|
PR PUNCTURE ASPIRATION CYST BREAST EACH ADDL CYST
|
Professional
|
$48.30
|
|
|
Service Code
|
CPT 19001
|
| Hospital Charge Code |
z19001
|
| Min. Negotiated Rate |
$19.51 |
| Max. Negotiated Rate |
$43.03 |
| Rate for Payer: Aetna Medicare |
$19.51
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$36.93
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$36.93
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$22.44
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$21.46
|
| Rate for Payer: Cash Price |
$29.95
|
| Rate for Payer: Cash Price |
$29.95
|
| Rate for Payer: Coventry All Commercial |
$23.41
|
| Rate for Payer: Frontpath All Commercial |
$27.52
|
| Rate for Payer: Humana ChoiceCare |
$21.38
|
| Rate for Payer: Humana Medicare |
$19.51
|
| Rate for Payer: Lucent All Commercial |
$33.17
|
| Rate for Payer: Lutheran Preferred All Commercial |
$25.00
|
| Rate for Payer: PHCS All Commercial |
$36.22
|
| Rate for Payer: PHP All Commercial |
$26.64
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$19.51
|
| Rate for Payer: Signature Care EPO |
$43.03
|
| Rate for Payer: Signature Care PPO |
$43.03
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$23.00
|
| Rate for Payer: United Healthcare Commercial |
$26.23
|
| Rate for Payer: United Healthcare Medicare |
$19.51
|
|
|
PR PUNCTURE ASPIRATION CYST OF BREAST
|
Professional
|
$186.10
|
|
|
Service Code
|
CPT 19000
|
| Hospital Charge Code |
z19000
|
| Min. Negotiated Rate |
$39.81 |
| Max. Negotiated Rate |
$143.88 |
| Rate for Payer: Aetna Medicare |
$39.81
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$143.88
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$143.88
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$45.78
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$43.79
|
| Rate for Payer: Cash Price |
$115.38
|
| Rate for Payer: Cash Price |
$115.38
|
| Rate for Payer: Coventry All Commercial |
$47.77
|
| Rate for Payer: Frontpath All Commercial |
$55.44
|
| Rate for Payer: Humana ChoiceCare |
$43.80
|
| Rate for Payer: Humana Medicare |
$39.81
|
| Rate for Payer: Lucent All Commercial |
$67.68
|
| Rate for Payer: Lutheran Preferred All Commercial |
$52.00
|
| Rate for Payer: PHCS All Commercial |
$139.58
|
| Rate for Payer: PHP All Commercial |
$54.37
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$39.81
|
| Rate for Payer: Signature Care EPO |
$114.75
|
| Rate for Payer: Signature Care PPO |
$114.75
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$48.00
|
| Rate for Payer: United Healthcare Commercial |
$52.45
|
| Rate for Payer: United Healthcare Medicare |
$39.81
|
|
|
PR PURAPLY 1 SQ CM
|
Professional
|
$71.23
|
|
|
Service Code
|
CPT Q4195
|
| Hospital Charge Code |
zQ4195
|
| Min. Negotiated Rate |
$71.23 |
| Max. Negotiated Rate |
$71.23 |
| Rate for Payer: Humana ChoiceCare |
$71.23
|
| Rate for Payer: United Healthcare Commercial |
$71.23
|
|
|
PR PURAPLY AM 1 SQ CM
|
Professional
|
$109.76
|
|
|
Service Code
|
CPT Q4196
|
| Hospital Charge Code |
zQ4196
|
| Min. Negotiated Rate |
$109.76 |
| Max. Negotiated Rate |
$109.76 |
| Rate for Payer: Humana ChoiceCare |
$109.76
|
|
|
PR PURAPLY XT 1 SQ CM
|
Professional
|
$178.34
|
|
|
Service Code
|
CPT Q4197
|
| Hospital Charge Code |
zQ4197
|
| Min. Negotiated Rate |
$178.34 |
| Max. Negotiated Rate |
$178.34 |
| Rate for Payer: Humana ChoiceCare |
$178.34
|
|
|
PR PURE TONE AUDIOMETRY, AIR
|
Professional
|
$63.56
|
|
|
Service Code
|
CPT 92552
|
| Hospital Charge Code |
z92552
|
| Min. Negotiated Rate |
$17.50 |
| Max. Negotiated Rate |
$55.39 |
