|
PR REMOVE EYELID FOREIGN BODY,EMBEDDED
|
Professional
|
$497.98
|
|
|
Service Code
|
CPT 67938
|
| Hospital Charge Code |
z67938
|
| Min. Negotiated Rate |
$97.97 |
| Max. Negotiated Rate |
$373.48 |
| Rate for Payer: Aetna Medicare |
$110.43
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$370.23
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$370.23
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$126.99
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$121.47
|
| Rate for Payer: Cash Price |
$308.75
|
| Rate for Payer: Cash Price |
$308.75
|
| Rate for Payer: Coventry All Commercial |
$132.52
|
| Rate for Payer: Frontpath All Commercial |
$145.78
|
| Rate for Payer: Humana ChoiceCare |
$97.97
|
| Rate for Payer: Humana Medicare |
$110.43
|
| Rate for Payer: Lucent All Commercial |
$187.73
|
| Rate for Payer: Lutheran Preferred All Commercial |
$177.00
|
| Rate for Payer: PHCS All Commercial |
$373.48
|
| Rate for Payer: PHP All Commercial |
$199.30
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$110.43
|
| Rate for Payer: Signature Care EPO |
$360.40
|
| Rate for Payer: Signature Care PPO |
$360.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$166.00
|
| Rate for Payer: United Healthcare Commercial |
$114.63
|
| Rate for Payer: United Healthcare Medicare |
$110.43
|
|
|
PR REMOVE FOREARM/WRIST FOREIGN BODY
|
Professional
|
$759.68
|
|
|
Service Code
|
CPT 25248
|
| Hospital Charge Code |
z25248
|
| Min. Negotiated Rate |
$389.33 |
| Max. Negotiated Rate |
$667.83 |
| Rate for Payer: Aetna Medicare |
$389.33
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$530.90
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$530.90
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$447.73
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$428.26
|
| Rate for Payer: Cash Price |
$471.00
|
| Rate for Payer: Cash Price |
$471.00
|
| Rate for Payer: Coventry All Commercial |
$467.20
|
| Rate for Payer: Frontpath All Commercial |
$545.14
|
| Rate for Payer: Humana ChoiceCare |
$575.46
|
| Rate for Payer: Humana Medicare |
$389.33
|
| Rate for Payer: Lucent All Commercial |
$661.86
|
| Rate for Payer: Lutheran Preferred All Commercial |
$623.00
|
| Rate for Payer: PHCS All Commercial |
$569.76
|
| Rate for Payer: PHP All Commercial |
$660.91
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$389.33
|
| Rate for Payer: Signature Care EPO |
$667.83
|
| Rate for Payer: Signature Care PPO |
$667.83
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$584.00
|
| Rate for Payer: United Healthcare Commercial |
$468.68
|
| Rate for Payer: United Healthcare Medicare |
$389.33
|
|
|
PR REMOVE INTRAUTERINE DEVICE
|
Professional
|
$201.70
|
|
|
Service Code
|
CPT 58301
|
| Hospital Charge Code |
z58301
|
| Min. Negotiated Rate |
$61.69 |
| Max. Negotiated Rate |
$151.28 |
| Rate for Payer: Aetna Medicare |
$61.69
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$134.12
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$134.12
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$70.94
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$67.86
|
| Rate for Payer: Cash Price |
$125.05
|
| Rate for Payer: Cash Price |
$125.05
|
| Rate for Payer: Coventry All Commercial |
$74.03
|
| Rate for Payer: Frontpath All Commercial |
$87.10
|
| Rate for Payer: Humana ChoiceCare |
$78.50
|
| Rate for Payer: Humana Medicare |
$61.69
|
| Rate for Payer: Lucent All Commercial |
$104.87
|
| Rate for Payer: Lutheran Preferred All Commercial |
$86.00
|
| Rate for Payer: PHCS All Commercial |
$151.28
|
| Rate for Payer: PHP All Commercial |
$79.45
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$61.69
|
| Rate for Payer: Signature Care EPO |
$127.50
|
| Rate for Payer: Signature Care PPO |
$127.50
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$80.00
|
| Rate for Payer: United Healthcare Commercial |
$77.86
|
| Rate for Payer: United Healthcare Medicare |
$61.69
|
|
|
PR REMOVE KNEE CYST/GANGLION
|
Professional
|
$964.14
|
|
|
Service Code
|
CPT 27347
|
| Hospital Charge Code |
z27347
|
