|
PR CLOSED RX RAD/ULNA SHAFT FX,MANIP
|
Professional
|
$962.38
|
|
|
Service Code
|
CPT 25565
|
| Hospital Charge Code |
z25565
|
| Min. Negotiated Rate |
$440.74 |
| Max. Negotiated Rate |
$749.26 |
| Rate for Payer: Aetna Medicare |
$440.74
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$628.90
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$628.90
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$506.85
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$484.81
|
| Rate for Payer: Cash Price |
$596.68
|
| Rate for Payer: Cash Price |
$596.68
|
| Rate for Payer: Coventry All Commercial |
$528.89
|
| Rate for Payer: Frontpath All Commercial |
$607.29
|
| Rate for Payer: Humana ChoiceCare |
$478.23
|
| Rate for Payer: Humana Medicare |
$440.74
|
| Rate for Payer: Lucent All Commercial |
$749.26
|
| Rate for Payer: Lutheran Preferred All Commercial |
$705.00
|
| Rate for Payer: PHCS All Commercial |
$721.78
|
| Rate for Payer: PHP All Commercial |
$748.19
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$440.74
|
| Rate for Payer: Signature Care EPO |
$744.60
|
| Rate for Payer: Signature Care PPO |
$744.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$661.00
|
| Rate for Payer: United Healthcare Commercial |
$494.85
|
| Rate for Payer: United Healthcare Medicare |
$440.74
|
|
|
PR CLOSED RX SCAPULA FX
|
Professional
|
$436.72
|
|
|
Service Code
|
CPT 23570
|
| Hospital Charge Code |
z23570
|
| Min. Negotiated Rate |
$218.91 |
| Max. Negotiated Rate |
$392.56 |
| Rate for Payer: Aetna Medicare |
$230.92
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$233.10
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$233.10
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$265.56
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$254.01
|
| Rate for Payer: Cash Price |
$270.77
|
| Rate for Payer: Cash Price |
$270.77
|
| Rate for Payer: Coventry All Commercial |
$277.10
|
| Rate for Payer: Frontpath All Commercial |
$311.92
|
| Rate for Payer: Humana ChoiceCare |
$218.91
|
| Rate for Payer: Humana Medicare |
$230.92
|
| Rate for Payer: Lucent All Commercial |
$392.56
|
| Rate for Payer: Lutheran Preferred All Commercial |
$369.00
|
| Rate for Payer: PHCS All Commercial |
$327.54
|
| Rate for Payer: PHP All Commercial |
$391.99
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$230.92
|
| Rate for Payer: Signature Care EPO |
$335.75
|
| Rate for Payer: Signature Care PPO |
$335.75
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$346.00
|
| Rate for Payer: United Healthcare Commercial |
$233.36
|
| Rate for Payer: United Healthcare Medicare |
$230.92
|
|
|
PR CLOSED RX SESAMOID BONE FX
|
Professional
|
$214.18
|
|
|
Service Code
|
CPT 28530
|
| Hospital Charge Code |
z28530
|
| Min. Negotiated Rate |
$95.57 |
| Max. Negotiated Rate |
$162.47 |
| Rate for Payer: Aetna Medicare |
$95.57
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$109.91
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$105.13
|
| Rate for Payer: Cash Price |
$132.79
|
| Rate for Payer: Cash Price |
$132.79
|
| Rate for Payer: Coventry All Commercial |
$114.68
|
| Rate for Payer: Frontpath All Commercial |
$124.68
|
| Rate for Payer: Humana ChoiceCare |
$105.90
|
| Rate for Payer: Humana Medicare |
$95.57
|
| Rate for Payer: Lucent All Commercial |
$162.47
|
| Rate for Payer: PHCS All Commercial |
$160.64
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$95.57
|
| Rate for Payer: United Healthcare Commercial |
$108.34
|
| Rate for Payer: United Healthcare Medicare |
$95.57
|
|
|
PR CLOSED RX SHLDR DISLOC,ANESTHESIA
|
Professional
|
$750.22
|
|
|
Service Code
|
CPT 23655
|
| Hospital Charge Code |
z23655
|
| Min. Negotiated Rate |
$377.54 |
| Max. Negotiated Rate |
$653.63 |
| Rate for Payer: Aetna Medicare |
$384.49
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$398.20
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$398.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$442.16
