|
PR EXPLORE/DRAIN ELBOW FOR INFECT
|
Professional
|
$874.90
|
|
|
Service Code
|
CPT 24000
|
| Hospital Charge Code |
z24000
|
| Min. Negotiated Rate |
$448.39 |
| Max. Negotiated Rate |
$762.26 |
| Rate for Payer: Aetna Medicare |
$448.39
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$585.80
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$585.80
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$515.65
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$493.23
|
| Rate for Payer: Cash Price |
$542.44
|
| Rate for Payer: Cash Price |
$542.44
|
| Rate for Payer: Coventry All Commercial |
$538.07
|
| Rate for Payer: Frontpath All Commercial |
$614.03
|
| Rate for Payer: Humana ChoiceCare |
$486.89
|
| Rate for Payer: Humana Medicare |
$448.39
|
| Rate for Payer: Lucent All Commercial |
$762.26
|
| Rate for Payer: Lutheran Preferred All Commercial |
$717.00
|
| Rate for Payer: PHCS All Commercial |
$656.18
|
| Rate for Payer: PHP All Commercial |
$761.17
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$448.39
|
| Rate for Payer: Signature Care EPO |
$649.40
|
| Rate for Payer: Signature Care PPO |
$649.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$673.00
|
| Rate for Payer: United Healthcare Commercial |
$504.00
|
| Rate for Payer: United Healthcare Medicare |
$448.39
|
|
|
PR EXPLORE/TREAT INTERPHALANGEAL JT,EA
|
Professional
|
$732.74
|
|
|
Service Code
|
CPT 26080
|
| Hospital Charge Code |
z26080
|
| Min. Negotiated Rate |
$375.53 |
| Max. Negotiated Rate |
$638.40 |
| Rate for Payer: Aetna Medicare |
$375.53
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$532.80
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$532.80
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$431.86
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$413.08
|
| Rate for Payer: Cash Price |
$454.30
|
| Rate for Payer: Cash Price |
$454.30
|
| Rate for Payer: Coventry All Commercial |
$450.64
|
| Rate for Payer: Frontpath All Commercial |
$513.53
|
| Rate for Payer: Humana ChoiceCare |
$389.47
|
| Rate for Payer: Humana Medicare |
$375.53
|
| Rate for Payer: Lucent All Commercial |
$638.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$601.00
|
| Rate for Payer: PHCS All Commercial |
$549.56
|
| Rate for Payer: PHP All Commercial |
$637.48
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$375.53
|
| Rate for Payer: Signature Care EPO |
$518.50
|
| Rate for Payer: Signature Care PPO |
$518.50
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$563.00
|
| Rate for Payer: United Healthcare Commercial |
$400.63
|
| Rate for Payer: United Healthcare Medicare |
$375.53
|
|
|
PR EXPLORE & TREAT METACARPO-PHAL JT
|
Professional
|
$623.90
|
|
|
Service Code
|
CPT 26075
|
| Hospital Charge Code |
z26075
|
| Min. Negotiated Rate |
$319.44 |
| Max. Negotiated Rate |
$543.05 |
| Rate for Payer: Aetna Medicare |
$319.44
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$511.70
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$511.70
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$367.36
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$351.38
|
| Rate for Payer: Cash Price |
$386.82
|
| Rate for Payer: Cash Price |
$386.82
|
| Rate for Payer: Coventry All Commercial |
$383.33
|
| Rate for Payer: Frontpath All Commercial |
$435.68
|
| Rate for Payer: Humana ChoiceCare |
$325.03
|
| Rate for Payer: Humana Medicare |
$319.44
|
| Rate for Payer: Lucent All Commercial |
$543.05
|
| Rate for Payer: Lutheran Preferred All Commercial |
$511.00
|
| Rate for Payer: PHCS All Commercial |
$467.92
|
| Rate for Payer: PHP All Commercial |
$542.79
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$319.44
|
| Rate for Payer: Signature Care EPO |
$433.50
|
| Rate for Payer: Signature Care PPO |
$433.50
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$479.00
