|
PR TENOTOMY ELBOW LATERAL/MEDIAL DEBRIDE REPAIR
|
Professional
|
$1,210.08
|
|
|
Service Code
|
CPT 24359
|
| Hospital Charge Code |
z24359
|
| Min. Negotiated Rate |
$620.17 |
| Max. Negotiated Rate |
$1,054.29 |
| Rate for Payer: Aetna Medicare |
$620.17
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$884.53
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$884.53
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$713.20
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$682.19
|
| Rate for Payer: Cash Price |
$750.25
|
| Rate for Payer: Cash Price |
$750.25
|
| Rate for Payer: Coventry All Commercial |
$744.20
|
| Rate for Payer: Frontpath All Commercial |
$859.55
|
| Rate for Payer: Humana ChoiceCare |
$622.13
|
| Rate for Payer: Humana Medicare |
$620.17
|
| Rate for Payer: Lucent All Commercial |
$1,054.29
|
| Rate for Payer: Lutheran Preferred All Commercial |
$992.00
|
| Rate for Payer: PHCS All Commercial |
$907.56
|
| Rate for Payer: PHP All Commercial |
$1,052.78
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$620.17
|
| Rate for Payer: Signature Care EPO |
$844.63
|
| Rate for Payer: Signature Care PPO |
$844.63
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$930.00
|
| Rate for Payer: United Healthcare Commercial |
$701.15
|
| Rate for Payer: United Healthcare Medicare |
$620.17
|
|
|
PR TETANUS IMMUNE GLOBULIN INJ
|
Professional
|
$587.42
|
|
|
Service Code
|
CPT J1670
|
| Hospital Charge Code |
zJ1670
|
| Min. Negotiated Rate |
$524.41 |
| Max. Negotiated Rate |
$587.42 |
| Rate for Payer: Humana ChoiceCare |
$524.41
|
| Rate for Payer: PHP All Commercial |
$587.42
|
|
|
PR TETANUS IMMUNIZATION, IM
|
Professional
|
$48.00
|
|
|
Service Code
|
CPT 90703
|
| Hospital Charge Code |
z90703
|
| Min. Negotiated Rate |
$47.05 |
| Max. Negotiated Rate |
$48.00 |
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$48.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$48.00
|
| Rate for Payer: Frontpath All Commercial |
$47.05
|
|
|
PR THERAPEUTIC SPINAL PUNCTURE DRAINAGE CSF
|
Professional
|
$319.16
|
|
|
Service Code
|
CPT 62272
|
| Hospital Charge Code |
z62272
|
| Min. Negotiated Rate |
$81.76 |
| Max. Negotiated Rate |
$271.47 |
| Rate for Payer: Aetna Medicare |
$81.76
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$174.50
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$174.50
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$94.02
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$89.94
|
| Rate for Payer: Cash Price |
$197.88
|
| Rate for Payer: Cash Price |
$197.88
|
| Rate for Payer: Coventry All Commercial |
$98.11
|
| Rate for Payer: Frontpath All Commercial |
$117.39
|
| Rate for Payer: Humana ChoiceCare |
$105.99
|
| Rate for Payer: Humana Medicare |
$81.76
|
| Rate for Payer: Lucent All Commercial |
$138.99
|
| Rate for Payer: Lutheran Preferred All Commercial |
$131.00
|
| Rate for Payer: PHCS All Commercial |
$239.37
|
| Rate for Payer: PHP All Commercial |
$139.60
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$81.76
|
| Rate for Payer: Signature Care EPO |
$271.47
|
| Rate for Payer: Signature Care PPO |
$271.47
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$123.00
|
| Rate for Payer: United Healthcare Commercial |
$93.04
|
| Rate for Payer: United Healthcare Medicare |
$81.76
|
|
|
PR THORACENTESIS NEEDLE/CATH PLEURA W/IMAGING
|
Professional
|
$579.24
|
|
|
Service Code
|
CPT 32555
|
| Hospital Charge Code |
z32555
|
| Min. Negotiated Rate |
$102.99 |
| Max. Negotiated Rate |
$825.10 |
| Rate for Payer: Aetna Medicare |
$102.99
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$825.10
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$825.10
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$118.44
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$113.29
|
| Rate for Payer: Cash Price |
$359.13
|
| Rate for Payer: Cash Price |
$359.13
|
| Rate for Payer: Coventry All Commercial |
$123.59
|
| Rate for Payer: Frontpath All Commercial |
$142.36
|
| Rate for Payer: Humana ChoiceCare |
$130.19
