|
PR LONG LEG CAST, ADULT
|
Professional
|
$81.84
|
|
|
Service Code
|
CPT Q4050
|
| Hospital Charge Code |
zQ4050E
|
| Min. Negotiated Rate |
$55.65 |
| Max. Negotiated Rate |
$61.38 |
| Rate for Payer: Cash Price |
$50.74
|
| Rate for Payer: PHCS All Commercial |
$61.38
|
| Rate for Payer: Signature Care EPO |
$55.65
|
| Rate for Payer: Signature Care PPO |
$55.65
|
|
|
PR LONG LEG CAST, PEDIATRIC
|
Professional
|
$55.38
|
|
|
Service Code
|
CPT Q4050
|
| Hospital Charge Code |
zQ4050F
|
| Min. Negotiated Rate |
$37.66 |
| Max. Negotiated Rate |
$41.54 |
| Rate for Payer: Cash Price |
$34.34
|
| Rate for Payer: PHCS All Commercial |
$41.54
|
| Rate for Payer: Signature Care EPO |
$37.66
|
| Rate for Payer: Signature Care PPO |
$37.66
|
|
|
PR LOUDNESS BALANCE TEST
|
Professional
|
$85.86
|
|
|
Service Code
|
CPT 92562
|
| Hospital Charge Code |
z92562
|
| Min. Negotiated Rate |
$16.10 |
| Max. Negotiated Rate |
$74.80 |
| Rate for Payer: Aetna Medicare |
$44.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$16.10
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$16.10
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$50.60
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$48.40
|
| Rate for Payer: Cash Price |
$53.23
|
| Rate for Payer: Cash Price |
$53.23
|
| Rate for Payer: Coventry All Commercial |
$52.80
|
| Rate for Payer: Frontpath All Commercial |
$47.33
|
| Rate for Payer: Humana ChoiceCare |
$17.25
|
| Rate for Payer: Humana Medicare |
$44.00
|
| Rate for Payer: Lucent All Commercial |
$74.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$57.00
|
| Rate for Payer: PHCS All Commercial |
$64.40
|
| Rate for Payer: PHP All Commercial |
$62.24
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$44.00
|
| Rate for Payer: Signature Care EPO |
$36.30
|
| Rate for Payer: Signature Care PPO |
$36.30
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$53.00
|
| Rate for Payer: United Healthcare Commercial |
$25.09
|
| Rate for Payer: United Healthcare Medicare |
$44.00
|
|
|
PR LYSIS ADNEXAL ADHESIONS
|
Professional
|
$1,641.28
|
|
|
Service Code
|
CPT 58740
|
| Hospital Charge Code |
z58740
|
| Min. Negotiated Rate |
$841.48 |
| Max. Negotiated Rate |
$1,430.52 |
| Rate for Payer: Aetna Medicare |
$841.48
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,117.99
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,117.99
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$967.70
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$925.63
|
| Rate for Payer: Cash Price |
$1,017.59
|
| Rate for Payer: Cash Price |
$1,017.59
|
| Rate for Payer: Coventry All Commercial |
$1,009.78
|
| Rate for Payer: Frontpath All Commercial |
$1,182.57
|
| Rate for Payer: Humana ChoiceCare |
$940.17
|
| Rate for Payer: Humana Medicare |
$841.48
|
| Rate for Payer: Lucent All Commercial |
$1,430.52
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,178.00
|
| Rate for Payer: PHCS All Commercial |
$1,230.96
|
| Rate for Payer: PHP All Commercial |
$1,083.25
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$841.48
|
| Rate for Payer: Signature Care EPO |
$1,035.30
|
| Rate for Payer: Signature Care PPO |
$1,035.30
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,094.00
|
| Rate for Payer: United Healthcare Commercial |
$983.49
|
| Rate for Payer: United Healthcare Medicare |
$841.48
|
|
|
PR LYSIS INTRANASAL SYNECHIA
|
Professional
|
$593.76
|
|
|
Service Code
|
CPT 30560
|
| Hospital Charge Code |
z30560
|
| Min. Negotiated Rate |
$122.90 |
| Max. Negotiated Rate |
$445.32 |
| Rate for Payer: Aetna Medicare |
$141.61
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$122.90