| Rate for Payer: Aetna Medicare |
$32.58
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$17.50
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$17.50
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$37.47
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$35.84
|
| Rate for Payer: Cash Price |
$39.41
|
| Rate for Payer: Cash Price |
$39.41
|
| Rate for Payer: Coventry All Commercial |
$39.10
|
| Rate for Payer: Frontpath All Commercial |
$34.47
|
| Rate for Payer: Humana ChoiceCare |
$18.45
|
| Rate for Payer: Humana Medicare |
$32.58
|
| Rate for Payer: Lucent All Commercial |
$55.39
|
| Rate for Payer: Lutheran Preferred All Commercial |
$42.00
|
| Rate for Payer: PHCS All Commercial |
$47.67
|
| Rate for Payer: PHP All Commercial |
$46.08
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$32.58
|
| Rate for Payer: Signature Care EPO |
$26.08
|
| Rate for Payer: Signature Care PPO |
$26.08
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$39.00
|
| Rate for Payer: United Healthcare Commercial |
$23.84
|
| Rate for Payer: United Healthcare Medicare |
$32.58
|
|
|
PR PURE TONE HEARING TEST, AIR
|
Professional
|
$21.40
|
|
|
Service Code
|
CPT 92551
|
| Hospital Charge Code |
z92551
|
| Min. Negotiated Rate |
$11.54 |
| Max. Negotiated Rate |
$18.70 |
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$13.15
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$13.15
|
| Rate for Payer: Cash Price |
$13.27
|
| Rate for Payer: Cash Price |
$13.27
|
| Rate for Payer: Frontpath All Commercial |
$11.54
|
| Rate for Payer: Humana ChoiceCare |
$11.84
|
| Rate for Payer: Lutheran Preferred All Commercial |
$14.00
|
| Rate for Payer: PHCS All Commercial |
$16.05
|
| Rate for Payer: PHP All Commercial |
$15.51
|
| Rate for Payer: Signature Care EPO |
$18.70
|
| Rate for Payer: Signature Care PPO |
$18.70
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$13.00
|
| Rate for Payer: United Healthcare Commercial |
$11.86
|
|
|
PR RECMPL WND HEAD,FAC,HAND 1.1-2.5 CM
|
Professional
|
$712.22
|
|
|
Service Code
|
CPT 13131
|
| Hospital Charge Code |
z13131
|
| Min. Negotiated Rate |
$225.79 |
| Max. Negotiated Rate |
$534.16 |
| Rate for Payer: Aetna Medicare |
$225.79
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$259.66
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$248.37
|
| Rate for Payer: Cash Price |
$441.58
|
| Rate for Payer: Cash Price |
$441.58
|
| Rate for Payer: Coventry All Commercial |
$270.95
|
| Rate for Payer: Frontpath All Commercial |
$308.00
|
| Rate for Payer: Humana ChoiceCare |
$239.91
|
| Rate for Payer: Humana Medicare |
$225.79
|
| Rate for Payer: Lucent All Commercial |
$383.84
|
| Rate for Payer: PHCS All Commercial |
$534.16
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$225.79
|
| Rate for Payer: United Healthcare Commercial |
$298.36
|
| Rate for Payer: United Healthcare Medicare |
$225.79
|
|
|
PR RECMPL WND HEAD,FAC,HAND 2.6-7.5 CM
|
Professional
|
$865.22
|
|
|
Service Code
|
CPT 13132
|
| Hospital Charge Code |
z13132
|
| Min. Negotiated Rate |
$283.21 |
| Max. Negotiated Rate |
$648.92 |
| Rate for Payer: Aetna Medicare |
$283.21
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$516.40
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$516.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$325.69
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$311.53
|
| Rate for Payer: Cash Price |
$536.44
|
| Rate for Payer: Cash Price |
$536.44
|
| Rate for Payer: Coventry All Commercial |
$339.85
|
| Rate for Payer: Frontpath All Commercial |
