|
PR DILATION/CURETTAGE,DIAGNOSTIC
|
Professional
|
$545.04
|
|
|
Service Code
|
CPT 58120
|
| Hospital Charge Code |
z58120
|
| Min. Negotiated Rate |
$218.52 |
| Max. Negotiated Rate |
$408.78 |
| Rate for Payer: Aetna Medicare |
$218.52
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$292.22
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$292.22
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$251.30
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$240.37
|
| Rate for Payer: Cash Price |
$337.92
|
| Rate for Payer: Cash Price |
$337.92
|
| Rate for Payer: Coventry All Commercial |
$262.22
|
| Rate for Payer: Frontpath All Commercial |
$305.23
|
| Rate for Payer: Humana ChoiceCare |
$228.06
|
| Rate for Payer: Humana Medicare |
$218.52
|
| Rate for Payer: Lucent All Commercial |
$371.48
|
| Rate for Payer: Lutheran Preferred All Commercial |
$306.00
|
| Rate for Payer: PHCS All Commercial |
$408.78
|
| Rate for Payer: PHP All Commercial |
$281.41
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$218.52
|
| Rate for Payer: Signature Care EPO |
$276.25
|
| Rate for Payer: Signature Care PPO |
$276.25
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$284.00
|
| Rate for Payer: United Healthcare Commercial |
$242.55
|
| Rate for Payer: United Healthcare Medicare |
$218.52
|
|
|
PR DILATION OF CERVICAL CANAL
|
Professional
|
$142.02
|
|
|
Service Code
|
CPT 57800
|
| Hospital Charge Code |
z57800
|
| Min. Negotiated Rate |
$44.39 |
| Max. Negotiated Rate |
$106.52 |
| Rate for Payer: Aetna Medicare |
$44.39
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$79.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$79.30
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$51.05
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$48.83
|
| Rate for Payer: Cash Price |
$88.05
|
| Rate for Payer: Cash Price |
$88.05
|
| Rate for Payer: Coventry All Commercial |
$53.27
|
| Rate for Payer: Frontpath All Commercial |
$61.49
|
| Rate for Payer: Humana ChoiceCare |
$54.77
|
| Rate for Payer: Humana Medicare |
$44.39
|
| Rate for Payer: Lucent All Commercial |
$75.46
|
| Rate for Payer: Lutheran Preferred All Commercial |
$62.00
|
| Rate for Payer: PHCS All Commercial |
$106.52
|
| Rate for Payer: PHP All Commercial |
$57.16
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$44.39
|
| Rate for Payer: Signature Care EPO |
$74.80
|
| Rate for Payer: Signature Care PPO |
$74.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$58.00
|
| Rate for Payer: United Healthcare Commercial |
$54.94
|
| Rate for Payer: United Healthcare Medicare |
$44.39
|
|
|
PR DILATION OF SALIVARY DUCT
|
Professional
|
$136.90
|
|
|
Service Code
|
CPT 42650
|
| Hospital Charge Code |
z42650
|
| Min. Negotiated Rate |
$55.03 |
| Max. Negotiated Rate |
$117.36 |
| Rate for Payer: Aetna Medicare |
$55.03
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$117.36
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$117.36
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$63.28
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$60.53
|
| Rate for Payer: Cash Price |
$84.88
|
| Rate for Payer: Cash Price |
$84.88
|
| Rate for Payer: Coventry All Commercial |
$66.04
|
| Rate for Payer: Frontpath All Commercial |
$74.15
|
| Rate for Payer: Humana ChoiceCare |
$65.50
|
| Rate for Payer: Humana Medicare |
$55.03
|
| Rate for Payer: Lucent All Commercial |
$93.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$83.00
|
| Rate for Payer: PHCS All Commercial |
$102.68
|
| Rate for Payer: PHP All Commercial |
$93.95
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$55.03
|
| Rate for Payer: Signature Care EPO |
$107.10
|
| Rate for Payer: Signature Care PPO |
$107.10