|
| Rate for Payer: United Healthcare Commercial |
$332.66
|
| Rate for Payer: United Healthcare Medicare |
$319.44
|
|
|
PR EXPLORE WOUND,EXTREMITY
|
Professional
|
$1,024.18
|
|
|
Service Code
|
CPT 20103
|
| Hospital Charge Code |
z20103
|
| Min. Negotiated Rate |
$319.60 |
| Max. Negotiated Rate |
$768.14 |
| Rate for Payer: Aetna Medicare |
$319.60
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$589.09
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$589.09
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$367.54
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$351.56
|
| Rate for Payer: Cash Price |
$634.99
|
| Rate for Payer: Cash Price |
$634.99
|
| Rate for Payer: Coventry All Commercial |
$383.52
|
| Rate for Payer: Frontpath All Commercial |
$447.92
|
| Rate for Payer: Humana ChoiceCare |
$379.71
|
| Rate for Payer: Humana Medicare |
$319.60
|
| Rate for Payer: Lucent All Commercial |
$543.32
|
| Rate for Payer: Lutheran Preferred All Commercial |
$511.00
|
| Rate for Payer: PHCS All Commercial |
$768.14
|
| Rate for Payer: PHP All Commercial |
$542.54
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$319.60
|
| Rate for Payer: Signature Care EPO |
$547.40
|
| Rate for Payer: Signature Care PPO |
$547.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$479.00
|
| Rate for Payer: United Healthcare Commercial |
$384.23
|
| Rate for Payer: United Healthcare Medicare |
$319.60
|
|
|
PR EXPLOR METATARSO-PHALANG JT
|
Professional
|
$885.86
|
|
|
Service Code
|
CPT 28022
|
| Hospital Charge Code |
z28022
|
| Min. Negotiated Rate |
$307.98 |
| Max. Negotiated Rate |
$664.40 |
| Rate for Payer: Aetna Medicare |
$307.98
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$449.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$449.30
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$354.18
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$338.78
|
| Rate for Payer: Cash Price |
$549.23
|
| Rate for Payer: Cash Price |
$549.23
|
| Rate for Payer: Coventry All Commercial |
$369.58
|
| Rate for Payer: Frontpath All Commercial |
$418.03
|
| Rate for Payer: Humana ChoiceCare |
$367.93
|
| Rate for Payer: Humana Medicare |
$307.98
|
| Rate for Payer: Lucent All Commercial |
$523.57
|
| Rate for Payer: Lutheran Preferred All Commercial |
$493.00
|
| Rate for Payer: PHCS All Commercial |
$664.40
|
| Rate for Payer: PHP All Commercial |
$523.34
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$307.98
|
| Rate for Payer: Signature Care EPO |
$617.10
|
| Rate for Payer: Signature Care PPO |
$617.10
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$462.00
|
| Rate for Payer: United Healthcare Commercial |
$371.08
|
| Rate for Payer: United Healthcare Medicare |
$307.98
|
|
|
PR EXT ECG,PT DEMAND EVENT, SYMPT MEMORY LOOP, RECORD
|
Professional
|
$14.78
|
|
|
Service Code
|
CPT 93270
|
| Hospital Charge Code |
z93270
|
| Min. Negotiated Rate |
$7.57 |
| Max. Negotiated Rate |
$59.66 |
| Rate for Payer: Aetna Medicare |
$7.57
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$8.69
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$8.69
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$8.71
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$8.33
|
| Rate for Payer: Cash Price |
$9.16
|
| Rate for Payer: Cash Price |
$9.16
|
| Rate for Payer: Coventry All Commercial |
$9.08
|
| Rate for Payer: Frontpath All Commercial |
$8.76
|
| Rate for Payer: Humana ChoiceCare |
$59.66
|
| Rate for Payer: Humana Medicare |
$7.57
|
| Rate for Payer: Lucent All Commercial |
$12.87
|
| Rate for Payer: Lutheran Preferred All Commercial |
$12.00
|
| Rate for Payer: PHCS All Commercial |
$11.08
|
| Rate for Payer: PHP All Commercial |
$10.86
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$7.57
|
| Rate for Payer: Signature Care EPO |