| Min. Negotiated Rate |
$419.80 |
| Max. Negotiated Rate |
$840.00 |
| Rate for Payer: Aetna Medicare |
$494.12
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$419.80
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$419.80
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$568.24
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$543.53
|
| Rate for Payer: Cash Price |
$597.77
|
| Rate for Payer: Cash Price |
$597.77
|
| Rate for Payer: Coventry All Commercial |
$592.94
|
| Rate for Payer: Frontpath All Commercial |
$682.36
|
| Rate for Payer: Humana ChoiceCare |
$485.73
|
| Rate for Payer: Humana Medicare |
$494.12
|
| Rate for Payer: Lucent All Commercial |
$840.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$791.00
|
| Rate for Payer: PHCS All Commercial |
$723.10
|
| Rate for Payer: PHP All Commercial |
$838.79
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$494.12
|
| Rate for Payer: Signature Care EPO |
$650.25
|
| Rate for Payer: Signature Care PPO |
$650.25
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$741.00
|
| Rate for Payer: United Healthcare Commercial |
$548.25
|
| Rate for Payer: United Healthcare Medicare |
$494.12
|
|
|
PR REMOVE NASAL FOREIGN BODY
|
Professional
|
$385.22
|
|
|
Service Code
|
CPT 30300
|
| Hospital Charge Code |
z30300
|
| Min. Negotiated Rate |
$114.90 |
| Max. Negotiated Rate |
$297.50 |
| Rate for Payer: Aetna Medicare |
$116.54
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$114.90
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$114.90
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$134.02
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$128.19
|
| Rate for Payer: Cash Price |
$238.84
|
| Rate for Payer: Cash Price |
$238.84
|
| Rate for Payer: Coventry All Commercial |
$139.85
|
| Rate for Payer: Frontpath All Commercial |
$157.38
|
| Rate for Payer: Humana ChoiceCare |
$129.59
|
| Rate for Payer: Humana Medicare |
$116.54
|
| Rate for Payer: Lucent All Commercial |
$198.12
|
| Rate for Payer: Lutheran Preferred All Commercial |
$186.00
|
| Rate for Payer: PHCS All Commercial |
$288.92
|
| Rate for Payer: PHP All Commercial |
$159.18
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$116.54
|
| Rate for Payer: Signature Care EPO |
$297.50
|
| Rate for Payer: Signature Care PPO |
$297.50
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$175.00
|
| Rate for Payer: United Healthcare Commercial |
$127.34
|
| Rate for Payer: United Healthcare Medicare |
$116.54
|
|
|
PR REMOVE TONSILS/ADENOIDS,<12 Y/O
|
Professional
|
$535.50
|
|
|
Service Code
|
CPT 42820
|
| Hospital Charge Code |
z42820
|
| Min. Negotiated Rate |
$274.44 |
| Max. Negotiated Rate |
$468.56 |
| Rate for Payer: Aetna Medicare |
$274.44
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$358.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$358.30
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$315.61
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$301.88
|
| Rate for Payer: Cash Price |
$332.01
|
| Rate for Payer: Cash Price |
$332.01
|
| Rate for Payer: Coventry All Commercial |
$329.33
|
| Rate for Payer: Frontpath All Commercial |
$375.05
|
| Rate for Payer: Humana ChoiceCare |
$318.68
|
| Rate for Payer: Humana Medicare |
$274.44
|
| Rate for Payer: Lucent All Commercial |
$466.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$412.00
|
| Rate for Payer: PHCS All Commercial |
$401.62
|
| Rate for Payer: PHP All Commercial |
$468.56
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$274.44
|
| Rate for Payer: Signature Care EPO |
$414.80
|
| Rate for Payer: Signature Care PPO |
$414.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$384.00
|
| Rate for Payer: United Healthcare Commercial |
$320.94
|
| Rate for Payer: United Healthcare Medicare |
$274.44
|
|
|
PR REMOVE TONSILS/ADENOIDS,12+ Y/O
|
Professional
|
$560.18
|
|
|
Service Code
|
CPT 42821
|
| Hospital Charge Code |
z42821
|
| Min. Negotiated Rate |
$287.09 |
| Max. Negotiated Rate |
$490.16 |
| Rate for Payer: Aetna Medicare |
$287.09
