|
PR REVAGINAL PROLAPSE,UTEROSACRAL
|
Professional
|
$1,279.38
|
|
|
Service Code
|
CPT 57283
|
| Hospital Charge Code |
z57283
|
| Min. Negotiated Rate |
$655.69 |
| Max. Negotiated Rate |
$1,114.67 |
| Rate for Payer: Aetna Medicare |
$655.69
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$870.80
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$870.80
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$754.04
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$721.26
|
| Rate for Payer: Cash Price |
$793.22
|
| Rate for Payer: Cash Price |
$793.22
|
| Rate for Payer: Coventry All Commercial |
$786.83
|
| Rate for Payer: Frontpath All Commercial |
$915.37
|
| Rate for Payer: Humana ChoiceCare |
$738.59
|
| Rate for Payer: Humana Medicare |
$655.69
|
| Rate for Payer: Lucent All Commercial |
$1,114.67
|
| Rate for Payer: Lutheran Preferred All Commercial |
$918.00
|
| Rate for Payer: PHCS All Commercial |
$959.54
|
| Rate for Payer: PHP All Commercial |
$844.40
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$655.69
|
| Rate for Payer: Signature Care EPO |
$838.95
|
| Rate for Payer: Signature Care PPO |
$838.95
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$852.00
|
| Rate for Payer: United Healthcare Commercial |
$775.99
|
| Rate for Payer: United Healthcare Medicare |
$655.69
|
|
|
PR REVISE ACETABULAR PART OF TOTAL HIP
|
Professional
|
$2,636.28
|
|
|
Service Code
|
CPT 27137
|
| Hospital Charge Code |
z27137
|
| Min. Negotiated Rate |
$1,350.93 |
| Max. Negotiated Rate |
$2,296.58 |
| Rate for Payer: Aetna Medicare |
$1,350.93
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,073.90
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,073.90
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,553.57
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,486.02
|
| Rate for Payer: Cash Price |
$1,634.49
|
| Rate for Payer: Cash Price |
$1,634.49
|
| Rate for Payer: Coventry All Commercial |
$1,621.12
|
| Rate for Payer: Frontpath All Commercial |
$1,907.84
|
| Rate for Payer: Humana ChoiceCare |
$1,545.36
|
| Rate for Payer: Humana Medicare |
$1,350.93
|
| Rate for Payer: Lucent All Commercial |
$2,296.58
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,161.00
|
| Rate for Payer: PHCS All Commercial |
$1,977.21
|
| Rate for Payer: PHP All Commercial |
$2,293.56
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,350.93
|
| Rate for Payer: Signature Care EPO |
$2,062.95
|
| Rate for Payer: Signature Care PPO |
$2,062.95
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,026.00
|
| Rate for Payer: United Healthcare Commercial |
$1,643.26
|
| Rate for Payer: United Healthcare Medicare |
$1,350.93
|
|
|
PR REVISE FEM PART OFTOTAL HIP
|
Professional
|
$2,738.16
|
|
|
Service Code
|
CPT 27138
|
| Hospital Charge Code |
z27138
|
| Min. Negotiated Rate |
$1,403.31 |
| Max. Negotiated Rate |
$2,385.63 |
| Rate for Payer: Aetna Medicare |
$1,403.31
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,158.80
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,158.80
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,613.81
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,543.64
|
| Rate for Payer: Cash Price |
$1,697.66
|
| Rate for Payer: Cash Price |
$1,697.66
|
| Rate for Payer: Coventry All Commercial |
$1,683.97
|
| Rate for Payer: Frontpath All Commercial |
$1,983.71
|
| Rate for Payer: Humana ChoiceCare |
$1,610.45
|
| Rate for Payer: Humana Medicare |
$1,403.31
|
| Rate for Payer: Lucent All Commercial |
$2,385.63
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,245.00
|
| Rate for Payer: PHCS All Commercial |
$2,053.62
|
| Rate for Payer: PHP All Commercial |
$2,382.20
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,403.31
|
| Rate for Payer: Signature Care EPO |