$12.99
|
| Rate for Payer: Signature Care PPO |
$12.99
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$11.00
|
| Rate for Payer: United Healthcare Commercial |
$23.69
|
| Rate for Payer: United Healthcare Medicare |
$7.57
|
|
|
PR EXT ECG RECORD CONTIN 48 HR, RECORD
|
Professional
|
$32.84
|
|
|
Service Code
|
CPT 93225
|
| Hospital Charge Code |
z93225
|
| Min. Negotiated Rate |
$16.83 |
| Max. Negotiated Rate |
$59.66 |
| Rate for Payer: Aetna Medicare |
$16.83
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$19.35
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$18.51
|
| Rate for Payer: Cash Price |
$20.36
|
| Rate for Payer: Cash Price |
$20.36
|
| Rate for Payer: Coventry All Commercial |
$20.20
|
| Rate for Payer: Frontpath All Commercial |
$19.88
|
| Rate for Payer: Humana ChoiceCare |
$59.66
|
| Rate for Payer: Humana Medicare |
$16.83
|
| Rate for Payer: Lucent All Commercial |
$28.61
|
| Rate for Payer: PHCS All Commercial |
$24.63
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$16.83
|
| Rate for Payer: United Healthcare Commercial |
$39.83
|
| Rate for Payer: United Healthcare Medicare |
$16.83
|
|
|
PR EXTERNAL ECG REC>48HR<7D RECORDING
|
Professional
|
$21.40
|
|
|
Service Code
|
CPT 93242
|
| Hospital Charge Code |
z93242
|
| Min. Negotiated Rate |
$10.97 |
| Max. Negotiated Rate |
$19.98 |
| Rate for Payer: Aetna Medicare |
$10.97
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$13.67
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$13.67
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$12.62
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$12.07
|
| Rate for Payer: Cash Price |
$13.27
|
| Rate for Payer: Cash Price |
$13.27
|
| Rate for Payer: Coventry All Commercial |
$13.16
|
| Rate for Payer: Frontpath All Commercial |
$14.66
|
| Rate for Payer: Humana ChoiceCare |
$18.58
|
| Rate for Payer: Humana Medicare |
$10.97
|
| Rate for Payer: Lucent All Commercial |
$18.65
|
| Rate for Payer: Lutheran Preferred All Commercial |
$18.00
|
| Rate for Payer: PHCS All Commercial |
$16.05
|
| Rate for Payer: PHP All Commercial |
$15.73
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$10.97
|
| Rate for Payer: Signature Care EPO |
$19.98
|
| Rate for Payer: Signature Care PPO |
$19.98
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$16.00
|
| Rate for Payer: United Healthcare Commercial |
$18.48
|
| Rate for Payer: United Healthcare Medicare |
$10.97
|
|
|
PR EXTERNAL ECG REC>48HR<7D REVIEW & INTERPRETATION
|
Professional
|
$43.92
|
|
|
Service Code
|
CPT 93244
|
| Hospital Charge Code |
z93244
|
| Min. Negotiated Rate |
$22.51 |
| Max. Negotiated Rate |
$38.27 |
| Rate for Payer: Aetna Medicare |
$22.51
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$23.74
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$23.74
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$25.89
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$24.76
|
| Rate for Payer: Cash Price |
$27.23
|
| Rate for Payer: Cash Price |
$27.23
|
| Rate for Payer: Coventry All Commercial |
$27.01
|
| Rate for Payer: Frontpath All Commercial |
$26.47
|
| Rate for Payer: Humana ChoiceCare |
$32.26
|
| Rate for Payer: Humana Medicare |
$22.51
|
| Rate for Payer: Lucent All Commercial |
$38.27
|
| Rate for Payer: Lutheran Preferred All Commercial |
$36.00
|
| Rate for Payer: PHCS All Commercial |
$32.94
|
| Rate for Payer: PHP All Commercial |
$32.29
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$22.51
|
| Rate for Payer: Signature Care EPO |
$34.71
|
| Rate for Payer: Signature Care PPO |
$34.71
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$34.00
|
| Rate for Payer: United Healthcare Commercial |
$31.36
|
| Rate for Payer: United Healthcare Medicare |
$22.51
|
|
|
PR EXTERNAL ECG REC>7D<15D RECORDING
|
Professional
|
$21.40
|
