|
PR REM MNTR PHYSIOL PARAM 1ST DEV SUPPLY EA 30 D
|
Professional
|
$88.86
|
|
|
Service Code
|
CPT 99454
|
| Hospital Charge Code |
z99454
|
| Min. Negotiated Rate |
$45.54 |
| Max. Negotiated Rate |
$77.42 |
| Rate for Payer: Aetna Medicare |
$45.54
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$52.37
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$50.09
|
| Rate for Payer: Cash Price |
$55.09
|
| Rate for Payer: Cash Price |
$55.09
|
| Rate for Payer: Coventry All Commercial |
$54.65
|
| Rate for Payer: Frontpath All Commercial |
$52.97
|
| Rate for Payer: Humana ChoiceCare |
$62.52
|
| Rate for Payer: Humana Medicare |
$45.54
|
| Rate for Payer: Lucent All Commercial |
$77.42
|
| Rate for Payer: PHCS All Commercial |
$66.64
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$45.54
|
| Rate for Payer: United Healthcare Commercial |
$61.76
|
| Rate for Payer: United Healthcare Medicare |
$45.54
|
|
|
PR REM MNTR PHYSIOL PARAM 1ST SET UP PT EDUCAJ EQP
|
Professional
|
$33.76
|
|
|
Service Code
|
CPT 99453
|
| Hospital Charge Code |
z99453
|
| Min. Negotiated Rate |
$17.30 |
| Max. Negotiated Rate |
$29.41 |
| Rate for Payer: Aetna Medicare |
$17.30
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$19.90
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$19.03
|
| Rate for Payer: Cash Price |
$20.93
|
| Rate for Payer: Cash Price |
$20.93
|
| Rate for Payer: Coventry All Commercial |
$20.76
|
| Rate for Payer: Frontpath All Commercial |
$18.14
|
| Rate for Payer: Humana ChoiceCare |
$18.82
|
| Rate for Payer: Humana Medicare |
$17.30
|
| Rate for Payer: Lucent All Commercial |
$29.41
|
| Rate for Payer: PHCS All Commercial |
$25.32
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$17.30
|
| Rate for Payer: United Healthcare Commercial |
$18.65
|
| Rate for Payer: United Healthcare Medicare |
$17.30
|
|
|
PR REMOTE PHYSIOLOGIC MONITORING 1ST 20 MIN MONTH
|
Professional
|
$89.18
|
|
|
Service Code
|
CPT 99457
|
| Hospital Charge Code |
z99457
|
| Min. Negotiated Rate |
$28.72 |
| Max. Negotiated Rate |
$66.88 |
| Rate for Payer: Aetna Medicare |
$28.72
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$33.03
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$31.59
|
| Rate for Payer: Cash Price |
$55.29
|
| Rate for Payer: Cash Price |
$55.29
|
| Rate for Payer: Coventry All Commercial |
$34.46
|
| Rate for Payer: Frontpath All Commercial |
$31.74
|
| Rate for Payer: Humana ChoiceCare |
$32.78
|
| Rate for Payer: Humana Medicare |
$28.72
|
| Rate for Payer: Lucent All Commercial |
$48.82
|
| Rate for Payer: PHCS All Commercial |
$66.88
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$28.72
|
| Rate for Payer: United Healthcare Commercial |
$32.70
|
| Rate for Payer: United Healthcare Medicare |
$28.72
|
|
|
PR REMOTE PHYSIOLOGIC MONITORING EA ADDL 20 MIN MO
|
Professional
|
$72.92
|
|
|
Service Code
|
CPT 99458
|
| Hospital Charge Code |
z99458
|
| Min. Negotiated Rate |
$28.72 |
| Max. Negotiated Rate |
$54.69 |
| Rate for Payer: Aetna Medicare |
$28.72
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$33.03
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$31.59
|
| Rate for Payer: Cash Price |
$45.21
|
| Rate for Payer: Cash Price |
$45.21
|
| Rate for Payer: Coventry All Commercial |
$34.46
|
| Rate for Payer: Frontpath All Commercial |
$31.74
|
| Rate for Payer: Humana ChoiceCare |
$32.97
|
| Rate for Payer: Humana Medicare |
$28.72
|
| Rate for Payer: Lucent All Commercial |
$48.82
|
| Rate for Payer: PHCS All Commercial |
$54.69
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$28.72
|
| Rate for Payer: United Healthcare Commercial |
$32.93
|
| Rate for Payer: United Healthcare Medicare |
$28.72
|
|
|
PR REMOTE THERAPEUTIC MNTR 1ST SETUP&PT EDUCAJ EQP
|
Professional
|
$36.24
|
|
|
Service Code
|
CPT 98975
|
| Hospital Charge Code |
z98975
|
| Min. Negotiated Rate |
$17.30 |
| Max. Negotiated Rate |
$29.41 |
| Rate for Payer: Aetna Medicare |
$17.30
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$19.90
