|
PR REPAIR NONUNION RADIUS OR ULNA
|
Professional
|
$1,462.12
|
|
|
Service Code
|
CPT 25400
|
| Hospital Charge Code |
z25400
|
| Min. Negotiated Rate |
$749.34 |
| Max. Negotiated Rate |
$1,274.15 |
| Rate for Payer: Aetna Medicare |
$749.34
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,185.20
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,185.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$861.74
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$824.27
|
| Rate for Payer: Cash Price |
$906.51
|
| Rate for Payer: Cash Price |
$906.51
|
| Rate for Payer: Coventry All Commercial |
$899.21
|
| Rate for Payer: Frontpath All Commercial |
$1,041.85
|
| Rate for Payer: Humana ChoiceCare |
$1,112.92
|
| Rate for Payer: Humana Medicare |
$749.34
|
| Rate for Payer: Lucent All Commercial |
$1,273.88
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,199.00
|
| Rate for Payer: PHCS All Commercial |
$1,096.59
|
| Rate for Payer: PHP All Commercial |
$1,272.05
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$749.34
|
| Rate for Payer: Signature Care EPO |
$1,274.15
|
| Rate for Payer: Signature Care PPO |
$1,274.15
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,124.00
|
| Rate for Payer: United Healthcare Commercial |
$943.65
|
| Rate for Payer: United Healthcare Medicare |
$749.34
|
|
|
PR REPAIR OF BICEPS TENDON AT ELBOW
|
Professional
|
$1,098.44
|
|
|
Service Code
|
CPT 24340
|
| Hospital Charge Code |
z24340
|
| Min. Negotiated Rate |
$562.95 |
| Max. Negotiated Rate |
$957.02 |
| Rate for Payer: Aetna Medicare |
$562.95
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$743.40
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$743.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$647.39
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$619.24
|
| Rate for Payer: Cash Price |
$681.03
|
| Rate for Payer: Cash Price |
$681.03
|
| Rate for Payer: Coventry All Commercial |
$675.54
|
| Rate for Payer: Frontpath All Commercial |
$802.80
|
| Rate for Payer: Humana ChoiceCare |
$646.79
|
| Rate for Payer: Humana Medicare |
$562.95
|
| Rate for Payer: Lucent All Commercial |
$957.02
|
| Rate for Payer: Lutheran Preferred All Commercial |
$901.00
|
| Rate for Payer: PHCS All Commercial |
$823.83
|
| Rate for Payer: PHP All Commercial |
$955.64
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$562.95
|
| Rate for Payer: Signature Care EPO |
$862.75
|
| Rate for Payer: Signature Care PPO |
$862.75
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$844.00
|
| Rate for Payer: United Healthcare Commercial |
$657.15
|
| Rate for Payer: United Healthcare Medicare |
$562.95
|
|
|
PR REPAIR OF PERINEUM,NON OBSTETRICAL
|
Professional
|
$497.48
|
|
|
Service Code
|
CPT 56810
|
| Hospital Charge Code |
z56810
|
| Min. Negotiated Rate |
$254.96 |
| Max. Negotiated Rate |
$433.43 |
| Rate for Payer: Aetna Medicare |
$254.96
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$338.24
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$338.24
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$293.20
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$280.46
|
| Rate for Payer: Cash Price |
$308.44
|
| Rate for Payer: Cash Price |
$308.44
|
| Rate for Payer: Coventry All Commercial |
$305.95
|
| Rate for Payer: Frontpath All Commercial |
$355.03
|
| Rate for Payer: Humana ChoiceCare |
$284.54
|
| Rate for Payer: Humana Medicare |
$254.96
|
| Rate for Payer: Lucent All Commercial |
$433.43
|
| Rate for Payer: Lutheran Preferred All Commercial |
$357.00
|
| Rate for Payer: PHCS All Commercial |
$373.11
|
| Rate for Payer: PHP All Commercial |
$328.34
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$254.96
|
| Rate for Payer: Signature Care EPO |
$320.45
|
| Rate for Payer: Signature Care PPO |
$320.45
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$331.00
|
| Rate for Payer: United Healthcare Commercial |
$294.69
|
| Rate for Payer: United Healthcare Medicare |
$254.96
|
|
|
PR REPAIR OF RUPTURED UTERUS