|
|
Service Code
|
CPT 93246
|
| Hospital Charge Code |
z93246
|
| Min. Negotiated Rate |
$10.97 |
| Max. Negotiated Rate |
$19.98 |
| Rate for Payer: Aetna Medicare |
$10.97
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$13.67
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$13.67
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$12.62
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$12.07
|
| Rate for Payer: Cash Price |
$13.27
|
| Rate for Payer: Cash Price |
$13.27
|
| Rate for Payer: Coventry All Commercial |
$13.16
|
| Rate for Payer: Frontpath All Commercial |
$14.66
|
| Rate for Payer: Humana ChoiceCare |
$18.58
|
| Rate for Payer: Humana Medicare |
$10.97
|
| Rate for Payer: Lucent All Commercial |
$18.65
|
| Rate for Payer: Lutheran Preferred All Commercial |
$18.00
|
| Rate for Payer: PHCS All Commercial |
$16.05
|
| Rate for Payer: PHP All Commercial |
$15.73
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$10.97
|
| Rate for Payer: Signature Care EPO |
$19.98
|
| Rate for Payer: Signature Care PPO |
$19.98
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$16.00
|
| Rate for Payer: United Healthcare Commercial |
$18.48
|
| Rate for Payer: United Healthcare Medicare |
$10.97
|
|
|
PR EXTERNAL ECG REC>7D<15D REVIEW & INTERPRETATION
|
Professional
|
$48.44
|
|
|
Service Code
|
CPT 93248
|
| Hospital Charge Code |
z93248
|
| Min. Negotiated Rate |
$24.83 |
| Max. Negotiated Rate |
$42.21 |
| Rate for Payer: Aetna Medicare |
$24.83
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$26.11
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$26.11
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$28.55
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$27.31
|
| Rate for Payer: Cash Price |
$30.03
|
| Rate for Payer: Cash Price |
$30.03
|
| Rate for Payer: Coventry All Commercial |
$29.80
|
| Rate for Payer: Frontpath All Commercial |
$29.07
|
| Rate for Payer: Humana ChoiceCare |
$35.48
|
| Rate for Payer: Humana Medicare |
$24.83
|
| Rate for Payer: Lucent All Commercial |
$42.21
|
| Rate for Payer: Lutheran Preferred All Commercial |
$40.00
|
| Rate for Payer: PHCS All Commercial |
$36.33
|
| Rate for Payer: PHP All Commercial |
$35.60
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$24.83
|
| Rate for Payer: Signature Care EPO |
$38.17
|
| Rate for Payer: Signature Care PPO |
$38.17
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$37.00
|
| Rate for Payer: United Healthcare Commercial |
$34.44
|
| Rate for Payer: United Healthcare Medicare |
$24.83
|
|
|
PR EX TUM/VASC MALF SFT TISS HAND/FNGR SUBQ 1.5+CM
|
Professional
|
$759.06
|
|
|
Service Code
|
CPT 26111
|
| Hospital Charge Code |
z26111
|
| Min. Negotiated Rate |
$389.02 |
| Max. Negotiated Rate |
$661.33 |
| Rate for Payer: Aetna Medicare |
$389.02
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$481.32
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$481.32
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$447.37
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$427.92
|
| Rate for Payer: Cash Price |
$470.62
|
| Rate for Payer: Cash Price |
$470.62
|
| Rate for Payer: Coventry All Commercial |
$466.82
|
| Rate for Payer: Frontpath All Commercial |
$536.78
|
| Rate for Payer: Humana ChoiceCare |
$430.51
|
| Rate for Payer: Humana Medicare |
$389.02
|
| Rate for Payer: Lucent All Commercial |
$661.33
|
| Rate for Payer: Lutheran Preferred All Commercial |
$622.00
|
| Rate for Payer: PHCS All Commercial |
$569.30
|
| Rate for Payer: PHP All Commercial |
$660.38
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$389.02
|
| Rate for Payer: Signature Care EPO |
$413.10
|
| Rate for Payer: Signature Care PPO |
$413.10
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$584.00
|
| Rate for Payer: United Healthcare Commercial |
$471.41
|
