|
PR SUB GRFT F/S/N/H/F/G/M/D />100SCM ADL 100SCM
|
Professional
|
$172.68
|
|
|
Service Code
|
CPT 15278
|
| Hospital Charge Code |
z15278
|
| Min. Negotiated Rate |
$51.15 |
| Max. Negotiated Rate |
$129.51 |
| Rate for Payer: Aetna Medicare |
$51.15
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$58.82
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$56.26
|
| Rate for Payer: Cash Price |
$107.06
|
| Rate for Payer: Cash Price |
$107.06
|
| Rate for Payer: Coventry All Commercial |
$61.38
|
| Rate for Payer: Frontpath All Commercial |
$74.14
|
| Rate for Payer: Humana ChoiceCare |
$51.83
|
| Rate for Payer: Humana Medicare |
$51.15
|
| Rate for Payer: Lucent All Commercial |
$86.96
|
| Rate for Payer: PHCS All Commercial |
$129.51
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$51.15
|
| Rate for Payer: United Healthcare Commercial |
$68.46
|
| Rate for Payer: United Healthcare Medicare |
$51.15
|
|
|
PR SUB GRFT F/S/N/H/F/G/M/D /<100SCM EA ADL 25SCM
|
Professional
|
$59.36
|
|
|
Service Code
|
CPT 15276
|
| Hospital Charge Code |
z15276
|
| Min. Negotiated Rate |
$23.32 |
| Max. Negotiated Rate |
$44.52 |
| Rate for Payer: Aetna Medicare |
$23.32
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$26.82
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$25.65
|
| Rate for Payer: Cash Price |
$36.80
|
| Rate for Payer: Cash Price |
$36.80
|
| Rate for Payer: Coventry All Commercial |
$27.98
|
| Rate for Payer: Frontpath All Commercial |
$33.41
|
| Rate for Payer: Humana ChoiceCare |
$23.61
|
| Rate for Payer: Humana Medicare |
$23.32
|
| Rate for Payer: Lucent All Commercial |
$39.64
|
| Rate for Payer: PHCS All Commercial |
$44.52
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$23.32
|
| Rate for Payer: United Healthcare Commercial |
$31.20
|
| Rate for Payer: United Healthcare Medicare |
$23.32
|
|
|
PR SUBSEQUENT HOSPITAL CARE, NORMAL NEWBORN
|
Professional
|
$76.10
|
|
|
Service Code
|
CPT 99462
|
| Hospital Charge Code |
z99462
|
| Min. Negotiated Rate |
$30.53 |
| Max. Negotiated Rate |
$145.00 |
| Rate for Payer: Aetna Medicare |
$39.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$56.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$56.30
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$44.85
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$42.90
|
| Rate for Payer: Cash Price |
$47.18
|
| Rate for Payer: Cash Price |
$47.18
|
| Rate for Payer: Coventry All Commercial |
$46.80
|
| Rate for Payer: Frontpath All Commercial |
$43.17
|
| Rate for Payer: Humana ChoiceCare |
$44.20
|
| Rate for Payer: Humana Medicare |
$39.00
|
| Rate for Payer: Lucent All Commercial |
$66.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$145.00
|
| Rate for Payer: PHCS All Commercial |
$57.08
|
| Rate for Payer: PHP All Commercial |
$39.19
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$39.00
|
| Rate for Payer: Signature Care EPO |
$34.40
|
| Rate for Payer: Signature Care PPO |
$34.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$145.00
|
| Rate for Payer: United Healthcare Commercial |
$30.53
|
| Rate for Payer: United Healthcare Medicare |
$39.00
|
|
|
PR SUPRACERV ABD HYSTERECTOMY
|
Professional
|
$1,749.00
|
|
|
Service Code
|
CPT 58180
|
| Hospital Charge Code |
z58180
|
| Min. Negotiated Rate |
$896.36 |
| Max. Negotiated Rate |
$1,523.81 |
| Rate for Payer: Aetna Medicare |
$896.36
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,193.37
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,193.37
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,030.81