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$403.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$403.30
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$330.15
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$315.80
|
| Rate for Payer: Cash Price |
$347.31
|
| Rate for Payer: Cash Price |
$347.31
|
| Rate for Payer: Coventry All Commercial |
$344.51
|
| Rate for Payer: Frontpath All Commercial |
$391.29
|
| Rate for Payer: Humana ChoiceCare |
$345.33
|
| Rate for Payer: Humana Medicare |
$287.09
|
| Rate for Payer: Lucent All Commercial |
$488.05
|
| Rate for Payer: Lutheran Preferred All Commercial |
$431.00
|
| Rate for Payer: PHCS All Commercial |
$420.14
|
| Rate for Payer: PHP All Commercial |
$490.16
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$287.09
|
| Rate for Payer: Signature Care EPO |
$447.95
|
| Rate for Payer: Signature Care PPO |
$447.95
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$402.00
|
| Rate for Payer: United Healthcare Commercial |
$334.95
|
| Rate for Payer: United Healthcare Medicare |
$287.09
|
|
|
PR REMOVE UTERUS AFTER CESAREAN
|
Professional
|
$842.28
|
|
|
Service Code
|
CPT 59525
|
| Hospital Charge Code |
z59525
|
| Min. Negotiated Rate |
$431.67 |
| Max. Negotiated Rate |
$733.84 |
| Rate for Payer: Aetna Medicare |
$431.67
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$552.79
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$552.79
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$496.42
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$474.84
|
| Rate for Payer: Cash Price |
$522.21
|
| Rate for Payer: Cash Price |
$522.21
|
| Rate for Payer: Coventry All Commercial |
$518.00
|
| Rate for Payer: Frontpath All Commercial |
$627.69
|
| Rate for Payer: Humana ChoiceCare |
$468.97
|
| Rate for Payer: Humana Medicare |
$431.67
|
| Rate for Payer: Lucent All Commercial |
$733.84
|
| Rate for Payer: Lutheran Preferred All Commercial |
$604.00
|
| Rate for Payer: PHCS All Commercial |
$631.71
|
| Rate for Payer: PHP All Commercial |
$555.91
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$431.67
|
| Rate for Payer: Signature Care EPO |
$604.35
|
| Rate for Payer: Signature Care PPO |
$604.35
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$561.00
|
| Rate for Payer: United Healthcare Commercial |
$549.79
|
| Rate for Payer: United Healthcare Medicare |
$431.67
|
|
|
PR REM THER MNTR DEV SPLY W/REC COG BHV THER EA 30D
|
Professional
|
$71.86
|
|
|
Service Code
|
CPT 98978
|
| Hospital Charge Code |
z98978
|
| Min. Negotiated Rate |
$53.90 |
| Max. Negotiated Rate |
$53.90 |
| Rate for Payer: Cash Price |
$44.55
|
| Rate for Payer: PHCS All Commercial |
$53.90
|
|
|
PR REM THER MNTR DEV SPLY W/REC MUSCSKEL SYS EA 30D
|
Professional
|
$86.88
|
|
|
Service Code
|
CPT 98977
|
| Hospital Charge Code |
z98977
|
| 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 |
$53.87
|
| Rate for Payer: Cash Price |
$53.87
|
| Rate for Payer: Coventry All Commercial |
$54.65
|
| Rate for Payer: Humana ChoiceCare |
$45.54
|
| Rate for Payer: Humana Medicare |
$45.54
|
| Rate for Payer: Lucent All Commercial |
$77.42
|
| Rate for Payer: PHCS All Commercial |
$65.16
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$45.54
|
| Rate for Payer: United Healthcare Commercial |
$55.85
|
| Rate for Payer: United Healthcare Medicare |
$45.54
|
|
|
PR REM THER MNTR DEV SUPPLY W/REC RESPIR SYS EA 30D
|
Professional
|
$86.88
|
|
|
Service Code
|
CPT 98976
|
| Hospital Charge Code |
z98976
|
| 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 |
$53.87
|
| Rate for Payer: Cash Price |
$53.87
|
| Rate for Payer: Coventry All Commercial |
$54.65
|
| Rate for Payer: Humana ChoiceCare |
$45.54
|
| Rate for Payer: Humana Medicare |
$45.54
|
| Rate for Payer: Lucent All Commercial |
$77.42
|
| Rate for Payer: PHCS All Commercial |
$65.16
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$45.54
|
| Rate for Payer: United Healthcare Commercial |
$55.85
|
| Rate for Payer: United Healthcare Medicare |
$45.54
|
|
|
PR REMV BENIGN FEMUR LESION
|
Professional
|
