|
PR CLOSED RX CARPAL FX
|
Professional
|
$569.74
|
|
|
Service Code
|
CPT 25630
|
| Hospital Charge Code |
z25630
|
| Min. Negotiated Rate |
$250.99 |
| Max. Negotiated Rate |
$461.23 |
| Rate for Payer: Aetna Medicare |
$271.31
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$401.51
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$401.51
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$312.01
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$298.44
|
| Rate for Payer: Cash Price |
$353.24
|
| Rate for Payer: Cash Price |
$353.24
|
| Rate for Payer: Coventry All Commercial |
$325.57
|
| Rate for Payer: Frontpath All Commercial |
$367.68
|
| Rate for Payer: Humana ChoiceCare |
$250.99
|
| Rate for Payer: Humana Medicare |
$271.31
|
| Rate for Payer: Lucent All Commercial |
$461.23
|
| Rate for Payer: Lutheran Preferred All Commercial |
$434.00
|
| Rate for Payer: PHCS All Commercial |
$427.30
|
| Rate for Payer: PHP All Commercial |
$461.09
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$271.31
|
| Rate for Payer: Signature Care EPO |
$424.15
|
| Rate for Payer: Signature Care PPO |
$424.15
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$407.00
|
| Rate for Payer: United Healthcare Commercial |
$275.89
|
| Rate for Payer: United Healthcare Medicare |
$271.31
|
|
|
PR CLOSED RX, CARPOMETACAR DISLOC,NON-THUMB
|
Professional
|
$647.26
|
|
|
Service Code
|
CPT 26670
|
| Hospital Charge Code |
z26670
|
| Min. Negotiated Rate |
$284.77 |
| Max. Negotiated Rate |
$503.57 |
| Rate for Payer: Aetna Medicare |
$296.22
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$394.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$394.00
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$340.65
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$325.84
|
| Rate for Payer: Cash Price |
$401.30
|
| Rate for Payer: Cash Price |
$401.30
|
| Rate for Payer: Coventry All Commercial |
$355.46
|
| Rate for Payer: Frontpath All Commercial |
$407.77
|
| Rate for Payer: Humana ChoiceCare |
$284.77
|
| Rate for Payer: Humana Medicare |
$296.22
|
| Rate for Payer: Lucent All Commercial |
$503.57
|
| Rate for Payer: Lutheran Preferred All Commercial |
$474.00
|
| Rate for Payer: PHCS All Commercial |
$485.44
|
| Rate for Payer: PHP All Commercial |
$502.85
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$296.22
|
| Rate for Payer: Signature Care EPO |
$487.05
|
| Rate for Payer: Signature Care PPO |
$487.05
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$444.00
|
| Rate for Payer: United Healthcare Commercial |
$302.06
|
| Rate for Payer: United Healthcare Medicare |
$296.22
|
|
|
PR CLOSED RX CLAVICLE FRACTURE
|
Professional
|
$415.96
|
|
|
Service Code
|
CPT 23500
|
| Hospital Charge Code |
z23500
|
| Min. Negotiated Rate |
$196.59 |
| Max. Negotiated Rate |
$370.28 |
| Rate for Payer: Aetna Medicare |
$217.81
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$307.48
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$307.48
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$250.48
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$239.59
|
| Rate for Payer: Cash Price |
$257.90
|
| Rate for Payer: Cash Price |
$257.90
|
| Rate for Payer: Coventry All Commercial |
$261.37
|
| Rate for Payer: Frontpath All Commercial |
$292.60
|
| Rate for Payer: Humana ChoiceCare |
$196.59
|
| Rate for Payer: Humana Medicare |
$217.81
|
| Rate for Payer: Lucent All Commercial |
$370.28
|
| Rate for Payer: Lutheran Preferred All Commercial |
$348.00
|
| Rate for Payer: PHCS All Commercial |
$311.97
|
| Rate for Payer: PHP All Commercial |
$369.74
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$217.81
|
| Rate for Payer: Signature Care EPO |
$324.70
|
| Rate for Payer: Signature Care PPO |
$324.70
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$327.00
|
| Rate for Payer: United Healthcare Commercial |
$214.21
|
| Rate for Payer: United Healthcare Medicare |
$217.81
|
|
|
PR CLOSED RX CLAVICLE FX,MANIPULATN
|
Professional
|
$665.32
|
|
|
Service Code
|
CPT 23505
|
| Hospital Charge Code |
z23505
|
| Min. Negotiated Rate |
$316.28 |
