10.76
|
| Rate for Payer: Signature Care PPO |
$10.76
|
| Rate for Payer: United Healthcare Commercial |
$67.66
|
|
|
PR HIB PRP-OMP VACCINE 3 DOSE SCHEDULE IM USE
|
Professional
|
$40.42
|
|
|
Service Code
|
CPT 90647
|
| Hospital Charge Code |
z90647
|
| Min. Negotiated Rate |
$30.00 |
| Max. Negotiated Rate |
$40.42 |
| 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: Frontpath All Commercial |
$32.13
|
| Rate for Payer: Humana ChoiceCare |
$32.77
|
| Rate for Payer: Lutheran Preferred All Commercial |
$40.42
|
| Rate for Payer: PHP All Commercial |
$31.75
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$40.42
|
| Rate for Payer: United Healthcare Commercial |
$34.49
|
|
|
PR HOME/RES VISIT EST PATIENT HIGH MDM 60 MINUTES
|
Professional
|
$345.28
|
|
|
Service Code
|
CPT 99350
|
| Hospital Charge Code |
z99350
|
| Min. Negotiated Rate |
$163.66 |
| Max. Negotiated Rate |
$300.83 |
| Rate for Payer: Aetna Medicare |
$176.96
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$203.50
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$194.66
|
| Rate for Payer: Cash Price |
$214.07
|
| Rate for Payer: Cash Price |
$214.07
|
| Rate for Payer: Coventry All Commercial |
$212.35
|
| Rate for Payer: Frontpath All Commercial |
$180.34
|
| Rate for Payer: Humana ChoiceCare |
$167.57
|
| Rate for Payer: Humana Medicare |
$176.96
|
| Rate for Payer: Lucent All Commercial |
$300.83
|
| Rate for Payer: PHCS All Commercial |
$258.96
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$176.96
|
| Rate for Payer: United Healthcare Commercial |
$163.66
|
| Rate for Payer: United Healthcare Medicare |
$176.96
|
|
|
PR HOME/RES VISIT EST PATIENT LOW MDM 30 MINUTES
|
Professional
|
$142.06
|
|
|
Service Code
|
CPT 99348
|
| Hospital Charge Code |
z99348
|
| Min. Negotiated Rate |
$72.80 |
| Max. Negotiated Rate |
$123.76 |
| Rate for Payer: Aetna Medicare |
$72.80
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$83.72
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$80.08
|
| Rate for Payer: Cash Price |
$88.08
|
| Rate for Payer: Cash Price |
$88.08
|
| Rate for Payer: Coventry All Commercial |
$87.36
|
| Rate for Payer: Frontpath All Commercial |
$84.33
|
| Rate for Payer: Humana ChoiceCare |
$73.05
|
| Rate for Payer: Humana Medicare |
$72.80
|
| Rate for Payer: Lucent All Commercial |
$123.76
|
| Rate for Payer: PHCS All Commercial |
$106.54
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$72.80
|
| Rate for Payer: United Healthcare Commercial |
$80.60
|
| Rate for Payer: United Healthcare Medicare |
$72.80
|
|
|
PR HOME/RES VISIT EST PATIENT MOD MDM 40 MINUTES
|
Professional
|
$236.54
|
|
|
Service Code
|
CPT 99349
|
| Hospital Charge Code |
z99349
|
| Min. Negotiated Rate |
$113.36 |
| Max. Negotiated Rate |
$206.09 |
| Rate for Payer: Aetna Medicare |
$121.23
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$139.41
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$133.35
|
| Rate for Payer: Cash Price |
$146.65
|
| Rate for Payer: Cash Price |
$146.65
|
| Rate for Payer: Coventry All Commercial |
$145.48
|
| Rate for Payer: Frontpath All Commercial |
$129.79
|
| Rate for Payer: Humana ChoiceCare |
$113.36
|
| Rate for Payer: Humana Medicare |
$121.23
|
| Rate for Payer: Lucent All Commercial |
$206.09
|
| Rate for Payer: PHCS All Commercial |
$177.40
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$121.23
|
| Rate for Payer: United Healthcare Commercial |
$117.39
|
| Rate for Payer: United Healthcare Medicare |
$121.23
|
|
|
PR HOME/RES VISIT EST PATIENT SF MDM 20 MINUTES
|
Professional
|
$83.66
|
|
|
Service Code
|
CPT 99347
|
| Hospital Charge Code |
z99347
|
| Min. Negotiated Rate |
$42.87 |
| Max. Negotiated Rate |
$72.88 |
| Rate for Payer: Aetna Medicare |
$42.87
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$49.30
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$47.16
|