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$77.00
|
| Rate for Payer: United Healthcare Commercial |
$64.75
|
| Rate for Payer: United Healthcare Medicare |
$55.03
|
|
|
PR DIPHENHYDRAMINE HCL INJECTIO
|
Professional
|
$1.82
|
|
|
Service Code
|
CPT J1200
|
| Hospital Charge Code |
zJ1200
|
| Min. Negotiated Rate |
$1.16 |
| Max. Negotiated Rate |
$1.82 |
| Rate for Payer: Humana ChoiceCare |
$1.16
|
| Rate for Payer: PHP All Commercial |
$1.82
|
|
|
PR DISPENSING FEE BINAURAL
|
Professional
|
$800.00
|
|
|
Service Code
|
CPT V5160
|
| Hospital Charge Code |
zV5160
|
| Min. Negotiated Rate |
$239.05 |
| Max. Negotiated Rate |
$680.00 |
| Rate for Payer: Cash Price |
$496.00
|
| Rate for Payer: Cash Price |
$496.00
|
| Rate for Payer: Humana ChoiceCare |
$239.05
|
| Rate for Payer: PHCS All Commercial |
$600.00
|
| Rate for Payer: Signature Care EPO |
$680.00
|
| Rate for Payer: Signature Care PPO |
$680.00
|
| Rate for Payer: United Healthcare Commercial |
$409.73
|
|
|
PR DISPENSING FEE, MONAURAL
|
Professional
|
$400.00
|
|
|
Service Code
|
CPT V5241
|
| Hospital Charge Code |
zV5241
|
| Min. Negotiated Rate |
$300.00 |
| Max. Negotiated Rate |
$340.00 |
| Rate for Payer: Cash Price |
$248.00
|
| Rate for Payer: Cash Price |
$248.00
|
| Rate for Payer: PHCS All Commercial |
$300.00
|
| Rate for Payer: Signature Care EPO |
$340.00
|
| Rate for Payer: Signature Care PPO |
$340.00
|
|
|
PR DOPPLER COLOR FLOW VELOCITY MAP
|
Professional
|
$5.84
|
|
|
Service Code
|
CPT 93325
|
| Hospital Charge Code |
z93325
|
| Min. Negotiated Rate |
$4.38 |
| Max. Negotiated Rate |
$145.73 |
| Rate for Payer: Aetna Medicare |
$21.82
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$68.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$68.00
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$25.09
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$24.00
|
| Rate for Payer: Cash Price |
$3.62
|
| Rate for Payer: Cash Price |
$3.62
|
| Rate for Payer: Coventry All Commercial |
$26.18
|
| Rate for Payer: Frontpath All Commercial |
$24.90
|
| Rate for Payer: Humana ChoiceCare |
$145.73
|
| Rate for Payer: Humana Medicare |
$21.82
|
| Rate for Payer: Lucent All Commercial |
$37.09
|
| Rate for Payer: Lutheran Preferred All Commercial |
$35.00
|
| Rate for Payer: PHCS All Commercial |
$4.38
|
| Rate for Payer: PHP All Commercial |
$31.29
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$21.82
|
| Rate for Payer: Signature Care EPO |
$7.10
|
| Rate for Payer: Signature Care PPO |
$7.10
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$33.00
|
| Rate for Payer: United Healthcare Commercial |
$59.18
|
| Rate for Payer: United Healthcare Medicare |
$21.82
|
|
|
PR DOPPLER ECHO HEART,COMPLETE
|
Professional
|
$33.28
|
|
|
Service Code
|
CPT 93320
|
| Hospital Charge Code |
z93320
|
| Min. Negotiated Rate |
$24.96 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Aetna Medicare |
$47.47
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$114.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$114.00
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$54.59
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$52.22
|
| Rate for Payer: Cash Price |
$20.63
|
| Rate for Payer: Cash Price |
$20.63
|
| Rate for Payer: Coventry All Commercial |
$56.96
|
| Rate for Payer: Frontpath All Commercial |
$54.57
|
| Rate for Payer: Humana ChoiceCare |
$109.28
|
| Rate for Payer: Humana Medicare |
$47.47
|
| Rate for Payer: Lucent All Commercial |
$80.70
|
| Rate for Payer: Lutheran Preferred All Commercial |
$76.00
|
| Rate for Payer: PHCS All Commercial |
$24.96
|
| Rate for Payer: PHP All Commercial |
$68.07
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$47.47
|
| Rate for Payer: Signature Care EPO |
