|
PR CLOSED TREAT VERT BODY FRACT
|
Professional
|
$565.50
|
|
|
Service Code
|
CPT 22310
|
| Hospital Charge Code |
z22310
|
| Min. Negotiated Rate |
$216.82 |
| Max. Negotiated Rate |
$470.66 |
| Rate for Payer: Aetna Medicare |
$276.86
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$290.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$290.30
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$318.39
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$304.55
|
| Rate for Payer: Cash Price |
$350.61
|
| Rate for Payer: Cash Price |
$350.61
|
| Rate for Payer: Coventry All Commercial |
$332.23
|
| Rate for Payer: Frontpath All Commercial |
$382.71
|
| Rate for Payer: Humana ChoiceCare |
$216.82
|
| Rate for Payer: Humana Medicare |
$276.86
|
| Rate for Payer: Lucent All Commercial |
$470.66
|
| Rate for Payer: Lutheran Preferred All Commercial |
$443.00
|
| Rate for Payer: PHCS All Commercial |
$424.12
|
| Rate for Payer: PHP All Commercial |
$469.98
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$276.86
|
| Rate for Payer: Signature Care EPO |
$425.00
|
| Rate for Payer: Signature Care PPO |
$425.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$415.00
|
| Rate for Payer: United Healthcare Commercial |
$284.15
|
| Rate for Payer: United Healthcare Medicare |
$276.86
|
|
|
PR CLOSED TX BIMALLEOLAR ANKLE FRACTURE W MANIP
|
Professional
|
$875.98
|
|
|
Service Code
|
CPT 27810
|
| Hospital Charge Code |
z27810
|
| Min. Negotiated Rate |
$403.87 |
| Max. Negotiated Rate |
$692.75 |
| Rate for Payer: Aetna Medicare |
$403.87
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$604.50
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$604.50
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$464.45
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$444.26
|
| Rate for Payer: Cash Price |
$543.11
|
| Rate for Payer: Cash Price |
$543.11
|
| Rate for Payer: Coventry All Commercial |
$484.64
|
| Rate for Payer: Frontpath All Commercial |
$553.97
|
| Rate for Payer: Humana ChoiceCare |
$443.23
|
| Rate for Payer: Humana Medicare |
$403.87
|
| Rate for Payer: Lucent All Commercial |
$686.58
|
| Rate for Payer: Lutheran Preferred All Commercial |
$646.00
|
| Rate for Payer: PHCS All Commercial |
$656.98
|
| Rate for Payer: PHP All Commercial |
$685.60
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$403.87
|
| Rate for Payer: Signature Care EPO |
$692.75
|
| Rate for Payer: Signature Care PPO |
$692.75
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$606.00
|
| Rate for Payer: United Healthcare Commercial |
$452.75
|
| Rate for Payer: United Healthcare Medicare |
$403.87
|
|
|
PR CLOSED TX BIMALLEOLAR ANKLE FRACTURE W/O MANIP
|
Professional
|
$622.72
|
|
|
Service Code
|
CPT 27808
|
| Hospital Charge Code |
z27808
|
| Min. Negotiated Rate |
$279.05 |
| Max. Negotiated Rate |
$494.78 |
| Rate for Payer: Aetna Medicare |
$291.05
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$455.89
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$455.89
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$334.71
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$320.16
|
| Rate for Payer: Cash Price |
$386.09
|
| Rate for Payer: Cash Price |
$386.09
|
| Rate for Payer: Coventry All Commercial |
$349.26
|
| Rate for Payer: Frontpath All Commercial |
$394.80
|
| Rate for Payer: Humana ChoiceCare |
$279.05
|
| Rate for Payer: Humana Medicare |
$291.05
|
| Rate for Payer: Lucent All Commercial |
$494.78
|
| Rate for Payer: Lutheran Preferred All Commercial |
$466.00
|
| Rate for Payer: PHCS All Commercial |
$467.04
|
| Rate for Payer: PHP All Commercial |
$494.08
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$291.05
|
| Rate for Payer: Signature Care EPO |
$481.10
|
| Rate for Payer: Signature Care PPO |
$481.10
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$437.00
|
| Rate for Payer: United Healthcare Commercial |