| Rate for Payer: Cash Price |
$51.87
|
| Rate for Payer: Cash Price |
$51.87
|
| Rate for Payer: Coventry All Commercial |
$51.44
|
| Rate for Payer: Frontpath All Commercial |
$55.37
|
| Rate for Payer: Humana ChoiceCare |
$45.96
|
| Rate for Payer: Humana Medicare |
$42.87
|
| Rate for Payer: Lucent All Commercial |
$72.88
|
| Rate for Payer: PHCS All Commercial |
$62.74
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$42.87
|
| Rate for Payer: United Healthcare Commercial |
$53.38
|
| Rate for Payer: United Healthcare Medicare |
$42.87
|
|
|
PR HOME/RES VISIT NEW PATIENT LOW MDM 30 MINUTES
|
Professional
|
$145.94
|
|
|
Service Code
|
CPT 99342
|
| Hospital Charge Code |
z99342
|
| Min. Negotiated Rate |
$73.95 |
| Max. Negotiated Rate |
$127.16 |
| Rate for Payer: Aetna Medicare |
$74.80
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$95.50
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$95.50
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$86.02
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$82.28
|
| Rate for Payer: Cash Price |
$90.48
|
| Rate for Payer: Cash Price |
$90.48
|
| Rate for Payer: Coventry All Commercial |
$89.76
|
| Rate for Payer: Frontpath All Commercial |
$78.23
|
| Rate for Payer: Humana ChoiceCare |
$87.37
|
| Rate for Payer: Humana Medicare |
$74.80
|
| Rate for Payer: Lucent All Commercial |
$127.16
|
| Rate for Payer: Lutheran Preferred All Commercial |
$79.00
|
| Rate for Payer: PHCS All Commercial |
$109.46
|
| Rate for Payer: PHP All Commercial |
$75.16
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$74.80
|
| Rate for Payer: Signature Care EPO |
$73.95
|
| Rate for Payer: Signature Care PPO |
$73.95
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$77.00
|
| Rate for Payer: United Healthcare Commercial |
$79.66
|
| Rate for Payer: United Healthcare Medicare |
$74.80
|
|
|
PR HOSPITAL IP/OBS CARE SAME DATE HIGH MDM 85 MIN
|
Professional
|
$388.92
|
|
|
Service Code
|
CPT 99236
|
| Hospital Charge Code |
z99236
|
| Min. Negotiated Rate |
$199.01 |
| Max. Negotiated Rate |
$338.32 |
| Rate for Payer: Aetna Medicare |
$199.01
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$226.90
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$226.90
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$228.86
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$218.91
|
| Rate for Payer: Cash Price |
$241.13
|
| Rate for Payer: Cash Price |
$241.13
|
| Rate for Payer: Coventry All Commercial |
$238.81
|
| Rate for Payer: Frontpath All Commercial |
$216.27
|
| Rate for Payer: Humana ChoiceCare |
$214.03
|
| Rate for Payer: Humana Medicare |
$199.01
|
| Rate for Payer: Lucent All Commercial |
$338.32
|
| Rate for Payer: Lutheran Preferred All Commercial |
$209.00
|
| Rate for Payer: PHCS All Commercial |
$291.69
|
| Rate for Payer: PHP All Commercial |
$200.29
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$199.01
|
| Rate for Payer: Signature Care EPO |
$240.55
|
| Rate for Payer: Signature Care PPO |
$240.55
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$205.00
|
| Rate for Payer: United Healthcare Commercial |
$210.83
|
| Rate for Payer: United Healthcare Medicare |
$199.01
|
|
|
PR HOSPITAL IP/OBS CARE SAME DATE MOD MDM 70 MIN
|
Professional
|
$296.16
|
|
|
Service Code
|
CPT 99235
|
| Hospital Charge Code |
z99235
|
| Min. Negotiated Rate |
$151.78 |
| Max. Negotiated Rate |
$258.03 |
| Rate for Payer: Aetna Medicare |
$151.78
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$182.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$182.00
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$174.55
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$166.96
|
| Rate for Payer: Cash Price |
$183.62
|
| Rate for Payer: Cash Price |
$183.62
|
| Rate for Payer: Coventry All Commercial |
$182.14
|
| Rate for Payer: Frontpath All Commercial |
$168.77
|