$2,150.50
|
| Rate for Payer: Signature Care PPO |
$2,150.50
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,105.00
|
| Rate for Payer: United Healthcare Commercial |
$1,710.74
|
| Rate for Payer: United Healthcare Medicare |
$1,403.31
|
|
|
PR REVISE KNEE JOINT REPLACE,1 PART
|
Professional
|
$2,530.16
|
|
|
Service Code
|
CPT 27486
|
| Hospital Charge Code |
z27486
|
| Min. Negotiated Rate |
$1,296.70 |
| Max. Negotiated Rate |
$2,204.39 |
| Rate for Payer: Aetna Medicare |
$1,296.70
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,887.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,887.30
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,491.20
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,426.37
|
| Rate for Payer: Cash Price |
$1,568.70
|
| Rate for Payer: Cash Price |
$1,568.70
|
| Rate for Payer: Coventry All Commercial |
$1,556.04
|
| Rate for Payer: Frontpath All Commercial |
$1,824.88
|
| Rate for Payer: Humana ChoiceCare |
$1,439.10
|
| Rate for Payer: Humana Medicare |
$1,296.70
|
| Rate for Payer: Lucent All Commercial |
$2,204.39
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,075.00
|
| Rate for Payer: PHCS All Commercial |
$1,897.62
|
| Rate for Payer: PHP All Commercial |
$2,201.24
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,296.70
|
| Rate for Payer: Signature Care EPO |
$1,918.45
|
| Rate for Payer: Signature Care PPO |
$1,918.45
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,945.00
|
| Rate for Payer: United Healthcare Commercial |
$1,551.89
|
| Rate for Payer: United Healthcare Medicare |
$1,296.70
|
|
|
PR REVISE KNEE JOINT REPLACE,ALL PARTS
|
Professional
|
$3,153.08
|
|
|
Service Code
|
CPT 27487
|
| Hospital Charge Code |
z27487
|
| Min. Negotiated Rate |
$1,615.79 |
| Max. Negotiated Rate |
$2,746.84 |
| Rate for Payer: Aetna Medicare |
$1,615.79
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,439.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,439.30
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,858.16
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,777.37
|
| Rate for Payer: Cash Price |
$1,954.91
|
| Rate for Payer: Cash Price |
$1,954.91
|
| Rate for Payer: Coventry All Commercial |
$1,938.95
|
| Rate for Payer: Frontpath All Commercial |
$2,281.07
|
| Rate for Payer: Humana ChoiceCare |
$1,841.64
|
| Rate for Payer: Humana Medicare |
$1,615.79
|
| Rate for Payer: Lucent All Commercial |
$2,746.84
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,585.00
|
| Rate for Payer: PHCS All Commercial |
$2,364.81
|
| Rate for Payer: PHP All Commercial |
$2,743.18
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,615.79
|
| Rate for Payer: Signature Care EPO |
$2,458.20
|
| Rate for Payer: Signature Care PPO |
$2,458.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,424.00
|
| Rate for Payer: United Healthcare Commercial |
$1,960.26
|
| Rate for Payer: United Healthcare Medicare |
$1,615.79
|
|
|
PR REVISE MEDIAN N/CARPAL TUNNEL SURG
|
Professional
|
$810.86
|
|
|
Service Code
|
CPT 64721
|
| Hospital Charge Code |
z64721
|
| Min. Negotiated Rate |
$408.16 |
| Max. Negotiated Rate |
$696.86 |
| Rate for Payer: Aetna Medicare |
$408.16
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$490.67
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$490.67
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$469.38
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$448.98
|
| Rate for Payer: Cash Price |
$502.73
|
| Rate for Payer: Cash Price |
$502.73
|
| Rate for Payer: Coventry All Commercial |
$489.79
|
| Rate for Payer: Frontpath All Commercial |
$560.25
|
| Rate for Payer: Humana ChoiceCare |
$484.64
|
| Rate for Payer: Humana Medicare |
$408.16
|
| Rate for Payer: Lucent All Commercial |