|
Professional
|
$488.48
|
|
|
Service Code
|
CPT 59350
|
| Hospital Charge Code |
z59350
|
| Min. Negotiated Rate |
$250.35 |
| Max. Negotiated Rate |
$425.60 |
| Rate for Payer: Aetna Medicare |
$250.35
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$391.10
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$391.10
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$287.90
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$275.38
|
| Rate for Payer: Cash Price |
$302.86
|
| Rate for Payer: Cash Price |
$302.86
|
| Rate for Payer: Coventry All Commercial |
$300.42
|
| Rate for Payer: Frontpath All Commercial |
$362.37
|
| Rate for Payer: Humana ChoiceCare |
$271.10
|
| Rate for Payer: Humana Medicare |
$250.35
|
| Rate for Payer: Lucent All Commercial |
$425.60
|
| Rate for Payer: Lutheran Preferred All Commercial |
$350.00
|
| Rate for Payer: PHCS All Commercial |
$366.36
|
| Rate for Payer: PHP All Commercial |
$322.40
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$250.35
|
| Rate for Payer: Signature Care EPO |
$351.05
|
| Rate for Payer: Signature Care PPO |
$351.05
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$325.00
|
| Rate for Payer: United Healthcare Commercial |
$314.73
|
| Rate for Payer: United Healthcare Medicare |
$250.35
|
|
|
PR REPAIR RECURR INGUIN HERN,REDUCIBL
|
Professional
|
$1,132.68
|
|
|
Service Code
|
CPT 49520
|
| Hospital Charge Code |
z49520
|
| Min. Negotiated Rate |
$580.34 |
| Max. Negotiated Rate |
$991.09 |
| Rate for Payer: Aetna Medicare |
$580.34
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$672.10
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$672.10
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$667.39
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$638.37
|
| Rate for Payer: Cash Price |
$702.26
|
| Rate for Payer: Cash Price |
$702.26
|
| Rate for Payer: Coventry All Commercial |
$696.41
|
| Rate for Payer: Frontpath All Commercial |
$838.55
|
| Rate for Payer: Humana ChoiceCare |
$644.19
|
| Rate for Payer: Humana Medicare |
$580.34
|
| Rate for Payer: Lucent All Commercial |
$986.58
|
| Rate for Payer: Lutheran Preferred All Commercial |
$871.00
|
| Rate for Payer: PHCS All Commercial |
$849.51
|
| Rate for Payer: PHP All Commercial |
$991.09
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$580.34
|
| Rate for Payer: Signature Care EPO |
$812.60
|
| Rate for Payer: Signature Care PPO |
$812.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$812.00
|
| Rate for Payer: United Healthcare Commercial |
$667.58
|
| Rate for Payer: United Healthcare Medicare |
$580.34
|
|
|
PR REPAIR ROTATOR CUFF,ACUTE
|
Professional
|
$1,489.40
|
|
|
Service Code
|
CPT 23410
|
| Hospital Charge Code |
z23410
|
| Min. Negotiated Rate |
$763.32 |
| Max. Negotiated Rate |
$1,297.64 |
| Rate for Payer: Aetna Medicare |
$763.32
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,192.70
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,192.70
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$877.82
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$839.65
|
| Rate for Payer: Cash Price |
$923.43
|
| Rate for Payer: Cash Price |
$923.43
|
| Rate for Payer: Coventry All Commercial |
$915.98
|
| Rate for Payer: Frontpath All Commercial |
$1,064.61
|
| Rate for Payer: Humana ChoiceCare |
$956.78
|
| Rate for Payer: Humana Medicare |
$763.32
|
| Rate for Payer: Lucent All Commercial |
$1,297.64
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,221.00
|
| Rate for Payer: PHCS All Commercial |
$1,117.05
|
| Rate for Payer: PHP All Commercial |
$1,295.78
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$763.32
|
| Rate for Payer: Signature Care EPO |
$1,280.10
|
| Rate for Payer: Signature Care PPO |
$1,280.10
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,145.00
|
| Rate for Payer: United Healthcare Commercial |
$903.01
|
| Rate for Payer: United Healthcare Medicare |
$763.32
|
|
|
PR REPAIR ROTATOR CUFF,CHRONIC
|
Professional
|
$1,546.64
|
|
