|
PR CLOSED RX METACARPAL FX
|
Professional
|
$560.78
|
|
|
Service Code
|
CPT 26600
|
| Hospital Charge Code |
z26600
|
| Min. Negotiated Rate |
$196.50 |
| Max. Negotiated Rate |
$464.95 |
| Rate for Payer: Aetna Medicare |
$273.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$322.22
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$322.22
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$314.52
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$300.85
|
| Rate for Payer: Cash Price |
$347.68
|
| Rate for Payer: Cash Price |
$347.68
|
| Rate for Payer: Coventry All Commercial |
$328.20
|
| Rate for Payer: Frontpath All Commercial |
$368.30
|
| Rate for Payer: Humana ChoiceCare |
$196.50
|
| Rate for Payer: Humana Medicare |
$273.50
|
| Rate for Payer: Lucent All Commercial |
$464.95
|
| Rate for Payer: Lutheran Preferred All Commercial |
$438.00
|
| Rate for Payer: PHCS All Commercial |
$420.58
|
| Rate for Payer: PHP All Commercial |
$464.29
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$273.50
|
| Rate for Payer: Signature Care EPO |
$340.00
|
| Rate for Payer: Signature Care PPO |
$340.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$410.00
|
| Rate for Payer: United Healthcare Commercial |
$255.65
|
| Rate for Payer: United Healthcare Medicare |
$273.50
|
|
|
PR CLOSED RX METACARPAL FX,MANIP
|
Professional
|
$614.32
|
|
|
Service Code
|
CPT 26605
|
| Hospital Charge Code |
z26605
|
| Min. Negotiated Rate |
$278.52 |
| Max. Negotiated Rate |
$482.22 |
| Rate for Payer: Aetna Medicare |
$283.66
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$435.05
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$435.05
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$326.21
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$312.03
|
| Rate for Payer: Cash Price |
$380.88
|
| Rate for Payer: Cash Price |
$380.88
|
| Rate for Payer: Coventry All Commercial |
$340.39
|
| Rate for Payer: Frontpath All Commercial |
$385.59
|
| Rate for Payer: Humana ChoiceCare |
$278.52
|
| Rate for Payer: Humana Medicare |
$283.66
|
| Rate for Payer: Lucent All Commercial |
$482.22
|
| Rate for Payer: Lutheran Preferred All Commercial |
$454.00
|
| Rate for Payer: PHCS All Commercial |
$460.74
|
| Rate for Payer: PHP All Commercial |
$481.53
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$283.66
|
| Rate for Payer: Signature Care EPO |
$459.00
|
| Rate for Payer: Signature Care PPO |
$459.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$425.00
|
| Rate for Payer: United Healthcare Commercial |
$291.80
|
| Rate for Payer: United Healthcare Medicare |
$283.66
|
|
|
PR CLOSED RX METACARPAL FX,PERCUT
|
Professional
|
$885.14
|
|
|
Service Code
|
CPT 26608
|
| Hospital Charge Code |
z26608
|
| Min. Negotiated Rate |
$453.96 |
| Max. Negotiated Rate |
$771.73 |
| Rate for Payer: Aetna Medicare |
$453.96
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$530.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$530.00
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$522.05
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$499.36
|
| Rate for Payer: Cash Price |
$548.79
|
| Rate for Payer: Cash Price |
$548.79
|
| Rate for Payer: Coventry All Commercial |
$544.75
|
| Rate for Payer: Frontpath All Commercial |
$622.56
|
| Rate for Payer: Humana ChoiceCare |
$498.32
|
| Rate for Payer: Humana Medicare |
$453.96
|
| Rate for Payer: Lucent All Commercial |
$771.73
|
| Rate for Payer: Lutheran Preferred All Commercial |
$726.00
|
| Rate for Payer: PHCS All Commercial |
$663.86
|
| Rate for Payer: PHP All Commercial |
$770.08
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$453.96
|
| Rate for Payer: Signature Care EPO |
$674.05
|
| Rate for Payer: Signature Care PPO |
$674.05
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$681.00
|
| Rate for Payer: United Healthcare Commercial |
$498.26
|
| Rate for Payer: United Healthcare Medicare |
$453.96
|
|
|
PR CLOSED RX METACARP FX,W/MANIP,W/EXT FIX
|
Professional
|
$933.92
|
|
|
Service Code
|
CPT 26607
|
| Hospital Charge Code |