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$422.94
|
| Rate for Payer: Cash Price |
$465.14
|
| Rate for Payer: Cash Price |
$465.14
|
| Rate for Payer: Coventry All Commercial |
$461.39
|
| Rate for Payer: Frontpath All Commercial |
$530.35
|
| Rate for Payer: Humana ChoiceCare |
$377.54
|
| Rate for Payer: Humana Medicare |
$384.49
|
| Rate for Payer: Lucent All Commercial |
$653.63
|
| Rate for Payer: Lutheran Preferred All Commercial |
$615.00
|
| Rate for Payer: PHCS All Commercial |
$562.66
|
| Rate for Payer: PHP All Commercial |
$652.70
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$384.49
|
| Rate for Payer: Signature Care EPO |
$504.05
|
| Rate for Payer: Signature Care PPO |
$504.05
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$577.00
|
| Rate for Payer: United Healthcare Commercial |
$401.64
|
| Rate for Payer: United Healthcare Medicare |
$384.49
|
|
|
PR CLOSED RX SHLDR DISLOCATION
|
Professional
|
$615.04
|
|
|
Service Code
|
CPT 23650
|
| Hospital Charge Code |
z23650
|
| Min. Negotiated Rate |
$262.84 |
| Max. Negotiated Rate |
$483.36 |
| Rate for Payer: Aetna Medicare |
$284.33
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$333.90
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$333.90
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$326.98
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$312.76
|
| Rate for Payer: Cash Price |
$381.32
|
| Rate for Payer: Cash Price |
$381.32
|
| Rate for Payer: Coventry All Commercial |
$341.20
|
| Rate for Payer: Frontpath All Commercial |
$384.90
|
| Rate for Payer: Humana ChoiceCare |
$262.84
|
| Rate for Payer: Humana Medicare |
$284.33
|
| Rate for Payer: Lucent All Commercial |
$483.36
|
| Rate for Payer: Lutheran Preferred All Commercial |
$455.00
|
| Rate for Payer: PHCS All Commercial |
$461.28
|
| Rate for Payer: PHP All Commercial |
$482.67
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$284.33
|
| Rate for Payer: Signature Care EPO |
$457.30
|
| Rate for Payer: Signature Care PPO |
$457.30
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$426.00
|
| Rate for Payer: United Healthcare Commercial |
$277.41
|
| Rate for Payer: United Healthcare Medicare |
$284.33
|
|
|
PR CLOSED RX SHLDR DISLOC,GR TUB FX
|
Professional
|
$802.94
|
|
|
Service Code
|
CPT 23665
|
| Hospital Charge Code |
z23665
|
| Min. Negotiated Rate |
$377.86 |
| Max. Negotiated Rate |
$642.36 |
| Rate for Payer: Aetna Medicare |
$377.86
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$434.54
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$415.65
|
| Rate for Payer: Cash Price |
$497.82
|
| Rate for Payer: Cash Price |
$497.82
|
| Rate for Payer: Coventry All Commercial |
$453.43
|
| Rate for Payer: Frontpath All Commercial |
$519.27
|
| Rate for Payer: Humana ChoiceCare |
$395.32
|
| Rate for Payer: Humana Medicare |
$377.86
|
| Rate for Payer: Lucent All Commercial |
$642.36
|
| Rate for Payer: PHCS All Commercial |
$602.20
|
| Rate for Payer: PHP All Commercial |
$641.43
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$377.86
|
| Rate for Payer: Signature Care EPO |
$630.70
|
| Rate for Payer: Signature Care PPO |
$630.70
|
| Rate for Payer: United Healthcare Commercial |
$406.78
|
| Rate for Payer: United Healthcare Medicare |
$377.86
|
|
|
PR CLOSED RX TALOTARSAL DISLOC
|
Professional
|
$433.98
|
|
|
Service Code
|
CPT 28570
|
| Hospital Charge Code |
z28570
|
| Min. Negotiated Rate |
$161.90 |
| Max. Negotiated Rate |
$325.48 |
| Rate for Payer: Aetna Medicare |
$185.98
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$213.88
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$204.58
|
| Rate for Payer: Cash Price |
$269.07
|
| Rate for Payer: Cash Price |
$269.07
|
| Rate for Payer: Coventry All Commercial |
$223.18
|
| Rate for Payer: Frontpath All Commercial |
$250.43
|
| Rate for Payer: Humana ChoiceCare |