$1,108.70
|
|
|
Service Code
|
CPT 27355
|
| Hospital Charge Code |
z27355
|
| Min. Negotiated Rate |
$568.21 |
| Max. Negotiated Rate |
$965.96 |
| Rate for Payer: Aetna Medicare |
$568.21
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$813.20
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$813.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$653.44
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$625.03
|
| Rate for Payer: Cash Price |
$687.39
|
| Rate for Payer: Cash Price |
$687.39
|
| Rate for Payer: Coventry All Commercial |
$681.85
|
| Rate for Payer: Frontpath All Commercial |
$790.57
|
| Rate for Payer: Humana ChoiceCare |
$627.24
|
| Rate for Payer: Humana Medicare |
$568.21
|
| Rate for Payer: Lucent All Commercial |
$965.96
|
| Rate for Payer: Lutheran Preferred All Commercial |
$909.00
|
| Rate for Payer: PHCS All Commercial |
$831.52
|
| Rate for Payer: PHP All Commercial |
$964.57
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$568.21
|
| Rate for Payer: Signature Care EPO |
$842.35
|
| Rate for Payer: Signature Care PPO |
$842.35
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$852.00
|
| Rate for Payer: United Healthcare Commercial |
$646.71
|
| Rate for Payer: United Healthcare Medicare |
$568.21
|
|
|
PR REMV BONE FOR GRAFT MINOR
|
Professional
|
$710.74
|
|
|
Service Code
|
CPT 20900
|
| Hospital Charge Code |
z20900
|
| Min. Negotiated Rate |
$168.22 |
| Max. Negotiated Rate |
$628.59 |
| Rate for Payer: Aetna Medicare |
$168.22
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$193.45
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$185.04
|
| Rate for Payer: Cash Price |
$440.66
|
| Rate for Payer: Cash Price |
$440.66
|
| Rate for Payer: Coventry All Commercial |
$201.86
|
| Rate for Payer: Frontpath All Commercial |
$235.73
|
| Rate for Payer: Humana ChoiceCare |
$486.13
|
| Rate for Payer: Humana Medicare |
$168.22
|
| Rate for Payer: Lucent All Commercial |
$285.97
|
| Rate for Payer: PHCS All Commercial |
$533.06
|
| Rate for Payer: PHP All Commercial |
$285.56
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$168.22
|
| Rate for Payer: Signature Care EPO |
$628.59
|
| Rate for Payer: Signature Care PPO |
$628.59
|
| Rate for Payer: United Healthcare Commercial |
$286.45
|
| Rate for Payer: United Healthcare Medicare |
$168.22
|
|
|
PR REMV EXT CANAL F.B.,GEN ANESTH
|
Professional
|
$350.84
|
|
|
Service Code
|
CPT 69205
|
| Hospital Charge Code |
z69205
|
| Min. Negotiated Rate |
$89.90 |
| Max. Negotiated Rate |
$263.13 |
| Rate for Payer: Aetna Medicare |
$89.90
|
| Rate for Payer: Aetna Medicare |
$89.90
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$117.30
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$117.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$117.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$117.30
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$103.38
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$103.38
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$98.89
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$98.89
|
| Rate for Payer: Cash Price |
$217.52
|
| Rate for Payer: Cash Price |
$108.76
|
| Rate for Payer: Cash Price |
$108.76
|
| Rate for Payer: Cash Price |
$217.52
|
| Rate for Payer: Coventry All Commercial |
$107.88
|
| Rate for Payer: Coventry All Commercial |
$107.88
|
| Rate for Payer: Frontpath All Commercial |
$121.13
|
| Rate for Payer: Frontpath All Commercial |
$121.13
|
| Rate for Payer: Humana ChoiceCare |
$103.87
|
| Rate for Payer: Humana ChoiceCare |
$103.87
|
| Rate for Payer: Humana Medicare |
$89.90
|
| Rate for Payer: Humana Medicare |
$89.90
|
| Rate for Payer: Lucent All Commercial |
$152.83
|
| Rate for Payer: Lucent All Commercial |
$152.83
|
| Rate for Payer: Lutheran Preferred All Commercial |
$144.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$144.00
|
| Rate for Payer: PHCS All Commercial |
$263.13
|
| Rate for Payer: PHCS All Commercial |
$131.56
|
| Rate for Payer: PHP All Commercial |
$114.02
|
| Rate for Payer: PHP All Commercial |