$693.87
|
| Rate for Payer: Lutheran Preferred All Commercial |
$653.00
|
| Rate for Payer: PHCS All Commercial |
$608.14
|
| Rate for Payer: PHP All Commercial |
$696.86
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$408.16
|
| Rate for Payer: Signature Care EPO |
$646.00
|
| Rate for Payer: Signature Care PPO |
$646.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$612.00
|
| Rate for Payer: United Healthcare Commercial |
$439.89
|
| Rate for Payer: United Healthcare Medicare |
$408.16
|
|
|
PR REVISE TOTAL HIP REPLACEMENT
|
Professional
|
$3,421.94
|
|
|
Service Code
|
CPT 27134
|
| Hospital Charge Code |
z27134
|
| Min. Negotiated Rate |
$1,753.74 |
| Max. Negotiated Rate |
$2,981.36 |
| Rate for Payer: Aetna Medicare |
$1,753.74
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,745.50
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,745.50
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,016.80
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,929.11
|
| Rate for Payer: Cash Price |
$2,121.60
|
| Rate for Payer: Cash Price |
$2,121.60
|
| Rate for Payer: Coventry All Commercial |
$2,104.49
|
| Rate for Payer: Frontpath All Commercial |
$2,482.45
|
| Rate for Payer: Humana ChoiceCare |
$2,043.05
|
| Rate for Payer: Humana Medicare |
$1,753.74
|
| Rate for Payer: Lucent All Commercial |
$2,981.36
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,806.00
|
| Rate for Payer: PHCS All Commercial |
$2,566.46
|
| Rate for Payer: PHP All Commercial |
$2,977.09
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,753.74
|
| Rate for Payer: Signature Care EPO |
$2,729.35
|
| Rate for Payer: Signature Care PPO |
$2,729.35
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,631.00
|
| Rate for Payer: United Healthcare Commercial |
$2,158.35
|
| Rate for Payer: United Healthcare Medicare |
$1,753.74
|
|
|
PR REVISE ULNAR NERVE AT ELBOW
|
Professional
|
$1,097.22
|
|
|
Service Code
|
CPT 64718
|
| Hospital Charge Code |
z64718
|
| Min. Negotiated Rate |
$562.33 |
| Max. Negotiated Rate |
$960.07 |
| Rate for Payer: Aetna Medicare |
$562.33
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$594.70
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$594.70
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$646.68
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$618.56
|
| Rate for Payer: Cash Price |
$680.28
|
| Rate for Payer: Cash Price |
$680.28
|
| Rate for Payer: Coventry All Commercial |
$674.80
|
| Rate for Payer: Frontpath All Commercial |
$773.72
|
| Rate for Payer: Humana ChoiceCare |
$607.95
|
| Rate for Payer: Humana Medicare |
$562.33
|
| Rate for Payer: Lucent All Commercial |
$955.96
|
| Rate for Payer: Lutheran Preferred All Commercial |
$900.00
|
| Rate for Payer: PHCS All Commercial |
$822.92
|
| Rate for Payer: PHP All Commercial |
$960.07
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$562.33
|
| Rate for Payer: Signature Care EPO |
$689.35
|
| Rate for Payer: Signature Care PPO |
$689.35
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$843.00
|
| Rate for Payer: United Healthcare Commercial |
$604.48
|
| Rate for Payer: United Healthcare Medicare |
$562.33
|
|
|
PR REVISION OF UNSTABLE PATELLA
|
Professional
|
$1,356.90
|
|
|
Service Code
|
CPT 27420
|
| Hospital Charge Code |
z27420
|
| Min. Negotiated Rate |
$695.41 |
| Max. Negotiated Rate |
$1,182.20 |
| Rate for Payer: Aetna Medicare |
$695.41
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$987.70
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$987.70
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$799.72
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$764.95
|
| Rate for Payer: Cash Price |
$841.28
|
| Rate for Payer: Cash Price |
$841.28
|
| Rate for Payer: Coventry All Commercial |