|
| Rate for Payer: Humana Medicare |
$102.99
|
| Rate for Payer: Lucent All Commercial |
$175.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$165.00
|
| Rate for Payer: PHCS All Commercial |
$434.43
|
| Rate for Payer: PHP All Commercial |
$140.67
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$102.99
|
| Rate for Payer: Signature Care EPO |
$259.85
|
| Rate for Payer: Signature Care PPO |
$259.85
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$154.00
|
| Rate for Payer: United Healthcare Commercial |
$141.66
|
| Rate for Payer: United Healthcare Medicare |
$102.99
|
|
|
PR THORACENTESIS NEEDLE/CATH PLEURA W/O IMAGING
|
Professional
|
$428.40
|
|
|
Service Code
|
CPT 32554
|
| Hospital Charge Code |
z32554
|
| Min. Negotiated Rate |
$82.80 |
| Max. Negotiated Rate |
$715.42 |
| Rate for Payer: Aetna Medicare |
$82.80
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$715.42
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$715.42
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$95.22
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$91.08
|
| Rate for Payer: Cash Price |
$265.61
|
| Rate for Payer: Cash Price |
$265.61
|
| Rate for Payer: Coventry All Commercial |
$99.36
|
| Rate for Payer: Frontpath All Commercial |
$116.36
|
| Rate for Payer: Humana ChoiceCare |
$104.34
|
| Rate for Payer: Humana Medicare |
$82.80
|
| Rate for Payer: Lucent All Commercial |
$140.76
|
| Rate for Payer: Lutheran Preferred All Commercial |
$132.00
|
| Rate for Payer: PHCS All Commercial |
$321.30
|
| Rate for Payer: PHP All Commercial |
$113.09
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$82.80
|
| Rate for Payer: Signature Care EPO |
$324.89
|
| Rate for Payer: Signature Care PPO |
$324.89
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$124.00
|
| Rate for Payer: United Healthcare Commercial |
$113.54
|
| Rate for Payer: United Healthcare Medicare |
$82.80
|
|
|
PR TIBIAL SCOPE/SURG/FX AID,UNICONDYLR
|
Professional
|
$1,418.02
|
|
|
Service Code
|
CPT 29855
|
| Hospital Charge Code |
z29855
|
| Min. Negotiated Rate |
$726.74 |
| Max. Negotiated Rate |
$1,235.46 |
| Rate for Payer: Aetna Medicare |
$726.74
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,073.10
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,073.10
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$835.75
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$799.41
|
| Rate for Payer: Cash Price |
$879.17
|
| Rate for Payer: Cash Price |
$879.17
|
| Rate for Payer: Coventry All Commercial |
$872.09
|
| Rate for Payer: Frontpath All Commercial |
$1,013.52
|
| Rate for Payer: Humana ChoiceCare |
$845.48
|
| Rate for Payer: Humana Medicare |
$726.74
|
| Rate for Payer: Lucent All Commercial |
$1,235.46
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,163.00
|
| Rate for Payer: PHCS All Commercial |
$1,063.52
|
| Rate for Payer: PHP All Commercial |
$1,233.68
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$726.74
|
| Rate for Payer: Signature Care EPO |
$1,124.55
|
| Rate for Payer: Signature Care PPO |
$1,124.55
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,090.00
|
| Rate for Payer: United Healthcare Commercial |
$852.31
|
| Rate for Payer: United Healthcare Medicare |
$726.74
|
|
|
PR TILT TABLE EVALUATION
|
Professional
|
$170.82
|
|
|
Service Code
|
CPT 93660
|
| Hospital Charge Code |
z93660
|
| Min. Negotiated Rate |
$128.12 |
| Max. Negotiated Rate |
$258.04 |
| Rate for Payer: Aetna Medicare |
$151.79
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$162.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$162.00
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$174.56
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$166.97
|
| Rate for Payer: Cash Price |
$105.91
|
| Rate for Payer: Cash Price |
$105.91
|
| Rate for Payer: Coventry All Commercial |
$182.15
|
| Rate for Payer: Frontpath All Commercial |
$170.02
|
| Rate for Payer: Humana ChoiceCare |
$212.06
|
| Rate for Payer: Humana Medicare |
$151.79
|
| Rate for Payer: Lucent All Commercial |