$114.02
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$89.90
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$89.90
|
| Rate for Payer: Signature Care EPO |
$122.40
|
| Rate for Payer: Signature Care EPO |
$122.40
|
| Rate for Payer: Signature Care PPO |
$122.40
|
| Rate for Payer: Signature Care PPO |
$122.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$135.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$135.00
|
| Rate for Payer: United Healthcare Commercial |
$109.36
|
| Rate for Payer: United Healthcare Commercial |
$109.36
|
| Rate for Payer: United Healthcare Medicare |
$89.90
|
| Rate for Payer: United Healthcare Medicare |
$89.90
|
|
|
PR REMV EXT CANAL FOREIGN BODY
|
Professional
|
$293.08
|
|
|
Service Code
|
CPT 69200
|
| Hospital Charge Code |
z69200
|
| Min. Negotiated Rate |
$44.23 |
| Max. Negotiated Rate |
$219.81 |
| Rate for Payer: Aetna Medicare |
$44.23
|
| Rate for Payer: Aetna Medicare |
$44.23
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$142.59
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$142.59
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$142.59
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$142.59
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$50.86
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$50.86
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$48.65
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$48.65
|
| Rate for Payer: Cash Price |
$90.85
|
| Rate for Payer: Cash Price |
$90.85
|
| Rate for Payer: Cash Price |
$181.71
|
| Rate for Payer: Cash Price |
$181.71
|
| Rate for Payer: Coventry All Commercial |
$53.08
|
| Rate for Payer: Coventry All Commercial |
$53.08
|
| Rate for Payer: Frontpath All Commercial |
$61.00
|
| Rate for Payer: Frontpath All Commercial |
$61.00
|
| Rate for Payer: Humana ChoiceCare |
$54.31
|
| Rate for Payer: Humana ChoiceCare |
$54.31
|
| Rate for Payer: Humana Medicare |
$44.23
|
| Rate for Payer: Humana Medicare |
$44.23
|
| Rate for Payer: Lucent All Commercial |
$75.19
|
| Rate for Payer: Lucent All Commercial |
$75.19
|
| Rate for Payer: Lutheran Preferred All Commercial |
$71.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$71.00
|
| Rate for Payer: PHCS All Commercial |
$219.81
|
| Rate for Payer: PHCS All Commercial |
$109.90
|
| Rate for Payer: PHP All Commercial |
$56.09
|
| Rate for Payer: PHP All Commercial |
$56.09
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$44.23
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$44.23
|
| Rate for Payer: Signature Care EPO |
$127.74
|
| Rate for Payer: Signature Care EPO |
$127.74
|
| Rate for Payer: Signature Care PPO |
$127.74
|
| Rate for Payer: Signature Care PPO |
$127.74
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$66.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$66.00
|
| Rate for Payer: United Healthcare Commercial |
$61.16
|
| Rate for Payer: United Healthcare Commercial |
$61.16
|
| Rate for Payer: United Healthcare Medicare |
$44.23
|
| Rate for Payer: United Healthcare Medicare |
$44.23
|
|
|
PR REMV EXT CANAL SOFT TISSUE LESN
|
Professional
|
$756.08
|
|
|
Service Code
|
CPT 69145
|
| Hospital Charge Code |
z69145
|
| Min. Negotiated Rate |
$239.57 |
| Max. Negotiated Rate |
$567.06 |
| Rate for Payer: Aetna Medicare |
$242.71
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$320.29
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$320.29
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$279.12
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$266.98
|
| Rate for Payer: Cash Price |
$468.77
|
| Rate for Payer: Cash Price |
$468.77
|
| Rate for Payer: Coventry All Commercial |
$291.25
|
| Rate for Payer: Frontpath All Commercial |
$328.78
|
| Rate for Payer: Humana ChoiceCare |
$239.57
|
| Rate for Payer: Humana Medicare |
$242.71
|
| Rate for Payer: Lucent All Commercial |
$412.61
|
| Rate for Payer: Lutheran Preferred All Commercial |
$388.00
|
| Rate for Payer: PHCS All Commercial |
$567.06
|
| Rate for Payer: PHP All Commercial |
$307.82