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$19.03
|
| Rate for Payer: Cash Price |
$22.47
|
| Rate for Payer: Cash Price |
$22.47
|
| Rate for Payer: Coventry All Commercial |
$20.76
|
| Rate for Payer: Humana ChoiceCare |
$17.30
|
| Rate for Payer: Humana Medicare |
$17.30
|
| Rate for Payer: Lucent All Commercial |
$29.41
|
| Rate for Payer: PHCS All Commercial |
$27.18
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$17.30
|
| Rate for Payer: United Healthcare Commercial |
$19.23
|
| Rate for Payer: United Healthcare Medicare |
$17.30
|
|
|
PR REMOTE THER MNTR TX MGMT PHYS/QHP 1ST 20 MIN
|
Professional
|
$95.36
|
|
|
Service Code
|
CPT 98980
|
| Hospital Charge Code |
z98980
|
| Min. Negotiated Rate |
$29.37 |
| Max. Negotiated Rate |
$71.52 |
| Rate for Payer: Aetna Medicare |
$29.37
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$33.78
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$32.31
|
| Rate for Payer: Cash Price |
$59.12
|
| Rate for Payer: Cash Price |
$59.12
|
| Rate for Payer: Coventry All Commercial |
$35.24
|
| Rate for Payer: Humana ChoiceCare |
$29.37
|
| Rate for Payer: Humana Medicare |
$29.37
|
| Rate for Payer: Lucent All Commercial |
$49.93
|
| Rate for Payer: PHCS All Commercial |
$71.52
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$29.37
|
| Rate for Payer: United Healthcare Commercial |
$33.08
|
| Rate for Payer: United Healthcare Medicare |
$29.37
|
|
|
PR REMOTE THER MNTR TX MGMT PHYS/QHP EA ADDL 20 MIN
|
Professional
|
$75.66
|
|
|
Service Code
|
CPT 98981
|
| Hospital Charge Code |
z98981
|
| Min. Negotiated Rate |
$28.72 |
| Max. Negotiated Rate |
$56.74 |
| Rate for Payer: Aetna Medicare |
$28.72
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$33.03
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$31.59
|
| Rate for Payer: Cash Price |
$46.91
|
| Rate for Payer: Cash Price |
$46.91
|
| Rate for Payer: Coventry All Commercial |
$34.46
|
| Rate for Payer: Humana ChoiceCare |
$28.72
|
| Rate for Payer: Humana Medicare |
$28.72
|
| Rate for Payer: Lucent All Commercial |
$48.82
|
| Rate for Payer: PHCS All Commercial |
$56.74
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$28.72
|
| Rate for Payer: United Healthcare Commercial |
$32.93
|
| Rate for Payer: United Healthcare Medicare |
$28.72
|
|
|
PR REMOVAL ADENOIDS,PRIMARY,<12 Y/O
|
Professional
|
$390.44
|
|
|
Service Code
|
CPT 42830
|
| Hospital Charge Code |
z42830
|
| Min. Negotiated Rate |
$200.10 |
| Max. Negotiated Rate |
$341.64 |
| Rate for Payer: Aetna Medicare |
$200.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$228.40
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$228.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$230.12
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$220.11
|
| Rate for Payer: Cash Price |
$242.07
|
| Rate for Payer: Cash Price |
$242.07
|
| Rate for Payer: Coventry All Commercial |
$240.12
|
| Rate for Payer: Frontpath All Commercial |
$271.49
|
| Rate for Payer: Humana ChoiceCare |
$226.16
|
| Rate for Payer: Humana Medicare |
$200.10
|
| Rate for Payer: Lucent All Commercial |
$340.17
|
| Rate for Payer: Lutheran Preferred All Commercial |
$300.00
|
| Rate for Payer: PHCS All Commercial |
$292.83
|
| Rate for Payer: PHP All Commercial |
$341.64
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$200.10
|
| Rate for Payer: Signature Care EPO |
$290.70
|
| Rate for Payer: Signature Care PPO |
$290.70
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$280.00
|
| Rate for Payer: United Healthcare Commercial |
$225.25
|
| Rate for Payer: United Healthcare Medicare |
$200.10
|
|
|
PR REMOVAL ANAL FISTULA,INTERSPNINCTERIC
|
Professional
|
$1,028.80
|
|
|
Service Code
|
CPT 46275
|
| Hospital Charge Code |
z46275
|
| Min. Negotiated Rate |
$339.16 |
| Max. Negotiated Rate |
$771.60 |
| Rate for Payer: Aetna Medicare |
$393.89
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$470.90
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$470.90
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$452.97