$169.40
|
| Rate for Payer: Humana Medicare |
$185.98
|
| Rate for Payer: Lucent All Commercial |
$316.17
|
| Rate for Payer: PHCS All Commercial |
$325.48
|
| Rate for Payer: PHP All Commercial |
$315.72
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$185.98
|
| Rate for Payer: Signature Care EPO |
$258.40
|
| Rate for Payer: Signature Care PPO |
$258.40
|
| Rate for Payer: United Healthcare Commercial |
$161.90
|
| Rate for Payer: United Healthcare Medicare |
$185.98
|
|
|
PR CLOSED RX TALOTARSAL DISLOC,ANESTH
|
Professional
|
$697.00
|
|
|
Service Code
|
CPT 28575
|
| Hospital Charge Code |
z28575
|
| Min. Negotiated Rate |
$302.70 |
| Max. Negotiated Rate |
$544.29 |
| Rate for Payer: Aetna Medicare |
$320.17
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$368.20
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$352.19
|
| Rate for Payer: Cash Price |
$432.14
|
| Rate for Payer: Cash Price |
$432.14
|
| Rate for Payer: Coventry All Commercial |
$384.20
|
| Rate for Payer: Frontpath All Commercial |
$436.50
|
| Rate for Payer: Humana ChoiceCare |
$302.70
|
| Rate for Payer: Humana Medicare |
$320.17
|
| Rate for Payer: Lucent All Commercial |
$544.29
|
| Rate for Payer: PHCS All Commercial |
$522.75
|
| Rate for Payer: PHP All Commercial |
$543.51
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$320.17
|
| Rate for Payer: Signature Care EPO |
$440.30
|
| Rate for Payer: Signature Care PPO |
$440.30
|
| Rate for Payer: United Healthcare Commercial |
$321.88
|
| Rate for Payer: United Healthcare Medicare |
$320.17
|
|
|
PR CLOSED RX TALUS FX
|
Professional
|
$444.50
|
|
|
Service Code
|
CPT 28430
|
| Hospital Charge Code |
z28430
|
| Min. Negotiated Rate |
$198.80 |
| Max. Negotiated Rate |
$348.50 |
| Rate for Payer: Aetna Medicare |
$200.03
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$240.49
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$240.49
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$230.03
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$220.03
|
| Rate for Payer: Cash Price |
$275.59
|
| Rate for Payer: Cash Price |
$275.59
|
| Rate for Payer: Coventry All Commercial |
$240.04
|
| Rate for Payer: Frontpath All Commercial |
$270.31
|
| Rate for Payer: Humana ChoiceCare |
$198.80
|
| Rate for Payer: Humana Medicare |
$200.03
|
| Rate for Payer: Lucent All Commercial |
$340.05
|
| Rate for Payer: Lutheran Preferred All Commercial |
$320.00
|
| Rate for Payer: PHCS All Commercial |
$333.38
|
| Rate for Payer: PHP All Commercial |
$339.56
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$200.03
|
| Rate for Payer: Signature Care EPO |
$348.50
|
| Rate for Payer: Signature Care PPO |
$348.50
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$300.00
|
| Rate for Payer: United Healthcare Commercial |
$209.56
|
| Rate for Payer: United Healthcare Medicare |
$200.03
|
|
|
PR CLOSED RX TARSAL FX,EACH
|
Professional
|
$390.28
|
|
|
Service Code
|
CPT 28450
|
| Hospital Charge Code |
z28450
|
| Min. Negotiated Rate |
$181.19 |
| Max. Negotiated Rate |
$336.60 |
| Rate for Payer: Aetna Medicare |
$181.19
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$220.64
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$220.64
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$208.37
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$199.31
|
| Rate for Payer: Cash Price |
$241.97
|
| Rate for Payer: Cash Price |
$241.97
|
| Rate for Payer: Coventry All Commercial |
$217.43
|
| Rate for Payer: Frontpath All Commercial |
$244.35
|
| Rate for Payer: Humana ChoiceCare |
$186.37
|
| Rate for Payer: Humana Medicare |
$181.19
|
| Rate for Payer: Lucent All Commercial |
$308.02
|
| Rate for Payer: Lutheran Preferred All Commercial |
$290.00
|
| Rate for Payer: PHCS All Commercial |
$292.71
|
| Rate for Payer: PHP All Commercial |
$307.58
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$181.19
|
| Rate for Payer: Signature Care EPO |