$834.49
|
| Rate for Payer: Frontpath All Commercial |
$964.91
|
| Rate for Payer: Humana ChoiceCare |
$782.84
|
| Rate for Payer: Humana Medicare |
$695.41
|
| Rate for Payer: Lucent All Commercial |
$1,182.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,113.00
|
| Rate for Payer: PHCS All Commercial |
$1,017.68
|
| Rate for Payer: PHP All Commercial |
$1,180.49
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$695.41
|
| Rate for Payer: Signature Care EPO |
$1,045.50
|
| Rate for Payer: Signature Care PPO |
$1,045.50
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,043.00
|
| Rate for Payer: United Healthcare Commercial |
$808.61
|
| Rate for Payer: United Healthcare Medicare |
$695.41
|
|
|
PR REVIS SHOULDER ARTHRPLSTY HUMERAL&GLENOID COMPNT
|
Professional
|
$1,592.01
|
|
|
Service Code
|
CPT 23474
|
| Hospital Charge Code |
z23474
|
| Min. Negotiated Rate |
$1,194.01 |
| Max. Negotiated Rate |
$2,730.39 |
| Rate for Payer: Aetna Medicare |
$1,606.11
|
| Rate for Payer: Aetna Medicare |
$1,606.11
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,847.03
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,847.03
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,766.72
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,766.72
|
| Rate for Payer: Cash Price |
$1,974.08
|
| Rate for Payer: Cash Price |
$987.05
|
| Rate for Payer: Cash Price |
$1,974.08
|
| Rate for Payer: Cash Price |
$987.05
|
| Rate for Payer: Coventry All Commercial |
$1,927.33
|
| Rate for Payer: Coventry All Commercial |
$1,927.33
|
| Rate for Payer: Frontpath All Commercial |
$2,265.38
|
| Rate for Payer: Frontpath All Commercial |
$2,265.38
|
| Rate for Payer: Humana ChoiceCare |
$1,903.60
|
| Rate for Payer: Humana ChoiceCare |
$1,903.60
|
| Rate for Payer: Humana Medicare |
$1,606.11
|
| Rate for Payer: Humana Medicare |
$1,606.11
|
| Rate for Payer: Lucent All Commercial |
$2,730.39
|
| Rate for Payer: Lucent All Commercial |
$2,730.39
|
| Rate for Payer: PHCS All Commercial |
$2,388.00
|
| Rate for Payer: PHCS All Commercial |
$1,194.01
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,606.11
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,606.11
|
| Rate for Payer: United Healthcare Commercial |
$2,181.81
|
| Rate for Payer: United Healthcare Commercial |
$2,181.81
|
| Rate for Payer: United Healthcare Medicare |
$1,606.11
|
| Rate for Payer: United Healthcare Medicare |
$1,606.11
|
|
|
PR REVIS SHOULDER ARTHRPLSTY HUMERAL/GLENOID COMPNT
|
Professional
|
$2,904.06
|
|
|
Service Code
|
CPT 23473
|
| Hospital Charge Code |
z23473
|
| Min. Negotiated Rate |
$1,488.16 |
| Max. Negotiated Rate |
$2,529.87 |
| Rate for Payer: Aetna Medicare |
$1,488.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,711.38
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,636.98
|
| Rate for Payer: Cash Price |
$1,800.52
|
| Rate for Payer: Cash Price |
$1,800.52
|
| Rate for Payer: Coventry All Commercial |
$1,785.79
|
| Rate for Payer: Frontpath All Commercial |
$2,098.37
|
| Rate for Payer: Humana ChoiceCare |
$1,762.40
|
| Rate for Payer: Humana Medicare |
$1,488.16
|
| Rate for Payer: Lucent All Commercial |
$2,529.87
|
| Rate for Payer: PHCS All Commercial |
$2,178.04
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,488.16
|
| Rate for Payer: United Healthcare Commercial |
$2,019.96
|
| Rate for Payer: United Healthcare Medicare |
$1,488.16
|
|
|
PR RFIBULA NONUNION/MALUNION W INT FIXATION
|
Professional
|
$1,736.26
|
|
|
Service Code
|
CPT 27726
|
| Hospital Charge Code |
z27726
|
| Min. Negotiated Rate |
$888.02 |
| Max. Negotiated Rate |
$1,512.71 |
| Rate for Payer: Aetna Medicare |
$889.83
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,023.30
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$978.81
