|
PR PARTIAL REMOVAL OF OVARY(S)
|
Professional
|
$1,308.02
|
|
|
Service Code
|
CPT 58920
|
| Hospital Charge Code |
z58920
|
| Min. Negotiated Rate |
$670.36 |
| Max. Negotiated Rate |
$1,139.61 |
| Rate for Payer: Aetna Medicare |
$670.36
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$898.70
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$898.70
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$770.91
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$737.40
|
| Rate for Payer: Cash Price |
$810.97
|
| Rate for Payer: Cash Price |
$810.97
|
| Rate for Payer: Coventry All Commercial |
$804.43
|
| Rate for Payer: Frontpath All Commercial |
$938.76
|
| Rate for Payer: Humana ChoiceCare |
$755.02
|
| Rate for Payer: Humana Medicare |
$670.36
|
| Rate for Payer: Lucent All Commercial |
$1,139.61
|
| Rate for Payer: Lutheran Preferred All Commercial |
$939.00
|
| Rate for Payer: PHCS All Commercial |
$981.02
|
| Rate for Payer: PHP All Commercial |
$863.29
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$670.36
|
| Rate for Payer: Signature Care EPO |
$836.40
|
| Rate for Payer: Signature Care PPO |
$836.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$871.00
|
| Rate for Payer: United Healthcare Commercial |
$789.38
|
| Rate for Payer: United Healthcare Medicare |
$670.36
|
|
|
PR PARTIAL REMOVAL/REPAIR,ACROMION
|
Professional
|
$1,127.78
|
|
|
Service Code
|
CPT 23130
|
| Hospital Charge Code |
z23130
|
| Min. Negotiated Rate |
$577.99 |
| Max. Negotiated Rate |
$982.58 |
| Rate for Payer: Aetna Medicare |
$577.99
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$769.60
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$769.60
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$664.69
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$635.79
|
| Rate for Payer: Cash Price |
$699.22
|
| Rate for Payer: Cash Price |
$699.22
|
| Rate for Payer: Coventry All Commercial |
$693.59
|
| Rate for Payer: Frontpath All Commercial |
$802.49
|
| Rate for Payer: Humana ChoiceCare |
$636.73
|
| Rate for Payer: Humana Medicare |
$577.99
|
| Rate for Payer: Lucent All Commercial |
$982.58
|
| Rate for Payer: Lutheran Preferred All Commercial |
$925.00
|
| Rate for Payer: PHCS All Commercial |
$845.84
|
| Rate for Payer: PHP All Commercial |
$981.17
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$577.99
|
| Rate for Payer: Signature Care EPO |
$852.55
|
| Rate for Payer: Signature Care PPO |
$852.55
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$867.00
|
| Rate for Payer: United Healthcare Commercial |
$646.04
|
| Rate for Payer: United Healthcare Medicare |
$577.99
|
|
|
PR PART PALMAR FASCIEC,OPEN 1 DIGIT
|
Professional
|
$1,529.46
|
|
|
Service Code
|
CPT 26123
|
| Hospital Charge Code |
z26123
|
| Min. Negotiated Rate |
$783.60 |
| Max. Negotiated Rate |
$1,332.54 |
| Rate for Payer: Aetna Medicare |
$783.85
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,022.40
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,022.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$901.43
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$862.24
|
| Rate for Payer: Cash Price |
$948.27
|
| Rate for Payer: Cash Price |
$948.27
|
| Rate for Payer: Coventry All Commercial |
$940.62
|
| Rate for Payer: Frontpath All Commercial |
$1,080.05
|
| Rate for Payer: Humana ChoiceCare |
$783.60
|
| Rate for Payer: Humana Medicare |
$783.85
|
| Rate for Payer: Lucent All Commercial |
$1,332.54
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,254.00
|
| Rate for Payer: PHCS All Commercial |
$1,147.10
|
| Rate for Payer: PHP All Commercial |
$1,330.63
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$783.85
|
| Rate for Payer: Signature Care EPO |
$1,044.65
|
| Rate for Payer: Signature Care PPO |
$1,044.65
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,176.00
|
| Rate for Payer: United Healthcare Commercial |
$870.46
|
| Rate for Payer: United Healthcare Medicare |
$783.85
|
|
|
PR PART REMOVAL COLON W ANASTOMOSIS
|
Professional
|
$2,390.10
|
|
|
Service Code
|
CPT 44140
|
| Hospital Charge Code |
z44140
|