$336.60
|
| Rate for Payer: Signature Care PPO |
$336.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$272.00
|
| Rate for Payer: United Healthcare Commercial |
$194.80
|
| Rate for Payer: United Healthcare Medicare |
$181.19
|
|
|
PR CLOSED RX TIBIAL PLATEAU FX
|
Professional
|
$571.94
|
|
|
Service Code
|
CPT 27530
|
| Hospital Charge Code |
z27530
|
| Min. Negotiated Rate |
$275.21 |
| Max. Negotiated Rate |
$521.96 |
| Rate for Payer: Aetna Medicare |
$275.21
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$521.96
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$521.96
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$316.49
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$302.73
|
| Rate for Payer: Cash Price |
$354.60
|
| Rate for Payer: Cash Price |
$354.60
|
| Rate for Payer: Coventry All Commercial |
$330.25
|
| Rate for Payer: Frontpath All Commercial |
$372.93
|
| Rate for Payer: Humana ChoiceCare |
$352.19
|
| Rate for Payer: Humana Medicare |
$275.21
|
| Rate for Payer: Lucent All Commercial |
$467.86
|
| Rate for Payer: Lutheran Preferred All Commercial |
$440.00
|
| Rate for Payer: PHCS All Commercial |
$428.96
|
| Rate for Payer: PHP All Commercial |
$467.19
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$275.21
|
| Rate for Payer: Signature Care EPO |
$485.86
|
| Rate for Payer: Signature Care PPO |
$485.86
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$413.00
|
| Rate for Payer: United Healthcare Commercial |
$375.33
|
| Rate for Payer: United Healthcare Medicare |
$275.21
|
|
|
PR CLOSED RX TIBIA SHAFT FX
|
Professional
|
$645.02
|
|
|
Service Code
|
CPT 27750
|
| Hospital Charge Code |
z27750
|
| Min. Negotiated Rate |
$302.41 |
| Max. Negotiated Rate |
$521.56 |
| Rate for Payer: Aetna Medicare |
$306.80
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$461.48
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$461.48
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$352.82
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$337.48
|
| Rate for Payer: Cash Price |
$399.91
|
| Rate for Payer: Cash Price |
$399.91
|
| Rate for Payer: Coventry All Commercial |
$368.16
|
| Rate for Payer: Frontpath All Commercial |
$416.99
|
| Rate for Payer: Humana ChoiceCare |
$302.41
|
| Rate for Payer: Humana Medicare |
$306.80
|
| Rate for Payer: Lucent All Commercial |
$521.56
|
| Rate for Payer: Lutheran Preferred All Commercial |
$491.00
|
| Rate for Payer: PHCS All Commercial |
$483.76
|
| Rate for Payer: PHP All Commercial |
$520.82
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$306.80
|
| Rate for Payer: Signature Care EPO |
$487.05
|
| Rate for Payer: Signature Care PPO |
$487.05
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$460.00
|
| Rate for Payer: United Healthcare Commercial |
$317.85
|
| Rate for Payer: United Healthcare Medicare |
$306.80
|
|
|
PR CLOSED RX TIBIA SHAFT FX,MANIPULATN
|
Professional
|
$986.04
|
|
|
Service Code
|
CPT 27752
|
| Hospital Charge Code |
z27752
|
| Min. Negotiated Rate |
$461.82 |
| Max. Negotiated Rate |
$785.09 |
| Rate for Payer: Aetna Medicare |
$461.82
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$654.70
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$654.70
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$531.09
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$508.00
|
| Rate for Payer: Cash Price |
$611.34
|
| Rate for Payer: Cash Price |
$611.34
|
| Rate for Payer: Coventry All Commercial |
$554.18
|
| Rate for Payer: Frontpath All Commercial |
$638.76
|
| Rate for Payer: Humana ChoiceCare |
$498.82
|
| Rate for Payer: Humana Medicare |
$461.82
|
| Rate for Payer: Lucent All Commercial |
$785.09
|
| Rate for Payer: Lutheran Preferred All Commercial |
$739.00
|
| Rate for Payer: PHCS All Commercial |
$739.53
|
| Rate for Payer: PHP All Commercial |
$783.97
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$461.82