|
| Rate for Payer: Cash Price |
$1,076.48
|
| Rate for Payer: Cash Price |
$1,076.48
|
| Rate for Payer: Coventry All Commercial |
$1,067.80
|
| Rate for Payer: Frontpath All Commercial |
$1,247.82
|
| Rate for Payer: Humana ChoiceCare |
$888.02
|
| Rate for Payer: Humana Medicare |
$889.83
|
| Rate for Payer: Lucent All Commercial |
$1,512.71
|
| Rate for Payer: PHCS All Commercial |
$1,302.20
|
| Rate for Payer: PHP All Commercial |
$1,510.54
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$889.83
|
| Rate for Payer: Signature Care EPO |
$1,205.61
|
| Rate for Payer: Signature Care PPO |
$1,205.61
|
| Rate for Payer: United Healthcare Commercial |
$1,004.51
|
| Rate for Payer: United Healthcare Medicare |
$889.83
|
|
|
PR RH IG, FULL-DOSE, IM
|
Professional
|
$146.04
|
|
|
Service Code
|
CPT 90384
|
| Hospital Charge Code |
z90384
|
| Min. Negotiated Rate |
$73.50 |
| Max. Negotiated Rate |
$146.04 |
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$115.11
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$115.11
|
| Rate for Payer: Frontpath All Commercial |
$123.34
|
| Rate for Payer: Humana ChoiceCare |
$146.04
|
| Rate for Payer: PHP All Commercial |
$73.50
|
| Rate for Payer: United Healthcare Commercial |
$114.18
|
|
|
PR RHO D IMMUNE GLOBULIN INJ
|
Professional
|
$81.77
|
|
|
Service Code
|
CPT J2790
|
| Hospital Charge Code |
zJ2790
|
| Min. Negotiated Rate |
$73.50 |
| Max. Negotiated Rate |
$81.77 |
| Rate for Payer: Humana ChoiceCare |
$81.77
|
| Rate for Payer: PHP All Commercial |
$73.50
|
|
|
PR RHYTHM ECG WITH REPORT
|
Professional
|
$23.20
|
|
|
Service Code
|
CPT 93040
|
| Hospital Charge Code |
z93040
|
| Min. Negotiated Rate |
$11.89 |
| Max. Negotiated Rate |
$20.21 |
| Rate for Payer: Aetna Medicare |
$11.89
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$18.80
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$18.80
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$13.67
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$13.08
|
| Rate for Payer: Cash Price |
$14.38
|
| Rate for Payer: Cash Price |
$14.38
|
| Rate for Payer: Coventry All Commercial |
$14.27
|
| Rate for Payer: Frontpath All Commercial |
$13.50
|
| Rate for Payer: Humana ChoiceCare |
$18.02
|
| Rate for Payer: Humana Medicare |
$11.89
|
| Rate for Payer: Lucent All Commercial |
$20.21
|
| Rate for Payer: Lutheran Preferred All Commercial |
$19.00
|
| Rate for Payer: PHCS All Commercial |
$17.40
|
| Rate for Payer: PHP All Commercial |
$17.05
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$11.89
|
| Rate for Payer: Signature Care EPO |
$19.96
|
| Rate for Payer: Signature Care PPO |
$19.96
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$18.00
|
| Rate for Payer: United Healthcare Commercial |
$15.61
|
| Rate for Payer: United Healthcare Medicare |
$11.89
|
|
|
PR RIV4 VACC RECOMBINANT DNA PRSRV ANTIBIO FREE IM
|
Professional
|
$73.63
|
|
|
Service Code
|
CPT 90682
|
| Hospital Charge Code |
z90682
|
| Min. Negotiated Rate |
$31.28 |
| Max. Negotiated Rate |
$73.63 |
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$65.26
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$65.26
|
| Rate for Payer: Frontpath All Commercial |
$71.79
|
| Rate for Payer: Humana ChoiceCare |
$69.94
|
| Rate for Payer: PHP All Commercial |
$31.28
|
| Rate for Payer: United Healthcare Commercial |
$73.63
|
|
|
PR RMV KNEE SYNOVIUM,ANT/POST
|
Professional
|
$1,250.66
|
|
|
Service Code
|
CPT 27334
|
| Hospital Charge Code |
z27334
|
| Min. Negotiated Rate |
$640.96 |
| Max. Negotiated Rate |
$1,089.63 |
| Rate for Payer: Aetna Medicare |
$640.96
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$895.80
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$895.80