| Max. Negotiated Rate |
$537.68 |
| Rate for Payer: Aetna Medicare |
$316.28
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$369.60
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$369.60
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$363.72
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$347.91
|
| Rate for Payer: Cash Price |
$412.50
|
| Rate for Payer: Cash Price |
$412.50
|
| Rate for Payer: Coventry All Commercial |
$379.54
|
| Rate for Payer: Frontpath All Commercial |
$434.46
|
| Rate for Payer: Humana ChoiceCare |
$324.55
|
| Rate for Payer: Humana Medicare |
$316.28
|
| Rate for Payer: Lucent All Commercial |
$537.68
|
| Rate for Payer: Lutheran Preferred All Commercial |
$506.00
|
| Rate for Payer: PHCS All Commercial |
$498.99
|
| Rate for Payer: PHP All Commercial |
$537.43
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$316.28
|
| Rate for Payer: Signature Care EPO |
$515.10
|
| Rate for Payer: Signature Care PPO |
$515.10
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$474.00
|
| Rate for Payer: United Healthcare Commercial |
$338.21
|
| Rate for Payer: United Healthcare Medicare |
$316.28
|
|
|
PR CLOSED RX CONDYLAR FX
|
Professional
|
$926.30
|
|
|
Service Code
|
CPT 27501
|
| Hospital Charge Code |
z27501
|
| Min. Negotiated Rate |
$466.70 |
| Max. Negotiated Rate |
$793.39 |
| Rate for Payer: Aetna Medicare |
$466.70
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$778.10
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$778.10
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$536.70
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$513.37
|
| Rate for Payer: Cash Price |
$574.31
|
| Rate for Payer: Cash Price |
$574.31
|
| Rate for Payer: Coventry All Commercial |
$560.04
|
| Rate for Payer: Frontpath All Commercial |
$647.18
|
| Rate for Payer: Humana ChoiceCare |
$491.21
|
| Rate for Payer: Humana Medicare |
$466.70
|
| Rate for Payer: Lucent All Commercial |
$793.39
|
| Rate for Payer: Lutheran Preferred All Commercial |
$747.00
|
| Rate for Payer: PHCS All Commercial |
$694.72
|
| Rate for Payer: PHP All Commercial |
$792.25
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$466.70
|
| Rate for Payer: Signature Care EPO |
$775.20
|
| Rate for Payer: Signature Care PPO |
$775.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$700.00
|
| Rate for Payer: United Healthcare Commercial |
$525.95
|
| Rate for Payer: United Healthcare Medicare |
$466.70
|
|
|
PR CLOSED RX DIST FEM EPIPHYSIS
|
Professional
|
$953.26
|
|
|
Service Code
|
CPT 27516
|
| Hospital Charge Code |
z27516
|
| Min. Negotiated Rate |
$456.75 |
| Max. Negotiated Rate |
$776.48 |
| Rate for Payer: Aetna Medicare |
$456.75
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$617.70
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$617.70
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$525.26
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$502.42
|
| Rate for Payer: Cash Price |
$591.02
|
| Rate for Payer: Cash Price |
$591.02
|
| Rate for Payer: Coventry All Commercial |
$548.10
|
| Rate for Payer: Frontpath All Commercial |
$627.72
|
| Rate for Payer: Humana ChoiceCare |
$468.16
|
| Rate for Payer: Humana Medicare |
$456.75
|
| Rate for Payer: Lucent All Commercial |
$776.48
|
| Rate for Payer: Lutheran Preferred All Commercial |
$731.00
|
| Rate for Payer: PHCS All Commercial |
$714.94
|
| Rate for Payer: PHP All Commercial |
$775.36
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$456.75
|
| Rate for Payer: Signature Care EPO |
$724.20
|
| Rate for Payer: Signature Care PPO |
$724.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$685.00
|
| Rate for Payer: United Healthcare Commercial |
$481.96
|
| Rate for Payer: United Healthcare Medicare |
$456.75
|
|
|
PR CLOSED RX DIST FIBULA FX
|
Professional
|
$583.48
|
|
|
Service Code
|
CPT 27786
|
| Hospital Charge Code |
z27786
|
| Min. Negotiated Rate |
$264.86 |
| Max. Negotiated Rate |
$465.32 |
| Rate for Payer: Aetna Medicare |
$273.72
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$425.90
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$425.90
