|
PR METHYLPREDNISOLONE 20 MG INJ
|
Professional
|
$6.82
|
|
|
Service Code
|
CPT J1020
|
| Hospital Charge Code |
zJ1020
|
| Min. Negotiated Rate |
$4.61 |
| Max. Negotiated Rate |
$6.82 |
| Rate for Payer: Humana ChoiceCare |
$4.61
|
| Rate for Payer: PHP All Commercial |
$6.82
|
|
|
PR METHYLPREDNISOLONE 40 MG INJ
|
Professional
|
$8.35
|
|
|
Service Code
|
CPT J1030
|
| Hospital Charge Code |
zJ1030
|
| Min. Negotiated Rate |
$8.06 |
| Max. Negotiated Rate |
$8.35 |
| Rate for Payer: Humana ChoiceCare |
$8.06
|
| Rate for Payer: PHP All Commercial |
$8.35
|
|
|
PR METHYLPREDNISOLONE 80 MG INJ
|
Professional
|
$13.81
|
|
|
Service Code
|
CPT J1040
|
| Hospital Charge Code |
zJ1040
|
| Min. Negotiated Rate |
$12.22 |
| Max. Negotiated Rate |
$13.81 |
| Rate for Payer: Humana ChoiceCare |
$12.22
|
| Rate for Payer: PHP All Commercial |
$13.81
|
|
|
PR MIRENA, 52 MG
|
Professional
|
$1,075.47
|
|
|
Service Code
|
CPT J7298
|
| Hospital Charge Code |
zJ7298
|
| Min. Negotiated Rate |
$1,007.27 |
| Max. Negotiated Rate |
$1,075.47 |
| Rate for Payer: Humana ChoiceCare |
$1,075.47
|
| Rate for Payer: PHP All Commercial |
$1,007.27
|
|
|
PR MMR VIRUS IMMUNIZATION, SUBCUT
|
Professional
|
$125.82
|
|
|
Service Code
|
CPT 90707
|
| Hospital Charge Code |
z90707
|
| Min. Negotiated Rate |
$88.00 |
| Max. Negotiated Rate |
$125.82 |
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$88.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$88.00
|
| Rate for Payer: Frontpath All Commercial |
$100.12
|
| Rate for Payer: Humana ChoiceCare |
$99.11
|
| Rate for Payer: Lutheran Preferred All Commercial |
$125.82
|
| Rate for Payer: PHP All Commercial |
$98.85
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$125.82
|
| Rate for Payer: United Healthcare Commercial |
$107.41
|
|
|
PR MOBILIZE SPLENIC FLEX
|
Professional
|
$213.44
|
|
|
Service Code
|
CPT 44139
|
| Hospital Charge Code |
z44139
|
| Min. Negotiated Rate |
$109.39 |
| Max. Negotiated Rate |
$186.76 |
| Rate for Payer: Aetna Medicare |
$109.39
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$164.60
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$164.60
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$125.80
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$120.33
|
| Rate for Payer: Cash Price |
$132.33
|
| Rate for Payer: Cash Price |
$132.33
|
| Rate for Payer: Coventry All Commercial |
$131.27
|
| Rate for Payer: Frontpath All Commercial |
$159.43
|
| Rate for Payer: Humana ChoiceCare |
$137.93
|
| Rate for Payer: Humana Medicare |
$109.39
|
| Rate for Payer: Lucent All Commercial |
$185.96
|
| Rate for Payer: Lutheran Preferred All Commercial |
$164.00
|
| Rate for Payer: PHCS All Commercial |
$160.08
|
| Rate for Payer: PHP All Commercial |
$186.76
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$109.39
|
| Rate for Payer: Signature Care EPO |
$174.25
|
| Rate for Payer: Signature Care PPO |
$174.25
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$153.00
|
| Rate for Payer: United Healthcare Commercial |
$134.59
|
| Rate for Payer: United Healthcare Medicare |
$109.39
|
|
|
PR MOD SED OTHER PHYS/QHP INITIAL 15 MINS 5/> YRS
|
Professional
|
$139.46
|
|
|
Service Code
|
CPT 99156
|
| Hospital Charge Code |
z99156
|
| Min. Negotiated Rate |
$71.47 |
| Max. Negotiated Rate |
$121.50 |
| Rate for Payer: Aetna Medicare |
$71.47
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$73.45
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$73.45
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$82.19
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$78.62
|
| Rate for Payer: Cash Price |
$86.47
|
| Rate for Payer: Cash Price |
$86.47
|
| Rate for Payer: Coventry All Commercial |