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$737.10
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$705.06
|
| Rate for Payer: Cash Price |
$775.41
|
| Rate for Payer: Cash Price |
$775.41
|
| Rate for Payer: Coventry All Commercial |
$769.15
|
| Rate for Payer: Frontpath All Commercial |
$890.67
|
| Rate for Payer: Humana ChoiceCare |
$702.02
|
| Rate for Payer: Humana Medicare |
$640.96
|
| Rate for Payer: Lucent All Commercial |
$1,089.63
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,026.00
|
| Rate for Payer: PHCS All Commercial |
$938.00
|
| Rate for Payer: PHP All Commercial |
$1,088.07
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$640.96
|
| Rate for Payer: Signature Care EPO |
$938.40
|
| Rate for Payer: Signature Care PPO |
$938.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$961.00
|
| Rate for Payer: United Healthcare Commercial |
$730.70
|
| Rate for Payer: United Healthcare Medicare |
$640.96
|
|
|
PR RMVL IMPLTBL DFB PLSE GEN W/REPL PLSE GEN 1 LEAD
|
Professional
|
$662.02
|
|
|
Service Code
|
CPT 33262
|
| Hospital Charge Code |
z33262
|
| Min. Negotiated Rate |
$339.28 |
| Max. Negotiated Rate |
$576.78 |
| Rate for Payer: Aetna Medicare |
$339.28
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$468.23
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$468.23
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$390.17
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$373.21
|
| Rate for Payer: Cash Price |
$410.45
|
| Rate for Payer: Cash Price |
$410.45
|
| Rate for Payer: Coventry All Commercial |
$407.14
|
| Rate for Payer: Frontpath All Commercial |
$488.67
|
| Rate for Payer: Humana ChoiceCare |
$449.43
|
| Rate for Payer: Humana Medicare |
$339.28
|
| Rate for Payer: Lucent All Commercial |
$576.78
|
| Rate for Payer: Lutheran Preferred All Commercial |
$543.00
|
| Rate for Payer: PHCS All Commercial |
$496.52
|
| Rate for Payer: PHP All Commercial |
$463.41
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$339.28
|
| Rate for Payer: Signature Care EPO |
$439.10
|
| Rate for Payer: Signature Care PPO |
$439.10
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$509.00
|
| Rate for Payer: United Healthcare Commercial |
$454.51
|
| Rate for Payer: United Healthcare Medicare |
$339.28
|
|
|
PR RMVL IMPLTBL DFB PLSE GEN W/RPLCMT PLSE GEN 2 LD
|
Professional
|
$687.46
|
|
|
Service Code
|
CPT 33263
|
| Hospital Charge Code |
z33263
|
| Min. Negotiated Rate |
$352.32 |
| Max. Negotiated Rate |
$598.94 |
| Rate for Payer: Aetna Medicare |
$352.32
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$486.70
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$486.70
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$405.17
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$387.55
|
| Rate for Payer: Cash Price |
$426.23
|
| Rate for Payer: Cash Price |
$426.23
|
| Rate for Payer: Coventry All Commercial |
$422.78
|
| Rate for Payer: Frontpath All Commercial |
$508.36
|
| Rate for Payer: Humana ChoiceCare |
$467.16
|
| Rate for Payer: Humana Medicare |
$352.32
|
| Rate for Payer: Lucent All Commercial |
$598.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$564.00
|
| Rate for Payer: PHCS All Commercial |
$515.60
|
| Rate for Payer: PHP All Commercial |
$481.22
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$352.32
|
| Rate for Payer: Signature Care EPO |
$456.42
|
| Rate for Payer: Signature Care PPO |
$456.42
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$528.00
|
| Rate for Payer: United Healthcare Commercial |
$472.45
|
| Rate for Payer: United Healthcare Medicare |
$352.32
|
|
|
PR RMVL IMPLTBL DFB PLS GEN W/RPLCMT PLS GEN MLT LD
|
Professional
|
$717.12
|
|
|
Service Code
|
CPT 33264
|
| Hospital Charge Code |
z33264
|
| Min. Negotiated Rate |