$385.63
|
| Rate for Payer: Humana ChoiceCare |
$373.58
|
| Rate for Payer: Humana Medicare |
$283.21
|
| Rate for Payer: Lucent All Commercial |
$481.46
|
| Rate for Payer: Lutheran Preferred All Commercial |
$368.00
|
| Rate for Payer: PHCS All Commercial |
$648.92
|
| Rate for Payer: PHP All Commercial |
$386.82
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$283.21
|
| Rate for Payer: Signature Care EPO |
$436.90
|
| Rate for Payer: Signature Care PPO |
$436.90
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$340.00
|
| Rate for Payer: United Healthcare Commercial |
$503.16
|
| Rate for Payer: United Healthcare Medicare |
$283.21
|
|
|
PR RECMPL WND LID,NOS,EAR 2.5-7.5 CM
|
Professional
|
$912.02
|
|
|
Service Code
|
CPT 13152
|
| Hospital Charge Code |
z13152
|
| Min. Negotiated Rate |
$313.36 |
| Max. Negotiated Rate |
$684.02 |
| Rate for Payer: Aetna Medicare |
$313.36
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$577.80
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$577.80
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$360.36
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$344.70
|
| Rate for Payer: Cash Price |
$565.45
|
| Rate for Payer: Cash Price |
$565.45
|
| Rate for Payer: Coventry All Commercial |
$376.03
|
| Rate for Payer: Frontpath All Commercial |
$427.99
|
| Rate for Payer: Humana ChoiceCare |
$385.18
|
| Rate for Payer: Humana Medicare |
$313.36
|
| Rate for Payer: Lucent All Commercial |
$532.71
|
| Rate for Payer: Lutheran Preferred All Commercial |
$407.00
|
| Rate for Payer: PHCS All Commercial |
$684.02
|
| Rate for Payer: PHP All Commercial |
$428.01
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$313.36
|
| Rate for Payer: Signature Care EPO |
$508.30
|
| Rate for Payer: Signature Care PPO |
$508.30
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$376.00
|
| Rate for Payer: United Healthcare Commercial |
$465.90
|
| Rate for Payer: United Healthcare Medicare |
$313.36
|
|
|
PR RECMPL WND SCALP,EXTR 2.6-7.5 CM
|
Professional
|
$780.68
|
|
|
Service Code
|
CPT 13121
|
| Hospital Charge Code |
z13121
|
| Min. Negotiated Rate |
$240.80 |
| Max. Negotiated Rate |
$585.51 |
| Rate for Payer: Aetna Medicare |
$240.80
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$371.40
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$371.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$276.92
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$264.88
|
| Rate for Payer: Cash Price |
$484.02
|
| Rate for Payer: Cash Price |
$484.02
|
| Rate for Payer: Coventry All Commercial |
$288.96
|
| Rate for Payer: Frontpath All Commercial |
$327.13
|
| Rate for Payer: Humana ChoiceCare |
$263.99
|
| Rate for Payer: Humana Medicare |
$240.80
|
| Rate for Payer: Lucent All Commercial |
$409.36
|
| Rate for Payer: Lutheran Preferred All Commercial |
$313.00
|
| Rate for Payer: PHCS All Commercial |
$585.51
|
| Rate for Payer: PHP All Commercial |
$328.90
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$240.80
|
| Rate for Payer: Signature Care EPO |
$342.87
|
| Rate for Payer: Signature Care PPO |
$342.87
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$289.00
|
| Rate for Payer: United Healthcare Commercial |
$348.58
|
| Rate for Payer: United Healthcare Medicare |
$240.80
|
|
|
PR RECMPL WND TRUNK 2.6-7.5 CM
|
Professional
|
$728.60
|
|
|
Service Code
|
CPT 13101
|
| Hospital Charge Code |
z13101
|
| Min. Negotiated Rate |
$231.09 |
| Max. Negotiated Rate |
$546.45 |
| Rate for Payer: Aetna Medicare |
$231.09