$85.76
|
| Rate for Payer: Frontpath All Commercial |
$79.61
|
| Rate for Payer: Humana ChoiceCare |
$88.58
|
| Rate for Payer: Humana Medicare |
$71.47
|
| Rate for Payer: Lucent All Commercial |
$121.50
|
| Rate for Payer: Lutheran Preferred All Commercial |
$93.00
|
| Rate for Payer: PHCS All Commercial |
$104.60
|
| Rate for Payer: PHP All Commercial |
$83.67
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$71.47
|
| Rate for Payer: Signature Care EPO |
$96.14
|
| Rate for Payer: Signature Care PPO |
$96.14
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$86.00
|
| Rate for Payer: United Healthcare Commercial |
$92.93
|
| Rate for Payer: United Healthcare Medicare |
$71.47
|
|
|
PR MOD SED SAME PHYS/QHP EACH ADDL 15 MINS
|
Professional
|
$19.30
|
|
|
Service Code
|
CPT 99153
|
| Hospital Charge Code |
z99153
|
| Min. Negotiated Rate |
$9.89 |
| Max. Negotiated Rate |
$16.81 |
| Rate for Payer: Aetna Medicare |
$9.89
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$10.08
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$10.08
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$11.37
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$10.88
|
| Rate for Payer: Cash Price |
$11.97
|
| Rate for Payer: Cash Price |
$11.97
|
| Rate for Payer: Coventry All Commercial |
$11.87
|
| Rate for Payer: Frontpath All Commercial |
$10.65
|
| Rate for Payer: Humana ChoiceCare |
$12.16
|
| Rate for Payer: Humana Medicare |
$9.89
|
| Rate for Payer: Lucent All Commercial |
$16.81
|
| Rate for Payer: Lutheran Preferred All Commercial |
$13.00
|
| Rate for Payer: PHCS All Commercial |
$14.48
|
| Rate for Payer: PHP All Commercial |
$11.58
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$9.89
|
| Rate for Payer: Signature Care EPO |
$13.28
|
| Rate for Payer: Signature Care PPO |
$13.28
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$12.00
|
| Rate for Payer: United Healthcare Commercial |
$12.69
|
| Rate for Payer: United Healthcare Medicare |
$9.89
|
|
|
PR MOD SED SAME PHYS/QHP INITIAL 15 MINS 5/> YRS
|
Professional
|
$90.68
|
|
|
Service Code
|
CPT 99152
|
| Hospital Charge Code |
z99152
|
| Min. Negotiated Rate |
$11.59 |
| Max. Negotiated Rate |
$68.01 |
| Rate for Payer: Aetna Medicare |
$11.59
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$48.29
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$48.29
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$13.33
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$12.75
|
| Rate for Payer: Cash Price |
$56.22
|
| Rate for Payer: Cash Price |
$56.22
|
| Rate for Payer: Coventry All Commercial |
$13.91
|
| Rate for Payer: Frontpath All Commercial |
$13.20
|
| Rate for Payer: Humana ChoiceCare |
$14.44
|
| Rate for Payer: Humana Medicare |
$11.59
|
| Rate for Payer: Lucent All Commercial |
$19.70
|
| Rate for Payer: Lutheran Preferred All Commercial |
$15.00
|
| Rate for Payer: PHCS All Commercial |
$68.01
|
| Rate for Payer: PHP All Commercial |
$13.56
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$11.59
|
| Rate for Payer: Signature Care EPO |
$63.62
|
| Rate for Payer: Signature Care PPO |
$63.62
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$14.00
|
| Rate for Payer: United Healthcare Commercial |
$15.13
|
| Rate for Payer: United Healthcare Medicare |
$11.59
|
|
|
PR MONAURAL HEARING AID REPAIR/MODIFYING
|
Professional
|
$150.00
|
|
|
Service Code
|
CPT V5014
|
| Hospital Charge Code |
zV5014M
|
| Min. Negotiated Rate |
$73.21 |
| Max. Negotiated Rate |
$150.00 |
| Rate for Payer: Cash Price |
$93.00
|
| Rate for Payer: Cash Price |
$93.00
|
| Rate for Payer: Humana ChoiceCare |
$73.21
|
| Rate for Payer: PHCS All Commercial |
$112.50
|