$367.53 |
| Max. Negotiated Rate |
$624.80 |
| Rate for Payer: Aetna Medicare |
$367.53
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$505.17
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$505.17
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$422.66
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$404.28
|
| Rate for Payer: Cash Price |
$444.61
|
| Rate for Payer: Cash Price |
$444.61
|
| Rate for Payer: Coventry All Commercial |
$441.04
|
| Rate for Payer: Frontpath All Commercial |
$529.71
|
| Rate for Payer: Humana ChoiceCare |
$484.89
|
| Rate for Payer: Humana Medicare |
$367.53
|
| Rate for Payer: Lucent All Commercial |
$624.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$588.00
|
| Rate for Payer: PHCS All Commercial |
$537.84
|
| Rate for Payer: PHP All Commercial |
$501.99
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$367.53
|
| Rate for Payer: Signature Care EPO |
$473.74
|
| Rate for Payer: Signature Care PPO |
$473.74
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$551.00
|
| Rate for Payer: United Healthcare Commercial |
$490.38
|
| Rate for Payer: United Healthcare Medicare |
$367.53
|
|
|
PR RMVL PROSTC MATRL/MESH ABDL WALL FOR INFECTION
|
Professional
|
$481.54
|
|
|
Service Code
|
CPT 11008
|
| Hospital Charge Code |
z11008
|
| Min. Negotiated Rate |
$246.79 |
| Max. Negotiated Rate |
$419.54 |
| Rate for Payer: Aetna Medicare |
$246.79
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$357.85
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$357.85
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$283.81
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$271.47
|
| Rate for Payer: Cash Price |
$298.55
|
| Rate for Payer: Cash Price |
$298.55
|
| Rate for Payer: Coventry All Commercial |
$296.15
|
| Rate for Payer: Frontpath All Commercial |
$361.63
|
| Rate for Payer: Humana ChoiceCare |
$269.27
|
| Rate for Payer: Humana Medicare |
$246.79
|
| Rate for Payer: Lucent All Commercial |
$419.54
|
| Rate for Payer: Lutheran Preferred All Commercial |
$321.00
|
| Rate for Payer: PHCS All Commercial |
$361.16
|
| Rate for Payer: PHP All Commercial |
$337.08
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$246.79
|
| Rate for Payer: Signature Care EPO |
$302.60
|
| Rate for Payer: Signature Care PPO |
$302.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$296.00
|
| Rate for Payer: United Healthcare Commercial |
$306.45
|
| Rate for Payer: United Healthcare Medicare |
$246.79
|
|
|
PR RMVL RUPTURED BREAST IMPLANT W/IMPLANT CONTENTS
|
Professional
|
$1,172.50
|
|
|
Service Code
|
CPT 19330
|
| Hospital Charge Code |
z19330
|
| Min. Negotiated Rate |
$515.81 |
| Max. Negotiated Rate |
$1,021.80 |
| Rate for Payer: Aetna Medicare |
$601.06
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$606.90
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$606.90
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$691.22
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$661.17
|
| Rate for Payer: Cash Price |
$726.95
|
| Rate for Payer: Cash Price |
$726.95
|
| Rate for Payer: Coventry All Commercial |
$721.27
|
| Rate for Payer: Frontpath All Commercial |
$834.65
|
| Rate for Payer: Humana ChoiceCare |
$515.81
|
| Rate for Payer: Humana Medicare |
$601.06
|
| Rate for Payer: Lucent All Commercial |
$1,021.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$781.00
|
| Rate for Payer: PHCS All Commercial |
$879.38
|
| Rate for Payer: PHP All Commercial |
$820.74
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$601.06
|
| Rate for Payer: Signature Care EPO |
$571.20
|
| Rate for Payer: Signature Care PPO |
$571.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$721.00
|
| Rate for Payer: United Healthcare Commercial |