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$986.00
|
| Rate for Payer: Cash Price |
$1,084.38
|
| Rate for Payer: Cash Price |
$1,084.38
|
| Rate for Payer: Coventry All Commercial |
$1,075.63
|
| Rate for Payer: Frontpath All Commercial |
$1,258.14
|
| Rate for Payer: Humana ChoiceCare |
$1,008.87
|
| Rate for Payer: Humana Medicare |
$896.36
|
| Rate for Payer: Lucent All Commercial |
$1,523.81
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,255.00
|
| Rate for Payer: PHCS All Commercial |
$1,311.75
|
| Rate for Payer: PHP All Commercial |
$1,154.34
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$896.36
|
| Rate for Payer: Signature Care EPO |
$1,211.25
|
| Rate for Payer: Signature Care PPO |
$1,211.25
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,165.00
|
| Rate for Payer: United Healthcare Commercial |
$1,071.66
|
| Rate for Payer: United Healthcare Medicare |
$896.36
|
|
|
PR SURG EXCISION OF ANAL LESION(S)
|
Professional
|
$572.80
|
|
|
Service Code
|
CPT 46922
|
| Hospital Charge Code |
z46922
|
| Min. Negotiated Rate |
$128.09 |
| Max. Negotiated Rate |
$429.60 |
| Rate for Payer: Aetna Medicare |
$128.09
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$210.60
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$210.60
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$147.30
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$140.90
|
| Rate for Payer: Cash Price |
$355.14
|
| Rate for Payer: Cash Price |
$355.14
|
| Rate for Payer: Coventry All Commercial |
$153.71
|
| Rate for Payer: Frontpath All Commercial |
$177.41
|
| Rate for Payer: Humana ChoiceCare |
$132.70
|
| Rate for Payer: Humana Medicare |
$128.09
|
| Rate for Payer: Lucent All Commercial |
$217.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$192.00
|
| Rate for Payer: PHCS All Commercial |
$429.60
|
| Rate for Payer: PHP All Commercial |
$218.69
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$128.09
|
| Rate for Payer: Signature Care EPO |
$286.45
|
| Rate for Payer: Signature Care PPO |
$286.45
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$179.00
|
| Rate for Payer: United Healthcare Commercial |
$139.54
|
| Rate for Payer: United Healthcare Medicare |
$128.09
|
|
|
PR SURGICAL ARTHROSCOPY SHOULDER LMTD DBRDMT 1/2
|
Professional
|
$985.82
|
|
|
Service Code
|
CPT 29822
|
| Hospital Charge Code |
z29822
|
| Min. Negotiated Rate |
$505.24 |
| Max. Negotiated Rate |
$858.91 |
| Rate for Payer: Aetna Medicare |
$505.24
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$798.20
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$798.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$581.03
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$555.76
|
| Rate for Payer: Cash Price |
$611.21
|
| Rate for Payer: Cash Price |
$611.21
|
| Rate for Payer: Coventry All Commercial |
$606.29
|
| Rate for Payer: Frontpath All Commercial |
$701.02
|
| Rate for Payer: Humana ChoiceCare |
$613.72
|
| Rate for Payer: Humana Medicare |
$505.24
|
| Rate for Payer: Lucent All Commercial |
$858.91
|
| Rate for Payer: Lutheran Preferred All Commercial |
$808.00
|
| Rate for Payer: PHCS All Commercial |
$739.36
|
| Rate for Payer: PHP All Commercial |
$857.67
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$505.24
|
| Rate for Payer: Signature Care EPO |
$846.60
|
| Rate for Payer: Signature Care PPO |
$846.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$758.00
|
| Rate for Payer: United Healthcare Commercial |
$619.31
|
| Rate for Payer: United Healthcare Medicare |
$505.24
|
|
|