| Rate for Payer: Signature Care EPO |
$150.00
|
| Rate for Payer: Signature Care PPO |
$150.00
|
| Rate for Payer: United Healthcare Commercial |
$125.40
|
|
|
PR MULTIP FAMILY-GROUP PSYCHOTHERAPY
|
Professional
|
$69.16
|
|
|
Service Code
|
CPT 90849
|
| Hospital Charge Code |
z90849
|
| Min. Negotiated Rate |
$25.05 |
| Max. Negotiated Rate |
$51.87 |
| Rate for Payer: Aetna Medicare |
$27.72
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$33.35
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$33.35
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$31.88
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$30.49
|
| Rate for Payer: Cash Price |
$42.88
|
| Rate for Payer: Cash Price |
$42.88
|
| Rate for Payer: Coventry All Commercial |
$33.26
|
| Rate for Payer: Frontpath All Commercial |
$30.59
|
| Rate for Payer: Humana ChoiceCare |
$25.05
|
| Rate for Payer: Humana Medicare |
$27.72
|
| Rate for Payer: Lucent All Commercial |
$47.12
|
| Rate for Payer: Lutheran Preferred All Commercial |
$36.00
|
| Rate for Payer: PHCS All Commercial |
$51.87
|
| Rate for Payer: PHP All Commercial |
$29.48
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$27.72
|
| Rate for Payer: Signature Care EPO |
$35.70
|
| Rate for Payer: Signature Care PPO |
$35.70
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$33.00
|
| Rate for Payer: United Healthcare Commercial |
$36.25
|
| Rate for Payer: United Healthcare Medicare |
$27.72
|
|
|
PR MULTIPLE SLEEP LATENCY TEST
|
Professional
|
$755.10
|
|
|
Service Code
|
CPT 95805
|
| Hospital Charge Code |
z95805
|
| Min. Negotiated Rate |
$386.98 |
| Max. Negotiated Rate |
$877.86 |
| Rate for Payer: Aetna Medicare |
$386.98
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$393.58
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$393.58
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$445.03
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$425.68
|
| Rate for Payer: Cash Price |
$468.16
|
| Rate for Payer: Cash Price |
$468.16
|
| Rate for Payer: Coventry All Commercial |
$464.38
|
| Rate for Payer: Frontpath All Commercial |
$433.82
|
| Rate for Payer: Humana ChoiceCare |
$877.86
|
| Rate for Payer: Humana Medicare |
$386.98
|
| Rate for Payer: Lucent All Commercial |
$657.87
|
| Rate for Payer: Lutheran Preferred All Commercial |
$503.00
|
| Rate for Payer: PHCS All Commercial |
$566.32
|
| Rate for Payer: PHP All Commercial |
$622.95
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$386.98
|
| Rate for Payer: Signature Care EPO |
$656.85
|
| Rate for Payer: Signature Care PPO |
$656.85
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$464.00
|
| Rate for Payer: United Healthcare Commercial |
$484.58
|
| Rate for Payer: United Healthcare Medicare |
$386.98
|
|
|
PR MUSCLE-SKIN FLAP,TRUNK
|
Professional
|
$2,693.22
|
|
|
Service Code
|
CPT 15734
|
| Hospital Charge Code |
z15734
|
| Min. Negotiated Rate |
$1,142.28 |
| Max. Negotiated Rate |
$2,346.20 |
| Rate for Payer: Aetna Medicare |
$1,380.12
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,659.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,659.30
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,587.14
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,518.13
|
| Rate for Payer: Cash Price |
$1,669.80
|
| Rate for Payer: Cash Price |
$1,669.80
|
| Rate for Payer: Coventry All Commercial |
$1,656.14
|
| Rate for Payer: Frontpath All Commercial |
$1,958.12
|
| Rate for Payer: Humana ChoiceCare |
$1,142.28
|
| Rate for Payer: Humana Medicare |
$1,380.12
|
| Rate for Payer: Lucent All Commercial |
$2,346.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,794.00
|
| Rate for Payer: PHCS All Commercial |
$2,019.92
|