$296.75
|
| Rate for Payer: United Healthcare Medicare |
$291.05
|
|
|
PR CLOSED TX NASAL BONE FX W/MNPJ W/O STABILIZATION
|
Professional
|
$275.42
|
|
|
Service Code
|
CPT 21315
|
| Hospital Charge Code |
z21315
|
| Min. Negotiated Rate |
$55.95 |
| Max. Negotiated Rate |
$270.69 |
| Rate for Payer: Aetna Medicare |
$55.95
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$270.69
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$270.69
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$64.34
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$61.54
|
| Rate for Payer: Cash Price |
$170.76
|
| Rate for Payer: Cash Price |
$170.76
|
| Rate for Payer: Coventry All Commercial |
$67.14
|
| Rate for Payer: Frontpath All Commercial |
$76.36
|
| Rate for Payer: Humana ChoiceCare |
$143.34
|
| Rate for Payer: Humana Medicare |
$55.95
|
| Rate for Payer: Lucent All Commercial |
$95.12
|
| Rate for Payer: Lutheran Preferred All Commercial |
$90.00
|
| Rate for Payer: PHCS All Commercial |
$206.56
|
| Rate for Payer: PHP All Commercial |
$94.98
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$55.95
|
| Rate for Payer: Signature Care EPO |
$240.86
|
| Rate for Payer: Signature Care PPO |
$240.86
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$84.00
|
| Rate for Payer: United Healthcare Commercial |
$158.11
|
| Rate for Payer: United Healthcare Medicare |
$55.95
|
|
|
PR CLOSED TX NASAL BONE FX W/MNPJ W/STABILIZATION
|
Professional
|
$397.88
|
|
|
Service Code
|
CPT 21320
|
| Hospital Charge Code |
z21320
|
| Min. Negotiated Rate |
$88.76 |
| Max. Negotiated Rate |
$340.00 |
| Rate for Payer: Aetna Medicare |
$88.76
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$313.07
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$313.07
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$102.07
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$97.64
|
| Rate for Payer: Cash Price |
$246.69
|
| Rate for Payer: Cash Price |
$246.69
|
| Rate for Payer: Coventry All Commercial |
$106.51
|
| Rate for Payer: Frontpath All Commercial |
$123.59
|
| Rate for Payer: Humana ChoiceCare |
$148.27
|
| Rate for Payer: Humana Medicare |
$88.76
|
| Rate for Payer: Lucent All Commercial |
$150.89
|
| Rate for Payer: Lutheran Preferred All Commercial |
$142.00
|
| Rate for Payer: PHCS All Commercial |
$298.41
|
| Rate for Payer: PHP All Commercial |
$150.68
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$88.76
|
| Rate for Payer: Signature Care EPO |
$340.00
|
| Rate for Payer: Signature Care PPO |
$340.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$133.00
|
| Rate for Payer: United Healthcare Commercial |
$148.31
|
| Rate for Payer: United Healthcare Medicare |
$88.76
|
|
|
PR CLOSED TX ULNAR FRACTURE PROX END W/O MANIPULATE
|
Professional
|
$544.48
|
|
|
Service Code
|
CPT 24670
|
| Hospital Charge Code |
z24670
|
| Min. Negotiated Rate |
$240.53 |
| Max. Negotiated Rate |
$433.98 |
| Rate for Payer: Aetna Medicare |
$255.28
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$375.08
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$375.08
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$293.57
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$280.81
|
| Rate for Payer: Cash Price |
$337.58
|
| Rate for Payer: Cash Price |
$337.58
|
| Rate for Payer: Coventry All Commercial |
$306.34
|
| Rate for Payer: Frontpath All Commercial |
$346.40
|
| Rate for Payer: Humana ChoiceCare |
$240.53
|
| Rate for Payer: Humana Medicare |
$255.28
|
| Rate for Payer: Lucent All Commercial |
$433.98
|
| Rate for Payer: Lutheran Preferred All Commercial |
$408.00
|
| Rate for Payer: PHCS All Commercial |
$408.36
|
| Rate for Payer: PHP All Commercial |
$433.35
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$255.28
|
| Rate for Payer: Signature Care EPO |
$396.10
|
| Rate for Payer: Signature Care PPO |