|
| Rate for Payer: Signature Care EPO |
$759.90
|
| Rate for Payer: Signature Care PPO |
$759.90
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$693.00
|
| Rate for Payer: United Healthcare Commercial |
$524.30
|
| Rate for Payer: United Healthcare Medicare |
$461.82
|
|
|
PR CLOSED RX TIB TUBER FX
|
Professional
|
$892.62
|
|
|
Service Code
|
CPT 27538
|
| Hospital Charge Code |
z27538
|
| Min. Negotiated Rate |
$425.06 |
| Max. Negotiated Rate |
$722.60 |
| Rate for Payer: Aetna Medicare |
$425.06
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$647.49
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$647.49
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$488.82
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$467.57
|
| Rate for Payer: Cash Price |
$553.42
|
| Rate for Payer: Cash Price |
$553.42
|
| Rate for Payer: Coventry All Commercial |
$510.07
|
| Rate for Payer: Frontpath All Commercial |
$586.18
|
| Rate for Payer: Humana ChoiceCare |
$434.25
|
| Rate for Payer: Humana Medicare |
$425.06
|
| Rate for Payer: Lucent All Commercial |
$722.60
|
| Rate for Payer: Lutheran Preferred All Commercial |
$680.00
|
| Rate for Payer: PHCS All Commercial |
$669.46
|
| Rate for Payer: PHP All Commercial |
$721.56
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$425.06
|
| Rate for Payer: Signature Care EPO |
$682.55
|
| Rate for Payer: Signature Care PPO |
$682.55
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$638.00
|
| Rate for Payer: United Healthcare Commercial |
$453.19
|
| Rate for Payer: United Healthcare Medicare |
$425.06
|
|
|
PR CLOSED RX TOE FX
|
Professional
|
$223.92
|
|
|
Service Code
|
CPT 28510
|
| Hospital Charge Code |
z28510
|
| Min. Negotiated Rate |
$110.76 |
| Max. Negotiated Rate |
$194.04 |
| Rate for Payer: Aetna Medicare |
$114.14
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$118.22
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$118.22
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$131.26
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$125.55
|
| Rate for Payer: Cash Price |
$138.83
|
| Rate for Payer: Cash Price |
$138.83
|
| Rate for Payer: Coventry All Commercial |
$136.97
|
| Rate for Payer: Frontpath All Commercial |
$150.14
|
| Rate for Payer: Humana ChoiceCare |
$110.76
|
| Rate for Payer: Humana Medicare |
$114.14
|
| Rate for Payer: Lucent All Commercial |
$194.04
|
| Rate for Payer: Lutheran Preferred All Commercial |
$183.00
|
| Rate for Payer: PHCS All Commercial |
$167.94
|
| Rate for Payer: PHP All Commercial |
$193.76
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$114.14
|
| Rate for Payer: Signature Care EPO |
$173.40
|
| Rate for Payer: Signature Care PPO |
$173.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$171.00
|
| Rate for Payer: United Healthcare Commercial |
$118.84
|
| Rate for Payer: United Healthcare Medicare |
$114.14
|
|
|
PR CLOSED RX TOE FX,MANIPULATN
|
Professional
|
$303.36
|
|
|
Service Code
|
CPT 28515
|
| Hospital Charge Code |
z28515
|
| Min. Negotiated Rate |
$136.03 |
| Max. Negotiated Rate |
$231.25 |
| Rate for Payer: Aetna Medicare |
$136.03
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$156.43
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$149.63
|
| Rate for Payer: Cash Price |
$188.08
|
| Rate for Payer: Cash Price |
$188.08
|
| Rate for Payer: Coventry All Commercial |
$163.24
|
| Rate for Payer: Frontpath All Commercial |
$180.91
|
| Rate for Payer: Humana ChoiceCare |
$142.32
|
| Rate for Payer: Humana Medicare |
$136.03
|
| Rate for Payer: Lucent All Commercial |
$231.25
|
| Rate for Payer: PHCS All Commercial |
$227.52
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$136.03
|
| Rate for Payer: United Healthcare Commercial |
$147.40
|
| Rate for Payer: United Healthcare Medicare |
$136.03
|
|
|
PR CLOSED RX TRIMALLEOLAR FX
|
Professional
|
$613.34
|
|
|
Service Code
|
CPT 27816
|
| Hospital Charge Code |