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$433.28
|
| Rate for Payer: Cash Price |
$637.86
|
| Rate for Payer: Cash Price |
$637.86
|
| Rate for Payer: Coventry All Commercial |
$472.67
|
| Rate for Payer: Frontpath All Commercial |
$546.98
|
| Rate for Payer: Humana ChoiceCare |
$339.16
|
| Rate for Payer: Humana Medicare |
$393.89
|
| Rate for Payer: Lucent All Commercial |
$669.61
|
| Rate for Payer: Lutheran Preferred All Commercial |
$591.00
|
| Rate for Payer: PHCS All Commercial |
$771.60
|
| Rate for Payer: PHP All Commercial |
$672.50
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$393.89
|
| Rate for Payer: Signature Care EPO |
$502.35
|
| Rate for Payer: Signature Care PPO |
$502.35
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$551.00
|
| Rate for Payer: United Healthcare Commercial |
$408.64
|
| Rate for Payer: United Healthcare Medicare |
$393.89
|
|
|
PR REMOVAL ANAL FISTULA,SUBCUTANEOUS
|
Professional
|
$972.58
|
|
|
Service Code
|
CPT 46270
|
| Hospital Charge Code |
z46270
|
| Min. Negotiated Rate |
$294.11 |
| Max. Negotiated Rate |
$729.44 |
| Rate for Payer: Aetna Medicare |
$372.80
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$382.07
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$382.07
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$428.72
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$410.08
|
| Rate for Payer: Cash Price |
$603.00
|
| Rate for Payer: Cash Price |
$603.00
|
| Rate for Payer: Coventry All Commercial |
$447.36
|
| Rate for Payer: Frontpath All Commercial |
$518.73
|
| Rate for Payer: Humana ChoiceCare |
$294.11
|
| Rate for Payer: Humana Medicare |
$372.80
|
| Rate for Payer: Lucent All Commercial |
$633.76
|
| Rate for Payer: Lutheran Preferred All Commercial |
$559.00
|
| Rate for Payer: PHCS All Commercial |
$729.44
|
| Rate for Payer: PHP All Commercial |
$636.49
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$372.80
|
| Rate for Payer: Signature Care EPO |
$468.35
|
| Rate for Payer: Signature Care PPO |
$468.35
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$522.00
|
| Rate for Payer: United Healthcare Commercial |
$380.75
|
| Rate for Payer: United Healthcare Medicare |
$372.80
|
|
|
PR REMOVAL ARM/ELBOW F.B.,DEEP
|
Professional
|
$999.02
|
|
|
Service Code
|
CPT 24201
|
| Hospital Charge Code |
z24201
|
| Min. Negotiated Rate |
$342.21 |
| Max. Negotiated Rate |
$749.26 |
| Rate for Payer: Aetna Medicare |
$342.21
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$568.71
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$568.71
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$393.54
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$376.43
|
| Rate for Payer: Cash Price |
$619.39
|
| Rate for Payer: Cash Price |
$619.39
|
| Rate for Payer: Coventry All Commercial |
$410.65
|
| Rate for Payer: Frontpath All Commercial |
$475.23
|
| Rate for Payer: Humana ChoiceCare |
$380.06
|
| Rate for Payer: Humana Medicare |
$342.21
|
| Rate for Payer: Lucent All Commercial |
$581.76
|
| Rate for Payer: Lutheran Preferred All Commercial |
$548.00
|
| Rate for Payer: PHCS All Commercial |
$749.26
|
| Rate for Payer: PHP All Commercial |
$580.91
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$342.21
|
| Rate for Payer: Signature Care EPO |
$586.50
|
| Rate for Payer: Signature Care PPO |
$586.50
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$513.00
|
| Rate for Payer: United Healthcare Commercial |
$387.03
|
| Rate for Payer: United Healthcare Medicare |
$342.21
|
|
|
PR REMOVAL DRUG IMPLANT DEVICE
|
Professional
|
$203.68
|
|
|
Service Code
|
CPT 11982
|
| Hospital Charge Code |
z11982
|
| Min. Negotiated Rate |
$68.26 |
| Max. Negotiated Rate |
$171.20 |
| Rate for Payer: Aetna Medicare |
$68.26
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$171.20
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$171.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$78.50
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$75.09
|