| Rate for Payer: PHP All Commercial |
$1,885.25
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,380.12
|
| Rate for Payer: Signature Care EPO |
$1,477.30
|
| Rate for Payer: Signature Care PPO |
$1,477.30
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,656.00
|
| Rate for Payer: United Healthcare Commercial |
$1,458.96
|
| Rate for Payer: United Healthcare Medicare |
$1,380.12
|
|
|
PR MYOMECTOMY 1-4,W/TOT 250GMS/<,ABD APPRCH
|
Professional
|
$1,703.26
|
|
|
Service Code
|
CPT 58140
|
| Hospital Charge Code |
z58140
|
| Min. Negotiated Rate |
$872.92 |
| Max. Negotiated Rate |
$1,483.96 |
| Rate for Payer: Aetna Medicare |
$872.92
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,150.79
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,150.79
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,003.86
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$960.21
|
| Rate for Payer: Cash Price |
$1,056.02
|
| Rate for Payer: Cash Price |
$1,056.02
|
| Rate for Payer: Coventry All Commercial |
$1,047.50
|
| Rate for Payer: Frontpath All Commercial |
$1,227.04
|
| Rate for Payer: Humana ChoiceCare |
$967.50
|
| Rate for Payer: Humana Medicare |
$872.92
|
| Rate for Payer: Lucent All Commercial |
$1,483.96
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,222.00
|
| Rate for Payer: PHCS All Commercial |
$1,277.44
|
| Rate for Payer: PHP All Commercial |
$1,124.15
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$872.92
|
| Rate for Payer: Signature Care EPO |
$1,087.15
|
| Rate for Payer: Signature Care PPO |
$1,087.15
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,135.00
|
| Rate for Payer: United Healthcare Commercial |
$1,029.24
|
| Rate for Payer: United Healthcare Medicare |
$872.92
|
|
|
PR MYOMECTOMY 5/>,TOT>250 GMS,ABD APPRCH
|
Professional
|
$2,109.42
|
|
|
Service Code
|
CPT 58146
|
| Hospital Charge Code |
z58146
|
| Min. Negotiated Rate |
$1,081.08 |
| Max. Negotiated Rate |
$1,837.84 |
| Rate for Payer: Aetna Medicare |
$1,081.08
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,484.13
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,484.13
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,243.24
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,189.19
|
| Rate for Payer: Cash Price |
$1,307.84
|
| Rate for Payer: Cash Price |
$1,307.84
|
| Rate for Payer: Coventry All Commercial |
$1,297.30
|
| Rate for Payer: Frontpath All Commercial |
$1,519.75
|
| Rate for Payer: Humana ChoiceCare |
$1,248.74
|
| Rate for Payer: Humana Medicare |
$1,081.08
|
| Rate for Payer: Lucent All Commercial |
$1,837.84
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,514.00
|
| Rate for Payer: PHCS All Commercial |
$1,582.06
|
| Rate for Payer: PHP All Commercial |
$1,392.22
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,081.08
|
| Rate for Payer: Signature Care EPO |
$1,380.40
|
| Rate for Payer: Signature Care PPO |
$1,380.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,405.00
|
| Rate for Payer: United Healthcare Commercial |
$1,311.88
|
| Rate for Payer: United Healthcare Medicare |
$1,081.08
|
|
|
PR MYRINGOPLASTY
|
Professional
|
$1,365.42
|
|
|
Service Code
|
CPT 69620
|
| Hospital Charge Code |
z69620
|
| Min. Negotiated Rate |
$466.08 |
| Max. Negotiated Rate |
$1,024.06 |
| Rate for Payer: Aetna Medicare |
$466.08
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$666.56
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$666.56
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$535.99
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$512.69
|
| Rate for Payer: Cash Price |
$846.56
|
| Rate for Payer: Cash Price |
$846.56
|
| Rate for Payer: Coventry All Commercial |
$559.30
|