$34.72
|
| Rate for Payer: Signature Care PPO |
$34.72
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$71.00
|
| Rate for Payer: United Healthcare Commercial |
$89.34
|
| Rate for Payer: United Healthcare Medicare |
$47.47
|
|
|
PR DOPPLER ECHO HEART,LIMITED,F/U
|
Professional
|
$13.24
|
|
|
Service Code
|
CPT 93321
|
| Hospital Charge Code |
z93321
|
| Min. Negotiated Rate |
$9.93 |
| Max. Negotiated Rate |
$66.60 |
| Rate for Payer: Aetna Medicare |
$23.46
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$66.60
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$66.60
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$26.98
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$25.81
|
| Rate for Payer: Cash Price |
$8.21
|
| Rate for Payer: Cash Price |
$8.21
|
| Rate for Payer: Coventry All Commercial |
$28.15
|
| Rate for Payer: Frontpath All Commercial |
$26.98
|
| Rate for Payer: Humana ChoiceCare |
$64.34
|
| Rate for Payer: Humana Medicare |
$23.46
|
| Rate for Payer: Lucent All Commercial |
$39.88
|
| Rate for Payer: Lutheran Preferred All Commercial |
$38.00
|
| Rate for Payer: PHCS All Commercial |
$9.93
|
| Rate for Payer: PHP All Commercial |
$33.64
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$23.46
|
| Rate for Payer: Signature Care EPO |
$13.82
|
| Rate for Payer: Signature Care PPO |
$13.82
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$35.00
|
| Rate for Payer: United Healthcare Commercial |
$39.40
|
| Rate for Payer: United Healthcare Medicare |
$23.46
|
|
|
PR DRAIN ABD ABSCESS OPEN
|
Professional
|
$2,841.12
|
|
|
Service Code
|
CPT 49020
|
| Hospital Charge Code |
z49020
|
| Min. Negotiated Rate |
$1,165.00 |
| Max. Negotiated Rate |
$2,485.98 |
| Rate for Payer: Aetna Medicare |
$1,456.08
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,165.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,165.00
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,674.49
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,601.69
|
| Rate for Payer: Cash Price |
$1,761.49
|
| Rate for Payer: Cash Price |
$1,761.49
|
| Rate for Payer: Coventry All Commercial |
$1,747.30
|
| Rate for Payer: Frontpath All Commercial |
$2,103.67
|
| Rate for Payer: Humana ChoiceCare |
$1,510.53
|
| Rate for Payer: Humana Medicare |
$1,456.08
|
| Rate for Payer: Lucent All Commercial |
$2,475.34
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,184.00
|
| Rate for Payer: PHCS All Commercial |
$2,130.84
|
| Rate for Payer: PHP All Commercial |
$2,485.98
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,456.08
|
| Rate for Payer: Signature Care EPO |
$1,883.60
|
| Rate for Payer: Signature Care PPO |
$1,883.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,039.00
|
| Rate for Payer: United Healthcare Commercial |
$1,696.15
|
| Rate for Payer: United Healthcare Medicare |
$1,456.08
|
|
|
PR DRAIN ABSCESS/HEMATOMA,NASAL
|
Professional
|
$491.48
|
|
|
Service Code
|
CPT 30000
|
| Hospital Charge Code |
z30000
|
| Min. Negotiated Rate |
$113.89 |
| Max. Negotiated Rate |
$368.61 |
| Rate for Payer: Aetna Medicare |
$113.89
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$136.50
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$136.50
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$130.97
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$125.28
|
| Rate for Payer: Cash Price |
$304.72
|
| Rate for Payer: Cash Price |
$304.72
|
| Rate for Payer: Coventry All Commercial |
$136.67
|
| Rate for Payer: Frontpath All Commercial |
$153.72
|
| Rate for Payer: Humana ChoiceCare |
$126.24
|
| Rate for Payer: Humana Medicare |
$113.89
|
| Rate for Payer: Lucent All Commercial |
$193.61
|
| Rate for Payer: Lutheran Preferred All Commercial |