|
Service Code
|
CPT 23412
|
| Hospital Charge Code |
z23412
|
| Min. Negotiated Rate |
$792.65 |
| Max. Negotiated Rate |
$1,349.92 |
| Rate for Payer: Aetna Medicare |
$792.65
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,310.40
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,310.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$911.55
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$871.92
|
| Rate for Payer: Cash Price |
$958.92
|
| Rate for Payer: Cash Price |
$958.92
|
| Rate for Payer: Coventry All Commercial |
$951.18
|
| Rate for Payer: Frontpath All Commercial |
$1,106.64
|
| Rate for Payer: Humana ChoiceCare |
$1,016.56
|
| Rate for Payer: Humana Medicare |
$792.65
|
| Rate for Payer: Lucent All Commercial |
$1,347.50
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,268.00
|
| Rate for Payer: PHCS All Commercial |
$1,159.98
|
| Rate for Payer: PHP All Commercial |
$1,345.57
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$792.65
|
| Rate for Payer: Signature Care EPO |
$1,349.92
|
| Rate for Payer: Signature Care PPO |
$1,349.92
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,189.00
|
| Rate for Payer: United Healthcare Commercial |
$943.83
|
| Rate for Payer: United Healthcare Medicare |
$792.65
|
|
|
PR REPAIR RUPTURED UTERUS,NON OBSTECTR
|
Professional
|
$1,462.84
|
|
|
Service Code
|
CPT 58520
|
| Hospital Charge Code |
z58520
|
| Min. Negotiated Rate |
$749.70 |
| Max. Negotiated Rate |
$1,274.49 |
| Rate for Payer: Aetna Medicare |
$749.70
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$862.16
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$824.67
|
| Rate for Payer: Cash Price |
$906.96
|
| Rate for Payer: Cash Price |
$906.96
|
| Rate for Payer: Coventry All Commercial |
$899.64
|
| Rate for Payer: Frontpath All Commercial |
$1,049.88
|
| Rate for Payer: Humana ChoiceCare |
$799.11
|
| Rate for Payer: Humana Medicare |
$749.70
|
| Rate for Payer: Lucent All Commercial |
$1,274.49
|
| Rate for Payer: PHCS All Commercial |
$1,097.13
|
| Rate for Payer: PHP All Commercial |
$965.47
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$749.70
|
| Rate for Payer: Signature Care EPO |
$898.45
|
| Rate for Payer: Signature Care PPO |
$898.45
|
| Rate for Payer: United Healthcare Commercial |
$882.13
|
| Rate for Payer: United Healthcare Medicare |
$749.70
|
|
|
PR REPAIR TYMPANIC MEMBRANE
|
Professional
|
$704.50
|
|
|
Service Code
|
CPT 69610
|
| Hospital Charge Code |
z69610
|
| Min. Negotiated Rate |
$270.30 |
| Max. Negotiated Rate |
$528.38 |
| Rate for Payer: Aetna Medicare |
$270.30
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$374.01
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$374.01
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$310.84
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$297.33
|
| Rate for Payer: Cash Price |
$436.79
|
| Rate for Payer: Cash Price |
$436.79
|
| Rate for Payer: Coventry All Commercial |
$324.36
|
| Rate for Payer: Frontpath All Commercial |
$371.42
|
| Rate for Payer: Humana ChoiceCare |
$316.68
|
| Rate for Payer: Humana Medicare |
$270.30
|
| Rate for Payer: Lucent All Commercial |
$459.51
|
| Rate for Payer: Lutheran Preferred All Commercial |
$432.00
|
| Rate for Payer: PHCS All Commercial |
$528.38
|
| Rate for Payer: PHP All Commercial |
$342.82
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$270.30
|
| Rate for Payer: Signature Care EPO |
$470.05
|
| Rate for Payer: Signature Care PPO |
$470.05
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$405.00
|
| Rate for Payer: United Healthcare Commercial |
$327.01
|
| Rate for Payer: United Healthcare Medicare |
$270.30
|
|
|
PR REPAIR VAGINA/PERINEUM
|
Professional
|
$719.96
|
|
|
Service Code
|
CPT 57210
|
| Hospital Charge Code |
z57210
|
| Min. Negotiated Rate |
$368.98 |
| Max. Negotiated Rate |
$627.27 |
| Rate for Payer: Aetna Medicare |
$368.98
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$451.31
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$451.31