z26607
|
| Min. Negotiated Rate |
$461.46 |
| Max. Negotiated Rate |
$813.67 |
| Rate for Payer: Aetna Medicare |
$478.63
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$530.90
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$530.90
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$550.42
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$526.49
|
| Rate for Payer: Cash Price |
$579.03
|
| Rate for Payer: Cash Price |
$579.03
|
| Rate for Payer: Coventry All Commercial |
$574.36
|
| Rate for Payer: Frontpath All Commercial |
$660.97
|
| Rate for Payer: Humana ChoiceCare |
$498.92
|
| Rate for Payer: Humana Medicare |
$478.63
|
| Rate for Payer: Lucent All Commercial |
$813.67
|
| Rate for Payer: Lutheran Preferred All Commercial |
$766.00
|
| Rate for Payer: PHCS All Commercial |
$700.44
|
| Rate for Payer: PHP All Commercial |
$812.51
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$478.63
|
| Rate for Payer: Signature Care EPO |
$673.20
|
| Rate for Payer: Signature Care PPO |
$673.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$718.00
|
| Rate for Payer: United Healthcare Commercial |
$461.46
|
| Rate for Payer: United Healthcare Medicare |
$478.63
|
|
|
PR CLOSED RX METATARSAL FX
|
Professional
|
$403.54
|
|
|
Service Code
|
CPT 28470
|
| Hospital Charge Code |
z28470
|
| Min. Negotiated Rate |
$189.49 |
| Max. Negotiated Rate |
$330.65 |
| Rate for Payer: Aetna Medicare |
$194.46
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$222.08
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$222.08
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$223.63
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$213.91
|
| Rate for Payer: Cash Price |
$250.19
|
| Rate for Payer: Cash Price |
$250.19
|
| Rate for Payer: Coventry All Commercial |
$233.35
|
| Rate for Payer: Frontpath All Commercial |
$261.68
|
| Rate for Payer: Humana ChoiceCare |
$189.49
|
| Rate for Payer: Humana Medicare |
$194.46
|
| Rate for Payer: Lucent All Commercial |
$330.58
|
| Rate for Payer: Lutheran Preferred All Commercial |
$311.00
|
| Rate for Payer: PHCS All Commercial |
$302.66
|
| Rate for Payer: PHP All Commercial |
$330.11
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$194.46
|
| Rate for Payer: Signature Care EPO |
$330.65
|
| Rate for Payer: Signature Care PPO |
$330.65
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$292.00
|
| Rate for Payer: United Healthcare Commercial |
$195.90
|
| Rate for Payer: United Healthcare Medicare |
$194.46
|
|
|
PR CLOSED RX METATARSAL FX,MANIP
|
Professional
|
$479.28
|
|
|
Service Code
|
CPT 28475
|
| Hospital Charge Code |
z28475
|
| Min. Negotiated Rate |
$216.30 |
| Max. Negotiated Rate |
$402.05 |
| Rate for Payer: Aetna Medicare |
$216.30
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$276.94
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$276.94
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$248.74
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$237.93
|
| Rate for Payer: Cash Price |
$297.15
|
| Rate for Payer: Cash Price |
$297.15
|
| Rate for Payer: Coventry All Commercial |
$259.56
|
| Rate for Payer: Frontpath All Commercial |
$289.34
|
| Rate for Payer: Humana ChoiceCare |
$265.40
|
| Rate for Payer: Humana Medicare |
$216.30
|
| Rate for Payer: Lucent All Commercial |
$367.71
|
| Rate for Payer: Lutheran Preferred All Commercial |
$346.00
|
| Rate for Payer: PHCS All Commercial |
$359.46
|
| Rate for Payer: PHP All Commercial |
$367.18
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$216.30
|
| Rate for Payer: Signature Care EPO |
$402.05
|
| Rate for Payer: Signature Care PPO |
$402.05
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$324.00
|
| Rate for Payer: United Healthcare Commercial |
$256.28
|
| Rate for Payer: United Healthcare Medicare |
$216.30
|
|
|
PR CLOSED RX MID HUMERUS FRACTURE
|
Professional
|
$672.68
|
|
|
Service Code
|
CPT 24500
|
| Hospital Charge Code |
z24500
|
| Min. Negotiated Rate |
$295.61 |
| Max. Negotiated Rate |
$540.41 |
| Rate for Payer: Aetna Medicare |
$317.89