$182.00
|
| Rate for Payer: PHCS All Commercial |
$368.61
|
| Rate for Payer: PHP All Commercial |
$155.56
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$113.89
|
| Rate for Payer: Signature Care EPO |
$286.45
|
| Rate for Payer: Signature Care PPO |
$286.45
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$171.00
|
| Rate for Payer: United Healthcare Commercial |
$125.73
|
| Rate for Payer: United Healthcare Medicare |
$113.89
|
|
|
PR DRAIN ABSCESS/HEMATOMA,NASAL SEPTUM
|
Professional
|
$496.90
|
|
|
Service Code
|
CPT 30020
|
| Hospital Charge Code |
z30020
|
| Min. Negotiated Rate |
$114.82 |
| Max. Negotiated Rate |
$372.68 |
| Rate for Payer: Aetna Medicare |
$114.82
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$140.20
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$140.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$132.04
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$126.30
|
| Rate for Payer: Cash Price |
$308.08
|
| Rate for Payer: Cash Price |
$308.08
|
| Rate for Payer: Coventry All Commercial |
$137.78
|
| Rate for Payer: Frontpath All Commercial |
$155.45
|
| Rate for Payer: Humana ChoiceCare |
$129.58
|
| Rate for Payer: Humana Medicare |
$114.82
|
| Rate for Payer: Lucent All Commercial |
$195.19
|
| Rate for Payer: Lutheran Preferred All Commercial |
$184.00
|
| Rate for Payer: PHCS All Commercial |
$372.68
|
| Rate for Payer: PHP All Commercial |
$156.83
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$114.82
|
| Rate for Payer: Signature Care EPO |
$244.80
|
| Rate for Payer: Signature Care PPO |
$244.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$172.00
|
| Rate for Payer: United Healthcare Commercial |
$126.55
|
| Rate for Payer: United Healthcare Medicare |
$114.82
|
|
|
PR DRAINAGE OF GUM LESION
|
Professional
|
$530.62
|
|
|
Service Code
|
CPT 41800
|
| Hospital Charge Code |
z41800
|
| Min. Negotiated Rate |
$108.05 |
| Max. Negotiated Rate |
$397.96 |
| Rate for Payer: Aetna Medicare |
$143.20
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$185.29
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$185.29
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$164.68
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$157.52
|
| Rate for Payer: Cash Price |
$328.98
|
| Rate for Payer: Cash Price |
$328.98
|
| Rate for Payer: Coventry All Commercial |
$171.84
|
| Rate for Payer: Frontpath All Commercial |
$193.08
|
| Rate for Payer: Humana ChoiceCare |
$108.05
|
| Rate for Payer: Humana Medicare |
$143.20
|
| Rate for Payer: Lucent All Commercial |
$243.44
|
| Rate for Payer: Lutheran Preferred All Commercial |
$215.00
|
| Rate for Payer: PHCS All Commercial |
$397.96
|
| Rate for Payer: PHP All Commercial |
$244.50
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$143.20
|
| Rate for Payer: Signature Care EPO |
$233.35
|
| Rate for Payer: Signature Care PPO |
$233.35
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$200.00
|
| Rate for Payer: United Healthcare Commercial |
$136.01
|
| Rate for Payer: United Healthcare Medicare |
$143.20
|
|
|
PR DRAINAGE OF HIP JOINT
|
Professional
|
$1,694.88
|
|
|
Service Code
|
CPT 27030
|
| Hospital Charge Code |
z27030
|
| Min. Negotiated Rate |
$868.62 |
| Max. Negotiated Rate |
$1,476.65 |
| Rate for Payer: Aetna Medicare |
$868.62
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$998.91
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$955.48
|
| Rate for Payer: Cash Price |
$1,050.83
|
| Rate for Payer: Cash Price |
$1,050.83
|
| Rate for Payer: Coventry All Commercial |
$1,042.34
|
| Rate for Payer: Frontpath All Commercial |
$1,219.32
|
| Rate for Payer: Humana ChoiceCare |
$992.62
|
| Rate for Payer: Humana Medicare |