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$424.33
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$405.88
|
| Rate for Payer: Cash Price |
$446.38
|
| Rate for Payer: Cash Price |
$446.38
|
| Rate for Payer: Coventry All Commercial |
$442.78
|
| Rate for Payer: Frontpath All Commercial |
$514.19
|
| Rate for Payer: Humana ChoiceCare |
$378.97
|
| Rate for Payer: Humana Medicare |
$368.98
|
| Rate for Payer: Lucent All Commercial |
$627.27
|
| Rate for Payer: Lutheran Preferred All Commercial |
$517.00
|
| Rate for Payer: PHCS All Commercial |
$539.97
|
| Rate for Payer: PHP All Commercial |
$475.18
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$368.98
|
| Rate for Payer: Signature Care EPO |
$425.85
|
| Rate for Payer: Signature Care PPO |
$425.85
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$480.00
|
| Rate for Payer: United Healthcare Commercial |
$411.69
|
| Rate for Payer: United Healthcare Medicare |
$368.98
|
|
|
PR REPEAT CONTROL OF NOSEBLEED
|
Professional
|
$682.94
|
|
|
Service Code
|
CPT 30906
|
| Hospital Charge Code |
z30906
|
| Min. Negotiated Rate |
$124.33 |
| Max. Negotiated Rate |
$512.20 |
| Rate for Payer: Aetna Medicare |
$124.33
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$251.40
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$251.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$142.98
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$136.76
|
| Rate for Payer: Cash Price |
$423.42
|
| Rate for Payer: Cash Price |
$423.42
|
| Rate for Payer: Coventry All Commercial |
$149.20
|
| Rate for Payer: Frontpath All Commercial |
$177.06
|
| Rate for Payer: Humana ChoiceCare |
$166.89
|
| Rate for Payer: Humana Medicare |
$124.33
|
| Rate for Payer: Lucent All Commercial |
$211.36
|
| Rate for Payer: Lutheran Preferred All Commercial |
$199.00
|
| Rate for Payer: PHCS All Commercial |
$512.20
|
| Rate for Payer: PHP All Commercial |
$169.82
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$124.33
|
| Rate for Payer: Signature Care EPO |
$332.35
|
| Rate for Payer: Signature Care PPO |
$332.35
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$187.00
|
| Rate for Payer: United Healthcare Commercial |
$153.93
|
| Rate for Payer: United Healthcare Medicare |
$124.33
|
|
|
PR REPR,EYELID,NOSE,EAR,LIP+5 CM
|
Professional
|
$338.54
|
|
|
Service Code
|
CPT 13153
|
| Hospital Charge Code |
z13153
|
| Min. Negotiated Rate |
$126.89 |
| Max. Negotiated Rate |
$253.90 |
| Rate for Payer: Aetna Medicare |
$126.89
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$190.28
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$190.28
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$145.92
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$139.58
|
| Rate for Payer: Cash Price |
$209.89
|
| Rate for Payer: Cash Price |
$209.89
|
| Rate for Payer: Coventry All Commercial |
$152.27
|
| Rate for Payer: Frontpath All Commercial |
$176.38
|
| Rate for Payer: Humana ChoiceCare |
$133.30
|
| Rate for Payer: Humana Medicare |
$126.89
|
| Rate for Payer: Lucent All Commercial |
$215.71
|
| Rate for Payer: Lutheran Preferred All Commercial |
$165.00
|
| Rate for Payer: PHCS All Commercial |
$253.90
|
| Rate for Payer: PHP All Commercial |
$173.31
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$126.89
|
| Rate for Payer: Signature Care EPO |
$156.34
|
| Rate for Payer: Signature Care PPO |
$156.34
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$152.00
|
| Rate for Payer: United Healthcare Commercial |
$159.30
|
| Rate for Payer: United Healthcare Medicare |
$126.89
|
|
|
PR REP,SKIN,SCALP/EXTREM+5 CM/<
|
Professional
|
$232.24
|
|
|
Service Code
|
CPT 13122
|
| Hospital Charge Code |
z13122
|
| Min. Negotiated Rate |
$76.73 |
| Max. Negotiated Rate |
$174.18 |
| Rate for Payer: Aetna Medicare |
$76.73
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$122.23
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$122.23
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$88.24