$396.10
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$383.00
|
| Rate for Payer: United Healthcare Commercial |
$258.65
|
| Rate for Payer: United Healthcare Medicare |
$255.28
|
|
|
PR CLOSE ENTEROSTOMY
|
Professional
|
$1,549.26
|
|
|
Service Code
|
CPT 44620
|
| Hospital Charge Code |
z44620
|
| Min. Negotiated Rate |
$794.00 |
| Max. Negotiated Rate |
$1,355.60 |
| Rate for Payer: Aetna Medicare |
$794.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$840.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$840.00
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$913.10
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$873.40
|
| Rate for Payer: Cash Price |
$960.54
|
| Rate for Payer: Cash Price |
$960.54
|
| Rate for Payer: Coventry All Commercial |
$952.80
|
| Rate for Payer: Frontpath All Commercial |
$1,134.86
|
| Rate for Payer: Humana ChoiceCare |
$801.86
|
| Rate for Payer: Humana Medicare |
$794.00
|
| Rate for Payer: Lucent All Commercial |
$1,349.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,191.00
|
| Rate for Payer: PHCS All Commercial |
$1,161.94
|
| Rate for Payer: PHP All Commercial |
$1,355.60
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$794.00
|
| Rate for Payer: Signature Care EPO |
$1,011.50
|
| Rate for Payer: Signature Care PPO |
$1,011.50
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,112.00
|
| Rate for Payer: United Healthcare Commercial |
$920.73
|
| Rate for Payer: United Healthcare Medicare |
$794.00
|
|
|
PR CLOSE ENTEROSTOMY,RESEC+ANAST
|
Professional
|
$1,812.58
|
|
|
Service Code
|
CPT 44625
|
| Hospital Charge Code |
z44625
|
| Min. Negotiated Rate |
$928.94 |
| Max. Negotiated Rate |
$1,586.00 |
| Rate for Payer: Aetna Medicare |
$928.94
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,085.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,085.30
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,068.28
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,021.83
|
| Rate for Payer: Cash Price |
$1,123.80
|
| Rate for Payer: Cash Price |
$1,123.80
|
| Rate for Payer: Coventry All Commercial |
$1,114.73
|
| Rate for Payer: Frontpath All Commercial |
$1,325.08
|
| Rate for Payer: Humana ChoiceCare |
$978.15
|
| Rate for Payer: Humana Medicare |
$928.94
|
| Rate for Payer: Lucent All Commercial |
$1,579.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,393.00
|
| Rate for Payer: PHCS All Commercial |
$1,359.44
|
| Rate for Payer: PHP All Commercial |
$1,586.00
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$928.94
|
| Rate for Payer: Signature Care EPO |
$1,234.20
|
| Rate for Payer: Signature Care PPO |
$1,234.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,301.00
|
| Rate for Payer: United Healthcare Commercial |
$1,090.95
|
| Rate for Payer: United Healthcare Medicare |
$928.94
|
|
|
PR CLOSE ENTEROSTOMY,RESEC+COLOREC ANAS
|
Professional
|
$2,836.94
|
|
|
Service Code
|
CPT 44626
|
| Hospital Charge Code |
z44626
|
| Min. Negotiated Rate |
$1,453.93 |
| Max. Negotiated Rate |
$2,482.33 |
| Rate for Payer: Aetna Medicare |
$1,453.93
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,685.60
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,685.60
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,672.02
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,599.32
|
| Rate for Payer: Cash Price |
$1,758.90
|
| Rate for Payer: Cash Price |
$1,758.90
|
| Rate for Payer: Coventry All Commercial |
$1,744.72
|
| Rate for Payer: Frontpath All Commercial |
$2,103.14
|
| Rate for Payer: Humana ChoiceCare |
$1,617.49
|
| Rate for Payer: Humana Medicare |
$1,453.93
|
| Rate for Payer: Lucent All Commercial |
$2,471.68
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,181.00
|
| Rate for Payer: PHCS All Commercial |
$2,127.70
|
| Rate for Payer: PHP All Commercial |
$2,482.33
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,453.93