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$462.50
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$462.50
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$365.57
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$349.68
|
| Rate for Payer: Cash Price |
$417.06
|
| Rate for Payer: Cash Price |
$417.06
|
| Rate for Payer: Coventry All Commercial |
$381.47
|
| Rate for Payer: Frontpath All Commercial |
$431.60
|
| Rate for Payer: Humana ChoiceCare |
$295.61
|
| Rate for Payer: Humana Medicare |
$317.89
|
| Rate for Payer: Lucent All Commercial |
$540.41
|
| Rate for Payer: Lutheran Preferred All Commercial |
$509.00
|
| Rate for Payer: PHCS All Commercial |
$504.51
|
| Rate for Payer: PHP All Commercial |
$539.64
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$317.89
|
| Rate for Payer: Signature Care EPO |
$488.75
|
| Rate for Payer: Signature Care PPO |
$488.75
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$477.00
|
| Rate for Payer: United Healthcare Commercial |
$318.68
|
| Rate for Payer: United Healthcare Medicare |
$317.89
|
|
|
PR CLOSED RX MID HUMERUS FX,MANIPULATN
|
Professional
|
$930.62
|
|
|
Service Code
|
CPT 24505
|
| Hospital Charge Code |
z24505
|
| Min. Negotiated Rate |
$427.54 |
| Max. Negotiated Rate |
$726.82 |
| Rate for Payer: Aetna Medicare |
$427.54
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$616.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$616.30
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$491.67
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$470.29
|
| Rate for Payer: Cash Price |
$576.98
|
| Rate for Payer: Cash Price |
$576.98
|
| Rate for Payer: Coventry All Commercial |
$513.05
|
| Rate for Payer: Frontpath All Commercial |
$588.25
|
| Rate for Payer: Humana ChoiceCare |
$456.20
|
| Rate for Payer: Humana Medicare |
$427.54
|
| Rate for Payer: Lucent All Commercial |
$726.82
|
| Rate for Payer: Lutheran Preferred All Commercial |
$684.00
|
| Rate for Payer: PHCS All Commercial |
$697.96
|
| Rate for Payer: PHP All Commercial |
$725.78
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$427.54
|
| Rate for Payer: Signature Care EPO |
$713.15
|
| Rate for Payer: Signature Care PPO |
$713.15
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$641.00
|
| Rate for Payer: United Healthcare Commercial |
$469.31
|
| Rate for Payer: United Healthcare Medicare |
$427.54
|
|
|
PR CLOSED RX MT-PHAL TOE DISLOCATION
|
Professional
|
$288.02
|
|
|
Service Code
|
CPT 28630
|
| Hospital Charge Code |
z28630
|
| Min. Negotiated Rate |
$103.93 |
| Max. Negotiated Rate |
$216.02 |
| Rate for Payer: Aetna Medicare |
$103.93
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$119.52
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$114.32
|
| Rate for Payer: Cash Price |
$178.57
|
| Rate for Payer: Cash Price |
$178.57
|
| Rate for Payer: Coventry All Commercial |
$124.72
|
| Rate for Payer: Frontpath All Commercial |
$142.79
|
| Rate for Payer: Humana ChoiceCare |
$117.58
|
| Rate for Payer: Humana Medicare |
$103.93
|
| Rate for Payer: Lucent All Commercial |
$176.68
|
| Rate for Payer: PHCS All Commercial |
$216.02
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$103.93
|
| Rate for Payer: United Healthcare Commercial |
$121.44
|
| Rate for Payer: United Healthcare Medicare |
$103.93
|
|
|
PR CLOSED RX NAVIC/LUNATE FX/DISLOC
|
Professional
|
$973.76
|
|
|
Service Code
|
CPT 25680
|
| Hospital Charge Code |
z25680
|
| Min. Negotiated Rate |
$463.81 |
| Max. Negotiated Rate |
$848.38 |
| Rate for Payer: Aetna Medicare |
$499.05
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$501.80
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$501.80
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$573.91
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$548.96
|
| Rate for Payer: Cash Price |
$603.73
|
| Rate for Payer: Cash Price |
$603.73
|
| Rate for Payer: Coventry All Commercial |
$598.86
|
| Rate for Payer: Frontpath All Commercial |
$687.56
|
| Rate for Payer: Humana ChoiceCare |
$463.81
|