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$84.40
|
| Rate for Payer: Cash Price |
$143.99
|
| Rate for Payer: Cash Price |
$143.99
|
| Rate for Payer: Coventry All Commercial |
$92.08
|
| Rate for Payer: Frontpath All Commercial |
$106.25
|
| Rate for Payer: Humana ChoiceCare |
$78.68
|
| Rate for Payer: Humana Medicare |
$76.73
|
| Rate for Payer: Lucent All Commercial |
$130.44
|
| Rate for Payer: Lutheran Preferred All Commercial |
$100.00
|
| Rate for Payer: PHCS All Commercial |
$174.18
|
| Rate for Payer: PHP All Commercial |
$104.80
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$76.73
|
| Rate for Payer: Signature Care EPO |
$107.13
|
| Rate for Payer: Signature Care PPO |
$107.13
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$92.00
|
| Rate for Payer: United Healthcare Commercial |
$94.63
|
| Rate for Payer: United Healthcare Medicare |
$76.73
|
|
|
PR REP,SKIN,TRUNK,CMPLX,+5 CM/<
|
Professional
|
$212.64
|
|
|
Service Code
|
CPT 13102
|
| Hospital Charge Code |
z13102
|
| Min. Negotiated Rate |
$66.38 |
| Max. Negotiated Rate |
$159.48 |
| Rate for Payer: Aetna Medicare |
$66.38
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$76.34
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$73.02
|
| Rate for Payer: Cash Price |
$131.84
|
| Rate for Payer: Cash Price |
$131.84
|
| Rate for Payer: Coventry All Commercial |
$79.66
|
| Rate for Payer: Frontpath All Commercial |
$93.56
|
| Rate for Payer: Humana ChoiceCare |
$68.71
|
| Rate for Payer: Humana Medicare |
$66.38
|
| Rate for Payer: Lucent All Commercial |
$112.85
|
| Rate for Payer: PHCS All Commercial |
$159.48
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$66.38
|
| Rate for Payer: United Healthcare Commercial |
$82.59
|
| Rate for Payer: United Healthcare Medicare |
$66.38
|
|
|
PR RESEC HEAD OF PHALANX,TOE
|
Professional
|
$738.12
|
|
|
Service Code
|
CPT 28153
|
| Hospital Charge Code |
z28153
|
| Min. Negotiated Rate |
$248.94 |
| Max. Negotiated Rate |
$553.59 |
| Rate for Payer: Aetna Medicare |
$248.94
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$373.81
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$373.81
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$286.28
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$273.83
|
| Rate for Payer: Cash Price |
$457.63
|
| Rate for Payer: Cash Price |
$457.63
|
| Rate for Payer: Coventry All Commercial |
$298.73
|
| Rate for Payer: Frontpath All Commercial |
$337.04
|
| Rate for Payer: Humana ChoiceCare |
$274.69
|
| Rate for Payer: Humana Medicare |
$248.94
|
| Rate for Payer: Lucent All Commercial |
$423.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$398.00
|
| Rate for Payer: PHCS All Commercial |
$553.59
|
| Rate for Payer: PHP All Commercial |
$422.59
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$248.94
|
| Rate for Payer: Signature Care EPO |
$516.80
|
| Rate for Payer: Signature Care PPO |
$516.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$373.00
|
| Rate for Payer: United Healthcare Commercial |
$296.25
|
| Rate for Payer: United Healthcare Medicare |
$248.94
|
|
|
PR RESECT SMALL INTEST,SINGL RESEC/ANAS
|
Professional
|
$2,172.98
|
|
|
Service Code
|
CPT 44120
|
| Hospital Charge Code |
z44120
|
| Min. Negotiated Rate |
$1,105.51 |
| Max. Negotiated Rate |
$1,901.36 |
| Rate for Payer: Aetna Medicare |
$1,113.65
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,148.60
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,148.60
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,280.70
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,225.02
|
| Rate for Payer: Cash Price |
$1,347.25
|
| Rate for Payer: Cash Price |
$1,347.25
|
| Rate for Payer: Coventry All Commercial |
$1,336.38
|
| Rate for Payer: Frontpath All Commercial |
$1,615.25
|
| Rate for Payer: Humana ChoiceCare |
$1,105.51
|
| Rate for Payer: Humana Medicare |
$1,113.65
|
| Rate for Payer: Lucent All Commercial |
$1,893.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,670.00