$868.62
|
| Rate for Payer: Lucent All Commercial |
$1,476.65
|
| Rate for Payer: PHCS All Commercial |
$1,271.16
|
| Rate for Payer: PHP All Commercial |
$1,474.54
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$868.62
|
| Rate for Payer: Signature Care EPO |
$1,330.25
|
| Rate for Payer: Signature Care PPO |
$1,330.25
|
| Rate for Payer: United Healthcare Commercial |
$1,031.79
|
| Rate for Payer: United Healthcare Medicare |
$868.62
|
|
|
PR DRAINAGE OF HYDROCELE,TUNICA
|
Professional
|
$219.48
|
|
|
Service Code
|
CPT 55000
|
| Hospital Charge Code |
z55000
|
| Min. Negotiated Rate |
$78.52 |
| Max. Negotiated Rate |
$176.71 |
| Rate for Payer: Aetna Medicare |
$78.52
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$176.71
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$176.71
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$90.30
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$86.37
|
| Rate for Payer: Cash Price |
$136.08
|
| Rate for Payer: Cash Price |
$136.08
|
| Rate for Payer: Coventry All Commercial |
$94.22
|
| Rate for Payer: Frontpath All Commercial |
$108.60
|
| Rate for Payer: Humana ChoiceCare |
$99.40
|
| Rate for Payer: Humana Medicare |
$78.52
|
| Rate for Payer: Lucent All Commercial |
$133.48
|
| Rate for Payer: Lutheran Preferred All Commercial |
$110.00
|
| Rate for Payer: PHCS All Commercial |
$164.61
|
| Rate for Payer: PHP All Commercial |
$101.12
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$78.52
|
| Rate for Payer: Signature Care EPO |
$156.40
|
| Rate for Payer: Signature Care PPO |
$156.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$102.00
|
| Rate for Payer: United Healthcare Commercial |
$103.86
|
| Rate for Payer: United Healthcare Medicare |
$78.52
|
|
|
PR DRAIN BLOOD FROM UNDER NAIL
|
Professional
|
$104.02
|
|
|
Service Code
|
CPT 11740
|
| Hospital Charge Code |
z11740
|
| Min. Negotiated Rate |
$26.70 |
| Max. Negotiated Rate |
$78.02 |
| Rate for Payer: Aetna Medicare |
$29.85
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$45.26
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$45.26
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$34.33
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$32.84
|
| Rate for Payer: Cash Price |
$64.49
|
| Rate for Payer: Cash Price |
$64.49
|
| Rate for Payer: Coventry All Commercial |
$35.82
|
| Rate for Payer: Frontpath All Commercial |
$39.56
|
| Rate for Payer: Humana ChoiceCare |
$26.70
|
| Rate for Payer: Humana Medicare |
$29.85
|
| Rate for Payer: Lucent All Commercial |
$50.74
|
| Rate for Payer: Lutheran Preferred All Commercial |
$39.00
|
| Rate for Payer: PHCS All Commercial |
$78.02
|
| Rate for Payer: PHP All Commercial |
$40.77
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$29.85
|
| Rate for Payer: Signature Care EPO |
$49.30
|
| Rate for Payer: Signature Care PPO |
$49.30
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$36.00
|
| Rate for Payer: United Healthcare Commercial |
$34.31
|
| Rate for Payer: United Healthcare Medicare |
$29.85
|
|
|
PR DRAIN EXT AUD CANAL ABSCESS
|
Professional
|
$430.34
|
|
|
Service Code
|
CPT 69020
|
| Hospital Charge Code |
z69020
|
| Min. Negotiated Rate |
$135.65 |
| Max. Negotiated Rate |
$322.76 |
| Rate for Payer: Aetna Medicare |
$135.65
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$249.54
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$249.54
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$156.00
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$149.22
|
| Rate for Payer: Cash Price |
$266.81
|
| Rate for Payer: Cash Price |
$266.81
|
| Rate for Payer: Coventry All Commercial |
$162.78
|
| Rate for Payer: Frontpath All Commercial |
$183.17
|