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$242.71
|
| Rate for Payer: Signature Care EPO |
$332.02
|
| Rate for Payer: Signature Care PPO |
$332.02
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$364.00
|
| Rate for Payer: United Healthcare Commercial |
$264.20
|
| Rate for Payer: United Healthcare Medicare |
$242.71
|
|
|
PR REMV F.B.,EYE,CORNEA,NO SLIT
|
Professional
|
$109.72
|
|
|
Service Code
|
CPT 65220
|
| Hospital Charge Code |
z65220
|
| Min. Negotiated Rate |
$38.64 |
| Max. Negotiated Rate |
$140.64 |
| Rate for Payer: Aetna Medicare |
$38.64
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$140.64
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$140.64
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$44.44
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$42.50
|
| Rate for Payer: Cash Price |
$68.03
|
| Rate for Payer: Cash Price |
$68.03
|
| Rate for Payer: Coventry All Commercial |
$46.37
|
| Rate for Payer: Frontpath All Commercial |
$52.81
|
| Rate for Payer: Humana ChoiceCare |
$38.66
|
| Rate for Payer: Humana Medicare |
$38.64
|
| Rate for Payer: Lucent All Commercial |
$65.69
|
| Rate for Payer: Lutheran Preferred All Commercial |
$62.00
|
| Rate for Payer: PHCS All Commercial |
$82.29
|
| Rate for Payer: PHP All Commercial |
$69.73
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$38.64
|
| Rate for Payer: Signature Care EPO |
$68.85
|
| Rate for Payer: Signature Care PPO |
$68.85
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$58.00
|
| Rate for Payer: United Healthcare Commercial |
$45.36
|
| Rate for Payer: United Healthcare Medicare |
$38.64
|
|
|
PR REMV F.B.,EYE,CORNEA,SLIT LAMP
|
Professional
|
$124.26
|
|
|
Service Code
|
CPT 65222
|
| Hospital Charge Code |
z65222
|
| Min. Negotiated Rate |
$47.32 |
| Max. Negotiated Rate |
$93.20 |
| Rate for Payer: Aetna Medicare |
$47.32
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$89.35
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$89.35
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$54.42
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$52.05
|
| Rate for Payer: Cash Price |
$77.04
|
| Rate for Payer: Cash Price |
$77.04
|
| Rate for Payer: Coventry All Commercial |
$56.78
|
| Rate for Payer: Frontpath All Commercial |
$63.66
|
| Rate for Payer: Humana ChoiceCare |
$50.66
|
| Rate for Payer: Humana Medicare |
$47.32
|
| Rate for Payer: Lucent All Commercial |
$80.44
|
| Rate for Payer: Lutheran Preferred All Commercial |
$76.00
|
| Rate for Payer: PHCS All Commercial |
$93.20
|
| Rate for Payer: PHP All Commercial |
$85.41
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$47.32
|
| Rate for Payer: Signature Care EPO |
$88.40
|
| Rate for Payer: Signature Care PPO |
$88.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$71.00
|
| Rate for Payer: United Healthcare Commercial |
$60.80
|
| Rate for Payer: United Healthcare Medicare |
$47.32
|
|
|
PR REMV F.B.,EYE,SUPERF CONJUNC
|
Professional
|
$53.54
|
|
|
Service Code
|
CPT 65205
|
| Hospital Charge Code |
z65205
|
| Min. Negotiated Rate |
$27.44 |
| Max. Negotiated Rate |
$102.42 |
| Rate for Payer: Aetna Medicare |
$27.44
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$102.42
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$102.42
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$31.56
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$30.18
|
| Rate for Payer: Cash Price |
$33.19
|
| Rate for Payer: Cash Price |
$33.19
|
| Rate for Payer: Coventry All Commercial |
$32.93
|
| Rate for Payer: Frontpath All Commercial |
$37.15
|
| Rate for Payer: Humana ChoiceCare |
$38.67
|
| Rate for Payer: Humana Medicare |
$27.44
|
| Rate for Payer: Lucent All Commercial |
$46.65
|
| Rate for Payer: Lutheran Preferred All Commercial |
$44.00
|
| Rate for Payer: PHCS All Commercial |
$40.16
|
| Rate for Payer: PHP All Commercial |
$49.52
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$27.44
|
| Rate for Payer: Signature Care EPO |
$46.87
|
| Rate for Payer: Signature Care PPO |
$46.87
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$41.00