| Rate for Payer: Humana Medicare |
$499.05
|
| Rate for Payer: Lucent All Commercial |
$848.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$798.00
|
| Rate for Payer: PHCS All Commercial |
$730.32
|
| Rate for Payer: PHP All Commercial |
$847.17
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$499.05
|
| Rate for Payer: Signature Care EPO |
$621.35
|
| Rate for Payer: Signature Care PPO |
$621.35
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$749.00
|
| Rate for Payer: United Healthcare Commercial |
$483.48
|
| Rate for Payer: United Healthcare Medicare |
$499.05
|
|
|
PR CLOSED RX NAVICULAR FX
|
Professional
|
$573.38
|
|
|
Service Code
|
CPT 25622
|
| Hospital Charge Code |
z25622
|
| Min. Negotiated Rate |
$244.77 |
| Max. Negotiated Rate |
$461.24 |
| Rate for Payer: Aetna Medicare |
$271.32
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$388.80
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$388.80
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$312.02
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$298.45
|
| Rate for Payer: Cash Price |
$355.50
|
| Rate for Payer: Cash Price |
$355.50
|
| Rate for Payer: Coventry All Commercial |
$325.58
|
| Rate for Payer: Frontpath All Commercial |
$366.50
|
| Rate for Payer: Humana ChoiceCare |
$244.77
|
| Rate for Payer: Humana Medicare |
$271.32
|
| Rate for Payer: Lucent All Commercial |
$461.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$434.00
|
| Rate for Payer: PHCS All Commercial |
$430.04
|
| Rate for Payer: PHP All Commercial |
$460.59
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$271.32
|
| Rate for Payer: Signature Care EPO |
$410.55
|
| Rate for Payer: Signature Care PPO |
$410.55
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$407.00
|
| Rate for Payer: United Healthcare Commercial |
$267.64
|
| Rate for Payer: United Healthcare Medicare |
$271.32
|
|
|
PR CLOSED RX PATELLA FX
|
Professional
|
$605.06
|
|
|
Service Code
|
CPT 27520
|
| Hospital Charge Code |
z27520
|
| Min. Negotiated Rate |
$270.27 |
| Max. Negotiated Rate |
$487.27 |
| Rate for Payer: Aetna Medicare |
$286.63
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$434.03
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$434.03
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$329.62
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$315.29
|
| Rate for Payer: Cash Price |
$375.14
|
| Rate for Payer: Cash Price |
$375.14
|
| Rate for Payer: Coventry All Commercial |
$343.96
|
| Rate for Payer: Frontpath All Commercial |
$388.92
|
| Rate for Payer: Humana ChoiceCare |
$270.27
|
| Rate for Payer: Humana Medicare |
$286.63
|
| Rate for Payer: Lucent All Commercial |
$487.27
|
| Rate for Payer: Lutheran Preferred All Commercial |
$459.00
|
| Rate for Payer: PHCS All Commercial |
$453.80
|
| Rate for Payer: PHP All Commercial |
$486.57
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$286.63
|
| Rate for Payer: Signature Care EPO |
$458.15
|
| Rate for Payer: Signature Care PPO |
$458.15
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$430.00
|
| Rate for Payer: United Healthcare Commercial |
$290.05
|
| Rate for Payer: United Healthcare Medicare |
$286.63
|
|
|
PR CLOSED RX POST HIP ARTHRPLAS DISLOC
|
Professional
|
$763.48
|
|
|
Service Code
|
CPT 27265
|
| Hospital Charge Code |
z27265
|
| Min. Negotiated Rate |
$391.28 |
| Max. Negotiated Rate |
$665.18 |
| Rate for Payer: Aetna Medicare |
$391.28
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$470.90
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$470.90
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$449.97
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$430.41
|
| Rate for Payer: Cash Price |
$473.36
|
| Rate for Payer: Cash Price |
$473.36
|
| Rate for Payer: Coventry All Commercial |
$469.54
|
| Rate for Payer: Frontpath All Commercial |
$533.61
|
| Rate for Payer: Humana ChoiceCare |
$421.89
|
| Rate for Payer: Humana Medicare |
$391.28
|
| Rate for Payer: Lucent All Commercial |
$665.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$626.00