| Min. Negotiated Rate |
$1,224.62 |
| Max. Negotiated Rate |
$2,091.34 |
| Rate for Payer: Aetna Medicare |
$1,224.62
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,444.33
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,444.33
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,408.31
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,347.08
|
| Rate for Payer: Cash Price |
$1,481.86
|
| Rate for Payer: Cash Price |
$1,481.86
|
| Rate for Payer: Coventry All Commercial |
$1,469.54
|
| Rate for Payer: Frontpath All Commercial |
$1,771.50
|
| Rate for Payer: Humana ChoiceCare |
$1,361.00
|
| Rate for Payer: Humana Medicare |
$1,224.62
|
| Rate for Payer: Lucent All Commercial |
$2,081.85
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,837.00
|
| Rate for Payer: PHCS All Commercial |
$1,792.58
|
| Rate for Payer: PHP All Commercial |
$2,091.34
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,224.62
|
| Rate for Payer: Signature Care EPO |
$1,722.95
|
| Rate for Payer: Signature Care PPO |
$1,722.95
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,714.00
|
| Rate for Payer: United Healthcare Commercial |
$1,437.54
|
| Rate for Payer: United Healthcare Medicare |
$1,224.62
|
|
|
PR PART REMOVAL COLON W COLOPROC,COLOST
|
Professional
|
$3,744.76
|
|
|
Service Code
|
CPT 44146
|
| Hospital Charge Code |
z44146
|
| Min. Negotiated Rate |
$1,844.51 |
| Max. Negotiated Rate |
$3,276.66 |
| Rate for Payer: Aetna Medicare |
$1,919.35
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,960.90
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,960.90
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,207.25
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,111.28
|
| Rate for Payer: Cash Price |
$2,321.75
|
| Rate for Payer: Cash Price |
$2,321.75
|
| Rate for Payer: Coventry All Commercial |
$2,303.22
|
| Rate for Payer: Frontpath All Commercial |
$2,756.58
|
| Rate for Payer: Humana ChoiceCare |
$1,844.51
|
| Rate for Payer: Humana Medicare |
$1,919.35
|
| Rate for Payer: Lucent All Commercial |
$3,262.90
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,879.00
|
| Rate for Payer: PHCS All Commercial |
$2,808.57
|
| Rate for Payer: PHP All Commercial |
$3,276.66
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,919.35
|
| Rate for Payer: Signature Care EPO |
$2,323.90
|
| Rate for Payer: Signature Care PPO |
$2,323.90
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,687.00
|
| Rate for Payer: United Healthcare Commercial |
$2,241.24
|
| Rate for Payer: United Healthcare Medicare |
$1,919.35
|
|
|
PR PART REMOVAL COLON W COLOPROCTOSTOMY
|
Professional
|
$2,946.50
|
|
|
Service Code
|
CPT 44145
|
| Hospital Charge Code |
z44145
|
| Min. Negotiated Rate |
$1,510.24 |
| Max. Negotiated Rate |
$2,578.18 |
| Rate for Payer: Aetna Medicare |
$1,510.24
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,788.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,788.30
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,736.78
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,661.26
|
| Rate for Payer: Cash Price |
$1,826.83
|
| Rate for Payer: Cash Price |
$1,826.83
|
| Rate for Payer: Coventry All Commercial |
$1,812.29
|
| Rate for Payer: Frontpath All Commercial |
$2,169.32
|
| Rate for Payer: Humana ChoiceCare |
$1,706.66
|
| Rate for Payer: Humana Medicare |
$1,510.24
|
| Rate for Payer: Lucent All Commercial |
$2,567.41
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,265.00
|
| Rate for Payer: PHCS All Commercial |
$2,209.88
|
| Rate for Payer: PHP All Commercial |
$2,578.18
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,510.24
|
| Rate for Payer: Signature Care EPO |
$2,149.65
|
| Rate for Payer: Signature Care PPO |
$2,149.65
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,114.00
|
| Rate for Payer: United Healthcare Commercial |
$1,792.78
|
| Rate for Payer: United Healthcare Medicare |
$1,510.24
|
|
|
PR PART REMOVAL COLON W END COLOSTOMY
|
Professional
|
$2,943.28
|
|
|
Service Code
|
CPT 44143
|
| Hospital Charge Code |
z44143
|
| Min. Negotiated Rate |
$1,508.43 |