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$265.75
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$254.20
|
| Rate for Payer: Cash Price |
$451.73
|
| Rate for Payer: Cash Price |
$451.73
|
| Rate for Payer: Coventry All Commercial |
$277.31
|
| Rate for Payer: Frontpath All Commercial |
$314.74
|
| Rate for Payer: Humana ChoiceCare |
$244.84
|
| Rate for Payer: Humana Medicare |
$231.09
|
| Rate for Payer: Lucent All Commercial |
$392.85
|
| Rate for Payer: PHCS All Commercial |
$546.45
|
| Rate for Payer: PHP All Commercial |
$315.64
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$231.09
|
| Rate for Payer: Signature Care EPO |
$320.21
|
| Rate for Payer: Signature Care PPO |
$320.21
|
| Rate for Payer: United Healthcare Commercial |
$307.53
|
| Rate for Payer: United Healthcare Medicare |
$231.09
|
|
|
PR RECONSTR TOTAL SHOULDER IMPLANT
|
Professional
|
$2,609.08
|
|
|
Service Code
|
CPT 23472
|
| Hospital Charge Code |
z23472
|
| Min. Negotiated Rate |
$1,336.84 |
| Max. Negotiated Rate |
$2,272.63 |
| Rate for Payer: Aetna Medicare |
$1,336.84
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,673.90
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,673.90
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,537.37
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,470.52
|
| Rate for Payer: Cash Price |
$1,617.63
|
| Rate for Payer: Cash Price |
$1,617.63
|
| Rate for Payer: Coventry All Commercial |
$1,604.21
|
| Rate for Payer: Frontpath All Commercial |
$1,881.57
|
| Rate for Payer: Humana ChoiceCare |
$1,561.10
|
| Rate for Payer: Humana Medicare |
$1,336.84
|
| Rate for Payer: Lucent All Commercial |
$2,272.63
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,139.00
|
| Rate for Payer: PHCS All Commercial |
$1,956.81
|
| Rate for Payer: PHP All Commercial |
$2,269.91
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,336.84
|
| Rate for Payer: Signature Care EPO |
$2,063.80
|
| Rate for Payer: Signature Care PPO |
$2,063.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,005.00
|
| Rate for Payer: United Healthcare Commercial |
$1,656.36
|
| Rate for Payer: United Healthcare Medicare |
$1,336.84
|
|
|
PR RECONSTRUC OF NAIL BED
|
Professional
|
$342.04
|
|
|
Service Code
|
CPT 11760
|
| Hospital Charge Code |
z11760
|
| Min. Negotiated Rate |
$103.68 |
| Max. Negotiated Rate |
$256.53 |
| Rate for Payer: Aetna Medicare |
$103.68
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$220.56
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$220.56
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$119.23
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$114.05
|
| Rate for Payer: Cash Price |
$212.06
|
| Rate for Payer: Cash Price |
$212.06
|
| Rate for Payer: Coventry All Commercial |
$124.42
|
| Rate for Payer: Frontpath All Commercial |
$142.32
|
| Rate for Payer: Humana ChoiceCare |
$124.81
|
| Rate for Payer: Humana Medicare |
$103.68
|
| Rate for Payer: Lucent All Commercial |
$176.26
|
| Rate for Payer: Lutheran Preferred All Commercial |
$135.00
|
| Rate for Payer: PHCS All Commercial |
$256.53
|
| Rate for Payer: PHP All Commercial |
$141.61
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$103.68
|
| Rate for Payer: Signature Care EPO |
$182.98
|
| Rate for Payer: Signature Care PPO |
$182.98
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$124.00
|
| Rate for Payer: United Healthcare Commercial |
$140.71
|
| Rate for Payer: United Healthcare Medicare |
$103.68
|
|
|
PR RECONSTRUCT RADIAL HEAD W IMPLANT
|
Professional
|
$1,241.32
|
|
|
Service Code
|
CPT 24366