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$314.78
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$301.09
|
| Rate for Payer: Cash Price |
$361.76
|
| Rate for Payer: Cash Price |
$361.76
|
| Rate for Payer: Coventry All Commercial |
$328.46
|
| Rate for Payer: Frontpath All Commercial |
$372.90
|
| Rate for Payer: Humana ChoiceCare |
$264.86
|
| Rate for Payer: Humana Medicare |
$273.72
|
| Rate for Payer: Lucent All Commercial |
$465.32
|
| Rate for Payer: Lutheran Preferred All Commercial |
$438.00
|
| Rate for Payer: PHCS All Commercial |
$437.61
|
| Rate for Payer: PHP All Commercial |
$464.66
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$273.72
|
| Rate for Payer: Signature Care EPO |
$449.65
|
| Rate for Payer: Signature Care PPO |
$449.65
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$411.00
|
| Rate for Payer: United Healthcare Commercial |
$284.74
|
| Rate for Payer: United Healthcare Medicare |
$273.72
|
|
|
PR CLOSED RX DIST RAD/ULNA FX
|
Professional
|
$630.26
|
|
|
Service Code
|
CPT 25600
|
| Hospital Charge Code |
z25600
|
| Min. Negotiated Rate |
$240.69 |
| Max. Negotiated Rate |
$524.98 |
| Rate for Payer: Aetna Medicare |
$308.81
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$381.69
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$381.69
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$355.13
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$339.69
|
| Rate for Payer: Cash Price |
$390.76
|
| Rate for Payer: Cash Price |
$390.76
|
| Rate for Payer: Coventry All Commercial |
$370.57
|
| Rate for Payer: Frontpath All Commercial |
$415.83
|
| Rate for Payer: Humana ChoiceCare |
$240.69
|
| Rate for Payer: Humana Medicare |
$308.81
|
| Rate for Payer: Lucent All Commercial |
$524.98
|
| Rate for Payer: Lutheran Preferred All Commercial |
$494.00
|
| Rate for Payer: PHCS All Commercial |
$472.70
|
| Rate for Payer: PHP All Commercial |
$524.22
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$308.81
|
| Rate for Payer: Signature Care EPO |
$402.90
|
| Rate for Payer: Signature Care PPO |
$402.90
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$463.00
|
| Rate for Payer: United Healthcare Commercial |
$262.15
|
| Rate for Payer: United Healthcare Medicare |
$308.81
|
|
|
PR CLOSED RX DIST RAD/ULNA FX,MANIPUL
|
Professional
|
$997.66
|
|
|
Service Code
|
CPT 25605
|
| Hospital Charge Code |
z25605
|
| Min. Negotiated Rate |
$482.90 |
| Max. Negotiated Rate |
$820.93 |
| Rate for Payer: Aetna Medicare |
$482.90
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$623.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$623.30
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$555.34
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$531.19
|
| Rate for Payer: Cash Price |
$618.55
|
| Rate for Payer: Cash Price |
$618.55
|
| Rate for Payer: Coventry All Commercial |
$579.48
|
| Rate for Payer: Frontpath All Commercial |
$664.88
|
| Rate for Payer: Humana ChoiceCare |
$519.07
|
| Rate for Payer: Humana Medicare |
$482.90
|
| Rate for Payer: Lucent All Commercial |
$820.93
|
| Rate for Payer: Lutheran Preferred All Commercial |
$773.00
|
| Rate for Payer: PHCS All Commercial |
$748.24
|
| Rate for Payer: PHP All Commercial |
$819.75
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$482.90
|
| Rate for Payer: Signature Care EPO |
$793.05
|
| Rate for Payer: Signature Care PPO |
$793.05
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$724.00
|
| Rate for Payer: United Healthcare Commercial |
$600.91
|
| Rate for Payer: United Healthcare Medicare |
$482.90
|
|
|
PR CLOSED RX ELBOW DISLOCATION
|
Professional
|
$700.00
|
|
|
Service Code
|
CPT 24600
|
| Hospital Charge Code |
z24600
|
| Min. Negotiated Rate |
$324.49 |
| Max. Negotiated Rate |
$559.30 |
| Rate for Payer: Aetna Medicare |
$324.49
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$461.50
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$461.50
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$373.16
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$356.94
|