PR SURGICAL ARTHROSCOPY SHOULDER XTNSV DBRDMT 3+
|
Professional
|
$1,079.60
|
|
|
Service Code
|
CPT 29823
|
| Hospital Charge Code |
z29823
|
| Min. Negotiated Rate |
$553.29 |
| Max. Negotiated Rate |
$940.59 |
| Rate for Payer: Aetna Medicare |
$553.29
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$862.50
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$862.50
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$636.28
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$608.62
|
| Rate for Payer: Cash Price |
$669.35
|
| Rate for Payer: Cash Price |
$669.35
|
| Rate for Payer: Coventry All Commercial |
$663.95
|
| Rate for Payer: Frontpath All Commercial |
$768.56
|
| Rate for Payer: Humana ChoiceCare |
$669.46
|
| Rate for Payer: Humana Medicare |
$553.29
|
| Rate for Payer: Lucent All Commercial |
$940.59
|
| Rate for Payer: Lutheran Preferred All Commercial |
$885.00
|
| Rate for Payer: PHCS All Commercial |
$809.70
|
| Rate for Payer: PHP All Commercial |
$939.25
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$553.29
|
| Rate for Payer: Signature Care EPO |
$926.50
|
| Rate for Payer: Signature Care PPO |
$926.50
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$830.00
|
| Rate for Payer: United Healthcare Commercial |
$677.75
|
| Rate for Payer: United Healthcare Medicare |
$553.29
|
|
|
PR SURG RX INCOMPLETE ABORTN
|
Professional
|
$650.04
|
|
|
Service Code
|
CPT 59812
|
| Hospital Charge Code |
z59812
|
| Min. Negotiated Rate |
$254.84 |
| Max. Negotiated Rate |
$487.53 |
| Rate for Payer: Aetna Medicare |
$280.36
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$367.12
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$367.12
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$322.41
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$308.40
|
| Rate for Payer: Cash Price |
$403.02
|
| Rate for Payer: Cash Price |
$403.02
|
| Rate for Payer: Coventry All Commercial |
$336.43
|
| Rate for Payer: Frontpath All Commercial |
$398.55
|
| Rate for Payer: Humana ChoiceCare |
$254.84
|
| Rate for Payer: Humana Medicare |
$280.36
|
| Rate for Payer: Lucent All Commercial |
$476.61
|
| Rate for Payer: Lutheran Preferred All Commercial |
$393.00
|
| Rate for Payer: PHCS All Commercial |
$487.53
|
| Rate for Payer: PHP All Commercial |
$361.05
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$280.36
|
| Rate for Payer: Signature Care EPO |
$324.70
|
| Rate for Payer: Signature Care PPO |
$324.70
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$364.00
|
| Rate for Payer: United Healthcare Commercial |
$324.96
|
| Rate for Payer: United Healthcare Medicare |
$280.36
|
|
|
PR SURG RX MISSED ABORTN,1ST TRI
|
Professional
|
$788.72
|
|
|
Service Code
|
CPT 59820
|
| Hospital Charge Code |
z59820
|
| Min. Negotiated Rate |
$289.86 |
| Max. Negotiated Rate |
$601.10 |
| Rate for Payer: Aetna Medicare |
$353.59
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$459.14
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$459.14
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$406.63
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$388.95
|
| Rate for Payer: Cash Price |
$489.01
|
| Rate for Payer: Cash Price |
$489.01
|
| Rate for Payer: Coventry All Commercial |
$424.31
|
| Rate for Payer: Frontpath All Commercial |
$494.80
|
| Rate for Payer: Humana ChoiceCare |
$289.86
|
| Rate for Payer: Humana Medicare |
$353.59
|
| Rate for Payer: Lucent All Commercial |
$601.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$495.00
|
| Rate for Payer: PHCS All Commercial |
$591.54
|