| Rate for Payer: Humana ChoiceCare |
$142.96
|
| Rate for Payer: Humana Medicare |
$135.65
|
| Rate for Payer: Lucent All Commercial |
$230.60
|
| Rate for Payer: Lutheran Preferred All Commercial |
$217.00
|
| Rate for Payer: PHCS All Commercial |
$322.76
|
| Rate for Payer: PHP All Commercial |
$172.05
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$135.65
|
| Rate for Payer: Signature Care EPO |
$253.30
|
| Rate for Payer: Signature Care PPO |
$253.30
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$203.00
|
| Rate for Payer: United Healthcare Commercial |
$151.99
|
| Rate for Payer: United Healthcare Medicare |
$135.65
|
|
|
PR DRAIN EXT EAR ABSC/BLOOD,COMPLIC
|
Professional
|
$402.22
|
|
|
Service Code
|
CPT 69005
|
| Hospital Charge Code |
z69005
|
| Min. Negotiated Rate |
$150.57 |
| Max. Negotiated Rate |
$301.66 |
| Rate for Payer: Aetna Medicare |
$150.57
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$186.70
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$186.70
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$173.16
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$165.63
|
| Rate for Payer: Cash Price |
$249.38
|
| Rate for Payer: Cash Price |
$249.38
|
| Rate for Payer: Coventry All Commercial |
$180.68
|
| Rate for Payer: Frontpath All Commercial |
$205.75
|
| Rate for Payer: Humana ChoiceCare |
$161.57
|
| Rate for Payer: Humana Medicare |
$150.57
|
| Rate for Payer: Lucent All Commercial |
$255.97
|
| Rate for Payer: Lutheran Preferred All Commercial |
$241.00
|
| Rate for Payer: PHCS All Commercial |
$301.66
|
| Rate for Payer: PHP All Commercial |
$190.97
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$150.57
|
| Rate for Payer: Signature Care EPO |
$242.25
|
| Rate for Payer: Signature Care PPO |
$242.25
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$226.00
|
| Rate for Payer: United Healthcare Commercial |
$170.98
|
| Rate for Payer: United Healthcare Medicare |
$150.57
|
|
|
PR DRAIN EXT EAR ABSC/BLOOD,SIMPLE
|
Professional
|
$341.62
|
|
|
Service Code
|
CPT 69000
|
| Hospital Charge Code |
z69000
|
| Min. Negotiated Rate |
$114.72 |
| Max. Negotiated Rate |
$256.22 |
| Rate for Payer: Aetna Medicare |
$117.04
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$203.96
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$203.96
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$134.60
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$128.74
|
| Rate for Payer: Cash Price |
$211.80
|
| Rate for Payer: Cash Price |
$211.80
|
| Rate for Payer: Coventry All Commercial |
$140.45
|
| Rate for Payer: Frontpath All Commercial |
$158.48
|
| Rate for Payer: Humana ChoiceCare |
$114.72
|
| Rate for Payer: Humana Medicare |
$117.04
|
| Rate for Payer: Lucent All Commercial |
$198.97
|
| Rate for Payer: Lutheran Preferred All Commercial |
$187.00
|
| Rate for Payer: PHCS All Commercial |
$256.22
|
| Rate for Payer: PHP All Commercial |
$148.44
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$117.04
|
| Rate for Payer: Signature Care EPO |
$208.25
|
| Rate for Payer: Signature Care PPO |
$208.25
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$176.00
|
| Rate for Payer: United Healthcare Commercial |
$125.39
|
| Rate for Payer: United Healthcare Medicare |
$117.04
|
|
|
PR DRAIN FINGER ABSCESS,COMPLICATED
|
Professional
|
$880.22
|
|
|
Service Code
|
CPT 26011
|
| Hospital Charge Code |
z26011
|
| Min. Negotiated Rate |
$173.58 |
| Max. Negotiated Rate |
$660.16 |
| Rate for Payer: Aetna Medicare |
$173.58
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$439.63
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$439.63
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$199.62