|
| Hospital Charge Code |
z24366
|
| Min. Negotiated Rate |
$635.86 |
| Max. Negotiated Rate |
$1,080.96 |
| Rate for Payer: Aetna Medicare |
$635.86
|
| 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 |
$731.24
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$699.45
|
| Rate for Payer: Cash Price |
$769.62
|
| Rate for Payer: Cash Price |
$769.62
|
| Rate for Payer: Coventry All Commercial |
$763.03
|
| Rate for Payer: Frontpath All Commercial |
$885.26
|
| Rate for Payer: Humana ChoiceCare |
$726.12
|
| Rate for Payer: Humana Medicare |
$635.86
|
| Rate for Payer: Lucent All Commercial |
$1,080.96
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,017.00
|
| Rate for Payer: PHCS All Commercial |
$930.99
|
| Rate for Payer: PHP All Commercial |
$1,079.94
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$635.86
|
| Rate for Payer: Signature Care EPO |
$969.00
|
| Rate for Payer: Signature Care PPO |
$969.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$954.00
|
| Rate for Payer: United Healthcare Commercial |
$737.84
|
| Rate for Payer: United Healthcare Medicare |
$635.86
|
|
|
PR REFOREARM TEND/MUSC,EXTEN,PRIM,EA
|
Professional
|
$907.00
|
|
|
Service Code
|
CPT 25270
|
| Hospital Charge Code |
z25270
|
| Min. Negotiated Rate |
$464.83 |
| Max. Negotiated Rate |
$790.28 |
| Rate for Payer: Aetna Medicare |
$464.83
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$790.28
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$790.28
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$534.55
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$511.31
|
| Rate for Payer: Cash Price |
$562.34
|
| Rate for Payer: Cash Price |
$562.34
|
| Rate for Payer: Coventry All Commercial |
$557.80
|
| Rate for Payer: Frontpath All Commercial |
$639.03
|
| Rate for Payer: Humana ChoiceCare |
$756.61
|
| Rate for Payer: Humana Medicare |
$464.83
|
| Rate for Payer: Lucent All Commercial |
$790.21
|
| Rate for Payer: Lutheran Preferred All Commercial |
$744.00
|
| Rate for Payer: PHCS All Commercial |
$680.25
|
| Rate for Payer: PHP All Commercial |
$789.08
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$464.83
|
| Rate for Payer: Signature Care EPO |
$787.07
|
| Rate for Payer: Signature Care PPO |
$787.07
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$697.00
|
| Rate for Payer: United Healthcare Commercial |
$582.35
|
| Rate for Payer: United Healthcare Medicare |
$464.83
|
|
|
PR REINSERT BI/TRICEPS TENDON,DISTAL
|
Professional
|
$1,409.26
|
|
|
Service Code
|
CPT 24342
|
| Hospital Charge Code |
z24342
|
| Min. Negotiated Rate |
$722.25 |
| Max. Negotiated Rate |
$1,227.82 |
| Rate for Payer: Aetna Medicare |
$722.25
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,012.10
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,012.10
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$830.59
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$794.48
|
| Rate for Payer: Cash Price |
$873.74
|
| Rate for Payer: Cash Price |
$873.74
|
| Rate for Payer: Coventry All Commercial |
$866.70
|
| Rate for Payer: Frontpath All Commercial |
$1,007.44
|
| Rate for Payer: Humana ChoiceCare |
$835.78
|
| Rate for Payer: Humana Medicare |
$722.25
|
| Rate for Payer: Lucent All Commercial |
$1,227.82
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,156.00
|
| Rate for Payer: PHCS All Commercial |
$1,056.94
|
| Rate for Payer: PHP All Commercial |
$1,226.06
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$722.25
|
| Rate for Payer: Signature Care EPO |
$1,116.05
|
| Rate for Payer: Signature Care PPO |