|
| Rate for Payer: PHCS All Commercial |
$572.61
|
| Rate for Payer: PHP All Commercial |
$664.22
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$391.28
|
| Rate for Payer: Signature Care EPO |
$568.65
|
| Rate for Payer: Signature Care PPO |
$568.65
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$587.00
|
| Rate for Payer: United Healthcare Commercial |
$416.70
|
| Rate for Payer: United Healthcare Medicare |
$391.28
|
|
|
PR CLOSED RX POST HIP FIX DISLOC,ANESTH
|
Professional
|
$1,065.48
|
|
|
Service Code
|
CPT 27266
|
| Hospital Charge Code |
z27266
|
| Min. Negotiated Rate |
$546.06 |
| Max. Negotiated Rate |
$928.30 |
| Rate for Payer: Aetna Medicare |
$546.06
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$654.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$654.30
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$627.97
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$600.67
|
| Rate for Payer: Cash Price |
$660.60
|
| Rate for Payer: Cash Price |
$660.60
|
| Rate for Payer: Coventry All Commercial |
$655.27
|
| Rate for Payer: Frontpath All Commercial |
$760.55
|
| Rate for Payer: Humana ChoiceCare |
$602.68
|
| Rate for Payer: Humana Medicare |
$546.06
|
| Rate for Payer: Lucent All Commercial |
$928.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$874.00
|
| Rate for Payer: PHCS All Commercial |
$799.11
|
| Rate for Payer: PHP All Commercial |
$926.97
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$546.06
|
| Rate for Payer: Signature Care EPO |
$803.25
|
| Rate for Payer: Signature Care PPO |
$803.25
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$819.00
|
| Rate for Payer: United Healthcare Commercial |
$622.33
|
| Rate for Payer: United Healthcare Medicare |
$546.06
|
|
|
PR CLOSED RX PROX HUMERUS FRACTURE
|
Professional
|
$619.56
|
|
|
Service Code
|
CPT 23600
|
| Hospital Charge Code |
z23600
|
| Min. Negotiated Rate |
$277.86 |
| Max. Negotiated Rate |
$511.46 |
| Rate for Payer: Aetna Medicare |
$300.86
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$464.02
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$464.02
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$345.99
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$330.95
|
| Rate for Payer: Cash Price |
$384.13
|
| Rate for Payer: Cash Price |
$384.13
|
| Rate for Payer: Coventry All Commercial |
$361.03
|
| Rate for Payer: Frontpath All Commercial |
$407.24
|
| Rate for Payer: Humana ChoiceCare |
$277.86
|
| Rate for Payer: Humana Medicare |
$300.86
|
| Rate for Payer: Lucent All Commercial |
$511.46
|
| Rate for Payer: Lutheran Preferred All Commercial |
$481.00
|
| Rate for Payer: PHCS All Commercial |
$464.67
|
| Rate for Payer: PHP All Commercial |
$510.72
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$300.86
|
| Rate for Payer: Signature Care EPO |
$489.60
|
| Rate for Payer: Signature Care PPO |
$489.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$451.00
|
| Rate for Payer: United Healthcare Commercial |
$298.45
|
| Rate for Payer: United Healthcare Medicare |
$300.86
|
|
|
PR CLOSED RX PROX HUMERUS FX,MANIP
|
Professional
|
$868.66
|
|
|
Service Code
|
CPT 23605
|
| Hospital Charge Code |
z23605
|
| Min. Negotiated Rate |
$403.83 |
| Max. Negotiated Rate |
$686.51 |
| Rate for Payer: Aetna Medicare |
$403.83
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$545.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$545.00
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$464.40
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$444.21
|
| Rate for Payer: Cash Price |
$538.57
|
| Rate for Payer: Cash Price |
$538.57
|
| Rate for Payer: Coventry All Commercial |
$484.60
|
| Rate for Payer: Frontpath All Commercial |
$554.68
|
| Rate for Payer: Humana ChoiceCare |
$430.69
|
| Rate for Payer: Humana Medicare |
$403.83
|
| Rate for Payer: Lucent All Commercial |
$686.51
|
| Rate for Payer: Lutheran Preferred All Commercial |
$646.00
|
| Rate for Payer: PHCS All Commercial |
$651.50
|
| Rate for Payer: PHP All Commercial |
$685.52