|
| Rate for Payer: Signature Care EPO |
$2,045.95
|
| Rate for Payer: Signature Care PPO |
$2,045.95
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,036.00
|
| Rate for Payer: United Healthcare Commercial |
$1,735.69
|
| Rate for Payer: United Healthcare Medicare |
$1,453.93
|
|
|
PR CLOSE RX DIST FINGR FX
|
Professional
|
$350.48
|
|
|
Service Code
|
CPT 26750
|
| Hospital Charge Code |
z26750
|
| Min. Negotiated Rate |
$158.31 |
| Max. Negotiated Rate |
$307.97 |
| Rate for Payer: Aetna Medicare |
$181.16
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$257.68
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$257.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$208.33
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$199.28
|
| Rate for Payer: Cash Price |
$217.30
|
| Rate for Payer: Cash Price |
$217.30
|
| Rate for Payer: Coventry All Commercial |
$217.39
|
| Rate for Payer: Frontpath All Commercial |
$242.71
|
| Rate for Payer: Humana ChoiceCare |
$158.31
|
| Rate for Payer: Humana Medicare |
$181.16
|
| Rate for Payer: Lucent All Commercial |
$307.97
|
| Rate for Payer: Lutheran Preferred All Commercial |
$290.00
|
| Rate for Payer: PHCS All Commercial |
$262.86
|
| Rate for Payer: PHP All Commercial |
$307.54
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$181.16
|
| Rate for Payer: Signature Care EPO |
$272.85
|
| Rate for Payer: Signature Care PPO |
$272.85
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$272.00
|
| Rate for Payer: United Healthcare Commercial |
$174.61
|
| Rate for Payer: United Healthcare Medicare |
$181.16
|
|
|
PR CLOSE RX FINGR ARTICULAR FX
|
Professional
|
$434.02
|
|
|
Service Code
|
CPT 26740
|
| Hospital Charge Code |
z26740
|
| Min. Negotiated Rate |
$197.79 |
| Max. Negotiated Rate |
$358.20 |
| Rate for Payer: Aetna Medicare |
$210.70
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$294.27
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$294.27
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$242.30
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$231.77
|
| Rate for Payer: Cash Price |
$269.09
|
| Rate for Payer: Cash Price |
$269.09
|
| Rate for Payer: Coventry All Commercial |
$252.84
|
| Rate for Payer: Frontpath All Commercial |
$283.60
|
| Rate for Payer: Humana ChoiceCare |
$197.79
|
| Rate for Payer: Humana Medicare |
$210.70
|
| Rate for Payer: Lucent All Commercial |
$358.19
|
| Rate for Payer: Lutheran Preferred All Commercial |
$337.00
|
| Rate for Payer: PHCS All Commercial |
$325.52
|
| Rate for Payer: PHP All Commercial |
$358.20
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$210.70
|
| Rate for Payer: Signature Care EPO |
$311.10
|
| Rate for Payer: Signature Care PPO |
$311.10
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$316.00
|
| Rate for Payer: United Healthcare Commercial |
$209.41
|
| Rate for Payer: United Healthcare Medicare |
$210.70
|
|
|
PR CLOSE RX FINGR ARTICULAR FX,MANIP
|
Professional
|
$695.20
|
|
|
Service Code
|
CPT 26742
|
| Hospital Charge Code |
z26742
|
| Min. Negotiated Rate |
$319.56 |
| Max. Negotiated Rate |
$549.95 |
| Rate for Payer: Aetna Medicare |
$319.56
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$442.70
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$442.70
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$367.49
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$351.52
|
| Rate for Payer: Cash Price |
$431.02
|
| Rate for Payer: Cash Price |
$431.02
|
| Rate for Payer: Coventry All Commercial |
$383.47
|
| Rate for Payer: Frontpath All Commercial |
$437.06
|
| Rate for Payer: Humana ChoiceCare |
$332.55
|
| Rate for Payer: Humana Medicare |
$319.56
|
| Rate for Payer: Lucent All Commercial |
$543.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$511.00
|
| Rate for Payer: PHCS All Commercial |
$521.40
|
| Rate for Payer: PHP All Commercial |