| Rate for Payer: Cash Price |
$126.28
|
| Rate for Payer: Cash Price |
$126.28
|
| Rate for Payer: Coventry All Commercial |
$81.91
|
| Rate for Payer: Frontpath All Commercial |
$97.23
|
| Rate for Payer: Humana ChoiceCare |
$98.76
|
| Rate for Payer: Humana Medicare |
$68.26
|
| Rate for Payer: Lucent All Commercial |
$116.04
|
| Rate for Payer: Lutheran Preferred All Commercial |
$89.00
|
| Rate for Payer: PHCS All Commercial |
$152.76
|
| Rate for Payer: PHP All Commercial |
$93.24
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$68.26
|
| Rate for Payer: Signature Care EPO |
$154.70
|
| Rate for Payer: Signature Care PPO |
$154.70
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$82.00
|
| Rate for Payer: United Healthcare Commercial |
$117.13
|
| Rate for Payer: United Healthcare Medicare |
$68.26
|
|
|
PR REMOVAL EXTERNAL FIXATION SYSTEM UNDER ANES
|
Professional
|
$784.86
|
|
|
Service Code
|
CPT 20694
|
| Hospital Charge Code |
z20694
|
| Min. Negotiated Rate |
$318.58 |
| Max. Negotiated Rate |
$626.45 |
| Rate for Payer: Aetna Medicare |
$318.58
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$473.10
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$473.10
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$366.37
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$350.44
|
| Rate for Payer: Cash Price |
$486.61
|
| Rate for Payer: Cash Price |
$486.61
|
| Rate for Payer: Coventry All Commercial |
$382.30
|
| Rate for Payer: Frontpath All Commercial |
$436.64
|
| Rate for Payer: Humana ChoiceCare |
$354.89
|
| Rate for Payer: Humana Medicare |
$318.58
|
| Rate for Payer: Lucent All Commercial |
$541.59
|
| Rate for Payer: Lutheran Preferred All Commercial |
$510.00
|
| Rate for Payer: PHCS All Commercial |
$588.64
|
| Rate for Payer: PHP All Commercial |
$540.81
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$318.58
|
| Rate for Payer: Signature Care EPO |
$626.45
|
| Rate for Payer: Signature Care PPO |
$626.45
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$478.00
|
| Rate for Payer: United Healthcare Commercial |
$361.65
|
| Rate for Payer: United Healthcare Medicare |
$318.58
|
|
|
PR REMOVAL IMPACTED CERUMEN INSTRUMENTATION UNILAT
|
Professional
|
$173.64
|
|
|
Service Code
|
CPT 69210
|
| Hospital Charge Code |
z69210
|
| Min. Negotiated Rate |
$30.60 |
| Max. Negotiated Rate |
$130.23 |
| Rate for Payer: Aetna Medicare |
$30.60
|
| Rate for Payer: Aetna Medicare |
$30.60
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$62.80
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$62.80
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$62.80
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$62.80
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$35.19
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$35.19
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$33.66
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$33.66
|
| Rate for Payer: Cash Price |
$53.83
|
| Rate for Payer: Cash Price |
$53.83
|
| Rate for Payer: Cash Price |
$107.66
|
| Rate for Payer: Cash Price |
$107.66
|
| Rate for Payer: Coventry All Commercial |
$36.72
|
| Rate for Payer: Coventry All Commercial |
$36.72
|
| Rate for Payer: Frontpath All Commercial |
$42.96
|
| Rate for Payer: Frontpath All Commercial |
$42.96
|
| Rate for Payer: Humana ChoiceCare |
$35.25
|
| Rate for Payer: Humana ChoiceCare |
$35.25
|
| Rate for Payer: Humana Medicare |
$30.60
|
| Rate for Payer: Humana Medicare |
$30.60
|
| Rate for Payer: Lucent All Commercial |
$52.02
|
| Rate for Payer: Lucent All Commercial |
$52.02
|
| Rate for Payer: Lutheran Preferred All Commercial |
$49.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$49.00
|
| Rate for Payer: PHCS All Commercial |
$65.12
|
| Rate for Payer: PHCS All Commercial |
$130.23
|
| Rate for Payer: PHP All Commercial |
$38.81
|
| Rate for Payer: PHP All Commercial |
$38.81
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$30.60
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$30.60
|