| Max. Negotiated Rate |
$2,575.37 |
| Rate for Payer: Aetna Medicare |
$1,508.43
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,637.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,637.30
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,734.69
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,659.27
|
| Rate for Payer: Cash Price |
$1,824.83
|
| Rate for Payer: Cash Price |
$1,824.83
|
| Rate for Payer: Coventry All Commercial |
$1,810.12
|
| Rate for Payer: Frontpath All Commercial |
$2,184.27
|
| Rate for Payer: Humana ChoiceCare |
$1,541.84
|
| Rate for Payer: Humana Medicare |
$1,508.43
|
| Rate for Payer: Lucent All Commercial |
$2,564.33
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,263.00
|
| Rate for Payer: PHCS All Commercial |
$2,207.46
|
| Rate for Payer: PHP All Commercial |
$2,575.37
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,508.43
|
| Rate for Payer: Signature Care EPO |
$1,944.80
|
| Rate for Payer: Signature Care PPO |
$1,944.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,112.00
|
| Rate for Payer: United Healthcare Commercial |
$1,771.68
|
| Rate for Payer: United Healthcare Medicare |
$1,508.43
|
|
|
PR PART REMV BONE,DISTAL PHALANX
|
Professional
|
$808.70
|
|
|
Service Code
|
CPT 26236
|
| Hospital Charge Code |
z26236
|
| Min. Negotiated Rate |
$414.45 |
| Max. Negotiated Rate |
$704.56 |
| Rate for Payer: Aetna Medicare |
$414.45
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$599.90
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$599.90
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$476.62
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$455.90
|
| Rate for Payer: Cash Price |
$501.39
|
| Rate for Payer: Cash Price |
$501.39
|
| Rate for Payer: Coventry All Commercial |
$497.34
|
| Rate for Payer: Frontpath All Commercial |
$571.61
|
| Rate for Payer: Humana ChoiceCare |
$458.46
|
| Rate for Payer: Humana Medicare |
$414.45
|
| Rate for Payer: Lucent All Commercial |
$704.56
|
| Rate for Payer: Lutheran Preferred All Commercial |
$663.00
|
| Rate for Payer: PHCS All Commercial |
$606.52
|
| Rate for Payer: PHP All Commercial |
$703.56
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$414.45
|
| Rate for Payer: Signature Care EPO |
$612.85
|
| Rate for Payer: Signature Care PPO |
$612.85
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$622.00
|
| Rate for Payer: United Healthcare Commercial |
$464.70
|
| Rate for Payer: United Healthcare Medicare |
$414.45
|
|
|
PR PART REMV BONE METATARSAL HEAD,EA
|
Professional
|
$1,098.54
|
|
|
Service Code
|
CPT 28288
|
| Hospital Charge Code |
z28288
|
| Min. Negotiated Rate |
$408.64 |
| Max. Negotiated Rate |
$823.90 |
| Rate for Payer: Aetna Medicare |
$408.64
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$492.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$492.00
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$469.94
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$449.50
|
| Rate for Payer: Cash Price |
$681.09
|
| Rate for Payer: Cash Price |
$681.09
|
| Rate for Payer: Coventry All Commercial |
$490.37
|
| Rate for Payer: Frontpath All Commercial |
$553.54
|
| Rate for Payer: Humana ChoiceCare |
$412.29
|
| Rate for Payer: Humana Medicare |
$408.64
|
| Rate for Payer: Lucent All Commercial |
$694.69
|
| Rate for Payer: Lutheran Preferred All Commercial |
$654.00
|
| Rate for Payer: PHCS All Commercial |
$823.90
|
| Rate for Payer: PHP All Commercial |
$693.70
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$408.64
|
| Rate for Payer: Signature Care EPO |
$653.65
|
| Rate for Payer: Signature Care PPO |
$653.65
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$613.00
|
| Rate for Payer: United Healthcare Commercial |
$473.18
|
| Rate for Payer: United Healthcare Medicare |
$408.64
|
|
|
PR PART REMV PHALANX OF TOE
|
Professional
|
$867.88
|
|
|
Service Code
|
CPT 28124
|
| Hospital Charge Code |
z28124
|
| Min. Negotiated Rate |
$315.13 |
| Max. Negotiated Rate |
$650.91 |
| Rate for Payer: Aetna Medicare |
$315.13
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$455.01