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$403.83
|
| Rate for Payer: Signature Care EPO |
$657.05
|
| Rate for Payer: Signature Care PPO |
$657.05
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$606.00
|
| Rate for Payer: United Healthcare Commercial |
$442.40
|
| Rate for Payer: United Healthcare Medicare |
$403.83
|
|
|
PR CLOSED RX PROX/NECK FEMUR FX
|
Professional
|
$893.14
|
|
|
Service Code
|
CPT 27230
|
| Hospital Charge Code |
z27230
|
| Min. Negotiated Rate |
$448.78 |
| Max. Negotiated Rate |
$762.93 |
| Rate for Payer: Aetna Medicare |
$448.78
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$522.90
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$522.90
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$516.10
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$493.66
|
| Rate for Payer: Cash Price |
$553.75
|
| Rate for Payer: Cash Price |
$553.75
|
| Rate for Payer: Coventry All Commercial |
$538.54
|
| Rate for Payer: Frontpath All Commercial |
$618.89
|
| Rate for Payer: Humana ChoiceCare |
$459.89
|
| Rate for Payer: Humana Medicare |
$448.78
|
| Rate for Payer: Lucent All Commercial |
$762.93
|
| Rate for Payer: Lutheran Preferred All Commercial |
$718.00
|
| Rate for Payer: PHCS All Commercial |
$669.86
|
| Rate for Payer: PHP All Commercial |
$761.84
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$448.78
|
| Rate for Payer: Signature Care EPO |
$691.05
|
| Rate for Payer: Signature Care PPO |
$691.05
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$673.00
|
| Rate for Payer: United Healthcare Commercial |
$489.53
|
| Rate for Payer: United Healthcare Medicare |
$448.78
|
|
|
PR CLOSED RX PROX/SHAFT FIBULA FX
|
Professional
|
$575.14
|
|
|
Service Code
|
CPT 27780
|
| Hospital Charge Code |
z27780
|
| Min. Negotiated Rate |
$250.86 |
| Max. Negotiated Rate |
$461.21 |
| Rate for Payer: Aetna Medicare |
$271.30
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$405.06
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$405.06
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$312.00
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$298.43
|
| Rate for Payer: Cash Price |
$356.59
|
| Rate for Payer: Cash Price |
$356.59
|
| Rate for Payer: Coventry All Commercial |
$325.56
|
| Rate for Payer: Frontpath All Commercial |
$368.46
|
| Rate for Payer: Humana ChoiceCare |
$250.86
|
| Rate for Payer: Humana Medicare |
$271.30
|
| Rate for Payer: Lucent All Commercial |
$461.21
|
| Rate for Payer: Lutheran Preferred All Commercial |
$434.00
|
| Rate for Payer: PHCS All Commercial |
$431.36
|
| Rate for Payer: PHP All Commercial |
$460.54
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$271.30
|
| Rate for Payer: Signature Care EPO |
$428.40
|
| Rate for Payer: Signature Care PPO |
$428.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$407.00
|
| Rate for Payer: United Healthcare Commercial |
$270.28
|
| Rate for Payer: United Healthcare Medicare |
$271.30
|
|
|
PR CLOSED RX RADIAL HEAD DISLOC,CHILD
|
Professional
|
$193.02
|
|
|
Service Code
|
CPT 24640
|
| Hospital Charge Code |
z24640
|
| Min. Negotiated Rate |
$76.07 |
| Max. Negotiated Rate |
$208.70 |
| Rate for Payer: Aetna Medicare |
$76.07
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$208.70
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$208.70
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$87.48
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$83.68
|
| Rate for Payer: Cash Price |
$119.67
|
| Rate for Payer: Cash Price |
$119.67
|
| Rate for Payer: Coventry All Commercial |
$91.28
|
| Rate for Payer: Frontpath All Commercial |
$103.38
|
| Rate for Payer: Humana ChoiceCare |
$86.32
|
| Rate for Payer: Humana Medicare |
$76.07
|
| Rate for Payer: Lucent All Commercial |
$129.32
|
| Rate for Payer: Lutheran Preferred All Commercial |
$122.00
|
| Rate for Payer: PHCS All Commercial |
$144.76
|
| Rate for Payer: PHP All Commercial |
$129.14
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$76.07
|
| Rate for Payer: Signature Care EPO |
$169.71
|