| Rate for Payer: Signature Care EPO |
$59.50
|
| Rate for Payer: Signature Care EPO |
$59.50
|
| Rate for Payer: Signature Care PPO |
$59.50
|
| Rate for Payer: Signature Care PPO |
$59.50
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$46.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$46.00
|
| Rate for Payer: United Healthcare Commercial |
$36.71
|
| Rate for Payer: United Healthcare Commercial |
$36.71
|
| Rate for Payer: United Healthcare Medicare |
$30.60
|
| Rate for Payer: United Healthcare Medicare |
$30.60
|
|
|
PR REMOVAL IMPACTED CERUMEN IRRIGATION/LVG UNILAT
|
Professional
|
$54.84
|
|
|
Service Code
|
CPT 69209
|
| Hospital Charge Code |
z69209
|
| Min. Negotiated Rate |
$12.51 |
| Max. Negotiated Rate |
$41.13 |
| Rate for Payer: Aetna Medicare |
$14.05
|
| Rate for Payer: Aetna Medicare |
$14.05
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$23.07
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$23.07
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$23.07
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$23.07
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$16.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$16.16
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$15.46
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$15.46
|
| Rate for Payer: Cash Price |
$17.00
|
| Rate for Payer: Cash Price |
$17.00
|
| Rate for Payer: Cash Price |
$34.00
|
| Rate for Payer: Cash Price |
$34.00
|
| Rate for Payer: Coventry All Commercial |
$16.86
|
| Rate for Payer: Coventry All Commercial |
$16.86
|
| Rate for Payer: Frontpath All Commercial |
$18.56
|
| Rate for Payer: Frontpath All Commercial |
$18.56
|
| Rate for Payer: Humana ChoiceCare |
$13.02
|
| Rate for Payer: Humana ChoiceCare |
$13.02
|
| Rate for Payer: Humana Medicare |
$14.05
|
| Rate for Payer: Humana Medicare |
$14.05
|
| Rate for Payer: Lucent All Commercial |
$23.88
|
| Rate for Payer: Lucent All Commercial |
$23.88
|
| Rate for Payer: Lutheran Preferred All Commercial |
$22.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$22.00
|
| Rate for Payer: PHCS All Commercial |
$41.13
|
| Rate for Payer: PHCS All Commercial |
$20.56
|
| Rate for Payer: PHP All Commercial |
$17.82
|
| Rate for Payer: PHP All Commercial |
$17.82
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$14.05
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$14.05
|
| Rate for Payer: Signature Care EPO |
$12.51
|
| Rate for Payer: Signature Care EPO |
$12.51
|
| Rate for Payer: Signature Care PPO |
$12.51
|
| Rate for Payer: Signature Care PPO |
$12.51
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$21.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$21.00
|
| Rate for Payer: United Healthcare Commercial |
$14.75
|
| Rate for Payer: United Healthcare Commercial |
$14.75
|
| Rate for Payer: United Healthcare Medicare |
$14.05
|
| Rate for Payer: United Healthcare Medicare |
$14.05
|
|
|
PR REMOVAL IMPLANTABLE DEFIB PULSE GENERATOR ONLY
|
Professional
|
$382.28
|
|
|
Service Code
|
CPT 33241
|
| Hospital Charge Code |
z33241
|
| Min. Negotiated Rate |
$195.92 |
| Max. Negotiated Rate |
$337.79 |
| Rate for Payer: Aetna Medicare |
$195.92
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$320.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$320.30
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$225.31
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$215.51
|
| Rate for Payer: Cash Price |
$237.01
|
| Rate for Payer: Cash Price |
$237.01
|
| Rate for Payer: Coventry All Commercial |
$235.10
|
| Rate for Payer: Frontpath All Commercial |
$280.23
|
| Rate for Payer: Humana ChoiceCare |
$297.20
|
| Rate for Payer: Humana Medicare |
$195.92
|
| Rate for Payer: Lucent All Commercial |
$333.06
|
| Rate for Payer: Lutheran Preferred All Commercial |
$313.00
|
| Rate for Payer: PHCS All Commercial |
$286.71
|
| Rate for Payer: PHP All Commercial |
$267.60
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$195.92
|
| Rate for Payer: Signature Care EPO |