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$455.01
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$362.40
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$346.64
|
| Rate for Payer: Cash Price |
$538.09
|
| Rate for Payer: Cash Price |
$538.09
|
| Rate for Payer: Coventry All Commercial |
$378.16
|
| Rate for Payer: Frontpath All Commercial |
$424.45
|
| Rate for Payer: Humana ChoiceCare |
$365.75
|
| Rate for Payer: Humana Medicare |
$315.13
|
| Rate for Payer: Lucent All Commercial |
$535.72
|
| Rate for Payer: Lutheran Preferred All Commercial |
$504.00
|
| Rate for Payer: PHCS All Commercial |
$650.91
|
| Rate for Payer: PHP All Commercial |
$534.95
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$315.13
|
| Rate for Payer: Signature Care EPO |
$624.75
|
| Rate for Payer: Signature Care PPO |
$624.75
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$473.00
|
| Rate for Payer: United Healthcare Commercial |
$379.83
|
| Rate for Payer: United Healthcare Medicare |
$315.13
|
|
|
PR PART SIMPLE REMV VULVA
|
Professional
|
$1,071.46
|
|
|
Service Code
|
CPT 56620
|
| Hospital Charge Code |
z56620
|
| Min. Negotiated Rate |
$541.00 |
| Max. Negotiated Rate |
$933.50 |
| Rate for Payer: Aetna Medicare |
$549.12
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$644.17
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$644.17
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$631.49
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$604.03
|
| Rate for Payer: Cash Price |
$664.31
|
| Rate for Payer: Cash Price |
$664.31
|
| Rate for Payer: Coventry All Commercial |
$658.94
|
| Rate for Payer: Frontpath All Commercial |
$758.77
|
| Rate for Payer: Humana ChoiceCare |
$541.00
|
| Rate for Payer: Humana Medicare |
$549.12
|
| Rate for Payer: Lucent All Commercial |
$933.50
|
| Rate for Payer: Lutheran Preferred All Commercial |
$769.00
|
| Rate for Payer: PHCS All Commercial |
$803.60
|
| Rate for Payer: PHP All Commercial |
$707.16
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$549.12
|
| Rate for Payer: Signature Care EPO |
$611.15
|
| Rate for Payer: Signature Care PPO |
$611.15
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$714.00
|
| Rate for Payer: United Healthcare Commercial |
$551.84
|
| Rate for Payer: United Healthcare Medicare |
$549.12
|
|
|
PR PCV13 VACCINE FOR INTRAMUSCULAR USE
|
Professional
|
$317.00
|
|
|
Service Code
|
CPT 90670
|
| Hospital Charge Code |
z90670
|
| Min. Negotiated Rate |
$241.38 |
| Max. Negotiated Rate |
$317.00 |
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$241.38
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$241.38
|
| Rate for Payer: Frontpath All Commercial |
$265.52
|
| Rate for Payer: Humana ChoiceCare |
$257.99
|
| Rate for Payer: Lutheran Preferred All Commercial |
$317.00
|
| Rate for Payer: PHP All Commercial |
$249.07
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$317.00
|
| Rate for Payer: United Healthcare Commercial |
$275.81
|
|
|
PR PCV20 VACCINE FOR INTRAMUSCULAR USE
|
Professional
|
$309.37
|
|
|
Service Code
|
CPT 90677
|
| Hospital Charge Code |
z90677
|
| Min. Negotiated Rate |
$273.90 |
| Max. Negotiated Rate |
$309.37 |
| Rate for Payer: Frontpath All Commercial |
$291.21
|
| Rate for Payer: Humana ChoiceCare |
$283.72
|
| Rate for Payer: PHP All Commercial |
$273.90
|
| Rate for Payer: United Healthcare Commercial |
$309.37
|
|
|
PR PELVIC EXAMINATION
|
Professional
|
$41.74
|
|
|
Service Code
|
CPT 99459
|
| Hospital Charge Code |
z99459
|
| Min. Negotiated Rate |
$31.30 |
| Max. Negotiated Rate |
$31.30 |
| Rate for Payer: Cash Price |
$25.88
|
| Rate for Payer: PHCS All Commercial |
$31.30
|
|
|
PR PELVIC EXAMINATION W ANESTH
|
Professional
|
$191.66
|
|
|
Service Code
|
CPT 57410
|
| Hospital Charge Code |
z57410
|
| Min. Negotiated Rate |
$98.22 |
| Max. Negotiated Rate |
$193.35 |
| Rate for Payer: Aetna Medicare |
$98.22
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$193.35
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$193.35
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$112.95