$258.04
|
| Rate for Payer: Lutheran Preferred All Commercial |
$197.00
|
| Rate for Payer: PHCS All Commercial |
$128.12
|
| Rate for Payer: PHP All Commercial |
$217.69
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$151.79
|
| Rate for Payer: Signature Care EPO |
$178.54
|
| Rate for Payer: Signature Care PPO |
$178.54
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$182.00
|
| Rate for Payer: United Healthcare Commercial |
$202.43
|
| Rate for Payer: United Healthcare Medicare |
$151.79
|
|
|
PR TINNITUS ASSESSMENT
|
Professional
|
$127.90
|
|
|
Service Code
|
CPT 92625
|
| Hospital Charge Code |
z92625
|
| Min. Negotiated Rate |
$42.13 |
| Max. Negotiated Rate |
$99.88 |
| Rate for Payer: Aetna Medicare |
$58.75
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$42.13
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$42.13
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$67.56
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$64.62
|
| Rate for Payer: Cash Price |
$79.30
|
| Rate for Payer: Cash Price |
$79.30
|
| Rate for Payer: Coventry All Commercial |
$70.50
|
| Rate for Payer: Frontpath All Commercial |
$66.72
|
| Rate for Payer: Humana ChoiceCare |
$46.16
|
| Rate for Payer: Humana Medicare |
$58.75
|
| Rate for Payer: Lucent All Commercial |
$99.88
|
| Rate for Payer: Lutheran Preferred All Commercial |
$76.00
|
| Rate for Payer: PHCS All Commercial |
$95.92
|
| Rate for Payer: PHP All Commercial |
$83.12
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$58.75
|
| Rate for Payer: Signature Care EPO |
$57.54
|
| Rate for Payer: Signature Care PPO |
$57.54
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$71.00
|
| Rate for Payer: United Healthcare Commercial |
$68.80
|
| Rate for Payer: United Healthcare Medicare |
$58.75
|
|
|
PR TOBACCO USE CESSATION INTENSIVE >10 MINUTES
|
Professional
|
$51.18
|
|
|
Service Code
|
CPT 99407
|
| Hospital Charge Code |
z99407
|
| Min. Negotiated Rate |
$22.16 |
| Max. Negotiated Rate |
$40.39 |
| Rate for Payer: Aetna Medicare |
$23.76
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$27.32
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$26.14
|
| Rate for Payer: Cash Price |
$31.73
|
| Rate for Payer: Cash Price |
$31.73
|
| Rate for Payer: Coventry All Commercial |
$28.51
|
| Rate for Payer: Frontpath All Commercial |
$26.40
|
| Rate for Payer: Humana ChoiceCare |
$22.16
|
| Rate for Payer: Humana Medicare |
$23.76
|
| Rate for Payer: Lucent All Commercial |
$40.39
|
| Rate for Payer: PHCS All Commercial |
$38.38
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$23.76
|
| Rate for Payer: United Healthcare Commercial |
$24.38
|
| Rate for Payer: United Healthcare Medicare |
$23.76
|
|
|
PR TOBACCO USE CESSATION INTERMEDIATE 3-10 MINUTES
|
Professional
|
$27.34
|
|
|
Service Code
|
CPT 99406
|
| Hospital Charge Code |
z99406
|
| Min. Negotiated Rate |
$10.97 |
| Max. Negotiated Rate |
$20.50 |
| Rate for Payer: Aetna Medicare |
$11.23
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$16.75
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$16.75
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$12.91
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$12.35
|
| Rate for Payer: Cash Price |
$16.95
|
| Rate for Payer: Cash Price |
$16.95
|
| Rate for Payer: Coventry All Commercial |
$13.48
|
| Rate for Payer: Frontpath All Commercial |
$12.51
|
| Rate for Payer: Humana ChoiceCare |
$10.97
|
| Rate for Payer: Humana Medicare |
$11.23
|
| Rate for Payer: Lucent All Commercial |
$19.09
|
| Rate for Payer: Lutheran Preferred All Commercial |
$12.00
|
| Rate for Payer: PHCS All Commercial |
$20.50
|
| Rate for Payer: PHP All Commercial |
$11.29
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$11.23
|
| Rate for Payer: Signature Care EPO |
$12.36
|
| Rate for Payer: Signature Care PPO |
$12.36
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$12.00
|
| Rate for Payer: United Healthcare Commercial |
$11.75
|
| Rate for Payer: United Healthcare Medicare |
$11.23
|
|
|