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$122.90
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$162.85
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$155.77
|
| Rate for Payer: Cash Price |
$368.13
|
| Rate for Payer: Cash Price |
$368.13
|
| Rate for Payer: Coventry All Commercial |
$169.93
|
| Rate for Payer: Frontpath All Commercial |
$192.41
|
| Rate for Payer: Humana ChoiceCare |
$149.30
|
| Rate for Payer: Humana Medicare |
$141.61
|
| Rate for Payer: Lucent All Commercial |
$240.74
|
| Rate for Payer: Lutheran Preferred All Commercial |
$227.00
|
| Rate for Payer: PHCS All Commercial |
$445.32
|
| Rate for Payer: PHP All Commercial |
$193.42
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$141.61
|
| Rate for Payer: Signature Care EPO |
$313.65
|
| Rate for Payer: Signature Care PPO |
$313.65
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$212.00
|
| Rate for Payer: United Healthcare Commercial |
$145.25
|
| Rate for Payer: United Healthcare Medicare |
$141.61
|
|
|
PR LYSIS OF LABIAL LESION(S)
|
Professional
|
$336.34
|
|
|
Service Code
|
CPT 56441
|
| Hospital Charge Code |
z56441
|
| Min. Negotiated Rate |
$145.21 |
| Max. Negotiated Rate |
$252.26 |
| Rate for Payer: Aetna Medicare |
$145.21
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$195.31
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$195.31
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$166.99
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$159.73
|
| Rate for Payer: Cash Price |
$208.53
|
| Rate for Payer: Cash Price |
$208.53
|
| Rate for Payer: Coventry All Commercial |
$174.25
|
| Rate for Payer: Frontpath All Commercial |
$199.78
|
| Rate for Payer: Humana ChoiceCare |
$147.86
|
| Rate for Payer: Humana Medicare |
$145.21
|
| Rate for Payer: Lucent All Commercial |
$246.86
|
| Rate for Payer: Lutheran Preferred All Commercial |
$203.00
|
| Rate for Payer: PHCS All Commercial |
$252.26
|
| Rate for Payer: PHP All Commercial |
$187.00
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$145.21
|
| Rate for Payer: Signature Care EPO |
$186.15
|
| Rate for Payer: Signature Care PPO |
$186.15
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$189.00
|
| Rate for Payer: United Healthcare Commercial |
$158.85
|
| Rate for Payer: United Healthcare Medicare |
$145.21
|
|
|
PR MAKENA, 10 MG
|
Professional
|
$27.85
|
|
|
Service Code
|
CPT J1726
|
| Hospital Charge Code |
zJ1726
|
| Min. Negotiated Rate |
$26.21 |
| Max. Negotiated Rate |
$27.85 |
| Rate for Payer: Humana ChoiceCare |
$27.85
|
| Rate for Payer: PHP All Commercial |
$26.21
|
|
|
PR MANIPULATE FINGER JT W/ ANESTH,EACH
|
Professional
|
$652.94
|
|
|
Service Code
|
CPT 26340
|
| Hospital Charge Code |
z26340
|
| Min. Negotiated Rate |
$309.99 |
| Max. Negotiated Rate |
$568.87 |
| Rate for Payer: Aetna Medicare |
$334.63
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$344.70
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$344.70
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$384.82
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$368.09
|
| Rate for Payer: Cash Price |
$404.82
|
| Rate for Payer: Cash Price |
$404.82
|
| Rate for Payer: Coventry All Commercial |
$401.56
|
| Rate for Payer: Frontpath All Commercial |
$447.71
|
| Rate for Payer: Humana ChoiceCare |
$309.99
|
| Rate for Payer: Humana Medicare |
$334.63
|
| Rate for Payer: Lucent All Commercial |
$568.87
|
| Rate for Payer: Lutheran Preferred All Commercial |
$535.00
|
| Rate for Payer: PHCS All Commercial |
$489.70
|
| Rate for Payer: PHP All Commercial |
$568.05
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$334.63