z27816
|
| Min. Negotiated Rate |
$269.63 |
| Max. Negotiated Rate |
$474.56 |
| Rate for Payer: Aetna Medicare |
$279.15
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$411.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$411.30
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$321.02
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$307.06
|
| Rate for Payer: Cash Price |
$380.27
|
| Rate for Payer: Cash Price |
$380.27
|
| Rate for Payer: Coventry All Commercial |
$334.98
|
| Rate for Payer: Frontpath All Commercial |
$380.41
|
| Rate for Payer: Humana ChoiceCare |
$269.63
|
| Rate for Payer: Humana Medicare |
$279.15
|
| Rate for Payer: Lucent All Commercial |
$474.56
|
| Rate for Payer: Lutheran Preferred All Commercial |
$447.00
|
| Rate for Payer: PHCS All Commercial |
$460.00
|
| Rate for Payer: PHP All Commercial |
$473.87
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$279.15
|
| Rate for Payer: Signature Care EPO |
$447.10
|
| Rate for Payer: Signature Care PPO |
$447.10
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$419.00
|
| Rate for Payer: United Healthcare Commercial |
$282.46
|
| Rate for Payer: United Healthcare Medicare |
$279.15
|
|
|
PR CLOSED RX TRIMALLEOLAR FX,MANIP
|
Professional
|
$908.68
|
|
|
Service Code
|
CPT 27818
|
| Hospital Charge Code |
z27818
|
| Min. Negotiated Rate |
$415.07 |
| Max. Negotiated Rate |
$720.80 |
| Rate for Payer: Aetna Medicare |
$415.07
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$653.80
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$653.80
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$477.33
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$456.58
|
| Rate for Payer: Cash Price |
$563.38
|
| Rate for Payer: Cash Price |
$563.38
|
| Rate for Payer: Coventry All Commercial |
$498.08
|
| Rate for Payer: Frontpath All Commercial |
$569.87
|
| Rate for Payer: Humana ChoiceCare |
$460.18
|
| Rate for Payer: Humana Medicare |
$415.07
|
| Rate for Payer: Lucent All Commercial |
$705.62
|
| Rate for Payer: Lutheran Preferred All Commercial |
$664.00
|
| Rate for Payer: PHCS All Commercial |
$681.51
|
| Rate for Payer: PHP All Commercial |
$704.60
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$415.07
|
| Rate for Payer: Signature Care EPO |
$720.80
|
| Rate for Payer: Signature Care PPO |
$720.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$623.00
|
| Rate for Payer: United Healthcare Commercial |
$463.64
|
| Rate for Payer: United Healthcare Medicare |
$415.07
|
|
|
PR CLOSED RX ULNA SHAFT FX
|
Professional
|
$492.32
|
|
|
Service Code
|
CPT 25530
|
| Hospital Charge Code |
z25530
|
| Min. Negotiated Rate |
$211.24 |
| Max. Negotiated Rate |
$393.77 |
| Rate for Payer: Aetna Medicare |
$231.63
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$333.40
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$333.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$266.37
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$254.79
|
| Rate for Payer: Cash Price |
$305.24
|
| Rate for Payer: Cash Price |
$305.24
|
| Rate for Payer: Coventry All Commercial |
$277.96
|
| Rate for Payer: Frontpath All Commercial |
$311.21
|
| Rate for Payer: Humana ChoiceCare |
$211.24
|
| Rate for Payer: Humana Medicare |
$231.63
|
| Rate for Payer: Lucent All Commercial |
$393.77
|
| Rate for Payer: Lutheran Preferred All Commercial |
$371.00
|
| Rate for Payer: PHCS All Commercial |
$369.24
|
| Rate for Payer: PHP All Commercial |
$393.20
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$231.63
|
| Rate for Payer: Signature Care EPO |
$351.90
|
| Rate for Payer: Signature Care PPO |
$351.90
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$347.00
|
| Rate for Payer: United Healthcare Commercial |
$228.20
|
| Rate for Payer: United Healthcare Medicare |
$231.63
|
|
|
PR CLOSED RX ULNA SHAFT FX,MANIPULATN
|
Professional
|
$916.52
|
|
|
Service Code
|
CPT 25535