|
| Rate for Payer: PHCS All Commercial |
$1,629.74
|
| Rate for Payer: PHP All Commercial |
$1,901.36
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,113.65
|
| Rate for Payer: Signature Care EPO |
$1,390.60
|
| Rate for Payer: Signature Care PPO |
$1,390.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,559.00
|
| Rate for Payer: United Healthcare Commercial |
$1,302.05
|
| Rate for Payer: United Healthcare Medicare |
$1,113.65
|
|
|
PR RESUPERF WND BODY 12.6-20 CM
|
Professional
|
$320.78
|
|
|
Service Code
|
CPT 12005
|
| Hospital Charge Code |
z12005
|
| Min. Negotiated Rate |
$87.22 |
| Max. Negotiated Rate |
$243.08 |
| Rate for Payer: Aetna Medicare |
$87.22
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$243.08
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$243.08
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$100.30
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$95.94
|
| Rate for Payer: Cash Price |
$198.88
|
| Rate for Payer: Cash Price |
$198.88
|
| Rate for Payer: Coventry All Commercial |
$104.66
|
| Rate for Payer: Frontpath All Commercial |
$126.31
|
| Rate for Payer: Humana ChoiceCare |
$154.05
|
| Rate for Payer: Humana Medicare |
$87.22
|
| Rate for Payer: Lucent All Commercial |
$148.27
|
| Rate for Payer: Lutheran Preferred All Commercial |
$113.00
|
| Rate for Payer: PHCS All Commercial |
$240.58
|
| Rate for Payer: PHP All Commercial |
$119.13
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$87.22
|
| Rate for Payer: Signature Care EPO |
$235.45
|
| Rate for Payer: Signature Care PPO |
$235.45
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$105.00
|
| Rate for Payer: United Healthcare Commercial |
$182.65
|
| Rate for Payer: United Healthcare Medicare |
$87.22
|
|
|
PR RESUPERF WND BODY <2.5CM
|
Professional
|
$170.52
|
|
|
Service Code
|
CPT 12001
|
| Hospital Charge Code |
z12001
|
| Min. Negotiated Rate |
$41.39 |
| Max. Negotiated Rate |
$154.80 |
| Rate for Payer: Aetna Medicare |
$41.39
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$154.80
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$154.80
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$47.60
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$45.53
|
| Rate for Payer: Cash Price |
$105.72
|
| Rate for Payer: Cash Price |
$105.72
|
| Rate for Payer: Coventry All Commercial |
$49.67
|
| Rate for Payer: Frontpath All Commercial |
$59.31
|
| Rate for Payer: Humana ChoiceCare |
$93.34
|
| Rate for Payer: Humana Medicare |
$41.39
|
| Rate for Payer: Lucent All Commercial |
$70.36
|
| Rate for Payer: Lutheran Preferred All Commercial |
$54.00
|
| Rate for Payer: PHCS All Commercial |
$127.89
|
| Rate for Payer: PHP All Commercial |
$56.53
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$41.39
|
| Rate for Payer: Signature Care EPO |
$148.85
|
| Rate for Payer: Signature Care PPO |
$148.85
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$50.00
|
| Rate for Payer: United Healthcare Commercial |
$112.23
|
| Rate for Payer: United Healthcare Medicare |
$41.39
|
|
|
PR RESUPERF WND BODY >30 CM
|
Professional
|
$419.56
|
|
|
Service Code
|
CPT 12007
|
| Hospital Charge Code |
z12007
|
| Min. Negotiated Rate |
$133.22 |
| Max. Negotiated Rate |
$329.80 |
| Rate for Payer: Aetna Medicare |
$133.22
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$153.20
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$146.54
|
| Rate for Payer: Cash Price |
$260.13
|
| Rate for Payer: Cash Price |
$260.13
|
| Rate for Payer: Coventry All Commercial |
$159.86
|
| Rate for Payer: Frontpath All Commercial |
$192.53
|
| Rate for Payer: Humana ChoiceCare |
$225.68
|
| Rate for Payer: Humana Medicare |
$133.22
|
| Rate for Payer: Lucent All Commercial |
$226.47
|
| Rate for Payer: PHCS All Commercial |
$314.67
|
| Rate for Payer: PHP All Commercial |
$181.96
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$133.22
|
| Rate for Payer: Signature Care EPO |
$329.80
|