| Rate for Payer: PHP All Commercial |
$455.35
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$353.59
|
| Rate for Payer: Signature Care EPO |
$371.45
|
| Rate for Payer: Signature Care PPO |
$371.45
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$460.00
|
| Rate for Payer: United Healthcare Commercial |
$382.33
|
| Rate for Payer: United Healthcare Medicare |
$353.59
|
|
|
PR SURG RX MISSED ABORTN,2ND TRI
|
Professional
|
$776.46
|
|
|
Service Code
|
CPT 59821
|
| Hospital Charge Code |
z59821
|
| Min. Negotiated Rate |
$303.62 |
| Max. Negotiated Rate |
$586.48 |
| Rate for Payer: Aetna Medicare |
$344.99
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$479.70
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$479.70
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$396.74
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$379.49
|
| Rate for Payer: Cash Price |
$481.41
|
| Rate for Payer: Cash Price |
$481.41
|
| Rate for Payer: Coventry All Commercial |
$413.99
|
| Rate for Payer: Frontpath All Commercial |
$486.37
|
| Rate for Payer: Humana ChoiceCare |
$303.62
|
| Rate for Payer: Humana Medicare |
$344.99
|
| Rate for Payer: Lucent All Commercial |
$586.48
|
| Rate for Payer: Lutheran Preferred All Commercial |
$483.00
|
| Rate for Payer: PHCS All Commercial |
$582.34
|
| Rate for Payer: PHP All Commercial |
$444.48
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$344.99
|
| Rate for Payer: Signature Care EPO |
$392.70
|
| Rate for Payer: Signature Care PPO |
$392.70
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$448.00
|
| Rate for Payer: United Healthcare Commercial |
$388.44
|
| Rate for Payer: United Healthcare Medicare |
$344.99
|
|
|
PR SUSPENSION OF VAGINA,ABD APPRCH
|
Professional
|
$1,765.42
|
|
|
Service Code
|
CPT 57280
|
| Hospital Charge Code |
z57280
|
| Min. Negotiated Rate |
$904.78 |
| Max. Negotiated Rate |
$1,538.13 |
| Rate for Payer: Aetna Medicare |
$904.78
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,178.20
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,178.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,040.50
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$995.26
|
| Rate for Payer: Cash Price |
$1,094.56
|
| Rate for Payer: Cash Price |
$1,094.56
|
| Rate for Payer: Coventry All Commercial |
$1,085.74
|
| Rate for Payer: Frontpath All Commercial |
$1,266.34
|
| Rate for Payer: Humana ChoiceCare |
$994.75
|
| Rate for Payer: Humana Medicare |
$904.78
|
| Rate for Payer: Lucent All Commercial |
$1,538.13
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,267.00
|
| Rate for Payer: PHCS All Commercial |
$1,324.06
|
| Rate for Payer: PHP All Commercial |
$1,165.18
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$904.78
|
| Rate for Payer: Signature Care EPO |
$1,120.30
|
| Rate for Payer: Signature Care PPO |
$1,120.30
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,176.00
|
| Rate for Payer: United Healthcare Commercial |
$1,095.11
|
| Rate for Payer: United Healthcare Medicare |
$904.78
|
|
|
PR SUTURE LRG INTEST
|
Professional
|
$1,879.84
|
|
|
Service Code
|
CPT 44604
|
| Hospital Charge Code |
z44604
|
| Min. Negotiated Rate |
$963.42 |
| Max. Negotiated Rate |
$1,644.86 |
| Rate for Payer: Aetna Medicare |
$963.42
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,094.20
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,094.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,107.93
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,059.76
|
| Rate for Payer: Cash Price |
$1,165.50
|
| Rate for Payer: Cash Price |