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$108.04
|
| Rate for Payer: Cash Price |
$118.83
|
| Rate for Payer: Cash Price |
$118.83
|
| Rate for Payer: Coventry All Commercial |
$117.86
|
| Rate for Payer: Frontpath All Commercial |
$136.79
|
| Rate for Payer: Humana ChoiceCare |
$116.82
|
| Rate for Payer: Humana Medicare |
$98.22
|
| Rate for Payer: Lucent All Commercial |
$166.97
|
| Rate for Payer: Lutheran Preferred All Commercial |
$138.00
|
| Rate for Payer: PHCS All Commercial |
$143.74
|
| Rate for Payer: PHP All Commercial |
$126.49
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$98.22
|
| Rate for Payer: Signature Care EPO |
$168.05
|
| Rate for Payer: Signature Care PPO |
$168.05
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$128.00
|
| Rate for Payer: United Healthcare Commercial |
$120.59
|
| Rate for Payer: United Healthcare Medicare |
$98.22
|
|
|
PR PELVIS/HIP JOINT SURGERY UNLISTED
|
Professional
|
$1,312.41
|
|
|
Service Code
|
CPT 27299
|
| Hospital Charge Code |
z27299
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$1,115.55 |
| 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 |
$813.69
|
| Rate for Payer: Cash Price |
$813.69
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,115.55
|
| Rate for Payer: PHCS All Commercial |
$984.31
|
| Rate for Payer: Signature Care EPO |
$836.66
|
| Rate for Payer: Signature Care PPO |
$836.66
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$787.45
|
|
|
PR PENICILLIN G POTASSIUM INJ
|
Professional
|
$1.46
|
|
|
Service Code
|
CPT J2540
|
| Hospital Charge Code |
zJ2540
|
| Min. Negotiated Rate |
$0.78 |
| Max. Negotiated Rate |
$1.46 |
| Rate for Payer: Humana ChoiceCare |
$0.78
|
| Rate for Payer: PHP All Commercial |
$1.46
|
| Rate for Payer: United Healthcare Commercial |
$0.78
|
|
|
PR PERCUTANEOUS TESTS W/ALLERGENIC EXTRACTS
|
Professional
|
$7.00
|
|
|
Service Code
|
CPT 95004
|
| Hospital Charge Code |
z95004
|
| Min. Negotiated Rate |
$3.59 |
| Max. Negotiated Rate |
$6.51 |
| Rate for Payer: Aetna Medicare |
$3.59
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$6.07
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$6.07
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$4.13
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3.95
|
| Rate for Payer: Cash Price |
$4.34
|
| Rate for Payer: Cash Price |
$4.34
|
| Rate for Payer: Coventry All Commercial |
$4.31
|
| Rate for Payer: Frontpath All Commercial |
$4.70
|
| Rate for Payer: Humana ChoiceCare |
$4.76
|
| Rate for Payer: Humana Medicare |
$3.59
|
| Rate for Payer: Lucent All Commercial |
$6.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5.00
|
| Rate for Payer: PHCS All Commercial |
$5.25
|
| Rate for Payer: PHP All Commercial |
$4.02
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$3.59
|
| Rate for Payer: Signature Care EPO |
$4.97
|
| Rate for Payer: Signature Care PPO |
$4.97
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4.00
|
| Rate for Payer: United Healthcare Commercial |
$6.51
|
| Rate for Payer: United Healthcare Medicare |
$3.59
|
|
|
PR PERCUT FIX CARPOMETACAR DISLOC,NON-THUMB
|
Professional
|
$938.70
|
|
|
Service Code
|
CPT 26676
|
| Hospital Charge Code |
z26676
|
| Min. Negotiated Rate |
$481.08 |
| Max. Negotiated Rate |
$817.84 |
| Rate for Payer: Aetna Medicare |
$481.08
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$585.80
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$585.80
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$553.24
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$529.19
|
| Rate for Payer: Cash Price |
$581.99
|
| Rate for Payer: Cash Price |
$581.99
|
| Rate for Payer: Coventry All Commercial |
$577.30
|
| Rate for Payer: Frontpath All Commercial |
$656.73
|
| Rate for Payer: Humana ChoiceCare |
$523.28
|
| Rate for Payer: Humana Medicare |
$481.08
|
| Rate for Payer: Lucent All Commercial |
$817.84
|
| Rate for Payer: Lutheran Preferred All Commercial |
$770.00
|
| Rate for Payer: PHCS All Commercial |
$704.02
|
| Rate for Payer: PHP All Commercial |
$816.66
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$481.08