| Rate for Payer: Cash Price |
$434.00
|
| Rate for Payer: Cash Price |
$434.00
|
| Rate for Payer: Coventry All Commercial |
$389.39
|
| Rate for Payer: Frontpath All Commercial |
$443.39
|
| Rate for Payer: Humana ChoiceCare |
$332.59
|
| Rate for Payer: Humana Medicare |
$324.49
|
| Rate for Payer: Lucent All Commercial |
$551.63
|
| Rate for Payer: Lutheran Preferred All Commercial |
$519.00
|
| Rate for Payer: PHCS All Commercial |
$525.00
|
| Rate for Payer: PHP All Commercial |
$550.84
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$324.49
|
| Rate for Payer: Signature Care EPO |
$559.30
|
| Rate for Payer: Signature Care PPO |
$559.30
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$487.00
|
| Rate for Payer: United Healthcare Commercial |
$340.96
|
| Rate for Payer: United Healthcare Medicare |
$324.49
|
|
|
PR CLOSED RX ELBOW DISLOCATN,ANESTHESIA
|
Professional
|
$877.94
|
|
|
Service Code
|
CPT 24605
|
| Hospital Charge Code |
z24605
|
| Min. Negotiated Rate |
$441.30 |
| Max. Negotiated Rate |
$764.92 |
| Rate for Payer: Aetna Medicare |
$449.95
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$441.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$441.30
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$517.44
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$494.94
|
| Rate for Payer: Cash Price |
$544.32
|
| Rate for Payer: Cash Price |
$544.32
|
| Rate for Payer: Coventry All Commercial |
$539.94
|
| Rate for Payer: Frontpath All Commercial |
$619.79
|
| Rate for Payer: Humana ChoiceCare |
$465.93
|
| Rate for Payer: Humana Medicare |
$449.95
|
| Rate for Payer: Lucent All Commercial |
$764.92
|
| Rate for Payer: Lutheran Preferred All Commercial |
$720.00
|
| Rate for Payer: PHCS All Commercial |
$658.46
|
| Rate for Payer: PHP All Commercial |
$763.81
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$449.95
|
| Rate for Payer: Signature Care EPO |
$618.80
|
| Rate for Payer: Signature Care PPO |
$618.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$675.00
|
| Rate for Payer: United Healthcare Commercial |
$482.65
|
| Rate for Payer: United Healthcare Medicare |
$449.95
|
|
|
PR CLOSED RX FEMUR,DISTAL
|
Professional
|
$964.78
|
|
|
Service Code
|
CPT 27508
|
| Hospital Charge Code |
z27508
|
| Min. Negotiated Rate |
$468.52 |
| Max. Negotiated Rate |
$796.48 |
| Rate for Payer: Aetna Medicare |
$468.52
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$612.50
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$612.50
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$538.80
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$515.37
|
| Rate for Payer: Cash Price |
$598.16
|
| Rate for Payer: Cash Price |
$598.16
|
| Rate for Payer: Coventry All Commercial |
$562.22
|
| Rate for Payer: Frontpath All Commercial |
$647.69
|
| Rate for Payer: Humana ChoiceCare |
$490.10
|
| Rate for Payer: Humana Medicare |
$468.52
|
| Rate for Payer: Lucent All Commercial |
$796.48
|
| Rate for Payer: Lutheran Preferred All Commercial |
$750.00
|
| Rate for Payer: PHCS All Commercial |
$723.58
|
| Rate for Payer: PHP All Commercial |
$795.34
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$468.52
|
| Rate for Payer: Signature Care EPO |
$736.95
|
| Rate for Payer: Signature Care PPO |
$736.95
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$703.00
|
| Rate for Payer: United Healthcare Commercial |
$516.34
|
| Rate for Payer: United Healthcare Medicare |
$468.52
|
|
|
PR CLOSED RX FEMUR SHAFT FX
|
Professional
|
$960.32
|
|
|
Service Code
|
CPT 27500
|
| Hospital Charge Code |
z27500
|
| Min. Negotiated Rate |
$451.72 |
| Max. Negotiated Rate |
$767.92 |
| Rate for Payer: Aetna Medicare |
$451.72
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$760.20
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$760.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$519.48
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$496.89
|
| Rate for Payer: Cash Price |
$595.40
|
| Rate for Payer: Cash Price |
$595.40
|
| Rate for Payer: Coventry All Commercial |
$542.06
|
| Rate for Payer: Frontpath All Commercial |