|
| Rate for Payer: Signature Care EPO |
$408.85
|
| Rate for Payer: Signature Care PPO |
$408.85
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$502.00
|
| Rate for Payer: United Healthcare Commercial |
$321.10
|
| Rate for Payer: United Healthcare Medicare |
$334.63
|
|
|
PR MANIPULATE WRIST W/ANESTHES
|
Professional
|
$794.86
|
|
|
Service Code
|
CPT 25259
|
| Hospital Charge Code |
z25259
|
| Min. Negotiated Rate |
$402.12 |
| Max. Negotiated Rate |
$692.53 |
| Rate for Payer: Aetna Medicare |
$407.37
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$451.20
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$451.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$468.48
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$448.11
|
| Rate for Payer: Cash Price |
$492.81
|
| Rate for Payer: Cash Price |
$492.81
|
| Rate for Payer: Coventry All Commercial |
$488.84
|
| Rate for Payer: Frontpath All Commercial |
$550.54
|
| Rate for Payer: Humana ChoiceCare |
$402.12
|
| Rate for Payer: Humana Medicare |
$407.37
|
| Rate for Payer: Lucent All Commercial |
$692.53
|
| Rate for Payer: Lutheran Preferred All Commercial |
$652.00
|
| Rate for Payer: PHCS All Commercial |
$596.14
|
| Rate for Payer: PHP All Commercial |
$691.53
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$407.37
|
| Rate for Payer: Signature Care EPO |
$527.00
|
| Rate for Payer: Signature Care PPO |
$527.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$611.00
|
| Rate for Payer: United Healthcare Commercial |
$411.35
|
| Rate for Payer: United Healthcare Medicare |
$407.37
|
|
|
PR MANIPULATN KNEE JT+ANESTHESIA
|
Professional
|
$279.06
|
|
|
Service Code
|
CPT 27570
|
| Hospital Charge Code |
z27570
|
| Min. Negotiated Rate |
$143.01 |
| Max. Negotiated Rate |
$243.12 |
| Rate for Payer: Aetna Medicare |
$143.01
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$196.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$196.00
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$164.46
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$157.31
|
| Rate for Payer: Cash Price |
$173.02
|
| Rate for Payer: Cash Price |
$173.02
|
| Rate for Payer: Coventry All Commercial |
$171.61
|
| Rate for Payer: Frontpath All Commercial |
$196.50
|
| Rate for Payer: Humana ChoiceCare |
$152.09
|
| Rate for Payer: Humana Medicare |
$143.01
|
| Rate for Payer: Lucent All Commercial |
$243.12
|
| Rate for Payer: Lutheran Preferred All Commercial |
$229.00
|
| Rate for Payer: PHCS All Commercial |
$209.30
|
| Rate for Payer: PHP All Commercial |
$242.77
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$143.01
|
| Rate for Payer: Signature Care EPO |
$205.70
|
| Rate for Payer: Signature Care PPO |
$205.70
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$215.00
|
| Rate for Payer: United Healthcare Commercial |
$156.98
|
| Rate for Payer: United Healthcare Medicare |
$143.01
|
|
|
PR MANIPULATN SHLDR JT W ANESTHESIA
|
Professional
|
$356.70
|
|
|
Service Code
|
CPT 23700
|
| Hospital Charge Code |
z23700
|
| Min. Negotiated Rate |
$182.81 |
| Max. Negotiated Rate |
$310.78 |
| Rate for Payer: Aetna Medicare |
$182.81
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$252.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$252.30
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$210.23
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$201.09
|
| Rate for Payer: Cash Price |
$221.15
|
| Rate for Payer: Cash Price |
$221.15
|
| Rate for Payer: Coventry All Commercial |
$219.37
|
| Rate for Payer: Frontpath All Commercial |
$253.67
|
| Rate for Payer: Humana ChoiceCare |