$1,165.50
|
| Rate for Payer: Coventry All Commercial |
$1,156.10
|
| Rate for Payer: Frontpath All Commercial |
$1,390.99
|
| Rate for Payer: Humana ChoiceCare |
$1,033.91
|
| Rate for Payer: Humana Medicare |
$963.42
|
| Rate for Payer: Lucent All Commercial |
$1,637.81
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,445.00
|
| Rate for Payer: PHCS All Commercial |
$1,409.88
|
| Rate for Payer: PHP All Commercial |
$1,644.86
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$963.42
|
| Rate for Payer: Signature Care EPO |
$1,301.35
|
| Rate for Payer: Signature Care PPO |
$1,301.35
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,349.00
|
| Rate for Payer: United Healthcare Commercial |
$1,135.91
|
| Rate for Payer: United Healthcare Medicare |
$963.42
|
|
|
PR SUTURE OF MESENTERY
|
Professional
|
$1,334.44
|
|
|
Service Code
|
CPT 44850
|
| Hospital Charge Code |
z44850
|
| Min. Negotiated Rate |
$683.90 |
| Max. Negotiated Rate |
$1,167.64 |
| Rate for Payer: Aetna Medicare |
$683.90
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$754.20
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$754.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$786.48
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$752.29
|
| Rate for Payer: Cash Price |
$827.35
|
| Rate for Payer: Cash Price |
$827.35
|
| Rate for Payer: Coventry All Commercial |
$820.68
|
| Rate for Payer: Frontpath All Commercial |
$990.66
|
| Rate for Payer: Humana ChoiceCare |
$719.70
|
| Rate for Payer: Humana Medicare |
$683.90
|
| Rate for Payer: Lucent All Commercial |
$1,162.63
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,026.00
|
| Rate for Payer: PHCS All Commercial |
$1,000.83
|
| Rate for Payer: PHP All Commercial |
$1,167.64
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$683.90
|
| Rate for Payer: Signature Care EPO |
$908.65
|
| Rate for Payer: Signature Care PPO |
$908.65
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$957.00
|
| Rate for Payer: United Healthcare Commercial |
$789.30
|
| Rate for Payer: United Healthcare Medicare |
$683.90
|
|
|
PR SUTURE SM INTEST,SINGLE PERF
|
Professional
|
$2,500.08
|
|
|
Service Code
|
CPT 44602
|
| Hospital Charge Code |
z44602
|
| Min. Negotiated Rate |
$868.60 |
| Max. Negotiated Rate |
$2,187.57 |
| Rate for Payer: Aetna Medicare |
$1,281.29
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$868.60
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$868.60
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,473.48
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,409.42
|
| Rate for Payer: Cash Price |
$1,550.05
|
| Rate for Payer: Cash Price |
$1,550.05
|
| Rate for Payer: Coventry All Commercial |
$1,537.55
|
| Rate for Payer: Frontpath All Commercial |
$1,863.10
|
| Rate for Payer: Humana ChoiceCare |
$1,031.44
|
| Rate for Payer: Humana Medicare |
$1,281.29
|
| Rate for Payer: Lucent All Commercial |
$2,178.19
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,922.00
|
| Rate for Payer: PHCS All Commercial |
$1,875.06
|
| Rate for Payer: PHP All Commercial |
$2,187.57
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,281.29
|
| Rate for Payer: Signature Care EPO |
$1,286.90
|
| Rate for Payer: Signature Care PPO |
$1,286.90
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,794.00
|
| Rate for Payer: United Healthcare Commercial |
$1,480.99
|
| Rate for Payer: United Healthcare Medicare |
$1,281.29
|
|
|
PR SYNTHETIC SENTENCE TEST
|
Professional
|
$71.40
|
|
|
Service Code
|
CPT 92576
|
| Hospital Charge Code |
z92576