$624.42
|
| Rate for Payer: Humana ChoiceCare |
$475.20
|
| Rate for Payer: Humana Medicare |
$451.72
|
| Rate for Payer: Lucent All Commercial |
$767.92
|
| Rate for Payer: Lutheran Preferred All Commercial |
$723.00
|
| Rate for Payer: PHCS All Commercial |
$720.24
|
| Rate for Payer: PHP All Commercial |
$766.83
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$451.72
|
| Rate for Payer: Signature Care EPO |
$744.60
|
| Rate for Payer: Signature Care PPO |
$744.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$678.00
|
| Rate for Payer: United Healthcare Commercial |
$505.75
|
| Rate for Payer: United Healthcare Medicare |
$451.72
|
|
|
PR CLOSED RX GR TROCHANTERIC FX
|
Professional
|
$717.56
|
|
|
Service Code
|
CPT 27246
|
| Hospital Charge Code |
z27246
|
| Min. Negotiated Rate |
$363.74 |
| Max. Negotiated Rate |
$618.36 |
| Rate for Payer: Aetna Medicare |
$363.74
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$489.20
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$489.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$418.30
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$400.11
|
| Rate for Payer: Cash Price |
$444.89
|
| Rate for Payer: Cash Price |
$444.89
|
| Rate for Payer: Coventry All Commercial |
$436.49
|
| Rate for Payer: Frontpath All Commercial |
$501.70
|
| Rate for Payer: Humana ChoiceCare |
$395.84
|
| Rate for Payer: Humana Medicare |
$363.74
|
| Rate for Payer: Lucent All Commercial |
$618.36
|
| Rate for Payer: Lutheran Preferred All Commercial |
$582.00
|
| Rate for Payer: PHCS All Commercial |
$538.17
|
| Rate for Payer: PHP All Commercial |
$617.47
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$363.74
|
| Rate for Payer: Signature Care EPO |
$597.55
|
| Rate for Payer: Signature Care PPO |
$597.55
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$546.00
|
| Rate for Payer: United Healthcare Commercial |
$406.95
|
| Rate for Payer: United Healthcare Medicare |
$363.74
|
|
|
PR CLOSED RX GR TUBEROSITY HUM FX
|
Professional
|
$504.78
|
|
|
Service Code
|
CPT 23620
|
| Hospital Charge Code |
z23620
|
| Min. Negotiated Rate |
$230.66 |
| Max. Negotiated Rate |
$428.40 |
| Rate for Payer: Aetna Medicare |
$247.89
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$406.08
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$406.08
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$285.07
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$272.68
|
| Rate for Payer: Cash Price |
$312.96
|
| Rate for Payer: Cash Price |
$312.96
|
| Rate for Payer: Coventry All Commercial |
$297.47
|
| Rate for Payer: Frontpath All Commercial |
$336.15
|
| Rate for Payer: Humana ChoiceCare |
$230.66
|
| Rate for Payer: Humana Medicare |
$247.89
|
| Rate for Payer: Lucent All Commercial |
$421.41
|
| Rate for Payer: Lutheran Preferred All Commercial |
$397.00
|
| Rate for Payer: PHCS All Commercial |
$378.58
|
| Rate for Payer: PHP All Commercial |
$420.81
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$247.89
|
| Rate for Payer: Signature Care EPO |
$428.40
|
| Rate for Payer: Signature Care PPO |
$428.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$372.00
|
| Rate for Payer: United Healthcare Commercial |
$250.41
|
| Rate for Payer: United Healthcare Medicare |
$247.89
|
|
|
PR CLOSED RX HEEL FX
|
Professional
|
$458.00
|
|
|
Service Code
|
CPT 28400
|
| Hospital Charge Code |
z28400
|
| Min. Negotiated Rate |
$218.06 |
| Max. Negotiated Rate |
$370.70 |
| Rate for Payer: Aetna Medicare |
$218.06
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$255.42
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$255.42
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$250.77
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$239.87
|
| Rate for Payer: Cash Price |
$283.96
|
| Rate for Payer: Cash Price |
$283.96
|
| Rate for Payer: Coventry All Commercial |
$261.67
|
| Rate for Payer: Frontpath All Commercial |
$293.41
|
| Rate for Payer: Humana ChoiceCare |
$222.00
|
| Rate for Payer: Humana Medicare |
$218.06
|
| Rate for Payer: Lucent All Commercial |
$370.70
|