$337.79
|
| Rate for Payer: Signature Care PPO |
$337.79
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$294.00
|
| Rate for Payer: United Healthcare Commercial |
$274.34
|
| Rate for Payer: United Healthcare Medicare |
$195.92
|
|
|
PR REMOVAL IMPLANT DEEP
|
Professional
|
$1,094.14
|
|
|
Service Code
|
CPT 20680
|
| Hospital Charge Code |
z20680
|
| Min. Negotiated Rate |
$304.01 |
| Max. Negotiated Rate |
$820.60 |
| Rate for Payer: Aetna Medicare |
$390.65
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$623.38
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$623.38
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$449.25
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$429.72
|
| Rate for Payer: Cash Price |
$678.37
|
| Rate for Payer: Cash Price |
$678.37
|
| Rate for Payer: Coventry All Commercial |
$468.78
|
| Rate for Payer: Frontpath All Commercial |
$540.71
|
| Rate for Payer: Humana ChoiceCare |
$304.01
|
| Rate for Payer: Humana Medicare |
$390.65
|
| Rate for Payer: Lucent All Commercial |
$664.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$625.00
|
| Rate for Payer: PHCS All Commercial |
$820.60
|
| Rate for Payer: PHP All Commercial |
$663.15
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$390.65
|
| Rate for Payer: Signature Care EPO |
$499.20
|
| Rate for Payer: Signature Care PPO |
$499.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$586.00
|
| Rate for Payer: United Healthcare Commercial |
$448.31
|
| Rate for Payer: United Healthcare Medicare |
$390.65
|
|
|
PR REMOVAL IMPLANT SUPERFICIAL SEPARATE PROCEDURE
|
Professional
|
$650.90
|
|
|
Service Code
|
CPT 20670
|
| Hospital Charge Code |
z20670
|
| Min. Negotiated Rate |
$135.08 |
| Max. Negotiated Rate |
$488.18 |
| Rate for Payer: Aetna Medicare |
$135.08
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$257.12
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$257.12
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$155.34
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$148.59
|
| Rate for Payer: Cash Price |
$403.56
|
| Rate for Payer: Cash Price |
$403.56
|
| Rate for Payer: Coventry All Commercial |
$162.10
|
| Rate for Payer: Frontpath All Commercial |
$183.77
|
| Rate for Payer: Humana ChoiceCare |
$164.76
|
| Rate for Payer: Humana Medicare |
$135.08
|
| Rate for Payer: Lucent All Commercial |
$229.64
|
| Rate for Payer: Lutheran Preferred All Commercial |
$216.00
|
| Rate for Payer: PHCS All Commercial |
$488.18
|
| Rate for Payer: PHP All Commercial |
$229.31
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$135.08
|
| Rate for Payer: Signature Care EPO |
$466.65
|
| Rate for Payer: Signature Care PPO |
$466.65
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$203.00
|
| Rate for Payer: United Healthcare Commercial |
$160.58
|
| Rate for Payer: United Healthcare Medicare |
$135.08
|
|
|
PR REMOVAL INTACT BREAST IMPLANT
|
Professional
|
$1,005.14
|
|
|
Service Code
|
CPT 19328
|
| Hospital Charge Code |
z19328
|
| Min. Negotiated Rate |
$402.62 |
| Max. Negotiated Rate |
$875.72 |
| Rate for Payer: Aetna Medicare |
$515.13
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$487.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$487.30
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$592.40
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$566.64
|
| Rate for Payer: Cash Price |
$623.19
|
| Rate for Payer: Cash Price |
$623.19
|
| Rate for Payer: Coventry All Commercial |
$618.16
|
| Rate for Payer: Frontpath All Commercial |
$714.13
|
| Rate for Payer: Humana ChoiceCare |
$402.62
|
| Rate for Payer: Humana Medicare |
$515.13
|
| Rate for Payer: Lucent All Commercial |
$875.72
|
| Rate for Payer: Lutheran Preferred All Commercial |
$670.00
|
| Rate for Payer: PHCS All Commercial |
$753.86
|
| Rate for Payer: PHP All Commercial |
$703.59
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$515.13
|
| Rate for Payer: Signature Care EPO |
$447.95
|
| Rate for Payer: Signature Care PPO |
$447.95