$1,116.05
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,083.00
|
| Rate for Payer: United Healthcare Commercial |
$849.38
|
| Rate for Payer: United Healthcare Medicare |
$722.25
|
|
|
PR RELEASE I-P JT CONTRACTURE
|
Professional
|
$1,262.50
|
|
|
Service Code
|
CPT 26525
|
| Hospital Charge Code |
z26525
|
| Min. Negotiated Rate |
$647.04 |
| Max. Negotiated Rate |
$1,099.97 |
| Rate for Payer: Aetna Medicare |
$647.04
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$702.10
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$702.10
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$744.10
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$711.74
|
| Rate for Payer: Cash Price |
$782.75
|
| Rate for Payer: Cash Price |
$782.75
|
| Rate for Payer: Coventry All Commercial |
$776.45
|
| Rate for Payer: Frontpath All Commercial |
$885.73
|
| Rate for Payer: Humana ChoiceCare |
$801.83
|
| Rate for Payer: Humana Medicare |
$647.04
|
| Rate for Payer: Lucent All Commercial |
$1,099.97
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,035.00
|
| Rate for Payer: PHCS All Commercial |
$946.88
|
| Rate for Payer: PHP All Commercial |
$1,098.38
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$647.04
|
| Rate for Payer: Signature Care EPO |
$1,031.83
|
| Rate for Payer: Signature Care PPO |
$1,031.83
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$971.00
|
| Rate for Payer: United Healthcare Commercial |
$684.11
|
| Rate for Payer: United Healthcare Medicare |
$647.04
|
|
|
PR RELEASE PALM CONTRACT,OPEN,PARTIAL
|
Professional
|
$866.12
|
|
|
Service Code
|
CPT 26045
|
| Hospital Charge Code |
z26045
|
| Min. Negotiated Rate |
$443.88 |
| Max. Negotiated Rate |
$754.60 |
| Rate for Payer: Aetna Medicare |
$443.88
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$661.80
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$661.80
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$510.46
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$488.27
|
| Rate for Payer: Cash Price |
$536.99
|
| Rate for Payer: Cash Price |
$536.99
|
| Rate for Payer: Coventry All Commercial |
$532.66
|
| Rate for Payer: Frontpath All Commercial |
$610.53
|
| Rate for Payer: Humana ChoiceCare |
$483.87
|
| Rate for Payer: Humana Medicare |
$443.88
|
| Rate for Payer: Lucent All Commercial |
$754.60
|
| Rate for Payer: Lutheran Preferred All Commercial |
$710.00
|
| Rate for Payer: PHCS All Commercial |
$649.59
|
| Rate for Payer: PHP All Commercial |
$753.52
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$443.88
|
| Rate for Payer: Signature Care EPO |
$643.45
|
| Rate for Payer: Signature Care PPO |
$643.45
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$666.00
|
| Rate for Payer: United Healthcare Commercial |
$491.21
|
| Rate for Payer: United Healthcare Medicare |
$443.88
|
|
|
PR RELEASE TIB/FIB/ANKLE FLEX TENDON,EA
|
Professional
|
$766.98
|
|
|
Service Code
|
CPT 27680
|
| Hospital Charge Code |
z27680
|
| Min. Negotiated Rate |
$393.08 |
| Max. Negotiated Rate |
$668.24 |
| Rate for Payer: Aetna Medicare |
$393.08
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$557.60
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$557.60
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$452.04
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$432.39
|
| Rate for Payer: Cash Price |
$475.53
|
| Rate for Payer: Cash Price |
$475.53
|
| Rate for Payer: Coventry All Commercial |
$471.70
|
| Rate for Payer: Frontpath All Commercial |
$539.58
|
| Rate for Payer: Humana ChoiceCare |