$542.47
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$319.56
|
| Rate for Payer: Signature Care EPO |
$549.95
|
| Rate for Payer: Signature Care PPO |
$549.95
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$479.00
|
| Rate for Payer: United Healthcare Commercial |
$343.79
|
| Rate for Payer: United Healthcare Medicare |
$319.56
|
|
|
PR CLOSE RX PROX/MID FING SHFT FX
|
Professional
|
$374.62
|
|
|
Service Code
|
CPT 26720
|
| Hospital Charge Code |
z26720
|
| Min. Negotiated Rate |
$158.53 |
| Max. Negotiated Rate |
$311.10 |
| Rate for Payer: Aetna Medicare |
$180.26
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$294.27
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$294.27
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$207.30
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$198.29
|
| Rate for Payer: Cash Price |
$232.26
|
| Rate for Payer: Cash Price |
$232.26
|
| Rate for Payer: Coventry All Commercial |
$216.31
|
| Rate for Payer: Frontpath All Commercial |
$242.14
|
| Rate for Payer: Humana ChoiceCare |
$158.53
|
| Rate for Payer: Humana Medicare |
$180.26
|
| Rate for Payer: Lucent All Commercial |
$306.44
|
| Rate for Payer: Lutheran Preferred All Commercial |
$288.00
|
| Rate for Payer: PHCS All Commercial |
$280.96
|
| Rate for Payer: PHP All Commercial |
$306.01
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$180.26
|
| Rate for Payer: Signature Care EPO |
$311.10
|
| Rate for Payer: Signature Care PPO |
$311.10
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$270.00
|
| Rate for Payer: United Healthcare Commercial |
$175.41
|
| Rate for Payer: United Healthcare Medicare |
$180.26
|
|
|
PR CLOSE RX PROX/MID FING SHFT FX,MANIP
|
Professional
|
$636.06
|
|
|
Service Code
|
CPT 26725
|
| Hospital Charge Code |
z26725
|
| Min. Negotiated Rate |
$289.86 |
| Max. Negotiated Rate |
$532.95 |
| Rate for Payer: Aetna Medicare |
$289.86
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$312.40
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$312.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$333.34
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$318.85
|
| Rate for Payer: Cash Price |
$394.36
|
| Rate for Payer: Cash Price |
$394.36
|
| Rate for Payer: Coventry All Commercial |
$347.83
|
| Rate for Payer: Frontpath All Commercial |
$395.32
|
| Rate for Payer: Humana ChoiceCare |
$294.30
|
| Rate for Payer: Humana Medicare |
$289.86
|
| Rate for Payer: Lucent All Commercial |
$492.76
|
| Rate for Payer: Lutheran Preferred All Commercial |
$464.00
|
| Rate for Payer: PHCS All Commercial |
$477.04
|
| Rate for Payer: PHP All Commercial |
$492.06
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$289.86
|
| Rate for Payer: Signature Care EPO |
$532.95
|
| Rate for Payer: Signature Care PPO |
$532.95
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$435.00
|
| Rate for Payer: United Healthcare Commercial |
$309.51
|
| Rate for Payer: United Healthcare Medicare |
$289.86
|
|
|
PR CLSD TX PELVIC RING FX W/O MANIPULATION
|
Professional
|
$242.50
|
|
|
Service Code
|
CPT 27197
|
| Hospital Charge Code |
z27197
|
| Min. Negotiated Rate |
$111.82 |
| Max. Negotiated Rate |
$211.28 |
| Rate for Payer: Aetna Medicare |
$124.28
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$111.82
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$111.82
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$142.92
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$136.71
|
| Rate for Payer: Cash Price |
$150.35
|
| Rate for Payer: Cash Price |
$150.35
|
| Rate for Payer: Coventry All Commercial |
$149.14
|
| Rate for Payer: Frontpath All Commercial |
$172.39
|
| Rate for Payer: Humana ChoiceCare |
$128.82
|
| Rate for Payer: Humana Medicare |
$124.28
|
| Rate for Payer: Lucent All Commercial |
$211.28
|
| Rate for Payer: Lutheran Preferred All Commercial |
$199.00