|
| Min. Negotiated Rate |
$17.90 |
| Max. Negotiated Rate |
$62.20 |
| Rate for Payer: Aetna Medicare |
$36.59
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$17.90
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$17.90
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$42.08
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$40.25
|
| Rate for Payer: Cash Price |
$44.27
|
| Rate for Payer: Cash Price |
$44.27
|
| Rate for Payer: Coventry All Commercial |
$43.91
|
| Rate for Payer: Frontpath All Commercial |
$39.00
|
| Rate for Payer: Humana ChoiceCare |
$18.64
|
| Rate for Payer: Humana Medicare |
$36.59
|
| Rate for Payer: Lucent All Commercial |
$62.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$48.00
|
| Rate for Payer: PHCS All Commercial |
$53.55
|
| Rate for Payer: PHP All Commercial |
$51.76
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$36.59
|
| Rate for Payer: Signature Care EPO |
$29.52
|
| Rate for Payer: Signature Care PPO |
$29.52
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$44.00
|
| Rate for Payer: United Healthcare Commercial |
$23.29
|
| Rate for Payer: United Healthcare Medicare |
$36.59
|
|
|
PR SYNVISC OR SYNVISC-ONE
|
Professional
|
$27.39
|
|
|
Service Code
|
CPT J7325
|
| Hospital Charge Code |
zJ7325
|
| Min. Negotiated Rate |
$9.79 |
| Max. Negotiated Rate |
$27.39 |
| Rate for Payer: Humana ChoiceCare |
$9.79
|
| Rate for Payer: PHP All Commercial |
$27.39
|
|
|
PR TANGENTIAL BIOPSY SKIN EA SEP/ADDITIONAL LESION
|
Professional
|
$92.04
|
|
|
Service Code
|
CPT 11103
|
| Hospital Charge Code |
z11103
|
| Min. Negotiated Rate |
$20.31 |
| Max. Negotiated Rate |
$69.03 |
| Rate for Payer: Aetna Medicare |
$20.31
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$50.15
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$50.15
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$23.36
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$22.34
|
| Rate for Payer: Cash Price |
$57.06
|
| Rate for Payer: Cash Price |
$57.06
|
| Rate for Payer: Coventry All Commercial |
$24.37
|
| Rate for Payer: Frontpath All Commercial |
$28.11
|
| Rate for Payer: Humana ChoiceCare |
$22.00
|
| Rate for Payer: Humana Medicare |
$20.31
|
| Rate for Payer: Lucent All Commercial |
$34.53
|
| Rate for Payer: Lutheran Preferred All Commercial |
$26.00
|
| Rate for Payer: PHCS All Commercial |
$69.03
|
| Rate for Payer: PHP All Commercial |
$27.74
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$20.31
|
| Rate for Payer: Signature Care EPO |
$50.30
|
| Rate for Payer: Signature Care PPO |
$50.30
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$24.00
|
| Rate for Payer: United Healthcare Commercial |
$28.00
|
| Rate for Payer: United Healthcare Medicare |
$20.31
|
|
|
PR TANGENTIAL BIOPSY SKIN SINGLE LESION
|
Professional
|
$185.58
|
|
|
Service Code
|
CPT 11102
|
| Hospital Charge Code |
z11102
|
| Min. Negotiated Rate |
$35.53 |
| Max. Negotiated Rate |
$139.18 |
| Rate for Payer: Aetna Medicare |
$35.53
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$92.91
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$92.91
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$40.86
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$39.08
|
| Rate for Payer: Cash Price |
$115.06
|
| Rate for Payer: Cash Price |
$115.06
|
| Rate for Payer: Coventry All Commercial |
$42.64
|
| Rate for Payer: Frontpath All Commercial |
$48.33
|
| Rate for Payer: Humana ChoiceCare |
$37.93
|
| Rate for Payer: Humana Medicare |
$35.53
|
| Rate for Payer: Lucent All Commercial |