$204.62
|
| Rate for Payer: Humana Medicare |
$182.81
|
| Rate for Payer: Lucent All Commercial |
$310.78
|
| Rate for Payer: Lutheran Preferred All Commercial |
$293.00
|
| Rate for Payer: PHCS All Commercial |
$267.52
|
| Rate for Payer: PHP All Commercial |
$310.34
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$182.81
|
| Rate for Payer: Signature Care EPO |
$280.50
|
| Rate for Payer: Signature Care PPO |
$280.50
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$274.00
|
| Rate for Payer: United Healthcare Commercial |
$209.16
|
| Rate for Payer: United Healthcare Medicare |
$182.81
|
|
|
PR MANUAL PREP&INSJ I-ARTIC DRUG DELIVERY DEVICE
|
Professional
|
$263.80
|
|
|
Service Code
|
CPT 20704
|
| Hospital Charge Code |
z20704
|
| Min. Negotiated Rate |
$135.20 |
| Max. Negotiated Rate |
$229.84 |
| Rate for Payer: Aetna Medicare |
$135.20
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$135.72
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$135.72
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$155.48
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$148.72
|
| Rate for Payer: Cash Price |
$163.56
|
| Rate for Payer: Cash Price |
$163.56
|
| Rate for Payer: Coventry All Commercial |
$162.24
|
| Rate for Payer: Frontpath All Commercial |
$198.17
|
| Rate for Payer: Humana ChoiceCare |
$160.02
|
| Rate for Payer: Humana Medicare |
$135.20
|
| Rate for Payer: Lucent All Commercial |
$229.84
|
| Rate for Payer: Lutheran Preferred All Commercial |
$216.00
|
| Rate for Payer: PHCS All Commercial |
$197.85
|
| Rate for Payer: PHP All Commercial |
$184.66
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$135.20
|
| Rate for Payer: Signature Care EPO |
$197.12
|
| Rate for Payer: Signature Care PPO |
$197.12
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$203.00
|
| Rate for Payer: United Healthcare Commercial |
$177.78
|
| Rate for Payer: United Healthcare Medicare |
$135.20
|
|
|
PR MASTECTOMY FOR GYNECOMASTIA
|
Professional
|
$2,105.88
|
|
|
Service Code
|
CPT 19300
|
| Hospital Charge Code |
z19300
|
| Min. Negotiated Rate |
$309.02 |
| Max. Negotiated Rate |
$1,579.41 |
| Rate for Payer: Aetna Medicare |
$400.25
|
| Rate for Payer: Aetna Medicare |
$400.25
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$582.32
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$582.32
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$582.32
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$582.32
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$460.29
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$460.29
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$440.28
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$440.28
|
| Rate for Payer: Cash Price |
$652.82
|
| Rate for Payer: Cash Price |
$652.82
|
| Rate for Payer: Cash Price |
$1,305.65
|
| Rate for Payer: Cash Price |
$1,305.65
|
| Rate for Payer: Coventry All Commercial |
$480.30
|
| Rate for Payer: Coventry All Commercial |
$480.30
|
| Rate for Payer: Frontpath All Commercial |
$561.14
|
| Rate for Payer: Frontpath All Commercial |
$561.14
|
| Rate for Payer: Humana ChoiceCare |
$309.02
|
| Rate for Payer: Humana ChoiceCare |
$309.02
|
| Rate for Payer: Humana Medicare |
$400.25
|
| Rate for Payer: Humana Medicare |
$400.25
|
| Rate for Payer: Lucent All Commercial |
$680.42
|
| Rate for Payer: Lucent All Commercial |
$680.42
|
| Rate for Payer: Lutheran Preferred All Commercial |
$520.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$520.00
|
| Rate for Payer: PHCS All Commercial |
$1,579.41
|
| Rate for Payer: PHCS All Commercial |
$789.70
|
| Rate for Payer: PHP All Commercial |