| Rate for Payer: Humana ChoiceCare |
$171.36
|
| Rate for Payer: Humana Medicare |
$151.78
|
| Rate for Payer: Lucent All Commercial |
$258.03
|
| Rate for Payer: Lutheran Preferred All Commercial |
$159.00
|
| Rate for Payer: PHCS All Commercial |
$222.12
|
| Rate for Payer: PHP All Commercial |
$152.52
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$151.78
|
| Rate for Payer: Signature Care EPO |
$192.95
|
| Rate for Payer: Signature Care PPO |
$192.95
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$156.00
|
| Rate for Payer: United Healthcare Commercial |
$169.62
|
| Rate for Payer: United Healthcare Medicare |
$151.78
|
|
|
PR HOSPITAL IP/OBS CARE SAME DATE SF/LOW MDM 45 MIN
|
Professional
|
$182.48
|
|
|
Service Code
|
CPT 99234
|
| Hospital Charge Code |
z99234
|
| Min. Negotiated Rate |
$93.52 |
| Max. Negotiated Rate |
$158.98 |
| Rate for Payer: Aetna Medicare |
$93.52
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$136.97
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$136.97
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$107.55
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$102.87
|
| Rate for Payer: Cash Price |
$113.14
|
| Rate for Payer: Cash Price |
$113.14
|
| Rate for Payer: Coventry All Commercial |
$112.22
|
| Rate for Payer: Frontpath All Commercial |
$133.33
|
| Rate for Payer: Humana ChoiceCare |
$129.72
|
| Rate for Payer: Humana Medicare |
$93.52
|
| Rate for Payer: Lucent All Commercial |
$158.98
|
| Rate for Payer: Lutheran Preferred All Commercial |
$98.00
|
| Rate for Payer: PHCS All Commercial |
$136.86
|
| Rate for Payer: PHP All Commercial |
$93.97
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$93.52
|
| Rate for Payer: Signature Care EPO |
$146.20
|
| Rate for Payer: Signature Care PPO |
$146.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$96.00
|
| Rate for Payer: United Healthcare Commercial |
$129.10
|
| Rate for Payer: United Healthcare Medicare |
$93.52
|
|
|
PR HOSPITAL IP/OBS DISCHARGE DAY MGMT > 30 MIN
|
Professional
|
$211.96
|
|
|
Service Code
|
CPT 99239
|
| Hospital Charge Code |
z99239
|
| Min. Negotiated Rate |
$92.54 |
| Max. Negotiated Rate |
$184.67 |
| Rate for Payer: Aetna Medicare |
$108.63
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$108.35
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$108.35
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$124.92
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$119.49
|
| Rate for Payer: Cash Price |
$131.42
|
| Rate for Payer: Cash Price |
$131.42
|
| Rate for Payer: Coventry All Commercial |
$130.36
|
| Rate for Payer: Frontpath All Commercial |
$106.62
|
| Rate for Payer: Humana ChoiceCare |
$92.54
|
| Rate for Payer: Humana Medicare |
$108.63
|
| Rate for Payer: Lucent All Commercial |
$184.67
|
| Rate for Payer: Lutheran Preferred All Commercial |
$114.00
|
| Rate for Payer: PHCS All Commercial |
$158.97
|
| Rate for Payer: PHP All Commercial |
$109.16
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$108.63
|
| Rate for Payer: Signature Care EPO |
$101.15
|
| Rate for Payer: Signature Care PPO |
$101.15
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$112.00
|
| Rate for Payer: United Healthcare Commercial |
$97.88
|
| Rate for Payer: United Healthcare Medicare |
$108.63
|
|
|
PR HOSPITAL IP/OBS DISCHARGE DAY MGMT 30 MIN/<
|
Professional
|
$149.62
|
|
|
Service Code
|
CPT 99238
|
| Hospital Charge Code |
z99238
|
| Min. Negotiated Rate |
$67.34 |
| Max. Negotiated Rate |
$130.36 |
| Rate for Payer: Aetna Medicare |
$76.68
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$76.10
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$76.10
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$88.18
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$84.35
|
| Rate for Payer: Cash Price |
$92.76
|
| Rate for Payer: Cash Price |
$92.76
|