|
| Rate for Payer: United Healthcare Commercial |
$46.06
|
| Rate for Payer: United Healthcare Medicare |
$27.44
|
|
|
PR REMV FOOT FOREIGN BODY,DEEP
|
Professional
|
$836.46
|
|
|
Service Code
|
CPT 28192
|
| Hospital Charge Code |
z28192
|
| Min. Negotiated Rate |
$292.86 |
| Max. Negotiated Rate |
$629.85 |
| Rate for Payer: Aetna Medicare |
$292.86
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$438.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$438.00
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$336.79
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$322.15
|
| Rate for Payer: Cash Price |
$518.61
|
| Rate for Payer: Cash Price |
$518.61
|
| Rate for Payer: Coventry All Commercial |
$351.43
|
| Rate for Payer: Frontpath All Commercial |
$396.89
|
| Rate for Payer: Humana ChoiceCare |
$358.12
|
| Rate for Payer: Humana Medicare |
$292.86
|
| Rate for Payer: Lucent All Commercial |
$497.86
|
| Rate for Payer: Lutheran Preferred All Commercial |
$469.00
|
| Rate for Payer: PHCS All Commercial |
$627.34
|
| Rate for Payer: PHP All Commercial |
$497.14
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$292.86
|
| Rate for Payer: Signature Care EPO |
$629.85
|
| Rate for Payer: Signature Care PPO |
$629.85
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$439.00
|
| Rate for Payer: United Healthcare Commercial |
$362.84
|
| Rate for Payer: United Healthcare Medicare |
$292.86
|
|
|
PR REMV FOOT FOREIGN BODY,SUBCUTANEOUS
|
Professional
|
$439.46
|
|
|
Service Code
|
CPT 28190
|
| Hospital Charge Code |
z28190
|
| Min. Negotiated Rate |
$124.58 |
| Max. Negotiated Rate |
$389.52 |
| Rate for Payer: Aetna Medicare |
$124.58
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$229.80
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$229.80
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$143.27
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$137.04
|
| Rate for Payer: Cash Price |
$272.47
|
| Rate for Payer: Cash Price |
$272.47
|
| Rate for Payer: Coventry All Commercial |
$149.50
|
| Rate for Payer: Frontpath All Commercial |
$169.27
|
| Rate for Payer: Humana ChoiceCare |
$148.30
|
| Rate for Payer: Humana Medicare |
$124.58
|
| Rate for Payer: Lucent All Commercial |
$211.79
|
| Rate for Payer: Lutheran Preferred All Commercial |
$199.00
|
| Rate for Payer: PHCS All Commercial |
$329.60
|
| Rate for Payer: PHP All Commercial |
$211.48
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$124.58
|
| Rate for Payer: Signature Care EPO |
$389.52
|
| Rate for Payer: Signature Care PPO |
$389.52
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$187.00
|
| Rate for Payer: United Healthcare Commercial |
$151.49
|
| Rate for Payer: United Healthcare Medicare |
$124.58
|
|
|
PR REMV FOREIGN BODY,KNEE/THIGH,DEEP
|
Professional
|
$1,071.72
|
|
|
Service Code
|
CPT 27372
|
| Hospital Charge Code |
z27372
|
| Min. Negotiated Rate |
$373.29 |
| Max. Negotiated Rate |
$803.79 |
| Rate for Payer: Aetna Medicare |
$373.29
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$616.48
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$616.48
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$429.28
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$410.62
|
| Rate for Payer: Cash Price |
$664.47
|
| Rate for Payer: Cash Price |
$664.47
|
| Rate for Payer: Coventry All Commercial |
$447.95
|
| Rate for Payer: Frontpath All Commercial |
$521.17
|
| Rate for Payer: Humana ChoiceCare |
$422.81
|
| Rate for Payer: Humana Medicare |
$373.29
|
| Rate for Payer: Lucent All Commercial |
$634.59
|
| Rate for Payer: Lutheran Preferred All Commercial |
$597.00
|
| Rate for Payer: PHCS All Commercial |
$803.79
|
| Rate for Payer: PHP All Commercial |
$633.67
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$373.29
|
| Rate for Payer: Signature Care EPO |
$634.95
|
| Rate for Payer: Signature Care PPO |
$634.95
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$560.00
|
| Rate for Payer: United Healthcare Commercial |
$430.65
|