PR TONE DECAY HEARING TEST
|
Professional
|
$59.34
|
|
|
Service Code
|
CPT 92563
|
| Hospital Charge Code |
z92563
|
| Min. Negotiated Rate |
$15.00 |
| Max. Negotiated Rate |
$51.70 |
| Rate for Payer: Aetna Medicare |
$30.41
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$15.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$15.00
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$34.97
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$33.45
|
| Rate for Payer: Cash Price |
$36.79
|
| Rate for Payer: Cash Price |
$36.79
|
| Rate for Payer: Coventry All Commercial |
$36.49
|
| Rate for Payer: Frontpath All Commercial |
$32.74
|
| Rate for Payer: Humana ChoiceCare |
$16.04
|
| Rate for Payer: Humana Medicare |
$30.41
|
| Rate for Payer: Lucent All Commercial |
$51.70
|
| Rate for Payer: Lutheran Preferred All Commercial |
$40.00
|
| Rate for Payer: PHCS All Commercial |
$44.50
|
| Rate for Payer: PHP All Commercial |
$43.03
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$30.41
|
| Rate for Payer: Signature Care EPO |
$24.76
|
| Rate for Payer: Signature Care PPO |
$24.76
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$36.00
|
| Rate for Payer: United Healthcare Commercial |
$22.60
|
| Rate for Payer: United Healthcare Medicare |
$30.41
|
|
|
PR TOTAL ABDOM HYSTERECTOMY
|
Professional
|
$1,847.58
|
|
|
Service Code
|
CPT 58150
|
| Hospital Charge Code |
z58150
|
| Min. Negotiated Rate |
$947.20 |
| Max. Negotiated Rate |
$1,610.24 |
| Rate for Payer: Aetna Medicare |
$947.20
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,202.18
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,202.18
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,089.28
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,041.92
|
| Rate for Payer: Cash Price |
$1,145.50
|
| Rate for Payer: Cash Price |
$1,145.50
|
| Rate for Payer: Coventry All Commercial |
$1,136.64
|
| Rate for Payer: Frontpath All Commercial |
$1,325.65
|
| Rate for Payer: Humana ChoiceCare |
$1,011.72
|
| Rate for Payer: Humana Medicare |
$947.20
|
| Rate for Payer: Lucent All Commercial |
$1,610.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,326.00
|
| Rate for Payer: PHCS All Commercial |
$1,385.68
|
| Rate for Payer: PHP All Commercial |
$1,219.40
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$947.20
|
| Rate for Payer: Signature Care EPO |
$1,214.65
|
| Rate for Payer: Signature Care PPO |
$1,214.65
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,231.00
|
| Rate for Payer: United Healthcare Commercial |
$1,115.96
|
| Rate for Payer: United Healthcare Medicare |
$947.20
|
|
|
PR TOTAL HIP ARTHROPLASTY
|
Professional
|
$2,314.24
|
|
|
Service Code
|
CPT 27130
|
| Hospital Charge Code |
z27130
|
| Min. Negotiated Rate |
$1,186.05 |
| Max. Negotiated Rate |
$2,025.75 |
| Rate for Payer: Aetna Medicare |
$1,186.05
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,975.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,975.00
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,363.96
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,304.66
|
| Rate for Payer: Cash Price |
$1,434.83
|
| Rate for Payer: Cash Price |
$1,434.83
|
| Rate for Payer: Coventry All Commercial |
$1,423.26
|
| Rate for Payer: Frontpath All Commercial |
$1,671.01
|
| Rate for Payer: Humana ChoiceCare |
$1,471.36
|
| Rate for Payer: Humana Medicare |
$1,186.05
|
| Rate for Payer: Lucent All Commercial |
$2,016.28
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,898.00
|
| Rate for Payer: PHCS All Commercial |
$1,735.68
|
| Rate for Payer: PHP All Commercial |
$2,013.39
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,186.05
|
| Rate for Payer: Signature Care EPO |
$2,025.75
|
| Rate for Payer: Signature Care PPO |
$2,025.75
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,779.00
|
| Rate for Payer: United Healthcare Commercial |
$1,589.68
|
| Rate for Payer: United Healthcare Medicare |
$1,186.05
|
|
|
PR TOTAL KNEE ARTHROPLASTY
|
Professional
|
$2,312.12
|
|
|
Service Code
|
CPT 27447
|