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$618.00
|
| Rate for Payer: United Healthcare Commercial |
$520.26
|
| Rate for Payer: United Healthcare Medicare |
$515.13
|
|
|
PR REMOVAL OF COCCYX
|
Professional
|
$923.00
|
|
|
Service Code
|
CPT 27080
|
| Hospital Charge Code |
z27080
|
| Min. Negotiated Rate |
$473.04 |
| Max. Negotiated Rate |
$804.17 |
| Rate for Payer: Aetna Medicare |
$473.04
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$605.50
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$605.50
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$544.00
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$520.34
|
| Rate for Payer: Cash Price |
$572.26
|
| Rate for Payer: Cash Price |
$572.26
|
| Rate for Payer: Coventry All Commercial |
$567.65
|
| Rate for Payer: Frontpath All Commercial |
$667.11
|
| Rate for Payer: Humana ChoiceCare |
$487.68
|
| Rate for Payer: Humana Medicare |
$473.04
|
| Rate for Payer: Lucent All Commercial |
$804.17
|
| Rate for Payer: Lutheran Preferred All Commercial |
$757.00
|
| Rate for Payer: PHCS All Commercial |
$692.25
|
| Rate for Payer: PHP All Commercial |
$803.02
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$473.04
|
| Rate for Payer: Signature Care EPO |
$668.10
|
| Rate for Payer: Signature Care PPO |
$668.10
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$710.00
|
| Rate for Payer: United Healthcare Commercial |
$530.34
|
| Rate for Payer: United Healthcare Medicare |
$473.04
|
|
|
PR REMOVAL OF CONTRACEPTIVE CAPSUL
|
Professional
|
$263.54
|
|
|
Service Code
|
CPT 11976
|
| Hospital Charge Code |
z11976
|
| Min. Negotiated Rate |
$86.29 |
| Max. Negotiated Rate |
$197.66 |
| Rate for Payer: Aetna Medicare |
$86.29
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$168.27
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$168.27
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$99.23
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$94.92
|
| Rate for Payer: Cash Price |
$163.39
|
| Rate for Payer: Cash Price |
$163.39
|
| Rate for Payer: Coventry All Commercial |
$103.55
|
| Rate for Payer: Frontpath All Commercial |
$121.78
|
| Rate for Payer: Humana ChoiceCare |
$94.28
|
| Rate for Payer: Humana Medicare |
$86.29
|
| Rate for Payer: Lucent All Commercial |
$146.69
|
| Rate for Payer: Lutheran Preferred All Commercial |
$112.00
|
| Rate for Payer: PHCS All Commercial |
$197.66
|
| Rate for Payer: PHP All Commercial |
$117.86
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$86.29
|
| Rate for Payer: Signature Care EPO |
$144.50
|
| Rate for Payer: Signature Care PPO |
$144.50
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$104.00
|
| Rate for Payer: United Healthcare Commercial |
$108.69
|
| Rate for Payer: United Healthcare Medicare |
$86.29
|
|
|
PR REMOVAL OF ELBOW BURSA
|
Professional
|
$661.10
|
|
|
Service Code
|
CPT 24105
|
| Hospital Charge Code |
z24105
|
| Min. Negotiated Rate |
$338.82 |
| Max. Negotiated Rate |
$575.99 |
| Rate for Payer: Aetna Medicare |
$338.82
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$383.60
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$383.60
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$389.64
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$372.70
|
| Rate for Payer: Cash Price |
$409.88
|
| Rate for Payer: Cash Price |
$409.88
|
| Rate for Payer: Coventry All Commercial |
$406.58
|
| Rate for Payer: Frontpath All Commercial |
$462.45
|
| Rate for Payer: Humana ChoiceCare |
$342.81
|
| Rate for Payer: Humana Medicare |
$338.82
|
| Rate for Payer: Lucent All Commercial |
$575.99
|
| Rate for Payer: Lutheran Preferred All Commercial |
$542.00
|
| Rate for Payer: PHCS All Commercial |
$495.82
|
| Rate for Payer: PHP All Commercial |
$575.16
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$338.82
|
| Rate for Payer: Signature Care EPO |
$458.15
|
| Rate for Payer: Signature Care PPO |
$458.15
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$508.00
|
| Rate for Payer: United Healthcare Commercial |