| Rate for Payer: United Healthcare Medicare |
$389.02
|
|
|
PR EX TUM/VASC MAL SFT TIS HAND/FNGR SUBFSC 1.5+CM
|
Professional
|
$999.90
|
|
|
Service Code
|
CPT 26113
|
| Hospital Charge Code |
z26113
|
| Min. Negotiated Rate |
$512.45 |
| Max. Negotiated Rate |
$871.16 |
| Rate for Payer: Aetna Medicare |
$512.45
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$633.24
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$633.24
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$589.32
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$563.70
|
| Rate for Payer: Cash Price |
$619.94
|
| Rate for Payer: Cash Price |
$619.94
|
| Rate for Payer: Coventry All Commercial |
$614.94
|
| Rate for Payer: Frontpath All Commercial |
$705.69
|
| Rate for Payer: Humana ChoiceCare |
$566.65
|
| Rate for Payer: Humana Medicare |
$512.45
|
| Rate for Payer: Lucent All Commercial |
$871.16
|
| Rate for Payer: Lutheran Preferred All Commercial |
$820.00
|
| Rate for Payer: PHCS All Commercial |
$749.92
|
| Rate for Payer: PHP All Commercial |
$869.92
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$512.45
|
| Rate for Payer: Signature Care EPO |
$543.15
|
| Rate for Payer: Signature Care PPO |
$543.15
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$769.00
|
| Rate for Payer: United Healthcare Commercial |
$619.85
|
| Rate for Payer: United Healthcare Medicare |
$512.45
|
|
|
PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS
|
Professional
|
$181.98
|
|
|
Service Code
|
CPT 90846
|
| Hospital Charge Code |
z90846
|
| Min. Negotiated Rate |
$74.79 |
| Max. Negotiated Rate |
$158.02 |
| Rate for Payer: Aetna Medicare |
$92.95
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$83.76
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$83.76
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$106.89
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$102.24
|
| Rate for Payer: Cash Price |
$112.83
|
| Rate for Payer: Cash Price |
$112.83
|
| Rate for Payer: Coventry All Commercial |
$111.54
|
| Rate for Payer: Frontpath All Commercial |
$106.58
|
| Rate for Payer: Humana ChoiceCare |
$74.79
|
| Rate for Payer: Humana Medicare |
$92.95
|
| Rate for Payer: Lucent All Commercial |
$158.02
|
| Rate for Payer: Lutheran Preferred All Commercial |
$121.00
|
| Rate for Payer: PHCS All Commercial |
$136.48
|
| Rate for Payer: PHP All Commercial |
$98.85
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$92.95
|
| Rate for Payer: Signature Care EPO |
$102.85
|
| Rate for Payer: Signature Care PPO |
$102.85
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$112.00
|
| Rate for Payer: United Healthcare Commercial |
$103.86
|
| Rate for Payer: United Healthcare Medicare |
$92.95
|
|
|
PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS
|
Professional
|
$189.78
|
|
|
Service Code
|
CPT 90847
|
| Hospital Charge Code |
z90847
|
| Min. Negotiated Rate |
$89.64 |
| Max. Negotiated Rate |
$164.83 |
| Rate for Payer: Aetna Medicare |
$96.96
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$104.16
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$104.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$111.50
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$106.66
|
| Rate for Payer: Cash Price |
$117.66
|
| Rate for Payer: Cash Price |
$117.66
|
| Rate for Payer: Coventry All Commercial |
$116.35
|
| Rate for Payer: Frontpath All Commercial |
$110.74
|
| Rate for Payer: Humana ChoiceCare |
$89.64
|
| Rate for Payer: Humana Medicare |
$96.96
|
| Rate for Payer: Lucent All Commercial |
$164.83
|
| Rate for Payer: Lutheran Preferred All Commercial |
$126.00
|
| Rate for Payer: PHCS All Commercial |
$142.34
|
| Rate for Payer: PHP All Commercial |
$103.11
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$96.96
|
| Rate for Payer: Signature Care EPO |
$125.80