| Hospital Charge Code |
z27447
|
| Min. Negotiated Rate |
$1,184.96 |
| Max. Negotiated Rate |
$2,089.40 |
| Rate for Payer: Aetna Medicare |
$1,184.96
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,089.40
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,089.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,362.70
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,303.46
|
| Rate for Payer: Cash Price |
$1,433.51
|
| Rate for Payer: Cash Price |
$1,433.51
|
| Rate for Payer: Coventry All Commercial |
$1,421.95
|
| Rate for Payer: Frontpath All Commercial |
$1,669.28
|
| Rate for Payer: Humana ChoiceCare |
$1,587.67
|
| Rate for Payer: Humana Medicare |
$1,184.96
|
| Rate for Payer: Lucent All Commercial |
$2,014.43
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,896.00
|
| Rate for Payer: PHCS All Commercial |
$1,734.09
|
| Rate for Payer: PHP All Commercial |
$2,011.54
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,184.96
|
| Rate for Payer: Signature Care EPO |
$2,023.88
|
| Rate for Payer: Signature Care PPO |
$2,023.88
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,777.00
|
| Rate for Payer: United Healthcare Commercial |
$1,701.71
|
| Rate for Payer: United Healthcare Medicare |
$1,184.96
|
|
|
PR TRACHEOBRNCHSC THRU EST TRACHS INC
|
Professional
|
$315.64
|
|
|
Service Code
|
CPT 31615
|
| Hospital Charge Code |
z31615
|
| Min. Negotiated Rate |
$107.44 |
| Max. Negotiated Rate |
$246.50 |
| Rate for Payer: Aetna Medicare |
$107.44
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$227.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$227.00
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$123.56
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$118.18
|
| Rate for Payer: Cash Price |
$195.70
|
| Rate for Payer: Cash Price |
$195.70
|
| Rate for Payer: Coventry All Commercial |
$128.93
|
| Rate for Payer: Frontpath All Commercial |
$148.07
|
| Rate for Payer: Humana ChoiceCare |
$149.51
|
| Rate for Payer: Humana Medicare |
$107.44
|
| Rate for Payer: Lucent All Commercial |
$182.65
|
| Rate for Payer: Lutheran Preferred All Commercial |
$172.00
|
| Rate for Payer: PHCS All Commercial |
$236.73
|
| Rate for Payer: PHP All Commercial |
$146.74
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$107.44
|
| Rate for Payer: Signature Care EPO |
$246.50
|
| Rate for Payer: Signature Care PPO |
$246.50
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$161.00
|
| Rate for Payer: United Healthcare Commercial |
$144.49
|
| Rate for Payer: United Healthcare Medicare |
$107.44
|
|
|
PR TRANSFER SKIN PEDICLE FLAP
|
Professional
|
$983.02
|
|
|
Service Code
|
CPT 15650
|
| Hospital Charge Code |
z15650
|
| Min. Negotiated Rate |
$301.91 |
| Max. Negotiated Rate |
$737.26 |
| Rate for Payer: Aetna Medicare |
$374.44
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$512.87
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$512.87
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$430.61
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$411.88
|
| Rate for Payer: Cash Price |
$609.47
|
| Rate for Payer: Cash Price |
$609.47
|
| Rate for Payer: Coventry All Commercial |
$449.33
|
| Rate for Payer: Frontpath All Commercial |
$485.06
|
| Rate for Payer: Humana ChoiceCare |
$301.91
|
| Rate for Payer: Humana Medicare |
$374.44
|
| Rate for Payer: Lucent All Commercial |
$636.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$487.00
|
| Rate for Payer: PHCS All Commercial |
$737.26
|
| Rate for Payer: PHP All Commercial |
$511.44
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$374.44
|
| Rate for Payer: Signature Care EPO |
$432.65
|
| Rate for Payer: Signature Care PPO |
$432.65
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$449.00
|
| Rate for Payer: United Healthcare Commercial |
$412.15
|
| Rate for Payer: United Healthcare Medicare |
$374.44
|
|
|
PR TRANSJ CARE MGMT HIGH MDM F2F 7 CAL D DISCHARGE
|
Professional
|
$509.64
|
|
|
Service Code
|
CPT 99496
|
| Hospital Charge Code |
z99496
|
| Min. Negotiated Rate |