$353.69
|
| Rate for Payer: United Healthcare Medicare |
$338.82
|
|
|
PR REMOVAL OF FALLOPIAN TUBE
|
Professional
|
$1,455.66
|
|
|
Service Code
|
CPT 58700
|
| Hospital Charge Code |
z58700
|
| Min. Negotiated Rate |
$746.02 |
| Max. Negotiated Rate |
$1,268.23 |
| Rate for Payer: Aetna Medicare |
$746.02
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$956.46
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$956.46
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$857.92
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$820.62
|
| Rate for Payer: Cash Price |
$902.51
|
| Rate for Payer: Cash Price |
$902.51
|
| Rate for Payer: Coventry All Commercial |
$895.22
|
| Rate for Payer: Frontpath All Commercial |
$1,050.10
|
| Rate for Payer: Humana ChoiceCare |
$803.64
|
| Rate for Payer: Humana Medicare |
$746.02
|
| Rate for Payer: Lucent All Commercial |
$1,268.23
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,044.00
|
| Rate for Payer: PHCS All Commercial |
$1,091.74
|
| Rate for Payer: PHP All Commercial |
$960.73
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$746.02
|
| Rate for Payer: Signature Care EPO |
$887.40
|
| Rate for Payer: Signature Care PPO |
$887.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$970.00
|
| Rate for Payer: United Healthcare Commercial |
$858.04
|
| Rate for Payer: United Healthcare Medicare |
$746.02
|
|
|
PR REMOVAL OF FOREIGN BODY
|
Professional
|
$395.54
|
|
|
Service Code
|
CPT 20520
|
| Hospital Charge Code |
z20520
|
| Min. Negotiated Rate |
$137.57 |
| Max. Negotiated Rate |
$296.66 |
| Rate for Payer: Aetna Medicare |
$137.57
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$240.08
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$240.08
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$158.21
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$151.33
|
| Rate for Payer: Cash Price |
$245.23
|
| Rate for Payer: Cash Price |
$245.23
|
| Rate for Payer: Coventry All Commercial |
$165.08
|
| Rate for Payer: Frontpath All Commercial |
$188.30
|
| Rate for Payer: Humana ChoiceCare |
$154.77
|
| Rate for Payer: Humana Medicare |
$137.57
|
| Rate for Payer: Lucent All Commercial |
$233.87
|
| Rate for Payer: Lutheran Preferred All Commercial |
$220.00
|
| Rate for Payer: PHCS All Commercial |
$296.66
|
| Rate for Payer: PHP All Commercial |
$233.54
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$137.57
|
| Rate for Payer: Signature Care EPO |
$233.75
|
| Rate for Payer: Signature Care PPO |
$233.75
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$206.00
|
| Rate for Payer: United Healthcare Commercial |
$153.30
|
| Rate for Payer: United Healthcare Medicare |
$137.57
|
|
|
PR REMOVAL OF FOREIGN BODY DEEP/COMPLIC
|
Professional
|
$846.00
|
|
|
Service Code
|
CPT 20525
|
| Hospital Charge Code |
z20525
|
| Min. Negotiated Rate |
$229.21 |
| Max. Negotiated Rate |
$634.50 |
| Rate for Payer: Aetna Medicare |
$229.21
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$485.31
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$485.31
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$263.59
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$252.13
|
| Rate for Payer: Cash Price |
$524.52
|
| Rate for Payer: Cash Price |
$524.52
|
| Rate for Payer: Coventry All Commercial |
$275.05
|
| Rate for Payer: Frontpath All Commercial |
$318.90
|
| Rate for Payer: Humana ChoiceCare |
$266.10
|
| Rate for Payer: Humana Medicare |
$229.21
|
| Rate for Payer: Lucent All Commercial |
$389.66
|
| Rate for Payer: Lutheran Preferred All Commercial |
$367.00
|
| Rate for Payer: PHCS All Commercial |
$634.50
|
| Rate for Payer: PHP All Commercial |
$389.10
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$229.21
|
| Rate for Payer: Signature Care EPO |
$399.50
|
| Rate for Payer: Signature Care PPO |
$399.50
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$344.00
|
| Rate for Payer: United Healthcare Commercial |
$269.28
|
| Rate for Payer: United Healthcare Medicare |
$229.21
|
|