$546.47
|
| Rate for Payer: PHP All Commercial |
$546.47
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$400.25
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$400.25
|
| Rate for Payer: Signature Care EPO |
$491.30
|
| Rate for Payer: Signature Care EPO |
$491.30
|
| Rate for Payer: Signature Care PPO |
$491.30
|
| Rate for Payer: Signature Care PPO |
$491.30
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$480.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$480.00
|
| Rate for Payer: United Healthcare Commercial |
$408.26
|
| Rate for Payer: United Healthcare Commercial |
$408.26
|
| Rate for Payer: United Healthcare Medicare |
$400.25
|
| Rate for Payer: United Healthcare Medicare |
$400.25
|
|
|
PR MASTECTOMY, PARTIAL
|
Professional
|
$1,179.88
|
|
|
Service Code
|
CPT 19301
|
| Hospital Charge Code |
z19301
|
| Min. Negotiated Rate |
$337.65 |
| Max. Negotiated Rate |
$1,028.24 |
| Rate for Payer: Aetna Medicare |
$604.85
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$490.65
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$490.65
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$695.58
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$665.34
|
| Rate for Payer: Cash Price |
$731.53
|
| Rate for Payer: Cash Price |
$731.53
|
| Rate for Payer: Coventry All Commercial |
$725.82
|
| Rate for Payer: Frontpath All Commercial |
$870.80
|
| Rate for Payer: Humana ChoiceCare |
$337.65
|
| Rate for Payer: Humana Medicare |
$604.85
|
| Rate for Payer: Lucent All Commercial |
$1,028.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$786.00
|
| Rate for Payer: PHCS All Commercial |
$884.91
|
| Rate for Payer: PHP All Commercial |
$825.92
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$604.85
|
| Rate for Payer: Signature Care EPO |
$527.06
|
| Rate for Payer: Signature Care PPO |
$527.06
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$726.00
|
| Rate for Payer: United Healthcare Commercial |
$655.51
|
| Rate for Payer: United Healthcare Medicare |
$604.85
|
|
|
PR MASTECTOMY,PARTIAL, WITH AXILLARY LYMPHADENECTOMY
|
Professional
|
$1,619.76
|
|
|
Service Code
|
CPT 19302
|
| Hospital Charge Code |
z19302
|
| Min. Negotiated Rate |
$718.67 |
| Max. Negotiated Rate |
$1,411.24 |
| Rate for Payer: Aetna Medicare |
$830.14
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$948.64
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$948.64
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$954.66
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$913.15
|
| Rate for Payer: Cash Price |
$1,004.25
|
| Rate for Payer: Cash Price |
$1,004.25
|
| Rate for Payer: Coventry All Commercial |
$996.17
|
| Rate for Payer: Frontpath All Commercial |
$1,196.61
|
| Rate for Payer: Humana ChoiceCare |
$718.67
|
| Rate for Payer: Humana Medicare |
$830.14
|
| Rate for Payer: Lucent All Commercial |
$1,411.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,079.00
|
| Rate for Payer: PHCS All Commercial |
$1,214.82
|
| Rate for Payer: PHP All Commercial |
$1,133.83
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$830.14
|
| Rate for Payer: Signature Care EPO |
$800.70
|
| Rate for Payer: Signature Care PPO |
$800.70
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$996.00
|
| Rate for Payer: United Healthcare Commercial |
$937.16
|
| Rate for Payer: United Healthcare Medicare |
$830.14
|
|
|
PR MASTECTOMY, SIMPLE, COMPLETE
|
Professional
|
$1,710.06
|
|
|
Service Code
|
CPT 19303
|
| Hospital Charge Code |
z19303
|
| Min. Negotiated Rate |
$743.11 |
| Max. Negotiated Rate |
$1,489.88 |
| Rate for Payer: Aetna Medicare |
$876.40