$470.38
|
| Rate for Payer: Humana Medicare |
$393.08
|
| Rate for Payer: Lucent All Commercial |
$668.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$629.00
|
| Rate for Payer: PHCS All Commercial |
$575.24
|
| Rate for Payer: PHP All Commercial |
$667.28
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$393.08
|
| Rate for Payer: Signature Care EPO |
$636.65
|
| Rate for Payer: Signature Care PPO |
$636.65
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$590.00
|
| Rate for Payer: United Healthcare Commercial |
$471.98
|
| Rate for Payer: United Healthcare Medicare |
$393.08
|
|
|
PR RELOCATION OF SKIN POCKET FOR PACEMAKER
|
Professional
|
$610.62
|
|
|
Service Code
|
CPT 33222
|
| Hospital Charge Code |
z33222
|
| Min. Negotiated Rate |
$312.94 |
| Max. Negotiated Rate |
$532.00 |
| Rate for Payer: Aetna Medicare |
$312.94
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$501.80
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$501.80
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$359.88
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$344.23
|
| Rate for Payer: Cash Price |
$378.58
|
| Rate for Payer: Cash Price |
$378.58
|
| Rate for Payer: Coventry All Commercial |
$375.53
|
| Rate for Payer: Frontpath All Commercial |
$445.25
|
| Rate for Payer: Humana ChoiceCare |
$446.53
|
| Rate for Payer: Humana Medicare |
$312.94
|
| Rate for Payer: Lucent All Commercial |
$532.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$501.00
|
| Rate for Payer: PHCS All Commercial |
$457.96
|
| Rate for Payer: PHP All Commercial |
$427.43
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$312.94
|
| Rate for Payer: Signature Care EPO |
$518.50
|
| Rate for Payer: Signature Care PPO |
$518.50
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$469.00
|
| Rate for Payer: United Healthcare Commercial |
$414.76
|
| Rate for Payer: United Healthcare Medicare |
$312.94
|
|
|
PR REM INTERROG ICPMS <30 D PHYS/QHP
|
Professional
|
$47.68
|
|
|
Service Code
|
CPT 93297
|
| Hospital Charge Code |
z93297
|
| Min. Negotiated Rate |
$24.44 |
| Max. Negotiated Rate |
$41.55 |
| Rate for Payer: Aetna Medicare |
$24.44
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$36.98
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$36.98
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$28.11
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$26.88
|
| Rate for Payer: Cash Price |
$29.56
|
| Rate for Payer: Cash Price |
$29.56
|
| Rate for Payer: Coventry All Commercial |
$29.33
|
| Rate for Payer: Frontpath All Commercial |
$28.75
|
| Rate for Payer: Humana ChoiceCare |
$33.73
|
| Rate for Payer: Humana Medicare |
$24.44
|
| Rate for Payer: Lucent All Commercial |
$41.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$39.00
|
| Rate for Payer: PHCS All Commercial |
$35.76
|
| Rate for Payer: PHP All Commercial |
$35.05
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$24.44
|
| Rate for Payer: Signature Care EPO |
$37.97
|
| Rate for Payer: Signature Care PPO |
$37.97
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$37.00
|
| Rate for Payer: United Healthcare Commercial |
$31.03
|
| Rate for Payer: United Healthcare Medicare |
$24.44
|
|
|
PR REM INTERROG PM/LDLS PM <90 D PHYS/QHP
|
Professional
|
$55.38
|
|
|
Service Code
|
CPT 93294
|
| Hospital Charge Code |
z93294
|
| Min. Negotiated Rate |
$28.39 |
| Max. Negotiated Rate |
$52.67 |
| Rate for Payer: Aetna Medicare |
$28.39
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$52.67
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$52.67