|
| Rate for Payer: PHCS All Commercial |
$181.88
|
| Rate for Payer: PHP All Commercial |
$210.98
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$124.28
|
| Rate for Payer: Signature Care EPO |
$158.73
|
| Rate for Payer: Signature Care PPO |
$158.73
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$186.00
|
| Rate for Payer: United Healthcare Commercial |
$141.28
|
| Rate for Payer: United Healthcare Medicare |
$124.28
|
|
|
PR CMBND ANTERPOST COLPORRAPHY W/CYSTO
|
Professional
|
$1,424.84
|
|
|
Service Code
|
CPT 57260
|
| Hospital Charge Code |
z57260
|
| Min. Negotiated Rate |
$579.43 |
| Max. Negotiated Rate |
$1,241.39 |
| Rate for Payer: Aetna Medicare |
$730.23
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$688.71
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$688.71
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$839.76
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$803.25
|
| Rate for Payer: Cash Price |
$883.40
|
| Rate for Payer: Cash Price |
$883.40
|
| Rate for Payer: Coventry All Commercial |
$876.28
|
| Rate for Payer: Frontpath All Commercial |
$1,021.31
|
| Rate for Payer: Humana ChoiceCare |
$579.43
|
| Rate for Payer: Humana Medicare |
$730.23
|
| Rate for Payer: Lucent All Commercial |
$1,241.39
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,022.00
|
| Rate for Payer: PHCS All Commercial |
$1,068.63
|
| Rate for Payer: PHP All Commercial |
$940.40
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$730.23
|
| Rate for Payer: Signature Care EPO |
$696.15
|
| Rate for Payer: Signature Care PPO |
$696.15
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$949.00
|
| Rate for Payer: United Healthcare Commercial |
$914.05
|
| Rate for Payer: United Healthcare Medicare |
$730.23
|
|
|
PR CMBND ANTERPOST COLPORRAPHY W/CYSTO W/NTRCL RPR
|
Professional
|
$1,593.70
|
|
|
Service Code
|
CPT 57265
|
| Hospital Charge Code |
z57265
|
| Min. Negotiated Rate |
$770.49 |
| Max. Negotiated Rate |
$1,388.51 |
| Rate for Payer: Aetna Medicare |
$816.77
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$914.85
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$914.85
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$939.29
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$898.45
|
| Rate for Payer: Cash Price |
$988.09
|
| Rate for Payer: Cash Price |
$988.09
|
| Rate for Payer: Coventry All Commercial |
$980.12
|
| Rate for Payer: Frontpath All Commercial |
$1,144.46
|
| Rate for Payer: Humana ChoiceCare |
$770.49
|
| Rate for Payer: Humana Medicare |
$816.77
|
| Rate for Payer: Lucent All Commercial |
$1,388.51
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,143.00
|
| Rate for Payer: PHCS All Commercial |
$1,195.28
|
| Rate for Payer: PHP All Commercial |
$1,051.84
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$816.77
|
| Rate for Payer: Signature Care EPO |
$924.80
|
| Rate for Payer: Signature Care PPO |
$924.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,062.00
|
| Rate for Payer: United Healthcare Commercial |
$1,020.51
|
| Rate for Payer: United Healthcare Medicare |
$816.77
|
|
|
PR COCM BY RHC/FQHC 60 MIN MO
|
Professional
|
$283.66
|
|
|
Service Code
|
CPT G0512
|
| Hospital Charge Code |
zG0512
|
| Min. Negotiated Rate |
$75.74 |
| Max. Negotiated Rate |
$212.74 |
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$134.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$134.30
|
| Rate for Payer: Cash Price |
$175.87
|
| Rate for Payer: Cash Price |
$175.87
|
| Rate for Payer: Humana ChoiceCare |
$117.16
|
| Rate for Payer: PHCS All Commercial |
$212.74
|
| Rate for Payer: PHP All Commercial |
$138.51
|
| Rate for Payer: United Healthcare Commercial |
$75.74
|
|
|
PR COLLJ & INTERPJ PHYSIOL DATA MIN 30 MIN EA 30 D
|
Professional
|
$100.54
|
|
|
Service Code
|
CPT 99091
|
| Hospital Charge Code |
z99091
|
| Min. Negotiated Rate |