$60.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$46.00
|
| Rate for Payer: PHCS All Commercial |
$139.18
|
| Rate for Payer: PHP All Commercial |
$48.53
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$35.53
|
| Rate for Payer: Signature Care EPO |
$93.19
|
| Rate for Payer: Signature Care PPO |
$93.19
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$43.00
|
| Rate for Payer: United Healthcare Commercial |
$48.33
|
| Rate for Payer: United Healthcare Medicare |
$35.53
|
|
|
PR TARSAL TUNNEL RELEASE
|
Professional
|
$963.18
|
|
|
Service Code
|
CPT 28035
|
| Hospital Charge Code |
z28035
|
| Min. Negotiated Rate |
$337.42 |
| Max. Negotiated Rate |
$722.38 |
| Rate for Payer: Aetna Medicare |
$337.42
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$502.78
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$502.78
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$388.03
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$371.16
|
| Rate for Payer: Cash Price |
$597.17
|
| Rate for Payer: Cash Price |
$597.17
|
| Rate for Payer: Coventry All Commercial |
$404.90
|
| Rate for Payer: Frontpath All Commercial |
$455.73
|
| Rate for Payer: Humana ChoiceCare |
$397.28
|
| Rate for Payer: Humana Medicare |
$337.42
|
| Rate for Payer: Lucent All Commercial |
$573.61
|
| Rate for Payer: Lutheran Preferred All Commercial |
$540.00
|
| Rate for Payer: PHCS All Commercial |
$722.38
|
| Rate for Payer: PHP All Commercial |
$572.79
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$337.42
|
| Rate for Payer: Signature Care EPO |
$614.55
|
| Rate for Payer: Signature Care PPO |
$614.55
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$506.00
|
| Rate for Payer: United Healthcare Commercial |
$404.59
|
| Rate for Payer: United Healthcare Medicare |
$337.42
|
|
|
PR TCAT INSJ/RPL PERM LEADLESS PACEMAKER RV W/IMG
|
Professional
|
$850.18
|
|
|
Service Code
|
CPT 33274
|
| Hospital Charge Code |
z33274
|
| Min. Negotiated Rate |
$435.72 |
| Max. Negotiated Rate |
$740.72 |
| Rate for Payer: Aetna Medicare |
$435.72
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$458.18
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$458.18
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$501.08
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$479.29
|
| Rate for Payer: Cash Price |
$527.11
|
| Rate for Payer: Cash Price |
$527.11
|
| Rate for Payer: Coventry All Commercial |
$522.86
|
| Rate for Payer: Frontpath All Commercial |
$630.90
|
| Rate for Payer: Humana ChoiceCare |
$597.92
|
| Rate for Payer: Humana Medicare |
$435.72
|
| Rate for Payer: Lucent All Commercial |
$740.72
|
| Rate for Payer: Lutheran Preferred All Commercial |
$697.00
|
| Rate for Payer: PHCS All Commercial |
$637.64
|
| Rate for Payer: PHP All Commercial |
$595.13
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$435.72
|
| Rate for Payer: Signature Care EPO |
$646.49
|
| Rate for Payer: Signature Care PPO |
$646.49
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$654.00
|
| Rate for Payer: United Healthcare Commercial |
$590.90
|
| Rate for Payer: United Healthcare Medicare |
$435.72
|
|
|
PR TDAP VACCINE >7 YO, IM
|
Professional
|
$73.37
|
|
|
Service Code
|
CPT 90715
|
| Hospital Charge Code |
z90715
|
| Min. Negotiated Rate |
$37.50 |
| Max. Negotiated Rate |
$73.37 |
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$49.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$49.00
|
| Rate for Payer: Frontpath All Commercial |
$46.33
|
| Rate for Payer: Humana ChoiceCare |
$37.50
|
| Rate for Payer: Lutheran Preferred All Commercial |