| Rate for Payer: Signature Care PPO |
$329.80
|
| Rate for Payer: United Healthcare Commercial |
$263.74
|
| Rate for Payer: United Healthcare Medicare |
$133.22
|
|
|
PR RESUPERF WND BODY 7.6-12.5 CM
|
Professional
|
$239.82
|
|
|
Service Code
|
CPT 12004
|
| Hospital Charge Code |
z12004
|
| Min. Negotiated Rate |
$67.34 |
| Max. Negotiated Rate |
$194.89 |
| Rate for Payer: Aetna Medicare |
$67.34
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$194.89
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$194.89
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$77.44
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$74.07
|
| Rate for Payer: Cash Price |
$148.69
|
| Rate for Payer: Cash Price |
$148.69
|
| Rate for Payer: Coventry All Commercial |
$80.81
|
| Rate for Payer: Frontpath All Commercial |
$96.15
|
| Rate for Payer: Humana ChoiceCare |
$123.04
|
| Rate for Payer: Humana Medicare |
$67.34
|
| Rate for Payer: Lucent All Commercial |
$114.48
|
| Rate for Payer: Lutheran Preferred All Commercial |
$88.00
|
| Rate for Payer: PHCS All Commercial |
$179.86
|
| Rate for Payer: PHP All Commercial |
$91.98
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$67.34
|
| Rate for Payer: Signature Care EPO |
$188.70
|
| Rate for Payer: Signature Care PPO |
$188.70
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$81.00
|
| Rate for Payer: United Healthcare Commercial |
$146.46
|
| Rate for Payer: United Healthcare Medicare |
$67.34
|
|
|
PR RESUPERF WND FACE <2.5 CM
|
Professional
|
$204.14
|
|
|
Service Code
|
CPT 12011
|
| Hospital Charge Code |
z12011
|
| Min. Negotiated Rate |
$50.90 |
| Max. Negotiated Rate |
$197.34 |
| Rate for Payer: Aetna Medicare |
$50.90
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$197.34
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$197.34
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$58.54
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$55.99
|
| Rate for Payer: Cash Price |
$126.57
|
| Rate for Payer: Cash Price |
$126.57
|
| Rate for Payer: Coventry All Commercial |
$61.08
|
| Rate for Payer: Frontpath All Commercial |
$72.85
|
| Rate for Payer: Humana ChoiceCare |
$96.12
|
| Rate for Payer: Humana Medicare |
$50.90
|
| Rate for Payer: Lucent All Commercial |
$86.53
|
| Rate for Payer: Lutheran Preferred All Commercial |
$66.00
|
| Rate for Payer: PHCS All Commercial |
$153.10
|
| Rate for Payer: PHP All Commercial |
$69.52
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$50.90
|
| Rate for Payer: Signature Care EPO |
$160.65
|
| Rate for Payer: Signature Care PPO |
$160.65
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$61.00
|
| Rate for Payer: United Healthcare Commercial |
$116.03
|
| Rate for Payer: United Healthcare Medicare |
$50.90
|
|
|
PR RESUPERF WND FACE 2.6-5 CM
|
Professional
|
$213.20
|
|
|
Service Code
|
CPT 12013
|
| Hospital Charge Code |
z12013
|
| Min. Negotiated Rate |
$53.70 |
| Max. Negotiated Rate |
$217.88 |
| Rate for Payer: Aetna Medicare |
$53.70
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$217.88
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$217.88
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$61.76
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$59.07
|
| Rate for Payer: Cash Price |
$132.18
|
| Rate for Payer: Cash Price |
$132.18
|
| Rate for Payer: Coventry All Commercial |
$64.44
|
| Rate for Payer: Frontpath All Commercial |
$77.38
|
| Rate for Payer: Humana ChoiceCare |
$110.32
|
| Rate for Payer: Humana Medicare |
$53.70
|
| Rate for Payer: Lucent All Commercial |
$91.29
|
| Rate for Payer: Lutheran Preferred All Commercial |
$70.00
|
| Rate for Payer: PHCS All Commercial |
$159.90
|
| Rate for Payer: PHP All Commercial |
$73.35
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$53.70
|
| Rate for Payer: Signature Care EPO |
$175.95
|
| Rate for Payer: Signature Care PPO |
$175.95
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$64.00
|
| Rate for Payer: United Healthcare Commercial |
$132.31