$51.53 |
| Max. Negotiated Rate |
$87.60 |
| Rate for Payer: Aetna Medicare |
$51.53
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$59.26
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$56.68
|
| Rate for Payer: Cash Price |
$62.33
|
| Rate for Payer: Cash Price |
$62.33
|
| Rate for Payer: Coventry All Commercial |
$61.84
|
| Rate for Payer: Frontpath All Commercial |
$57.60
|
| Rate for Payer: Humana ChoiceCare |
$55.97
|
| Rate for Payer: Humana Medicare |
$51.53
|
| Rate for Payer: Lucent All Commercial |
$87.60
|
| Rate for Payer: PHCS All Commercial |
$75.40
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$51.53
|
| Rate for Payer: United Healthcare Commercial |
$65.99
|
| Rate for Payer: United Healthcare Medicare |
$51.53
|
|
|
PR COLON CA SCRN NOT HI RSK IND
|
Professional
|
$828.00
|
|
|
Service Code
|
CPT G0121
|
| Hospital Charge Code |
zG0121
|
| Min. Negotiated Rate |
$145.44 |
| Max. Negotiated Rate |
$621.00 |
| Rate for Payer: Aetna Medicare |
$171.11
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$417.70
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$417.70
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$196.78
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$188.22
|
| Rate for Payer: Cash Price |
$513.36
|
| Rate for Payer: Cash Price |
$513.36
|
| Rate for Payer: Coventry All Commercial |
$205.33
|
| Rate for Payer: Humana ChoiceCare |
$145.44
|
| Rate for Payer: Humana Medicare |
$171.11
|
| Rate for Payer: Lucent All Commercial |
$290.89
|
| Rate for Payer: PHCS All Commercial |
$621.00
|
| Rate for Payer: PHP All Commercial |
$146.90
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$171.11
|
| Rate for Payer: Signature Care EPO |
$472.36
|
| Rate for Payer: Signature Care PPO |
$472.36
|
| Rate for Payer: United Healthcare Commercial |
$248.13
|
| Rate for Payer: United Healthcare Medicare |
$171.11
|
|
|
PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD
|
Professional
|
$620.88
|
|
|
Service Code
|
CPT 45378
|
| Hospital Charge Code |
z45378
|
| Min. Negotiated Rate |
$170.95 |
| Max. Negotiated Rate |
$535.50 |
| Rate for Payer: Aetna Medicare |
$170.95
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$519.26
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$519.26
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$196.59
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$188.04
|
| Rate for Payer: Cash Price |
$384.95
|
| Rate for Payer: Cash Price |
$384.95
|
| Rate for Payer: Coventry All Commercial |
$205.14
|
| Rate for Payer: Frontpath All Commercial |
$237.82
|
| Rate for Payer: Humana ChoiceCare |
$233.74
|
| Rate for Payer: Humana Medicare |
$170.95
|
| Rate for Payer: Lucent All Commercial |
$290.62
|
| Rate for Payer: Lutheran Preferred All Commercial |
$256.00
|
| Rate for Payer: PHCS All Commercial |
$465.66
|
| Rate for Payer: PHP All Commercial |
$291.86
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$170.95
|
| Rate for Payer: Signature Care EPO |
$535.50
|
| Rate for Payer: Signature Care PPO |
$535.50
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$239.00
|
| Rate for Payer: United Healthcare Commercial |
$248.13
|
| Rate for Payer: United Healthcare Medicare |
$170.95
|
|
|
PR COLONOSCOPY STOMA CONTROL BLEEDING
|
Professional
|
$1,170.30
|
|
|
Service Code
|
CPT 44391
|
| Hospital Charge Code |
z44391
|
| Min. Negotiated Rate |
$213.89 |
| Max. Negotiated Rate |
$877.72 |
| Rate for Payer: Aetna Medicare |
$213.89
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$245.97
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$235.28
|
| Rate for Payer: Cash Price |
$725.59
|
| Rate for Payer: Cash Price |
$725.59
|
| Rate for Payer: Coventry All Commercial |
$256.67
|
| Rate for Payer: Frontpath All Commercial |
$297.45
|
| Rate for Payer: Humana ChoiceCare |
$271.70
|
| Rate for Payer: Humana Medicare |
$213.89
|