$669.70
|
| Rate for Payer: United Healthcare Medicare |
$601.06
|
|
|
PR RMVL SKIN TAGS MLT FIBRQ TAGS ANY EA ADDL 10
|
Professional
|
$33.68
|
|
|
Service Code
|
CPT 11201
|
| Hospital Charge Code |
z11201
|
| Min. Negotiated Rate |
$15.41 |
| Max. Negotiated Rate |
$26.20 |
| Rate for Payer: Aetna Medicare |
$15.41
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$21.43
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$21.43
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$17.72
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$16.95
|
| Rate for Payer: Cash Price |
$20.88
|
| Rate for Payer: Cash Price |
$20.88
|
| Rate for Payer: Coventry All Commercial |
$18.49
|
| Rate for Payer: Frontpath All Commercial |
$21.18
|
| Rate for Payer: Humana ChoiceCare |
$15.44
|
| Rate for Payer: Humana Medicare |
$15.41
|
| Rate for Payer: Lucent All Commercial |
$26.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$20.00
|
| Rate for Payer: PHCS All Commercial |
$25.26
|
| Rate for Payer: PHP All Commercial |
$21.05
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$15.41
|
| Rate for Payer: Signature Care EPO |
$18.70
|
| Rate for Payer: Signature Care PPO |
$18.70
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$18.00
|
| Rate for Payer: United Healthcare Commercial |
$18.58
|
| Rate for Payer: United Healthcare Medicare |
$15.41
|
|
|
PR RMVL SKIN TAGS MLT FIBRQ TAGS ANY UP TO&INC 15
|
Professional
|
$167.00
|
|
|
Service Code
|
CPT 11200
|
| Hospital Charge Code |
z11200
|
| Min. Negotiated Rate |
$55.94 |
| Max. Negotiated Rate |
$125.25 |
| Rate for Payer: Aetna Medicare |
$71.38
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$85.73
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$85.73
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$82.09
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$78.52
|
| Rate for Payer: Cash Price |
$103.54
|
| Rate for Payer: Cash Price |
$103.54
|
| Rate for Payer: Coventry All Commercial |
$85.66
|
| Rate for Payer: Frontpath All Commercial |
$95.12
|
| Rate for Payer: Humana ChoiceCare |
$55.94
|
| Rate for Payer: Humana Medicare |
$71.38
|
| Rate for Payer: Lucent All Commercial |
$121.35
|
| Rate for Payer: Lutheran Preferred All Commercial |
$93.00
|
| Rate for Payer: PHCS All Commercial |
$125.25
|
| Rate for Payer: PHP All Commercial |
$97.50
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$71.38
|
| Rate for Payer: Signature Care EPO |
$73.95
|
| Rate for Payer: Signature Care PPO |
$73.95
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$86.00
|
| Rate for Payer: United Healthcare Commercial |
$72.70
|
| Rate for Payer: United Healthcare Medicare |
$71.38
|
|
|
PR RMVL TRANSVNS PM ELTRD DUAL LEAD SYS
|
Professional
|
$1,129.72
|
|
|
Service Code
|
CPT 33235
|
| Hospital Charge Code |
z33235
|
| Min. Negotiated Rate |
$579.14 |
| Max. Negotiated Rate |
$984.54 |
| Rate for Payer: Aetna Medicare |
$579.14
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$666.01
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$637.05
|
| Rate for Payer: Cash Price |
$700.43
|
| Rate for Payer: Cash Price |
$700.43
|
| Rate for Payer: Coventry All Commercial |
$694.97
|
| Rate for Payer: Frontpath All Commercial |
$833.29
|
| Rate for Payer: Humana ChoiceCare |
$786.17
|
| Rate for Payer: Humana Medicare |
$579.14
|
| Rate for Payer: Lucent All Commercial |
$984.54
|
| Rate for Payer: PHCS All Commercial |
$847.29
|
| Rate for Payer: PHP All Commercial |
$790.80
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$579.14
|
| Rate for Payer: Signature Care EPO |
$908.65
|
| Rate for Payer: Signature Care PPO |
$908.65
|
| Rate for Payer: United Healthcare Commercial |
$762.06
|
| Rate for Payer: United Healthcare Medicare |
$579.14
|
|