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$980.90
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$980.90
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,007.86
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$964.04
|
| Rate for Payer: Cash Price |
$1,060.24
|
| Rate for Payer: Cash Price |
$1,060.24
|
| Rate for Payer: Coventry All Commercial |
$1,051.68
|
| Rate for Payer: Frontpath All Commercial |
$1,264.21
|
| Rate for Payer: Humana ChoiceCare |
$743.11
|
| Rate for Payer: Humana Medicare |
$876.40
|
| Rate for Payer: Lucent All Commercial |
$1,489.88
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,139.00
|
| Rate for Payer: PHCS All Commercial |
$1,282.54
|
| Rate for Payer: PHP All Commercial |
$1,197.04
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$876.40
|
| Rate for Payer: Signature Care EPO |
$827.90
|
| Rate for Payer: Signature Care PPO |
$827.90
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,052.00
|
| Rate for Payer: United Healthcare Commercial |
$1,014.36
|
| Rate for Payer: United Healthcare Medicare |
$876.40
|
|
|
PR MASTOTOMY W/EXPLORATION/DRAINAGE ABSCESS DEEP
|
Professional
|
$850.44
|
|
|
Service Code
|
CPT 19020
|
| Hospital Charge Code |
z19020
|
| Min. Negotiated Rate |
$234.37 |
| Max. Negotiated Rate |
$637.83 |
| Rate for Payer: Aetna Medicare |
$289.21
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$540.23
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$540.23
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$332.59
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$318.13
|
| Rate for Payer: Cash Price |
$527.27
|
| Rate for Payer: Cash Price |
$527.27
|
| Rate for Payer: Coventry All Commercial |
$347.05
|
| Rate for Payer: Frontpath All Commercial |
$404.64
|
| Rate for Payer: Humana ChoiceCare |
$234.37
|
| Rate for Payer: Humana Medicare |
$289.21
|
| Rate for Payer: Lucent All Commercial |
$491.66
|
| Rate for Payer: Lutheran Preferred All Commercial |
$376.00
|
| Rate for Payer: PHCS All Commercial |
$637.83
|
| Rate for Payer: PHP All Commercial |
$395.02
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$289.21
|
| Rate for Payer: Signature Care EPO |
$389.30
|
| Rate for Payer: Signature Care PPO |
$389.30
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$347.00
|
| Rate for Payer: United Healthcare Commercial |
$303.26
|
| Rate for Payer: United Healthcare Medicare |
$289.21
|
|
|
PR MATERNITY CARE PROCEDURE UNLISTED
|
Professional
|
$636.16
|
|
|
Service Code
|
CPT 59899
|
| Hospital Charge Code |
z59899
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$636.16 |
| 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: Frontpath All Commercial |
$636.16
|
|
|
PR MD CERTIFICATION HHA PATIENT
|
Professional
|
$91.00
|
|
|
Service Code
|
CPT G0180
|
| Hospital Charge Code |
zG0180
|
| Min. Negotiated Rate |
$41.89 |
| Max. Negotiated Rate |
$83.78 |
| Rate for Payer: Aetna Medicare |
$49.28
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$56.67
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$54.21
|
| Rate for Payer: Cash Price |
$56.42
|
| Rate for Payer: Cash Price |
$56.42
|
| Rate for Payer: Coventry All Commercial |
$59.14
|
| Rate for Payer: Humana ChoiceCare |
$41.89
|
| Rate for Payer: Humana Medicare |
$49.28
|
| Rate for Payer: Lucent All Commercial |
$83.78
|
| Rate for Payer: PHCS All Commercial |
$68.25
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$49.28
|
| Rate for Payer: United Healthcare Commercial |
$61.23
|
| Rate for Payer: United Healthcare Medicare |
$49.28
|
|
|
PR MD RECERTIFICATION HHA PT
|
Professional
|
$76.00
|
|
|
Service Code