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$32.65
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$31.23
|
| Rate for Payer: Cash Price |
$34.34
|
| Rate for Payer: Cash Price |
$34.34
|
| Rate for Payer: Coventry All Commercial |
$34.07
|
| Rate for Payer: Frontpath All Commercial |
$32.85
|
| Rate for Payer: Humana ChoiceCare |
$48.04
|
| Rate for Payer: Humana Medicare |
$28.39
|
| Rate for Payer: Lucent All Commercial |
$48.26
|
| Rate for Payer: Lutheran Preferred All Commercial |
$45.00
|
| Rate for Payer: PHCS All Commercial |
$41.54
|
| Rate for Payer: PHP All Commercial |
$40.71
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$28.39
|
| Rate for Payer: Signature Care EPO |
$49.10
|
| Rate for Payer: Signature Care PPO |
$49.10
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$43.00
|
| Rate for Payer: United Healthcare Commercial |
$44.19
|
| Rate for Payer: United Healthcare Medicare |
$28.39
|
|
|
PR REM INTERROG PM/LDLS PM/IDS <90 D PHYS/QHP
|
Professional
|
$40.08
|
|
|
Service Code
|
CPT 93296
|
| Hospital Charge Code |
z93296
|
| Min. Negotiated Rate |
$20.54 |
| Max. Negotiated Rate |
$49.66 |
| Rate for Payer: Aetna Medicare |
$20.54
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$49.66
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$49.66
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$23.62
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$22.59
|
| Rate for Payer: Cash Price |
$24.85
|
| Rate for Payer: Cash Price |
$24.85
|
| Rate for Payer: Coventry All Commercial |
$24.65
|
| Rate for Payer: Frontpath All Commercial |
$24.05
|
| Rate for Payer: Humana ChoiceCare |
$45.30
|
| Rate for Payer: Humana Medicare |
$20.54
|
| Rate for Payer: Lucent All Commercial |
$34.92
|
| Rate for Payer: Lutheran Preferred All Commercial |
$33.00
|
| Rate for Payer: PHCS All Commercial |
$30.06
|
| Rate for Payer: PHP All Commercial |
$29.45
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$20.54
|
| Rate for Payer: Signature Care EPO |
$36.28
|
| Rate for Payer: Signature Care PPO |
$36.28
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$31.00
|
| Rate for Payer: United Healthcare Commercial |
$41.66
|
| Rate for Payer: United Healthcare Medicare |
$20.54
|
|
|
PR REM INTERROG SCRMS <30 D PHYS/QHP
|
Professional
|
$48.28
|
|
|
Service Code
|
CPT 93298
|
| Hospital Charge Code |
z93298
|
| Min. Negotiated Rate |
$24.75 |
| Max. Negotiated Rate |
$42.81 |
| Rate for Payer: Aetna Medicare |
$24.75
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$42.41
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$42.41
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$28.46
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$27.22
|
| Rate for Payer: Cash Price |
$29.93
|
| Rate for Payer: Cash Price |
$29.93
|
| Rate for Payer: Coventry All Commercial |
$29.70
|
| Rate for Payer: Frontpath All Commercial |
$28.75
|
| Rate for Payer: Humana ChoiceCare |
$38.68
|
| Rate for Payer: Humana Medicare |
$24.75
|
| Rate for Payer: Lucent All Commercial |
$42.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$40.00
|
| Rate for Payer: PHCS All Commercial |
$36.21
|
| Rate for Payer: PHP All Commercial |
$35.49
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$24.75
|
| Rate for Payer: Signature Care EPO |
$42.81
|
| Rate for Payer: Signature Care PPO |
$42.81
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$37.00
|
| Rate for Payer: United Healthcare Commercial |
$35.58
|
| Rate for Payer: United Healthcare Medicare |
$24.75
|
|