|
| Rate for Payer: United Healthcare Medicare |
$53.70
|
|
|
PR RESUPERF WND FACE 5.1-7.5 CM
|
Professional
|
$259.60
|
|
|
Service Code
|
CPT 12014
|
| Hospital Charge Code |
z12014
|
| Min. Negotiated Rate |
$68.84 |
| Max. Negotiated Rate |
$257.34 |
| Rate for Payer: Aetna Medicare |
$68.84
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$257.34
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$257.34
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$79.17
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$75.72
|
| Rate for Payer: Cash Price |
$160.95
|
| Rate for Payer: Cash Price |
$160.95
|
| Rate for Payer: Coventry All Commercial |
$82.61
|
| Rate for Payer: Frontpath All Commercial |
$99.44
|
| Rate for Payer: Humana ChoiceCare |
$133.42
|
| Rate for Payer: Humana Medicare |
$68.84
|
| Rate for Payer: Lucent All Commercial |
$117.03
|
| Rate for Payer: Lutheran Preferred All Commercial |
$89.00
|
| Rate for Payer: PHCS All Commercial |
$194.70
|
| Rate for Payer: PHP All Commercial |
$94.02
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$68.84
|
| Rate for Payer: Signature Care EPO |
$208.25
|
| Rate for Payer: Signature Care PPO |
$208.25
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$83.00
|
| Rate for Payer: United Healthcare Commercial |
$159.40
|
| Rate for Payer: United Healthcare Medicare |
$68.84
|
|
|
PR RESUP NPTERF WND BODY 2.6-7.5 CM
|
Professional
|
$206.38
|
|
|
Service Code
|
CPT 12002
|
| Hospital Charge Code |
z12002
|
| Min. Negotiated Rate |
$54.21 |
| Max. Negotiated Rate |
$205.66 |
| Rate for Payer: Aetna Medicare |
$54.21
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$205.66
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$205.66
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$62.34
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$59.63
|
| Rate for Payer: Cash Price |
$127.96
|
| Rate for Payer: Cash Price |
$127.96
|
| Rate for Payer: Coventry All Commercial |
$65.05
|
| Rate for Payer: Frontpath All Commercial |
$77.73
|
| Rate for Payer: Humana ChoiceCare |
$104.20
|
| Rate for Payer: Humana Medicare |
$54.21
|
| Rate for Payer: Lucent All Commercial |
$92.16
|
| Rate for Payer: Lutheran Preferred All Commercial |
$70.00
|
| Rate for Payer: PHCS All Commercial |
$154.78
|
| Rate for Payer: PHP All Commercial |
$74.05
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$54.21
|
| Rate for Payer: Signature Care EPO |
$160.65
|
| Rate for Payer: Signature Care PPO |
$160.65
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$65.00
|
| Rate for Payer: United Healthcare Commercial |
$124.53
|
| Rate for Payer: United Healthcare Medicare |
$54.21
|
|
|
PR REVAGINAL PROLAPSE,SACROSP LIG
|
Professional
|
$1,270.96
|
|
|
Service Code
|
CPT 57282
|
| Hospital Charge Code |
z57282
|
| Min. Negotiated Rate |
$505.07 |
| Max. Negotiated Rate |
$1,107.33 |
| Rate for Payer: Aetna Medicare |
$651.37
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$606.48
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$606.48
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$749.08
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$716.51
|
| Rate for Payer: Cash Price |
$788.00
|
| Rate for Payer: Cash Price |
$788.00
|
| Rate for Payer: Coventry All Commercial |
$781.64
|
| Rate for Payer: Frontpath All Commercial |
$908.61
|
| Rate for Payer: Humana ChoiceCare |
$505.07
|
| Rate for Payer: Humana Medicare |
$651.37
|
| Rate for Payer: Lucent All Commercial |
$1,107.33
|
| Rate for Payer: Lutheran Preferred All Commercial |
$912.00
|
| Rate for Payer: PHCS All Commercial |
$953.22
|
| Rate for Payer: PHP All Commercial |
$838.84
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$651.37
|
| Rate for Payer: Signature Care EPO |
$704.65
|
| Rate for Payer: Signature Care PPO |
$704.65
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$847.00
|
| Rate for Payer: United Healthcare Commercial |
$572.20
|
| Rate for Payer: United Healthcare Medicare |
$651.37
|
|