|
| Hospital Charge Code |
z25535
|
| Min. Negotiated Rate |
$432.98 |
| Max. Negotiated Rate |
$736.07 |
| Rate for Payer: Aetna Medicare |
$432.98
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$562.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$562.30
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$497.93
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$476.28
|
| Rate for Payer: Cash Price |
$568.24
|
| Rate for Payer: Cash Price |
$568.24
|
| Rate for Payer: Coventry All Commercial |
$519.58
|
| Rate for Payer: Frontpath All Commercial |
$593.40
|
| Rate for Payer: Humana ChoiceCare |
$450.94
|
| Rate for Payer: Humana Medicare |
$432.98
|
| Rate for Payer: Lucent All Commercial |
$736.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$693.00
|
| Rate for Payer: PHCS All Commercial |
$687.39
|
| Rate for Payer: PHP All Commercial |
$735.02
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$432.98
|
| Rate for Payer: Signature Care EPO |
$686.80
|
| Rate for Payer: Signature Care PPO |
$686.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$649.00
|
| Rate for Payer: United Healthcare Commercial |
$467.96
|
| Rate for Payer: United Healthcare Medicare |
$432.98
|
|
|
PR CLOSED RX ULNA STYLOID FX
|
Professional
|
$616.18
|
|
|
Service Code
|
CPT 25650
|
| Hospital Charge Code |
z25650
|
| Min. Negotiated Rate |
$267.51 |
| Max. Negotiated Rate |
$496.96 |
| Rate for Payer: Aetna Medicare |
$292.33
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$423.36
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$423.36
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$336.18
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$321.56
|
| Rate for Payer: Cash Price |
$382.03
|
| Rate for Payer: Cash Price |
$382.03
|
| Rate for Payer: Coventry All Commercial |
$350.80
|
| Rate for Payer: Frontpath All Commercial |
$395.49
|
| Rate for Payer: Humana ChoiceCare |
$267.51
|
| Rate for Payer: Humana Medicare |
$292.33
|
| Rate for Payer: Lucent All Commercial |
$496.96
|
| Rate for Payer: Lutheran Preferred All Commercial |
$468.00
|
| Rate for Payer: PHCS All Commercial |
$462.14
|
| Rate for Payer: PHP All Commercial |
$496.24
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$292.33
|
| Rate for Payer: Signature Care EPO |
$447.95
|
| Rate for Payer: Signature Care PPO |
$447.95
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$438.00
|
| Rate for Payer: United Healthcare Commercial |
$293.11
|
| Rate for Payer: United Healthcare Medicare |
$292.33
|
|
|
PR CLOSED RX WEIGHT BEAR DIST TIBIA
|
Professional
|
$590.10
|
|
|
Service Code
|
CPT 27824
|
| Hospital Charge Code |
z27824
|
| Min. Negotiated Rate |
$275.95 |
| Max. Negotiated Rate |
$494.17 |
| Rate for Payer: Aetna Medicare |
$290.69
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$453.35
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$453.35
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$334.29
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$319.76
|
| Rate for Payer: Cash Price |
$365.86
|
| Rate for Payer: Cash Price |
$365.86
|
| Rate for Payer: Coventry All Commercial |
$348.83
|
| Rate for Payer: Frontpath All Commercial |
$393.74
|
| Rate for Payer: Humana ChoiceCare |
$275.95
|
| Rate for Payer: Humana Medicare |
$290.69
|
| Rate for Payer: Lucent All Commercial |
$494.17
|
| Rate for Payer: Lutheran Preferred All Commercial |
$465.00
|
| Rate for Payer: PHCS All Commercial |
$442.58
|
| Rate for Payer: PHP All Commercial |
$493.46
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$290.69
|
| Rate for Payer: Signature Care EPO |
$477.70
|
| Rate for Payer: Signature Care PPO |
$477.70
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$436.00
|
| Rate for Payer: United Healthcare Commercial |
$303.34
|
| Rate for Payer: United Healthcare Medicare |
$290.69
|
|
|
PR CLOSED RX WEIGHT BEAR DIST TIB,MANIP
|
Professional
|
$1,003.02
|