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$190.94
|
| Rate for Payer: Cash Price |
$545.74
|
| Rate for Payer: Cash Price |
$545.74
|
| Rate for Payer: Coventry All Commercial |
$208.30
|
| Rate for Payer: Frontpath All Commercial |
$238.34
|
| Rate for Payer: Humana ChoiceCare |
$194.05
|
| Rate for Payer: Humana Medicare |
$173.58
|
| Rate for Payer: Lucent All Commercial |
$295.09
|
| Rate for Payer: Lutheran Preferred All Commercial |
$278.00
|
| Rate for Payer: PHCS All Commercial |
$660.16
|
| Rate for Payer: PHP All Commercial |
$294.66
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$173.58
|
| Rate for Payer: Signature Care EPO |
$621.35
|
| Rate for Payer: Signature Care PPO |
$621.35
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$260.00
|
| Rate for Payer: United Healthcare Commercial |
$194.63
|
| Rate for Payer: United Healthcare Medicare |
$173.58
|
|
|
PR DRAIN FINGER ABSCESS,SIMPLE
|
Professional
|
$629.84
|
|
|
Service Code
|
CPT 26010
|
| Hospital Charge Code |
z26010
|
| Min. Negotiated Rate |
$132.01 |
| Max. Negotiated Rate |
$472.38 |
| Rate for Payer: Aetna Medicare |
$132.01
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$298.38
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$298.38
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$151.81
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$145.21
|
| Rate for Payer: Cash Price |
$390.50
|
| Rate for Payer: Cash Price |
$390.50
|
| Rate for Payer: Coventry All Commercial |
$158.41
|
| Rate for Payer: Frontpath All Commercial |
$180.12
|
| Rate for Payer: Humana ChoiceCare |
$135.13
|
| Rate for Payer: Humana Medicare |
$132.01
|
| Rate for Payer: Lucent All Commercial |
$224.42
|
| Rate for Payer: Lutheran Preferred All Commercial |
$211.00
|
| Rate for Payer: PHCS All Commercial |
$472.38
|
| Rate for Payer: PHP All Commercial |
$224.09
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$132.01
|
| Rate for Payer: Signature Care EPO |
$397.80
|
| Rate for Payer: Signature Care PPO |
$397.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$198.00
|
| Rate for Payer: United Healthcare Commercial |
$139.34
|
| Rate for Payer: United Healthcare Medicare |
$132.01
|
|
|
PR DRAIN HAND TENDON SHEATH
|
Professional
|
$1,018.34
|
|
|
Service Code
|
CPT 26020
|
| Hospital Charge Code |
z26020
|
| Min. Negotiated Rate |
$429.74 |
| Max. Negotiated Rate |
$887.23 |
| Rate for Payer: Aetna Medicare |
$521.90
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$565.10
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$565.10
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$600.18
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$574.09
|
| Rate for Payer: Cash Price |
$631.37
|
| Rate for Payer: Cash Price |
$631.37
|
| Rate for Payer: Coventry All Commercial |
$626.28
|
| Rate for Payer: Frontpath All Commercial |
$718.77
|
| Rate for Payer: Humana ChoiceCare |
$429.74
|
| Rate for Payer: Humana Medicare |
$521.90
|
| Rate for Payer: Lucent All Commercial |
$887.23
|
| Rate for Payer: Lutheran Preferred All Commercial |
$835.00
|
| Rate for Payer: PHCS All Commercial |
$763.76
|
| Rate for Payer: PHP All Commercial |
$885.95
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$521.90
|
| Rate for Payer: Signature Care EPO |
$588.20
|
| Rate for Payer: Signature Care PPO |
$588.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$783.00
|
| Rate for Payer: United Healthcare Commercial |
$448.64
|
| Rate for Payer: United Healthcare Medicare |
$521.90
|
|
|
PR DRAIN MOUTH ABSC/CYST/HEMATOMA,SIMPL
|
Professional
|
$370.02
|
|
|
Service Code
|
CPT 40800
|
| Hospital Charge Code |
z40800
|
| Min. Negotiated Rate |
$111.22 |
| Max. Negotiated Rate |
$277.52 |
| Rate for Payer: Aetna Medicare |