| Rate for Payer: United Healthcare Medicare |
$373.29
|
|
|
PR REMVL COLON & TERM ILEUM W/ILEOCOLOSTOMY
|
Professional
|
$2,214.12
|
|
|
Service Code
|
CPT 44160
|
| Hospital Charge Code |
z44160
|
| Min. Negotiated Rate |
$1,134.74 |
| Max. Negotiated Rate |
$1,937.36 |
| Rate for Payer: Aetna Medicare |
$1,134.74
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,317.90
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,317.90
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,304.95
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,248.21
|
| Rate for Payer: Cash Price |
$1,372.75
|
| Rate for Payer: Cash Price |
$1,372.75
|
| Rate for Payer: Coventry All Commercial |
$1,361.69
|
| Rate for Payer: Frontpath All Commercial |
$1,636.65
|
| Rate for Payer: Humana ChoiceCare |
$1,208.91
|
| Rate for Payer: Humana Medicare |
$1,134.74
|
| Rate for Payer: Lucent All Commercial |
$1,929.06
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,702.00
|
| Rate for Payer: PHCS All Commercial |
$1,660.59
|
| Rate for Payer: PHP All Commercial |
$1,937.36
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,134.74
|
| Rate for Payer: Signature Care EPO |
$1,531.70
|
| Rate for Payer: Signature Care PPO |
$1,531.70
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,589.00
|
| Rate for Payer: United Healthcare Commercial |
$1,324.89
|
| Rate for Payer: United Healthcare Medicare |
$1,134.74
|
|
|
PR REMVL PERM PM PLSE GEN W/REPL PLSE GEN SNGL LEAD
|
Professional
|
$601.94
|
|
|
Service Code
|
CPT 33227
|
| Hospital Charge Code |
z33227
|
| Min. Negotiated Rate |
$308.49 |
| Max. Negotiated Rate |
$524.43 |
| Rate for Payer: Aetna Medicare |
$308.49
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$475.16
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$475.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$354.76
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$339.34
|
| Rate for Payer: Cash Price |
$373.20
|
| Rate for Payer: Cash Price |
$373.20
|
| Rate for Payer: Coventry All Commercial |
$370.19
|
| Rate for Payer: Frontpath All Commercial |
$443.52
|
| Rate for Payer: Humana ChoiceCare |
$413.50
|
| Rate for Payer: Humana Medicare |
$308.49
|
| Rate for Payer: Lucent All Commercial |
$524.43
|
| Rate for Payer: Lutheran Preferred All Commercial |
$494.00
|
| Rate for Payer: PHCS All Commercial |
$451.46
|
| Rate for Payer: PHP All Commercial |
$421.36
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$308.49
|
| Rate for Payer: Signature Care EPO |
$404.00
|
| Rate for Payer: Signature Care PPO |
$404.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$463.00
|
| Rate for Payer: United Healthcare Commercial |
$418.16
|
| Rate for Payer: United Healthcare Medicare |
$308.49
|
|
|
PR REMVL PERM PM PLS GEN W/REPL PLSE GEN 2 LEAD SYS
|
Professional
|
$628.88
|
|
|
Service Code
|
CPT 33228
|
| Hospital Charge Code |
z33228
|
| Min. Negotiated Rate |
$322.30 |
| Max. Negotiated Rate |
$547.91 |
| Rate for Payer: Aetna Medicare |
$322.30
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$495.53
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$495.53
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$370.64
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$354.53
|
| Rate for Payer: Cash Price |
$389.91
|
| Rate for Payer: Cash Price |
$389.91
|
| Rate for Payer: Coventry All Commercial |
$386.76
|
| Rate for Payer: Frontpath All Commercial |
$464.54
|
| Rate for Payer: Humana ChoiceCare |
$431.22
|
| Rate for Payer: Humana Medicare |
$322.30
|
| Rate for Payer: Lucent All Commercial |
$547.91
|
| Rate for Payer: Lutheran Preferred All Commercial |
$516.00
|
| Rate for Payer: PHCS All Commercial |
$471.66
|
| Rate for Payer: PHP All Commercial |
$440.22
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$322.30
|
| Rate for Payer: Signature Care EPO |
$421.32
|
| Rate for Payer: Signature Care PPO |
$421.32
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$483.00
|
| Rate for Payer: United Healthcare Commercial |
$436.10
|
| Rate for Payer: United Healthcare Medicare |
$322.30
|
|