|
|
Service Code
|
CPT 27825
|
| Hospital Charge Code |
z27825
|
| Min. Negotiated Rate |
$463.11 |
| Max. Negotiated Rate |
$825.35 |
| Rate for Payer: Aetna Medicare |
$463.11
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$713.80
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$713.80
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$532.58
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$509.42
|
| Rate for Payer: Cash Price |
$621.87
|
| Rate for Payer: Cash Price |
$621.87
|
| Rate for Payer: Coventry All Commercial |
$555.73
|
| Rate for Payer: Frontpath All Commercial |
$639.98
|
| Rate for Payer: Humana ChoiceCare |
$502.81
|
| Rate for Payer: Humana Medicare |
$463.11
|
| Rate for Payer: Lucent All Commercial |
$787.29
|
| Rate for Payer: Lutheran Preferred All Commercial |
$741.00
|
| Rate for Payer: PHCS All Commercial |
$752.26
|
| Rate for Payer: PHP All Commercial |
$786.16
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$463.11
|
| Rate for Payer: Signature Care EPO |
$825.35
|
| Rate for Payer: Signature Care PPO |
$825.35
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$695.00
|
| Rate for Payer: United Healthcare Commercial |
$532.85
|
| Rate for Payer: United Healthcare Medicare |
$463.11
|
|
|
PR CLOSED TREATMENT PST MALLEOLUS FRACTURE W MANIP
|
Professional
|
$823.38
|
|
|
Service Code
|
CPT 27768
|
| Hospital Charge Code |
z27768
|
| Min. Negotiated Rate |
$382.94 |
| Max. Negotiated Rate |
$717.38 |
| Rate for Payer: Aetna Medicare |
$421.99
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$544.73
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$544.73
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$485.29
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$464.19
|
| Rate for Payer: Cash Price |
$510.50
|
| Rate for Payer: Cash Price |
$510.50
|
| Rate for Payer: Coventry All Commercial |
$506.39
|
| Rate for Payer: Frontpath All Commercial |
$579.06
|
| Rate for Payer: Humana ChoiceCare |
$382.94
|
| Rate for Payer: Humana Medicare |
$421.99
|
| Rate for Payer: Lucent All Commercial |
$717.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$675.00
|
| Rate for Payer: PHCS All Commercial |
$617.54
|
| Rate for Payer: PHP All Commercial |
$716.35
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$421.99
|
| Rate for Payer: Signature Care EPO |
$519.89
|
| Rate for Payer: Signature Care PPO |
$519.89
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$633.00
|
| Rate for Payer: United Healthcare Commercial |
$429.26
|
| Rate for Payer: United Healthcare Medicare |
$421.99
|
|
|
PR CLOSED TREATMENT PST MALLEOLUS FRACTURE W/O MANIP
|
Professional
|
$541.74
|
|
|
Service Code
|
CPT 27767
|
| Hospital Charge Code |
z27767
|
| Min. Negotiated Rate |
$249.35 |
| Max. Negotiated Rate |
$469.35 |
| Rate for Payer: Aetna Medicare |
$276.09
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$351.29
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$351.29
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$317.50
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$303.70
|
| Rate for Payer: Cash Price |
$335.88
|
| Rate for Payer: Cash Price |
$335.88
|
| Rate for Payer: Coventry All Commercial |
$331.31
|
| Rate for Payer: Frontpath All Commercial |
$372.16
|
| Rate for Payer: Humana ChoiceCare |
$249.35
|
| Rate for Payer: Humana Medicare |
$276.09
|
| Rate for Payer: Lucent All Commercial |
$469.35
|
| Rate for Payer: Lutheran Preferred All Commercial |
$442.00
|
| Rate for Payer: PHCS All Commercial |
$406.30
|
| Rate for Payer: PHP All Commercial |
$469.21
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$276.09
|
| Rate for Payer: Signature Care EPO |
$336.90
|
| Rate for Payer: Signature Care PPO |
$336.90
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$414.00
|
| Rate for Payer: United Healthcare Commercial |
$265.25
|
| Rate for Payer: United Healthcare Medicare |
$276.09
|
|