| Rate for Payer: Coventry All Commercial |
$92.02
|
| Rate for Payer: Frontpath All Commercial |
$72.95
|
| Rate for Payer: Humana ChoiceCare |
$67.88
|
| Rate for Payer: Humana Medicare |
$76.68
|
| Rate for Payer: Lucent All Commercial |
$130.36
|
| Rate for Payer: Lutheran Preferred All Commercial |
$81.00
|
| Rate for Payer: PHCS All Commercial |
$112.22
|
| Rate for Payer: PHP All Commercial |
$77.06
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$76.68
|
| Rate for Payer: Signature Care EPO |
$73.95
|
| Rate for Payer: Signature Care PPO |
$73.95
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$79.00
|
| Rate for Payer: United Healthcare Commercial |
$67.34
|
| Rate for Payer: United Healthcare Medicare |
$76.68
|
|
|
PR HYALGAN SUPARTZ VISCO-3 DOSE
|
Professional
|
$91.20
|
|
|
Service Code
|
CPT J7321
|
| Hospital Charge Code |
zJ7321
|
| Min. Negotiated Rate |
$78.68 |
| Max. Negotiated Rate |
$91.20 |
| Rate for Payer: Humana ChoiceCare |
$78.68
|
| Rate for Payer: PHP All Commercial |
$91.20
|
|
|
PR HYALURON/DERIV INTRA-ART INJ
|
Professional
|
$17.94
|
|
|
Service Code
|
CPT J7318
|
| Hospital Charge Code |
zJ7318
|
| Min. Negotiated Rate |
$17.94 |
| Max. Negotiated Rate |
$17.94 |
| Rate for Payer: Humana ChoiceCare |
$17.94
|
|
|
PR HYMENOTOMY, SIMPLE INCISION
|
Professional
|
$86.08
|
|
|
Service Code
|
CPT 56442
|
| Hospital Charge Code |
z56442
|
| Min. Negotiated Rate |
$44.12 |
| Max. Negotiated Rate |
$75.00 |
| Rate for Payer: Aetna Medicare |
$44.12
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$62.17
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$62.17
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$50.74
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$48.53
|
| Rate for Payer: Cash Price |
$53.37
|
| Rate for Payer: Cash Price |
$53.37
|
| Rate for Payer: Coventry All Commercial |
$52.94
|
| Rate for Payer: Frontpath All Commercial |
$60.24
|
| Rate for Payer: Humana ChoiceCare |
$49.10
|
| Rate for Payer: Humana Medicare |
$44.12
|
| Rate for Payer: Lucent All Commercial |
$75.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$62.00
|
| Rate for Payer: PHCS All Commercial |
$64.56
|
| Rate for Payer: PHP All Commercial |
$56.81
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$44.12
|
| Rate for Payer: Signature Care EPO |
$54.40
|
| Rate for Payer: Signature Care PPO |
$54.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$57.00
|
| Rate for Payer: United Healthcare Commercial |
$54.75
|
| Rate for Payer: United Healthcare Medicare |
$44.12
|
|
|
PR HYPNOTHERAPY
|
Professional
|
$196.68
|
|
|
Service Code
|
CPT 90880
|
| Hospital Charge Code |
z90880
|
| Min. Negotiated Rate |
$85.37 |
| Max. Negotiated Rate |
$147.51 |
| Rate for Payer: Aetna Medicare |
$85.37
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$105.19
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$105.19
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$98.18
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$93.91
|
| Rate for Payer: Cash Price |
$121.94
|
| Rate for Payer: Cash Price |
$121.94
|
| Rate for Payer: Coventry All Commercial |
$102.44
|
| Rate for Payer: Frontpath All Commercial |
$98.93
|
| Rate for Payer: Humana ChoiceCare |
$87.08
|
| Rate for Payer: Humana Medicare |
$85.37
|
| Rate for Payer: Lucent All Commercial |
$145.13
|
| Rate for Payer: Lutheran Preferred All Commercial |
$111.00
|
| Rate for Payer: PHCS All Commercial |
$147.51
|
| Rate for Payer: PHP All Commercial |
$90.78
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$85.37
|
| Rate for Payer: Signature Care EPO |
$133.45
|
| Rate for Payer: Signature Care PPO |
$133.45
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$102.00
|
| Rate for Payer: United Healthcare Commercial |
$119.95
|
| Rate for Payer: United Healthcare Medicare |
$85.37
|
|
|
PR HYSTEROSCOPY,DX,SEP PROC
|
Professional
|