| Rate for Payer: Signature Care PPO |
$169.71
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$114.00
|
| Rate for Payer: United Healthcare Commercial |
$90.94
|
| Rate for Payer: United Healthcare Medicare |
$76.07
|
|
|
PR CLOSED RX RADIAL HEAD/NECK FX
|
Professional
|
$491.84
|
|
|
Service Code
|
CPT 24650
|
| Hospital Charge Code |
z24650
|
| Min. Negotiated Rate |
$210.14 |
| Max. Negotiated Rate |
$398.60 |
| Rate for Payer: Aetna Medicare |
$234.47
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$358.31
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$358.31
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$269.64
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$257.92
|
| Rate for Payer: Cash Price |
$304.94
|
| Rate for Payer: Cash Price |
$304.94
|
| Rate for Payer: Coventry All Commercial |
$281.36
|
| Rate for Payer: Frontpath All Commercial |
$315.26
|
| Rate for Payer: Humana ChoiceCare |
$210.14
|
| Rate for Payer: Humana Medicare |
$234.47
|
| Rate for Payer: Lucent All Commercial |
$398.60
|
| Rate for Payer: Lutheran Preferred All Commercial |
$375.00
|
| Rate for Payer: PHCS All Commercial |
$368.88
|
| Rate for Payer: PHP All Commercial |
$398.03
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$234.47
|
| Rate for Payer: Signature Care EPO |
$378.25
|
| Rate for Payer: Signature Care PPO |
$378.25
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$352.00
|
| Rate for Payer: United Healthcare Commercial |
$231.21
|
| Rate for Payer: United Healthcare Medicare |
$234.47
|
|
|
PR CLOSED RX RADIAL HEAD/NECK FX,MANIP
|
Professional
|
$829.20
|
|
|
Service Code
|
CPT 24655
|
| Hospital Charge Code |
z24655
|
| Min. Negotiated Rate |
$382.98 |
| Max. Negotiated Rate |
$651.07 |
| Rate for Payer: Aetna Medicare |
$382.98
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$506.50
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$506.50
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$440.43
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$421.28
|
| Rate for Payer: Cash Price |
$514.10
|
| Rate for Payer: Cash Price |
$514.10
|
| Rate for Payer: Coventry All Commercial |
$459.58
|
| Rate for Payer: Frontpath All Commercial |
$523.89
|
| Rate for Payer: Humana ChoiceCare |
$394.84
|
| Rate for Payer: Humana Medicare |
$382.98
|
| Rate for Payer: Lucent All Commercial |
$651.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$613.00
|
| Rate for Payer: PHCS All Commercial |
$621.90
|
| Rate for Payer: PHP All Commercial |
$650.14
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$382.98
|
| Rate for Payer: Signature Care EPO |
$635.80
|
| Rate for Payer: Signature Care PPO |
$635.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$574.00
|
| Rate for Payer: United Healthcare Commercial |
$407.53
|
| Rate for Payer: United Healthcare Medicare |
$382.98
|
|
|
PR CLOSED RX RADIAL SHAFT FX
|
Professional
|
$530.06
|
|
|
Service Code
|
CPT 25500
|
| Hospital Charge Code |
z25500
|
| Min. Negotiated Rate |
$221.21 |
| Max. Negotiated Rate |
$417.72 |
| Rate for Payer: Aetna Medicare |
$245.72
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$344.58
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$344.58
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$282.58
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$270.29
|
| Rate for Payer: Cash Price |
$328.64
|
| Rate for Payer: Cash Price |
$328.64
|
| Rate for Payer: Coventry All Commercial |
$294.86
|
| Rate for Payer: Frontpath All Commercial |
$332.16
|
| Rate for Payer: Humana ChoiceCare |
$221.21
|
| Rate for Payer: Humana Medicare |
$245.72
|
| Rate for Payer: Lucent All Commercial |
$417.72
|
| Rate for Payer: Lutheran Preferred All Commercial |
$393.00
|
| Rate for Payer: PHCS All Commercial |
$397.54
|
| Rate for Payer: PHP All Commercial |
$417.12
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$245.72
|
| Rate for Payer: Signature Care EPO |
$364.65
|
| Rate for Payer: Signature Care PPO |
$364.65
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$369.00
|