$73.37
|
| Rate for Payer: PHP All Commercial |
$49.28
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$73.37
|
|
|
PR TD VACCINE PRSRV FREE 7 YRS OR OLDER FOR IM USE
|
Professional
|
$41.71
|
|
|
Service Code
|
CPT 90714
|
| Hospital Charge Code |
z90714
|
| Min. Negotiated Rate |
$28.83 |
| Max. Negotiated Rate |
$41.71 |
| Rate for Payer: Frontpath All Commercial |
$30.47
|
| Rate for Payer: Humana ChoiceCare |
$28.83
|
| Rate for Payer: PHP All Commercial |
$41.71
|
|
|
PR TELEHEALTH FACILITY FEE
|
Professional
|
$57.00
|
|
|
Service Code
|
CPT Q3014
|
| Hospital Charge Code |
zQ3014
|
| Min. Negotiated Rate |
$24.34 |
| Max. Negotiated Rate |
$42.75 |
| Rate for Payer: Cash Price |
$35.34
|
| Rate for Payer: Cash Price |
$35.34
|
| Rate for Payer: Humana ChoiceCare |
$24.34
|
| Rate for Payer: PHCS All Commercial |
$42.75
|
| Rate for Payer: United Healthcare Commercial |
$29.65
|
|
|
PR TEMPORAL ARTERY LIGATN OR BX
|
Professional
|
$564.84
|
|
|
Service Code
|
CPT 37609
|
| Hospital Charge Code |
z37609
|
| Min. Negotiated Rate |
$187.91 |
| Max. Negotiated Rate |
$423.63 |
| Rate for Payer: Aetna Medicare |
$187.91
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$320.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$320.30
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$216.10
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$206.70
|
| Rate for Payer: Cash Price |
$350.20
|
| Rate for Payer: Cash Price |
$350.20
|
| Rate for Payer: Coventry All Commercial |
$225.49
|
| Rate for Payer: Frontpath All Commercial |
$265.64
|
| Rate for Payer: Humana ChoiceCare |
$244.40
|
| Rate for Payer: Humana Medicare |
$187.91
|
| Rate for Payer: Lucent All Commercial |
$319.45
|
| Rate for Payer: Lutheran Preferred All Commercial |
$301.00
|
| Rate for Payer: PHCS All Commercial |
$423.63
|
| Rate for Payer: PHP All Commercial |
$256.66
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$187.91
|
| Rate for Payer: Signature Care EPO |
$420.75
|
| Rate for Payer: Signature Care PPO |
$420.75
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$282.00
|
| Rate for Payer: United Healthcare Commercial |
$224.09
|
| Rate for Payer: United Healthcare Medicare |
$187.91
|
|
|
PR TENOTOMY ELBOW LATERAL/MEDIAL DEBRIDE OPEN
|
Professional
|
$968.46
|
|
|
Service Code
|
CPT 24358
|
| Hospital Charge Code |
z24358
|
| Min. Negotiated Rate |
$496.34 |
| Max. Negotiated Rate |
$843.78 |
| Rate for Payer: Aetna Medicare |
$496.34
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$720.94
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$720.94
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$570.79
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$545.97
|
| Rate for Payer: Cash Price |
$600.45
|
| Rate for Payer: Cash Price |
$600.45
|
| Rate for Payer: Coventry All Commercial |
$595.61
|
| Rate for Payer: Frontpath All Commercial |
$685.05
|
| Rate for Payer: Humana ChoiceCare |
$506.14
|
| Rate for Payer: Humana Medicare |
$496.34
|
| Rate for Payer: Lucent All Commercial |
$843.78
|
| Rate for Payer: Lutheran Preferred All Commercial |
$794.00
|
| Rate for Payer: PHCS All Commercial |
$726.34
|
| Rate for Payer: PHP All Commercial |
$842.56
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$496.34
|
| Rate for Payer: Signature Care EPO |
$687.17
|
| Rate for Payer: Signature Care PPO |
$687.17
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$745.00
|
| Rate for Payer: United Healthcare Commercial |
$555.09
|
| Rate for Payer: United Healthcare Medicare |
$496.34
|
|