|
CPT G0179
|
| Hospital Charge Code |
zG0179
|
| Min. Negotiated Rate |
$32.93 |
| Max. Negotiated Rate |
$65.86 |
| Rate for Payer: Aetna Medicare |
$38.74
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$44.55
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$42.61
|
| Rate for Payer: Cash Price |
$47.12
|
| Rate for Payer: Cash Price |
$47.12
|
| Rate for Payer: Coventry All Commercial |
$46.49
|
| Rate for Payer: Humana ChoiceCare |
$32.93
|
| Rate for Payer: Humana Medicare |
$38.74
|
| Rate for Payer: Lucent All Commercial |
$65.86
|
| Rate for Payer: PHCS All Commercial |
$57.00
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$38.74
|
| Rate for Payer: United Healthcare Commercial |
$46.08
|
| Rate for Payer: United Healthcare Medicare |
$38.74
|
|
|
PR MD SERVICE REQUIRED FOR PMD
|
Professional
|
$60.00
|
|
|
Service Code
|
CPT G0372
|
| Hospital Charge Code |
zG0372
|
| Min. Negotiated Rate |
$7.13 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: Aetna Medicare |
$8.39
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$19.09
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$19.09
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$9.65
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$9.23
|
| Rate for Payer: Cash Price |
$37.20
|
| Rate for Payer: Cash Price |
$37.20
|
| Rate for Payer: Coventry All Commercial |
$10.07
|
| Rate for Payer: Humana ChoiceCare |
$7.13
|
| Rate for Payer: Humana Medicare |
$8.39
|
| Rate for Payer: Lucent All Commercial |
$14.26
|
| Rate for Payer: PHCS All Commercial |
$45.00
|
| Rate for Payer: PHP All Commercial |
$8.19
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$8.39
|
| Rate for Payer: Signature Care EPO |
$38.25
|
| Rate for Payer: Signature Care PPO |
$38.25
|
| Rate for Payer: United Healthcare Commercial |
$10.00
|
| Rate for Payer: United Healthcare Medicare |
$8.39
|
|
|
PR MEDROXYPROGESTERONE ACETATE
|
Professional
|
$0.52
|
|
|
Service Code
|
CPT J1050
|
| Hospital Charge Code |
zJ1050
|
| Min. Negotiated Rate |
$0.47 |
| Max. Negotiated Rate |
$0.52 |
| Rate for Payer: Humana ChoiceCare |
$0.47
|
| Rate for Payer: PHP All Commercial |
$0.52
|
| Rate for Payer: United Healthcare Commercial |
$0.51
|
|
|
PR MENACWYD/MENACWY-CRM CONJ VACC GRPS ACWY IM USE
|
Professional
|
$218.55
|
|
|
Service Code
|
CPT 90734
|
| Hospital Charge Code |
z90734
|
| Min. Negotiated Rate |
$127.47 |
| Max. Negotiated Rate |
$218.55 |
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$145.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$145.00
|
| Rate for Payer: Frontpath All Commercial |
$127.47
|
| Rate for Payer: Humana ChoiceCare |
$164.23
|
| Rate for Payer: Lutheran Preferred All Commercial |
$218.55
|
| Rate for Payer: PHP All Commercial |
$158.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$218.55
|
|
|
PR MENB-4C RECOMBNT PROT & OUTER MEMB VESIC VACC IM
|
Professional
|
$247.42
|
|
|
Service Code
|
CPT 90620
|
| Hospital Charge Code |
z90620
|
| Min. Negotiated Rate |
$188.32 |
| Max. Negotiated Rate |
$247.42 |
| Rate for Payer: Frontpath All Commercial |
$188.32
|
| Rate for Payer: Humana ChoiceCare |
$206.33
|
| Rate for Payer: PHP All Commercial |
$221.42
|
| Rate for Payer: United Healthcare Commercial |
$247.42
|
|
|
PR MENB-FHBP RECOMBNT LIPOPROTEIN VACC 2/3 DOSE IM
|
Professional
|
$215.48
|
|
|
Service Code
|
CPT 90621
|
| Hospital Charge Code |
z90621
|
| Min. Negotiated Rate |
$135.36 |
| Max. Negotiated Rate |
$215.48 |
| Rate for Payer: Frontpath All Commercial |
$135.36
|
| Rate for Payer: Humana ChoiceCare |
$172.35
|
| Rate for Payer: United Healthcare Commercial |
$215.48
|
|