| Rate for Payer: Frontpath All Commercial |
$636.12
|
| Rate for Payer: Humana ChoiceCare |
$495.29
|
| Rate for Payer: Humana Medicare |
$466.08
|
| Rate for Payer: Lucent All Commercial |
$792.34
|
| Rate for Payer: Lutheran Preferred All Commercial |
$746.00
|
| Rate for Payer: PHCS All Commercial |
$1,024.06
|
| Rate for Payer: PHP All Commercial |
$591.12
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$466.08
|
| Rate for Payer: Signature Care EPO |
$598.83
|
| Rate for Payer: Signature Care PPO |
$598.83
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$699.00
|
| Rate for Payer: United Healthcare Commercial |
$528.66
|
| Rate for Payer: United Healthcare Medicare |
$466.08
|
|
|
PR NARCOSYNTHESIS
|
Professional
|
$304.20
|
|
|
Service Code
|
CPT 90865
|
| Hospital Charge Code |
z90865
|
| Min. Negotiated Rate |
$114.10 |
| Max. Negotiated Rate |
$228.15 |
| Rate for Payer: Aetna Medicare |
$118.85
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$160.65
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$160.65
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$136.68
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$130.74
|
| Rate for Payer: Cash Price |
$188.60
|
| Rate for Payer: Cash Price |
$188.60
|
| Rate for Payer: Coventry All Commercial |
$142.62
|
| Rate for Payer: Frontpath All Commercial |
$137.02
|
| Rate for Payer: Humana ChoiceCare |
$114.10
|
| Rate for Payer: Humana Medicare |
$118.85
|
| Rate for Payer: Lucent All Commercial |
$202.04
|
| Rate for Payer: Lutheran Preferred All Commercial |
$155.00
|
| Rate for Payer: PHCS All Commercial |
$228.15
|
| Rate for Payer: PHP All Commercial |
$126.39
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$118.85
|
| Rate for Payer: Signature Care EPO |
$181.90
|
| Rate for Payer: Signature Care PPO |
$181.90
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$143.00
|
| Rate for Payer: United Healthcare Commercial |
$161.49
|
| Rate for Payer: United Healthcare Medicare |
$118.85
|
|
|
PR NASAL ENDOSCOPY,DX
|
Professional
|
$344.92
|
|
|
Service Code
|
CPT 31231
|
| Hospital Charge Code |
z31231
|
| Min. Negotiated Rate |
$60.39 |
| Max. Negotiated Rate |
$258.69 |
| Rate for Payer: Aetna Medicare |
$60.39
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$224.03
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$224.03
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$69.45
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$66.43
|
| Rate for Payer: Cash Price |
$213.85
|
| Rate for Payer: Cash Price |
$213.85
|
| Rate for Payer: Coventry All Commercial |
$72.47
|
| Rate for Payer: Frontpath All Commercial |
$82.25
|
| Rate for Payer: Humana ChoiceCare |
$89.17
|
| Rate for Payer: Humana Medicare |
$60.39
|
| Rate for Payer: Lucent All Commercial |
$102.66
|
| Rate for Payer: Lutheran Preferred All Commercial |
$97.00
|
| Rate for Payer: PHCS All Commercial |
$258.69
|
| Rate for Payer: PHP All Commercial |
$82.48
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$60.39
|
| Rate for Payer: Signature Care EPO |
$237.15
|
| Rate for Payer: Signature Care PPO |
$237.15
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$91.00
|
| Rate for Payer: United Healthcare Commercial |
$85.55
|
| Rate for Payer: United Healthcare Medicare |
$60.39
|
|
|
PR NASAL/SINUS NDSC SURG W/BX POLYPC/DBRDMT SPX
|
Professional
|
$469.66
|
|
|
Service Code
|
CPT 31237
|
| Hospital Charge Code |
z31237
|
| Min. Negotiated Rate |
$149.32 |
| Max. Negotiated Rate |
$409.82 |
| Rate for Payer: Aetna Medicare |
$149.32
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$300.60
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$300.60
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$171.72