| Rate for Payer: Lutheran Preferred All Commercial |
$349.00
|
| Rate for Payer: PHCS All Commercial |
$343.50
|
| Rate for Payer: PHP All Commercial |
$370.16
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$218.06
|
| Rate for Payer: Signature Care EPO |
$363.80
|
| Rate for Payer: Signature Care PPO |
$363.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$327.00
|
| Rate for Payer: United Healthcare Commercial |
$230.39
|
| Rate for Payer: United Healthcare Medicare |
$218.06
|
|
|
PR CLOSED RX HUMERAL SUPRACONDYLAR FX
|
Professional
|
$711.74
|
|
|
Service Code
|
CPT 24530
|
| Hospital Charge Code |
z24530
|
| Min. Negotiated Rate |
$323.41 |
| Max. Negotiated Rate |
$568.16 |
| Rate for Payer: Aetna Medicare |
$334.21
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$480.28
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$480.28
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$384.34
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$367.63
|
| Rate for Payer: Cash Price |
$441.28
|
| Rate for Payer: Cash Price |
$441.28
|
| Rate for Payer: Coventry All Commercial |
$401.05
|
| Rate for Payer: Frontpath All Commercial |
$454.13
|
| Rate for Payer: Humana ChoiceCare |
$323.41
|
| Rate for Payer: Humana Medicare |
$334.21
|
| Rate for Payer: Lucent All Commercial |
$568.16
|
| Rate for Payer: Lutheran Preferred All Commercial |
$535.00
|
| Rate for Payer: PHCS All Commercial |
$533.80
|
| Rate for Payer: PHP All Commercial |
$567.34
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$334.21
|
| Rate for Payer: Signature Care EPO |
$506.60
|
| Rate for Payer: Signature Care PPO |
$506.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$501.00
|
| Rate for Payer: United Healthcare Commercial |
$343.13
|
| Rate for Payer: United Healthcare Medicare |
$334.21
|
|
|
PR CLOSED RX HUMER EPICONDYLR FX
|
Professional
|
$620.04
|
|
|
Service Code
|
CPT 24560
|
| Hospital Charge Code |
z24560
|
| Min. Negotiated Rate |
$257.20 |
| Max. Negotiated Rate |
$478.30 |
| Rate for Payer: Aetna Medicare |
$281.35
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$421.33
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$421.33
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$323.55
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$309.48
|
| Rate for Payer: Cash Price |
$384.42
|
| Rate for Payer: Cash Price |
$384.42
|
| Rate for Payer: Coventry All Commercial |
$337.62
|
| Rate for Payer: Frontpath All Commercial |
$381.29
|
| Rate for Payer: Humana ChoiceCare |
$257.20
|
| Rate for Payer: Humana Medicare |
$281.35
|
| Rate for Payer: Lucent All Commercial |
$478.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$450.00
|
| Rate for Payer: PHCS All Commercial |
$465.03
|
| Rate for Payer: PHP All Commercial |
$477.60
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$281.35
|
| Rate for Payer: Signature Care EPO |
$445.40
|
| Rate for Payer: Signature Care PPO |
$445.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$422.00
|
| Rate for Payer: United Healthcare Commercial |
$280.33
|
| Rate for Payer: United Healthcare Medicare |
$281.35
|
|
|
PR CLOSED RX HUM SUPRACONDYLR FX,MANIPU
|
Professional
|
$1,142.04
|
|
|
Service Code
|
CPT 24535
|
| Hospital Charge Code |
z24535
|
| Min. Negotiated Rate |
$537.14 |
| Max. Negotiated Rate |
$913.14 |
| Rate for Payer: Aetna Medicare |
$537.14
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$715.70
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$715.70
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$617.71
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$590.85
|
| Rate for Payer: Cash Price |
$708.06
|
| Rate for Payer: Cash Price |
$708.06
|
| Rate for Payer: Coventry All Commercial |
$644.57
|
| Rate for Payer: Frontpath All Commercial |
$738.96
|
| Rate for Payer: Humana ChoiceCare |
$584.59
|
| Rate for Payer: Humana Medicare |
$537.14
|
| Rate for Payer: Lucent All Commercial |
$913.14
|
| Rate for Payer: Lutheran Preferred All Commercial |
$859.00
|
| Rate for Payer: PHCS All Commercial |
$856.53
|
| Rate for Payer: PHP All Commercial |
$911.83