| Rate for Payer: United Healthcare Commercial |
$239.74
|
| Rate for Payer: United Healthcare Medicare |
$245.72
|
|
|
PR CLOSED RX RADIAL SHAFT FX,MANIPULATN
|
Professional
|
$939.42
|
|
|
Service Code
|
CPT 25505
|
| Hospital Charge Code |
z25505
|
| Min. Negotiated Rate |
$436.37 |
| Max. Negotiated Rate |
$741.83 |
| Rate for Payer: Aetna Medicare |
$436.37
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$570.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$570.30
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$501.83
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$480.01
|
| Rate for Payer: Cash Price |
$582.44
|
| Rate for Payer: Cash Price |
$582.44
|
| Rate for Payer: Coventry All Commercial |
$523.64
|
| Rate for Payer: Frontpath All Commercial |
$595.80
|
| Rate for Payer: Humana ChoiceCare |
$459.33
|
| Rate for Payer: Humana Medicare |
$436.37
|
| Rate for Payer: Lucent All Commercial |
$741.83
|
| Rate for Payer: Lutheran Preferred All Commercial |
$698.00
|
| Rate for Payer: PHCS All Commercial |
$704.56
|
| Rate for Payer: PHP All Commercial |
$741.31
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$436.37
|
| Rate for Payer: Signature Care EPO |
$710.60
|
| Rate for Payer: Signature Care PPO |
$710.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$655.00
|
| Rate for Payer: United Healthcare Commercial |
$475.98
|
| Rate for Payer: United Healthcare Medicare |
$436.37
|
|
|
PR CLOSED RX RADIAL SHAFT FX W/DISLOCATION
|
Professional
|
$1,063.34
|
|
|
Service Code
|
CPT 25520
|
| Hospital Charge Code |
z25520
|
| Min. Negotiated Rate |
$513.17 |
| Max. Negotiated Rate |
$872.39 |
| Rate for Payer: Aetna Medicare |
$513.17
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$686.60
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$686.60
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$590.15
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$564.49
|
| Rate for Payer: Cash Price |
$659.27
|
| Rate for Payer: Cash Price |
$659.27
|
| Rate for Payer: Coventry All Commercial |
$615.80
|
| Rate for Payer: Frontpath All Commercial |
$707.01
|
| Rate for Payer: Humana ChoiceCare |
$533.91
|
| Rate for Payer: Humana Medicare |
$513.17
|
| Rate for Payer: Lucent All Commercial |
$872.39
|
| Rate for Payer: Lutheran Preferred All Commercial |
$821.00
|
| Rate for Payer: PHCS All Commercial |
$797.50
|
| Rate for Payer: PHP All Commercial |
$871.13
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$513.17
|
| Rate for Payer: Signature Care EPO |
$788.80
|
| Rate for Payer: Signature Care PPO |
$788.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$770.00
|
| Rate for Payer: United Healthcare Commercial |
$542.65
|
| Rate for Payer: United Healthcare Medicare |
$513.17
|
|
|
PR CLOSED RX RAD/ULNA SHAFT FX
|
Professional
|
$540.54
|
|
|
Service Code
|
CPT 25560
|
| Hospital Charge Code |
z25560
|
| Min. Negotiated Rate |
$216.43 |
| Max. Negotiated Rate |
$420.05 |
| Rate for Payer: Aetna Medicare |
$247.09
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$322.70
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$322.70
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$284.15
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$271.80
|
| Rate for Payer: Cash Price |
$335.13
|
| Rate for Payer: Cash Price |
$335.13
|
| Rate for Payer: Coventry All Commercial |
$296.51
|
| Rate for Payer: Frontpath All Commercial |
$334.26
|
| Rate for Payer: Humana ChoiceCare |
$216.43
|
| Rate for Payer: Humana Medicare |
$247.09
|
| Rate for Payer: Lucent All Commercial |
$420.05
|
| Rate for Payer: Lutheran Preferred All Commercial |
$395.00
|
| Rate for Payer: PHCS All Commercial |
$405.40
|
| Rate for Payer: PHP All Commercial |
$419.44
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$247.09
|
| Rate for Payer: Signature Care EPO |
$367.20
|
| Rate for Payer: Signature Care PPO |
$367.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$371.00
|
| Rate for Payer: United Healthcare Commercial |
$238.45
|
| Rate for Payer: United Healthcare Medicare |
$247.09
|
|