| Rate for Payer: Lucent All Commercial |
$363.61
|
| Rate for Payer: PHCS All Commercial |
$877.72
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$213.89
|
| Rate for Payer: United Healthcare Commercial |
$289.58
|
| Rate for Payer: United Healthcare Medicare |
$213.89
|
|
|
PR COLONOSCOPY STOMA DX INCLUDING COLLJ SPEC SPX
|
Professional
|
$575.84
|
|
|
Service Code
|
CPT 44388
|
| Hospital Charge Code |
z44388
|
| Min. Negotiated Rate |
$144.15 |
| Max. Negotiated Rate |
$437.75 |
| Rate for Payer: Aetna Medicare |
$144.15
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$347.10
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$347.10
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$165.77
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$158.56
|
| Rate for Payer: Cash Price |
$357.02
|
| Rate for Payer: Cash Price |
$357.02
|
| Rate for Payer: Coventry All Commercial |
$172.98
|
| Rate for Payer: Frontpath All Commercial |
$202.02
|
| Rate for Payer: Humana ChoiceCare |
$180.33
|
| Rate for Payer: Humana Medicare |
$144.15
|
| Rate for Payer: Lucent All Commercial |
$245.06
|
| Rate for Payer: Lutheran Preferred All Commercial |
$216.00
|
| Rate for Payer: PHCS All Commercial |
$431.88
|
| Rate for Payer: PHP All Commercial |
$246.12
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$144.15
|
| Rate for Payer: Signature Care EPO |
$437.75
|
| Rate for Payer: Signature Care PPO |
$437.75
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$202.00
|
| Rate for Payer: United Healthcare Commercial |
$189.61
|
| Rate for Payer: United Healthcare Medicare |
$144.15
|
|
|
PR COLONOSCOPY STOMA W/BIOPSY SINGLE/MULTIPLE
|
Professional
|
$752.88
|
|
|
Service Code
|
CPT 44389
|
| Hospital Charge Code |
z44389
|
| Min. Negotiated Rate |
$158.95 |
| Max. Negotiated Rate |
$564.66 |
| Rate for Payer: Aetna Medicare |
$158.95
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$182.79
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$174.84
|
| Rate for Payer: Cash Price |
$466.79
|
| Rate for Payer: Cash Price |
$466.79
|
| Rate for Payer: Coventry All Commercial |
$190.74
|
| Rate for Payer: Frontpath All Commercial |
$221.60
|
| Rate for Payer: Humana ChoiceCare |
$199.53
|
| Rate for Payer: Humana Medicare |
$158.95
|
| Rate for Payer: Lucent All Commercial |
$270.22
|
| Rate for Payer: PHCS All Commercial |
$564.66
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$158.95
|
| Rate for Payer: United Healthcare Commercial |
$211.73
|
| Rate for Payer: United Healthcare Medicare |
$158.95
|
|
|
PR COLONOSCOPY STOMA W/RMVL TUM POLYP/OTH LES SNARE
|
Professional
|
$801.46
|
|
|
Service Code
|
CPT 44394
|
| Hospital Charge Code |
z44394
|
| Min. Negotiated Rate |
$208.54 |
| Max. Negotiated Rate |
$668.95 |
| Rate for Payer: Aetna Medicare |
$208.54
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$500.40
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$500.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$239.82
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$229.39
|
| Rate for Payer: Cash Price |
$496.91
|
| Rate for Payer: Cash Price |
$496.91
|
| Rate for Payer: Coventry All Commercial |
$250.25
|
| Rate for Payer: Frontpath All Commercial |
$292.08
|
| Rate for Payer: Humana ChoiceCare |
$278.71
|
| Rate for Payer: Humana Medicare |
$208.54
|
| Rate for Payer: Lucent All Commercial |
$354.52
|
| Rate for Payer: Lutheran Preferred All Commercial |
$313.00
|
| Rate for Payer: PHCS All Commercial |
$601.10
|
| Rate for Payer: PHP All Commercial |
$356.05
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$208.54
|
| Rate for Payer: Signature Care EPO |
$668.95
|
| Rate for Payer: Signature Care PPO |
$668.95
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$292.00
|
| Rate for Payer: United Healthcare Commercial |
$294.79
|
| Rate for Payer: United Healthcare Medicare |
$208.54
|
|