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$164.25
|
| Rate for Payer: Cash Price |
$291.19
|
| Rate for Payer: Cash Price |
$291.19
|
| Rate for Payer: Coventry All Commercial |
$179.18
|
| Rate for Payer: Frontpath All Commercial |
$205.41
|
| Rate for Payer: Humana ChoiceCare |
$221.68
|
| Rate for Payer: Humana Medicare |
$149.32
|
| Rate for Payer: Lucent All Commercial |
$253.84
|
| Rate for Payer: Lutheran Preferred All Commercial |
$239.00
|
| Rate for Payer: PHCS All Commercial |
$352.24
|
| Rate for Payer: PHP All Commercial |
$203.95
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$149.32
|
| Rate for Payer: Signature Care EPO |
$409.82
|
| Rate for Payer: Signature Care PPO |
$409.82
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$224.00
|
| Rate for Payer: United Healthcare Commercial |
$206.48
|
| Rate for Payer: United Healthcare Medicare |
$149.32
|
|
|
PR NASAL/SINUS NDSC SURG W/CONTROL NASAL HEMORRHAGE
|
Professional
|
$458.76
|
|
|
Service Code
|
CPT 31238
|
| Hospital Charge Code |
z31238
|
| Min. Negotiated Rate |
$156.08 |
| Max. Negotiated Rate |
$400.61 |
| Rate for Payer: Aetna Medicare |
$156.08
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$331.60
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$331.60
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$179.49
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$171.69
|
| Rate for Payer: Cash Price |
$284.43
|
| Rate for Payer: Cash Price |
$284.43
|
| Rate for Payer: Coventry All Commercial |
$187.30
|
| Rate for Payer: Frontpath All Commercial |
$215.16
|
| Rate for Payer: Humana ChoiceCare |
$243.13
|
| Rate for Payer: Humana Medicare |
$156.08
|
| Rate for Payer: Lucent All Commercial |
$265.34
|
| Rate for Payer: Lutheran Preferred All Commercial |
$250.00
|
| Rate for Payer: PHCS All Commercial |
$344.07
|
| Rate for Payer: PHP All Commercial |
$213.18
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$156.08
|
| Rate for Payer: Signature Care EPO |
$400.61
|
| Rate for Payer: Signature Care PPO |
$400.61
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$234.00
|
| Rate for Payer: United Healthcare Commercial |
$224.20
|
| Rate for Payer: United Healthcare Medicare |
$156.08
|
|
|
PR NASOPHARYNGOSCOPY
|
Professional
|
$215.68
|
|
|
Service Code
|
CPT 92511
|
| Hospital Charge Code |
z92511
|
| Min. Negotiated Rate |
$35.82 |
| Max. Negotiated Rate |
$165.75 |
| Rate for Payer: Aetna Medicare |
$35.82
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$115.91
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$115.91
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$41.19
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$39.40
|
| Rate for Payer: Cash Price |
$133.72
|
| Rate for Payer: Cash Price |
$133.72
|
| Rate for Payer: Coventry All Commercial |
$42.98
|
| Rate for Payer: Frontpath All Commercial |
$40.52
|
| Rate for Payer: Humana ChoiceCare |
$69.16
|
| Rate for Payer: Humana Medicare |
$35.82
|
| Rate for Payer: Lucent All Commercial |
$60.89
|
| Rate for Payer: Lutheran Preferred All Commercial |
$47.00
|
| Rate for Payer: PHCS All Commercial |
$161.76
|
| Rate for Payer: PHP All Commercial |
$50.68
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$35.82
|
| Rate for Payer: Signature Care EPO |
$165.75
|
| Rate for Payer: Signature Care PPO |
$165.75
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$43.00
|
| Rate for Payer: United Healthcare Commercial |
$67.65
|
| Rate for Payer: United Healthcare Medicare |
$35.82
|
|
|
PR NDSC EVAL INTSTINAL POUCH W/BX SINGLE/MULTIPLE
|
Professional
|
$568.36
|
|
|
Service Code
|
CPT 44386
|
| Hospital Charge Code |
z44386
|
| Min. Negotiated Rate |
$82.91 |