|
| Rate for Payer: Signature Care PPO |
$125.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$116.00
|
| Rate for Payer: United Healthcare Commercial |
$124.58
|
| Rate for Payer: United Healthcare Medicare |
$96.96
|
|
|
PR FASCIOTOMY,ILIOTIBIAL,OPEN
|
Professional
|
$884.56
|
|
|
Service Code
|
CPT 27305
|
| Hospital Charge Code |
z27305
|
| Min. Negotiated Rate |
$453.02 |
| Max. Negotiated Rate |
$770.13 |
| Rate for Payer: Aetna Medicare |
$453.02
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$591.91
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$591.91
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$520.97
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$498.32
|
| Rate for Payer: Cash Price |
$548.43
|
| Rate for Payer: Cash Price |
$548.43
|
| Rate for Payer: Coventry All Commercial |
$543.62
|
| Rate for Payer: Frontpath All Commercial |
$627.15
|
| Rate for Payer: Humana ChoiceCare |
$482.93
|
| Rate for Payer: Humana Medicare |
$453.02
|
| Rate for Payer: Lucent All Commercial |
$770.13
|
| Rate for Payer: Lutheran Preferred All Commercial |
$725.00
|
| Rate for Payer: PHCS All Commercial |
$663.42
|
| Rate for Payer: PHP All Commercial |
$769.56
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$453.02
|
| Rate for Payer: Signature Care EPO |
$655.35
|
| Rate for Payer: Signature Care PPO |
$655.35
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$680.00
|
| Rate for Payer: United Healthcare Commercial |
$500.49
|
| Rate for Payer: United Healthcare Medicare |
$453.02
|
|
|
PR FEMORAL FX, OPEN TX
|
Professional
|
$2,153.46
|
|
|
Service Code
|
CPT 27236
|
| Hospital Charge Code |
z27236
|
| Min. Negotiated Rate |
$1,103.65 |
| Max. Negotiated Rate |
$1,876.20 |
| Rate for Payer: Aetna Medicare |
$1,103.65
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,514.40
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,514.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,269.20
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,214.02
|
| Rate for Payer: Cash Price |
$1,335.15
|
| Rate for Payer: Cash Price |
$1,335.15
|
| Rate for Payer: Coventry All Commercial |
$1,324.38
|
| Rate for Payer: Frontpath All Commercial |
$1,551.03
|
| Rate for Payer: Humana ChoiceCare |
$1,170.03
|
| Rate for Payer: Humana Medicare |
$1,103.65
|
| Rate for Payer: Lucent All Commercial |
$1,876.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,766.00
|
| Rate for Payer: PHCS All Commercial |
$1,615.10
|
| Rate for Payer: PHP All Commercial |
$1,873.51
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,103.65
|
| Rate for Payer: Signature Care EPO |
$1,560.60
|
| Rate for Payer: Signature Care PPO |
$1,560.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,655.00
|
| Rate for Payer: United Healthcare Commercial |
$1,302.09
|
| Rate for Payer: United Healthcare Medicare |
$1,103.65
|
|
|
PR FEMUR/KNEE SURG UNLISTED
|
Professional
|
$1,026.30
|
|
|
Service Code
|
CPT 27599
|
| Hospital Charge Code |
z27599
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$872.36 |
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$0.01
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$0.01
|
| Rate for Payer: Cash Price |
$636.31
|
| Rate for Payer: Cash Price |
$636.31
|
| Rate for Payer: Lutheran Preferred All Commercial |
$872.36
|
| Rate for Payer: PHCS All Commercial |
$769.72
|
| Rate for Payer: Signature Care EPO |
$654.27
|
| Rate for Payer: Signature Care PPO |
$654.27
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$615.78
|
|
|
PR FETAL CONTRACTN STRESS TEST
|
Professional
|
$125.50
|
|
|
Service Code
|
CPT 59020
|
| Hospital Charge Code |
z59020
|
| Min. Negotiated Rate |
$56.09 |
| Max. Negotiated Rate |
$109.34 |
| Rate for Payer: Aetna Medicare |
$64.32
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$83.21