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$537.14
|
| Rate for Payer: Signature Care EPO |
$878.90
|
| Rate for Payer: Signature Care PPO |
$878.90
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$806.00
|
| Rate for Payer: United Healthcare Commercial |
$598.93
|
| Rate for Payer: United Healthcare Medicare |
$537.14
|
|
|
PR CLOSED RX INTER/SUBTROCH FEMUR FX
|
Professional
|
$856.34
|
|
|
Service Code
|
CPT 27238
|
| Hospital Charge Code |
z27238
|
| Min. Negotiated Rate |
$438.87 |
| Max. Negotiated Rate |
$746.08 |
| Rate for Payer: Aetna Medicare |
$438.87
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$537.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$537.00
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$504.70
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$482.76
|
| Rate for Payer: Cash Price |
$530.93
|
| Rate for Payer: Cash Price |
$530.93
|
| Rate for Payer: Coventry All Commercial |
$526.64
|
| Rate for Payer: Frontpath All Commercial |
$606.24
|
| Rate for Payer: Humana ChoiceCare |
$461.20
|
| Rate for Payer: Humana Medicare |
$438.87
|
| Rate for Payer: Lucent All Commercial |
$746.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$702.00
|
| Rate for Payer: PHCS All Commercial |
$642.26
|
| Rate for Payer: PHP All Commercial |
$745.01
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$438.87
|
| Rate for Payer: Signature Care EPO |
$617.10
|
| Rate for Payer: Signature Care PPO |
$617.10
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$658.00
|
| Rate for Payer: United Healthcare Commercial |
$479.85
|
| Rate for Payer: United Healthcare Medicare |
$438.87
|
|
|
PR CLOSED RX INTER/SUBTROCH FX,MANIP
|
Professional
|
$1,732.02
|
|
|
Service Code
|
CPT 27240
|
| Hospital Charge Code |
z27240
|
| Min. Negotiated Rate |
$887.65 |
| Max. Negotiated Rate |
$1,509.00 |
| Rate for Payer: Aetna Medicare |
$887.65
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,111.50
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,111.50
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,020.80
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$976.42
|
| Rate for Payer: Cash Price |
$1,073.85
|
| Rate for Payer: Cash Price |
$1,073.85
|
| Rate for Payer: Coventry All Commercial |
$1,065.18
|
| Rate for Payer: Frontpath All Commercial |
$1,247.71
|
| Rate for Payer: Humana ChoiceCare |
$961.72
|
| Rate for Payer: Humana Medicare |
$887.65
|
| Rate for Payer: Lucent All Commercial |
$1,509.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,420.00
|
| Rate for Payer: PHCS All Commercial |
$1,299.02
|
| Rate for Payer: PHP All Commercial |
$1,506.85
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$887.65
|
| Rate for Payer: Signature Care EPO |
$1,280.95
|
| Rate for Payer: Signature Care PPO |
$1,280.95
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,331.00
|
| Rate for Payer: United Healthcare Commercial |
$1,039.88
|
| Rate for Payer: United Healthcare Medicare |
$887.65
|
|
|
PR CLOSED RX IP JT DISLOCATION
|
Professional
|
$535.54
|
|
|
Service Code
|
CPT 26770
|
| Hospital Charge Code |
z26770
|
| Min. Negotiated Rate |
$232.70 |
| Max. Negotiated Rate |
$424.61 |
| Rate for Payer: Aetna Medicare |
$249.77
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$269.20
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$269.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$287.24
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$274.75
|
| Rate for Payer: Cash Price |
$332.03
|
| Rate for Payer: Cash Price |
$332.03
|
| Rate for Payer: Coventry All Commercial |
$299.72
|
| Rate for Payer: Frontpath All Commercial |
$338.49
|
| Rate for Payer: Humana ChoiceCare |
$232.70
|
| Rate for Payer: Humana Medicare |
$249.77
|
| Rate for Payer: Lucent All Commercial |
$424.61
|
| Rate for Payer: Lutheran Preferred All Commercial |
$400.00
|
| Rate for Payer: PHCS All Commercial |
$401.66
|
| Rate for Payer: PHP All Commercial |
$423.99
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$249.77
|
| Rate for Payer: Signature Care EPO |
$419.90
|
| Rate for Payer: Signature Care PPO |
$419.90