$663.70
|
|
|
Service Code
|
CPT 58555
|
| Hospital Charge Code |
z58555
|
| Min. Negotiated Rate |
$140.72 |
| Max. Negotiated Rate |
$497.78 |
| Rate for Payer: Aetna Medicare |
$140.72
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$317.01
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$317.01
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$161.83
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$154.79
|
| Rate for Payer: Cash Price |
$411.49
|
| Rate for Payer: Cash Price |
$411.49
|
| Rate for Payer: Coventry All Commercial |
$168.86
|
| Rate for Payer: Frontpath All Commercial |
$196.16
|
| Rate for Payer: Humana ChoiceCare |
$217.66
|
| Rate for Payer: Humana Medicare |
$140.72
|
| Rate for Payer: Lucent All Commercial |
$239.22
|
| Rate for Payer: Lutheran Preferred All Commercial |
$197.00
|
| Rate for Payer: PHCS All Commercial |
$497.78
|
| Rate for Payer: PHP All Commercial |
$181.22
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$140.72
|
| Rate for Payer: Signature Care EPO |
$296.28
|
| Rate for Payer: Signature Care PPO |
$296.28
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$183.00
|
| Rate for Payer: United Healthcare Commercial |
$216.80
|
| Rate for Payer: United Healthcare Medicare |
$140.72
|
|
|
PR HYSTEROSCOPY,LYSIS ADHESIONS
|
Professional
|
$515.38
|
|
|
Service Code
|
CPT 58559
|
| Hospital Charge Code |
z58559
|
| Min. Negotiated Rate |
$264.13 |
| Max. Negotiated Rate |
$471.87 |
| Rate for Payer: Aetna Medicare |
$264.13
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$471.87
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$471.87
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$303.75
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$290.54
|
| Rate for Payer: Cash Price |
$319.54
|
| Rate for Payer: Cash Price |
$319.54
|
| Rate for Payer: Coventry All Commercial |
$316.96
|
| Rate for Payer: Frontpath All Commercial |
$372.37
|
| Rate for Payer: Humana ChoiceCare |
$397.51
|
| Rate for Payer: Humana Medicare |
$264.13
|
| Rate for Payer: Lucent All Commercial |
$449.02
|
| Rate for Payer: Lutheran Preferred All Commercial |
$370.00
|
| Rate for Payer: PHCS All Commercial |
$386.54
|
| Rate for Payer: PHP All Commercial |
$340.15
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$264.13
|
| Rate for Payer: Signature Care EPO |
$442.00
|
| Rate for Payer: Signature Care PPO |
$442.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$343.00
|
| Rate for Payer: United Healthcare Commercial |
$393.30
|
| Rate for Payer: United Healthcare Medicare |
$264.13
|
|
|
PR HYSTEROSCOPY,RMV FB
|
Professional
|
$792.40
|
|
|
Service Code
|
CPT 58562
|
| Hospital Charge Code |
z58562
|
| Min. Negotiated Rate |
$206.06 |
| Max. Negotiated Rate |
$594.30 |
| Rate for Payer: Aetna Medicare |
$206.06
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$457.94
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$457.94
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$236.97
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$226.67
|
| Rate for Payer: Cash Price |
$491.29
|
| Rate for Payer: Cash Price |
$491.29
|
| Rate for Payer: Coventry All Commercial |
$247.27
|
| Rate for Payer: Frontpath All Commercial |
$289.16
|
| Rate for Payer: Humana ChoiceCare |
$337.56
|
| Rate for Payer: Humana Medicare |
$206.06
|
| Rate for Payer: Lucent All Commercial |
$350.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$288.00
|
| Rate for Payer: PHCS All Commercial |
$594.30
|
| Rate for Payer: PHP All Commercial |
$265.37
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$206.06
|
| Rate for Payer: Signature Care EPO |
$372.30
|
| Rate for Payer: Signature Care PPO |
$372.30
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$268.00
|
| Rate for Payer: United Healthcare Commercial |
$333.39
|
| Rate for Payer: United Healthcare Medicare |
$206.06
|
|