$111.22
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$164.92
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$164.92
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$127.90
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$122.34
|
| Rate for Payer: Cash Price |
$229.41
|
| Rate for Payer: Cash Price |
$229.41
|
| Rate for Payer: Coventry All Commercial |
$133.46
|
| Rate for Payer: Frontpath All Commercial |
$149.55
|
| Rate for Payer: Humana ChoiceCare |
$128.80
|
| Rate for Payer: Humana Medicare |
$111.22
|
| Rate for Payer: Lucent All Commercial |
$189.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$167.00
|
| Rate for Payer: PHCS All Commercial |
$277.52
|
| Rate for Payer: PHP All Commercial |
$189.89
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$111.22
|
| Rate for Payer: Signature Care EPO |
$186.15
|
| Rate for Payer: Signature Care PPO |
$186.15
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$156.00
|
| Rate for Payer: United Healthcare Commercial |
$134.14
|
| Rate for Payer: United Healthcare Medicare |
$111.22
|
|
|
PR DRAIN OVARIAN ABSCESS,ABD APPRCH
|
Professional
|
$1,308.06
|
|
|
Service Code
|
CPT 58822
|
| Hospital Charge Code |
z58822
|
| Min. Negotiated Rate |
$670.38 |
| Max. Negotiated Rate |
$1,139.65 |
| Rate for Payer: Aetna Medicare |
$670.38
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$807.66
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$807.66
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$770.94
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$737.42
|
| Rate for Payer: Cash Price |
$811.00
|
| Rate for Payer: Cash Price |
$811.00
|
| Rate for Payer: Coventry All Commercial |
$804.46
|
| Rate for Payer: Frontpath All Commercial |
$938.55
|
| Rate for Payer: Humana ChoiceCare |
$680.80
|
| Rate for Payer: Humana Medicare |
$670.38
|
| Rate for Payer: Lucent All Commercial |
$1,139.65
|
| Rate for Payer: Lutheran Preferred All Commercial |
$939.00
|
| Rate for Payer: PHCS All Commercial |
$981.04
|
| Rate for Payer: PHP All Commercial |
$863.32
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$670.38
|
| Rate for Payer: Signature Care EPO |
$765.00
|
| Rate for Payer: Signature Care PPO |
$765.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$871.00
|
| Rate for Payer: United Healthcare Commercial |
$792.68
|
| Rate for Payer: United Healthcare Medicare |
$670.38
|
|
|
PR DRAIN OVARIAN CYST(S),ABD APPRCH
|
Professional
|
$784.88
|
|
|
Service Code
|
CPT 58805
|
| Hospital Charge Code |
z58805
|
| Min. Negotiated Rate |
$402.25 |
| Max. Negotiated Rate |
$683.82 |
| Rate for Payer: Aetna Medicare |
$402.25
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$492.92
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$492.92
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$462.59
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$442.48
|
| Rate for Payer: Cash Price |
$486.63
|
| Rate for Payer: Cash Price |
$486.63
|
| Rate for Payer: Coventry All Commercial |
$482.70
|
| Rate for Payer: Frontpath All Commercial |
$559.35
|
| Rate for Payer: Humana ChoiceCare |
$414.62
|
| Rate for Payer: Humana Medicare |
$402.25
|
| Rate for Payer: Lucent All Commercial |
$683.82
|
| Rate for Payer: Lutheran Preferred All Commercial |
$563.00
|
| Rate for Payer: PHCS All Commercial |
$588.66
|
| Rate for Payer: PHP All Commercial |
$518.02
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$402.25
|
| Rate for Payer: Signature Care EPO |
$468.35
|
| Rate for Payer: Signature Care PPO |
$468.35
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$523.00
|
| Rate for Payer: United Healthcare Commercial |
$453.45
|
| Rate for Payer: United Healthcare Medicare |
$402.25
|
|