$181.54 |
| Max. Negotiated Rate |
$382.23 |
| Rate for Payer: Aetna Medicare |
$181.54
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$208.77
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$199.69
|
| Rate for Payer: Cash Price |
$315.98
|
| Rate for Payer: Cash Price |
$315.98
|
| Rate for Payer: Coventry All Commercial |
$217.85
|
| Rate for Payer: Frontpath All Commercial |
$199.41
|
| Rate for Payer: Humana ChoiceCare |
$200.38
|
| Rate for Payer: Humana Medicare |
$181.54
|
| Rate for Payer: Lucent All Commercial |
$308.62
|
| Rate for Payer: PHCS All Commercial |
$382.23
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$181.54
|
| Rate for Payer: United Healthcare Commercial |
$209.03
|
| Rate for Payer: United Healthcare Medicare |
$181.54
|
|
|
PR TRANSJ CARE MGMT MOD MDM F2F 14 CAL D DISCHARGE
|
Professional
|
$376.20
|
|
|
Service Code
|
CPT 99495
|
| Hospital Charge Code |
z99495
|
| Min. Negotiated Rate |
$133.22 |
| Max. Negotiated Rate |
$282.15 |
| 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 |
$233.24
|
| Rate for Payer: Cash Price |
$233.24
|
| Rate for Payer: Coventry All Commercial |
$159.86
|
| Rate for Payer: Frontpath All Commercial |
$147.30
|
| Rate for Payer: Humana ChoiceCare |
$136.63
|
| Rate for Payer: Humana Medicare |
$133.22
|
| Rate for Payer: Lucent All Commercial |
$226.47
|
| Rate for Payer: PHCS All Commercial |
$282.15
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$133.22
|
| Rate for Payer: United Healthcare Commercial |
$142.53
|
| Rate for Payer: United Healthcare Medicare |
$133.22
|
|
|
PR TREAT ECTOPIC PREG,NON REMVAL
|
Professional
|
$1,449.02
|
|
|
Service Code
|
CPT 59121
|
| Hospital Charge Code |
z59121
|
| Min. Negotiated Rate |
$705.13 |
| Max. Negotiated Rate |
$1,262.45 |
| Rate for Payer: Aetna Medicare |
$742.62
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,016.67
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,016.67
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$854.01
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$816.88
|
| Rate for Payer: Cash Price |
$898.39
|
| Rate for Payer: Cash Price |
$898.39
|
| Rate for Payer: Coventry All Commercial |
$891.14
|
| Rate for Payer: Frontpath All Commercial |
$1,063.28
|
| Rate for Payer: Humana ChoiceCare |
$705.13
|
| Rate for Payer: Humana Medicare |
$742.62
|
| Rate for Payer: Lucent All Commercial |
$1,262.45
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,040.00
|
| Rate for Payer: PHCS All Commercial |
$1,086.76
|
| Rate for Payer: PHP All Commercial |
$956.36
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$742.62
|
| Rate for Payer: Signature Care EPO |
$906.10
|
| Rate for Payer: Signature Care PPO |
$906.10
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$965.00
|
| Rate for Payer: United Healthcare Commercial |
$883.59
|
| Rate for Payer: United Healthcare Medicare |
$742.62
|
|
|
PR TREAT ECTOPIC PREG,RMV TUBE/OVARY
|
Professional
|
$1,448.62
|
|
|
Service Code
|
CPT 59120
|
| Hospital Charge Code |
z59120
|
| Min. Negotiated Rate |
$694.57 |
| Max. Negotiated Rate |
$1,262.10 |
| Rate for Payer: Aetna Medicare |
$742.41
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,001.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,001.00
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$853.77
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$816.65
|
| Rate for Payer: Cash Price |
$898.14
|
| Rate for Payer: Cash Price |
$898.14
|
| Rate for Payer: Coventry All Commercial |
$890.89
|
| Rate for Payer: Frontpath All Commercial |
$1,062.05
|
| Rate for Payer: Humana ChoiceCare |
$694.57
|
| Rate for Payer: Humana Medicare |
$742.41
|
| Rate for Payer: Lucent All Commercial |
$1,262.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,039.00
|
| Rate for Payer: PHCS All Commercial |
$1,086.46
|
| Rate for Payer: PHP All Commercial |
$956.08
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$742.41
|
| Rate for Payer: Signature Care EPO |
$893.35
|
| Rate for Payer: Signature Care PPO |
$893.35