|
| Rate for Payer: Signature Care EPO |
$708.05
|
| Rate for Payer: Signature Care PPO |
$708.05
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$722.00
|
| Rate for Payer: United Healthcare Commercial |
$522.05
|
| Rate for Payer: United Healthcare Medicare |
$481.08
|
|
|
PR PERCUT FIX DISTAL FEMUR
|
Professional
|
$1,234.82
|
|
|
Service Code
|
CPT 27509
|
| Hospital Charge Code |
z27509
|
| Min. Negotiated Rate |
$632.84 |
| Max. Negotiated Rate |
$1,075.83 |
| Rate for Payer: Aetna Medicare |
$632.84
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$691.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$691.30
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$727.77
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$696.12
|
| Rate for Payer: Cash Price |
$765.59
|
| Rate for Payer: Cash Price |
$765.59
|
| Rate for Payer: Coventry All Commercial |
$759.41
|
| Rate for Payer: Frontpath All Commercial |
$878.28
|
| Rate for Payer: Humana ChoiceCare |
$677.32
|
| Rate for Payer: Humana Medicare |
$632.84
|
| Rate for Payer: Lucent All Commercial |
$1,075.83
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,013.00
|
| Rate for Payer: PHCS All Commercial |
$926.12
|
| Rate for Payer: PHP All Commercial |
$1,074.29
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$632.84
|
| Rate for Payer: Signature Care EPO |
$905.25
|
| Rate for Payer: Signature Care PPO |
$905.25
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$949.00
|
| Rate for Payer: United Healthcare Commercial |
$688.29
|
| Rate for Payer: United Healthcare Medicare |
$632.84
|
|
|
PR PERCUT FIX HUM SUPRACONDYLAR FX
|
Professional
|
$1,439.44
|
|
|
Service Code
|
CPT 24538
|
| Hospital Charge Code |
z24538
|
| Min. Negotiated Rate |
$737.87 |
| Max. Negotiated Rate |
$1,254.38 |
| Rate for Payer: Aetna Medicare |
$737.87
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$906.10
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$906.10
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$848.55
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$811.66
|
| Rate for Payer: Cash Price |
$892.45
|
| Rate for Payer: Cash Price |
$892.45
|
| Rate for Payer: Coventry All Commercial |
$885.44
|
| Rate for Payer: Frontpath All Commercial |
$1,025.60
|
| Rate for Payer: Humana ChoiceCare |
$787.78
|
| Rate for Payer: Humana Medicare |
$737.87
|
| Rate for Payer: Lucent All Commercial |
$1,254.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,181.00
|
| Rate for Payer: PHCS All Commercial |
$1,079.58
|
| Rate for Payer: PHP All Commercial |
$1,252.31
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$737.87
|
| Rate for Payer: Signature Care EPO |
$1,052.30
|
| Rate for Payer: Signature Care PPO |
$1,052.30
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,107.00
|
| Rate for Payer: United Healthcare Commercial |
$798.78
|
| Rate for Payer: United Healthcare Medicare |
$737.87
|
|
|
PR PERCUT FIX PROX/NECK FEMUR FX
|
Professional
|
$1,641.14
|
|
|
Service Code
|
CPT 27235
|
| Hospital Charge Code |
z27235
|
| Min. Negotiated Rate |
$841.08 |
| Max. Negotiated Rate |
$1,429.84 |
| Rate for Payer: Aetna Medicare |
$841.08
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,202.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,202.00
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$967.24
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$925.19
|
| Rate for Payer: Cash Price |
$1,017.51
|
| Rate for Payer: Cash Price |
$1,017.51
|
| Rate for Payer: Coventry All Commercial |
$1,009.30
|
| Rate for Payer: Frontpath All Commercial |
$1,179.89
|
| Rate for Payer: Humana ChoiceCare |
$945.15
|
| Rate for Payer: Humana Medicare |
$841.08
|
| Rate for Payer: Lucent All Commercial |
$1,429.84
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,346.00
|
| Rate for Payer: PHCS All Commercial |
$1,230.86
|
| Rate for Payer: PHP All Commercial |
$1,427.79
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$841.08
|
| Rate for Payer: Signature Care EPO |
$1,263.10
|
| Rate for Payer: Signature Care PPO |
$1,263.10