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$375.00
|
| Rate for Payer: United Healthcare Commercial |
$247.93
|
| Rate for Payer: United Healthcare Medicare |
$249.77
|
|
|
PR CLOSED RX KNEECAP DISLOCATN
|
Professional
|
$693.42
|
|
|
Service Code
|
CPT 27560
|
| Hospital Charge Code |
z27560
|
| Min. Negotiated Rate |
$300.13 |
| Max. Negotiated Rate |
$552.19 |
| Rate for Payer: Aetna Medicare |
$324.82
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$409.40
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$409.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$373.54
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$357.30
|
| Rate for Payer: Cash Price |
$429.92
|
| Rate for Payer: Cash Price |
$429.92
|
| Rate for Payer: Coventry All Commercial |
$389.78
|
| Rate for Payer: Frontpath All Commercial |
$437.72
|
| Rate for Payer: Humana ChoiceCare |
$300.13
|
| Rate for Payer: Humana Medicare |
$324.82
|
| Rate for Payer: Lucent All Commercial |
$552.19
|
| Rate for Payer: Lutheran Preferred All Commercial |
$520.00
|
| Rate for Payer: PHCS All Commercial |
$520.06
|
| Rate for Payer: PHP All Commercial |
$551.40
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$324.82
|
| Rate for Payer: Signature Care EPO |
$532.95
|
| Rate for Payer: Signature Care PPO |
$532.95
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$487.00
|
| Rate for Payer: United Healthcare Commercial |
$340.10
|
| Rate for Payer: United Healthcare Medicare |
$324.82
|
|
|
PR CLOSED RX KNEE DISLOCATN
|
Professional
|
$947.80
|
|
|
Service Code
|
CPT 27550
|
| Hospital Charge Code |
z27550
|
| Min. Negotiated Rate |
$445.62 |
| Max. Negotiated Rate |
$757.55 |
| Rate for Payer: Aetna Medicare |
$445.62
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$568.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$568.00
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$512.46
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$490.18
|
| Rate for Payer: Cash Price |
$587.64
|
| Rate for Payer: Cash Price |
$587.64
|
| Rate for Payer: Coventry All Commercial |
$534.74
|
| Rate for Payer: Frontpath All Commercial |
$616.76
|
| Rate for Payer: Humana ChoiceCare |
$460.89
|
| Rate for Payer: Humana Medicare |
$445.62
|
| Rate for Payer: Lucent All Commercial |
$757.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$713.00
|
| Rate for Payer: PHCS All Commercial |
$710.85
|
| Rate for Payer: PHP All Commercial |
$756.46
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$445.62
|
| Rate for Payer: Signature Care EPO |
$707.20
|
| Rate for Payer: Signature Care PPO |
$707.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$668.00
|
| Rate for Payer: United Healthcare Commercial |
$478.74
|
| Rate for Payer: United Healthcare Medicare |
$445.62
|
|
|
PR CLOSED RX MED MALLEOLUS FX
|
Professional
|
$617.44
|
|
|
Service Code
|
CPT 27760
|
| Hospital Charge Code |
z27760
|
| Min. Negotiated Rate |
$282.94 |
| Max. Negotiated Rate |
$496.48 |
| Rate for Payer: Aetna Medicare |
$292.05
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$443.69
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$443.69
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$335.86
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$321.26
|
| Rate for Payer: Cash Price |
$382.81
|
| Rate for Payer: Cash Price |
$382.81
|
| Rate for Payer: Coventry All Commercial |
$350.46
|
| Rate for Payer: Frontpath All Commercial |
$396.73
|
| Rate for Payer: Humana ChoiceCare |
$282.94
|
| Rate for Payer: Humana Medicare |
$292.05
|
| Rate for Payer: Lucent All Commercial |
$496.48
|
| Rate for Payer: Lutheran Preferred All Commercial |
$467.00
|
| Rate for Payer: PHCS All Commercial |
$463.08
|
| Rate for Payer: PHP All Commercial |
$495.78
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$292.05
|
| Rate for Payer: Signature Care EPO |
$468.35
|
| Rate for Payer: Signature Care PPO |
$468.35
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$438.00
|
| Rate for Payer: United Healthcare Commercial |
$302.91
|
| Rate for Payer: United Healthcare Medicare |
$292.05
|
|