| Max. Negotiated Rate |
$426.27 |
| Rate for Payer: Aetna Medicare |
$82.91
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$95.35
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$91.20
|
| Rate for Payer: Cash Price |
$352.38
|
| Rate for Payer: Cash Price |
$352.38
|
| Rate for Payer: Coventry All Commercial |
$99.49
|
| Rate for Payer: Frontpath All Commercial |
$115.12
|
| Rate for Payer: Humana ChoiceCare |
$136.29
|
| Rate for Payer: Humana Medicare |
$82.91
|
| Rate for Payer: Lucent All Commercial |
$140.95
|
| Rate for Payer: PHCS All Commercial |
$426.27
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$82.91
|
| Rate for Payer: United Healthcare Commercial |
$142.78
|
| Rate for Payer: United Healthcare Medicare |
$82.91
|
|
|
PR NEEDLE BIOPSY LIVER,W OTHR PROC
|
Professional
|
$182.84
|
|
|
Service Code
|
CPT 47001
|
| Hospital Charge Code |
z47001
|
| Min. Negotiated Rate |
$93.71 |
| Max. Negotiated Rate |
$159.99 |
| Rate for Payer: Aetna Medicare |
$93.71
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$150.10
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$150.10
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$107.77
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$103.08
|
| Rate for Payer: Cash Price |
$113.36
|
| Rate for Payer: Cash Price |
$113.36
|
| Rate for Payer: Coventry All Commercial |
$112.45
|
| Rate for Payer: Frontpath All Commercial |
$136.79
|
| Rate for Payer: Humana ChoiceCare |
$117.84
|
| Rate for Payer: Humana Medicare |
$93.71
|
| Rate for Payer: Lucent All Commercial |
$159.31
|
| Rate for Payer: Lutheran Preferred All Commercial |
$141.00
|
| Rate for Payer: PHCS All Commercial |
$137.13
|
| Rate for Payer: PHP All Commercial |
$159.99
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$93.71
|
| Rate for Payer: Signature Care EPO |
$148.75
|
| Rate for Payer: Signature Care PPO |
$148.75
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$131.00
|
| Rate for Payer: United Healthcare Commercial |
$115.18
|
| Rate for Payer: United Healthcare Medicare |
$93.71
|
|
|
PR NEG PRESSURE WOUND THERAPY NON DME <= 50 SQ CM
|
Professional
|
$660.58
|
|
|
Service Code
|
CPT 97607
|
| Hospital Charge Code |
z97607
|
| Min. Negotiated Rate |
$13.45 |
| Max. Negotiated Rate |
$495.44 |
| Rate for Payer: Aetna Medicare |
$20.27
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$23.31
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$22.30
|
| Rate for Payer: Cash Price |
$409.56
|
| Rate for Payer: Cash Price |
$409.56
|
| Rate for Payer: Coventry All Commercial |
$24.32
|
| Rate for Payer: Frontpath All Commercial |
$24.85
|
| Rate for Payer: Humana ChoiceCare |
$13.45
|
| Rate for Payer: Humana Medicare |
$20.27
|
| Rate for Payer: Lucent All Commercial |
$34.46
|
| Rate for Payer: PHCS All Commercial |
$495.44
|
| Rate for Payer: PHP All Commercial |
$19.77
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$20.27
|
| Rate for Payer: Signature Care EPO |
$303.83
|
| Rate for Payer: Signature Care PPO |
$303.83
|
| Rate for Payer: United Healthcare Commercial |
$186.82
|
| Rate for Payer: United Healthcare Medicare |
$20.27
|
|
|
PR NERVOUS SYSTEM SURGERY UNLISTED
|
Professional
|
$1,181.54
|
|
|
Service Code
|
CPT 64999
|
| Hospital Charge Code |
z64999
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$1,004.31 |
| 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 |
$732.55
|
| Rate for Payer: Cash Price |
$732.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,004.31
|
| Rate for Payer: PHCS All Commercial |
$886.16
|
| Rate for Payer: Signature Care EPO |
$753.24
|
| Rate for Payer: Signature Care PPO |
$753.24
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$708.92
|
|