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,262.00
|
| Rate for Payer: United Healthcare Commercial |
$993.44
|
| Rate for Payer: United Healthcare Medicare |
$841.08
|
|
|
PR PERCUT RX DIST FINGR FX
|
Professional
|
$783.12
|
|
|
Service Code
|
CPT 26756
|
| Hospital Charge Code |
z26756
|
| Min. Negotiated Rate |
$401.35 |
| Max. Negotiated Rate |
$682.30 |
| Rate for Payer: Aetna Medicare |
$401.35
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$432.40
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$432.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$461.55
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$441.48
|
| Rate for Payer: Cash Price |
$485.53
|
| Rate for Payer: Cash Price |
$485.53
|
| Rate for Payer: Coventry All Commercial |
$481.62
|
| Rate for Payer: Frontpath All Commercial |
$547.88
|
| Rate for Payer: Humana ChoiceCare |
$431.78
|
| Rate for Payer: Humana Medicare |
$401.35
|
| Rate for Payer: Lucent All Commercial |
$682.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$642.00
|
| Rate for Payer: PHCS All Commercial |
$587.34
|
| Rate for Payer: PHP All Commercial |
$681.31
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$401.35
|
| Rate for Payer: Signature Care EPO |
$595.85
|
| Rate for Payer: Signature Care PPO |
$595.85
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$602.00
|
| Rate for Payer: United Healthcare Commercial |
$430.90
|
| Rate for Payer: United Healthcare Medicare |
$401.35
|
|
|
PR PERCUT RX I-P JT,TOE DISLOC
|
Professional
|
$327.34
|
|
|
Service Code
|
CPT 28666
|
| Hospital Charge Code |
z28666
|
| Min. Negotiated Rate |
$167.76 |
| Max. Negotiated Rate |
$288.78 |
| Rate for Payer: Aetna Medicare |
$167.76
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$238.88
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$238.88
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$192.92
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$184.54
|
| Rate for Payer: Cash Price |
$202.95
|
| Rate for Payer: Cash Price |
$202.95
|
| Rate for Payer: Coventry All Commercial |
$201.31
|
| Rate for Payer: Frontpath All Commercial |
$228.18
|
| Rate for Payer: Humana ChoiceCare |
$226.76
|
| Rate for Payer: Humana Medicare |
$167.76
|
| Rate for Payer: Lucent All Commercial |
$285.19
|
| Rate for Payer: Lutheran Preferred All Commercial |
$268.00
|
| Rate for Payer: PHCS All Commercial |
$245.50
|
| Rate for Payer: PHP All Commercial |
$284.78
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$167.76
|
| Rate for Payer: Signature Care EPO |
$288.78
|
| Rate for Payer: Signature Care PPO |
$288.78
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$252.00
|
| Rate for Payer: United Healthcare Commercial |
$214.31
|
| Rate for Payer: United Healthcare Medicare |
$167.76
|
|
|
PR PERCUT RX PROX/MID FING SHFT FX
|
Professional
|
$873.20
|
|
|
Service Code
|
CPT 26727
|
| Hospital Charge Code |
z26727
|
| Min. Negotiated Rate |
$447.51 |
| Max. Negotiated Rate |
$760.77 |
| Rate for Payer: Aetna Medicare |
$447.51
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$499.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$499.00
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$514.64
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$492.26
|
| Rate for Payer: Cash Price |
$541.38
|
| Rate for Payer: Cash Price |
$541.38
|
| Rate for Payer: Coventry All Commercial |
$537.01
|
| Rate for Payer: Frontpath All Commercial |
$612.27
|
| Rate for Payer: Humana ChoiceCare |
$491.10
|
| Rate for Payer: Humana Medicare |
$447.51
|
| Rate for Payer: Lucent All Commercial |
$760.77
|
| Rate for Payer: Lutheran Preferred All Commercial |
$716.00
|
| Rate for Payer: PHCS All Commercial |
$654.90
|
| Rate for Payer: PHP All Commercial |
$759.68
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$447.51
|
| Rate for Payer: Signature Care EPO |
$668.10
|
| Rate for Payer: Signature Care PPO |
$668.10
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$671.00
|
| Rate for Payer: United Healthcare Commercial |
$489.66
|
| Rate for Payer: United Healthcare Medicare |
$447.51
|
|