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$965.00
|
| Rate for Payer: United Healthcare Commercial |
$879.60
|
| Rate for Payer: United Healthcare Medicare |
$742.41
|
|
|
PR TREAT INTER/SUBTROCH FX,W/PLATE/SCREW
|
Professional
|
$2,214.82
|
|
|
Service Code
|
CPT 27244
|
| Hospital Charge Code |
z27244
|
| Min. Negotiated Rate |
$1,135.10 |
| Max. Negotiated Rate |
$1,929.67 |
| Rate for Payer: Aetna Medicare |
$1,135.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,520.50
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,520.50
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,305.36
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,248.61
|
| Rate for Payer: Cash Price |
$1,373.19
|
| Rate for Payer: Cash Price |
$1,373.19
|
| Rate for Payer: Coventry All Commercial |
$1,362.12
|
| Rate for Payer: Frontpath All Commercial |
$1,595.80
|
| Rate for Payer: Humana ChoiceCare |
$1,195.90
|
| Rate for Payer: Humana Medicare |
$1,135.10
|
| Rate for Payer: Lucent All Commercial |
$1,929.67
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,816.00
|
| Rate for Payer: PHCS All Commercial |
$1,661.12
|
| Rate for Payer: PHP All Commercial |
$1,926.90
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,135.10
|
| Rate for Payer: Signature Care EPO |
$1,598.85
|
| Rate for Payer: Signature Care PPO |
$1,598.85
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,703.00
|
| Rate for Payer: United Healthcare Commercial |
$1,339.75
|
| Rate for Payer: United Healthcare Medicare |
$1,135.10
|
|
|
PR TREAT TIBIAL SHAFT FX, INTRAMED IMPLANT
|
Professional
|
$1,803.98
|
|
|
Service Code
|
CPT 27759
|
| Hospital Charge Code |
z27759
|
| Min. Negotiated Rate |
$924.54 |
| Max. Negotiated Rate |
$1,571.72 |
| Rate for Payer: Aetna Medicare |
$924.54
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,345.60
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,345.60
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,063.22
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,016.99
|
| Rate for Payer: Cash Price |
$1,118.47
|
| Rate for Payer: Cash Price |
$1,118.47
|
| Rate for Payer: Coventry All Commercial |
$1,109.45
|
| Rate for Payer: Frontpath All Commercial |
$1,296.87
|
| Rate for Payer: Humana ChoiceCare |
$1,054.15
|
| Rate for Payer: Humana Medicare |
$924.54
|
| Rate for Payer: Lucent All Commercial |
$1,571.72
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,479.00
|
| Rate for Payer: PHCS All Commercial |
$1,352.98
|
| Rate for Payer: PHP All Commercial |
$1,569.46
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$924.54
|
| Rate for Payer: Signature Care EPO |
$1,412.70
|
| Rate for Payer: Signature Care PPO |
$1,412.70
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,387.00
|
| Rate for Payer: United Healthcare Commercial |
$1,096.65
|
| Rate for Payer: United Healthcare Medicare |
$924.54
|
|
|
PR TRIAMCINOLONE ACETONIDE INJ
|
Professional
|
$2.32
|
|
|
Service Code
|
CPT J3301
|
| Hospital Charge Code |
zJ3301
|
| Min. Negotiated Rate |
$1.06 |
| Max. Negotiated Rate |
$2.32 |
| Rate for Payer: Humana ChoiceCare |
$1.06
|
| Rate for Payer: PHP All Commercial |
$2.32
|
|
|
PR TRIM NAIL(S)
|
Professional
|
$26.02
|
|
|
Service Code
|
CPT 11719
|
| Hospital Charge Code |
z11719
|
| Min. Negotiated Rate |
$7.16 |
| Max. Negotiated Rate |
$19.52 |
| Rate for Payer: Aetna Medicare |
$7.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$8.23
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$7.88
|
| Rate for Payer: Cash Price |
$16.13
|
| Rate for Payer: Cash Price |
$16.13
|
| Rate for Payer: Coventry All Commercial |
$8.59
|
| Rate for Payer: Frontpath All Commercial |
$9.79
|
| Rate for Payer: Humana ChoiceCare |
$9.18
|
| Rate for Payer: Humana Medicare |
$7.16
|
| Rate for Payer: Lucent All Commercial |
$12.17
|
| Rate for Payer: PHCS All Commercial |
$19.52
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$7.16
|
| Rate for Payer: United Healthcare Commercial |
$10.28
|
| Rate for Payer: United Healthcare Medicare |
$7.16
|
|