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$83.21
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$73.97
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$70.75
|
| Rate for Payer: Cash Price |
$77.81
|
| Rate for Payer: Cash Price |
$77.81
|
| Rate for Payer: Coventry All Commercial |
$77.18
|
| Rate for Payer: Frontpath All Commercial |
$88.19
|
| Rate for Payer: Humana ChoiceCare |
$56.09
|
| Rate for Payer: Humana Medicare |
$64.32
|
| Rate for Payer: Lucent All Commercial |
$109.34
|
| Rate for Payer: Lutheran Preferred All Commercial |
$90.00
|
| Rate for Payer: PHCS All Commercial |
$94.12
|
| Rate for Payer: PHP All Commercial |
$82.83
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$64.32
|
| Rate for Payer: Signature Care EPO |
$73.10
|
| Rate for Payer: Signature Care PPO |
$73.10
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$84.00
|
| Rate for Payer: United Healthcare Commercial |
$77.75
|
| Rate for Payer: United Healthcare Medicare |
$64.32
|
|
|
PR FETAL NON-STRESS TEST
|
Professional
|
$87.32
|
|
|
Service Code
|
CPT 59025
|
| Hospital Charge Code |
z59025
|
| Min. Negotiated Rate |
$37.67 |
| Max. Negotiated Rate |
$76.08 |
| Rate for Payer: Aetna Medicare |
$44.75
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$54.82
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$54.82
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$51.46
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$49.22
|
| Rate for Payer: Cash Price |
$54.14
|
| Rate for Payer: Cash Price |
$54.14
|
| Rate for Payer: Coventry All Commercial |
$53.70
|
| Rate for Payer: Frontpath All Commercial |
$60.43
|
| Rate for Payer: Humana ChoiceCare |
$37.67
|
| Rate for Payer: Humana Medicare |
$44.75
|
| Rate for Payer: Lucent All Commercial |
$76.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$63.00
|
| Rate for Payer: PHCS All Commercial |
$65.49
|
| Rate for Payer: PHP All Commercial |
$57.63
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$44.75
|
| Rate for Payer: Signature Care EPO |
$49.30
|
| Rate for Payer: Signature Care PPO |
$49.30
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$58.00
|
| Rate for Payer: United Healthcare Commercial |
$51.95
|
| Rate for Payer: United Healthcare Medicare |
$44.75
|
|
|
PR FILTERED SPEECH HEARING TEST
|
Professional
|
$53.92
|
|
|
Service Code
|
CPT 92571
|
| Hospital Charge Code |
z92571
|
| Min. Negotiated Rate |
$15.40 |
| Max. Negotiated Rate |
$46.99 |
| Rate for Payer: Aetna Medicare |
$27.64
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$15.40
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$15.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$31.79
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$30.40
|
| Rate for Payer: Cash Price |
$33.43
|
| Rate for Payer: Cash Price |
$33.43
|
| Rate for Payer: Coventry All Commercial |
$33.17
|
| Rate for Payer: Frontpath All Commercial |
$29.26
|
| Rate for Payer: Humana ChoiceCare |
$16.44
|
| Rate for Payer: Humana Medicare |
$27.64
|
| Rate for Payer: Lucent All Commercial |
$46.99
|
| Rate for Payer: Lutheran Preferred All Commercial |
$36.00
|
| Rate for Payer: PHCS All Commercial |
$40.44
|
| Rate for Payer: PHP All Commercial |
$39.10
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$27.64
|
| Rate for Payer: Signature Care EPO |
$22.11
|
| Rate for Payer: Signature Care PPO |
$22.11
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$33.00
|
| Rate for Payer: United Healthcare Commercial |
$18.05
|
| Rate for Payer: United Healthcare Medicare |
$27.64
|
|
|
PR FINE NEEDLE ASPIRATION BX W/O IMG GDN 1ST LESION
|
Professional
|
$185.74
|
|
|
Service Code
|
CPT 10021
|
| Hospital Charge Code |
z10021
|
| Min. Negotiated Rate |
$51.36 |
| Max. Negotiated Rate |
$142.98 |
| Rate for Payer: Aetna Medicare |
$51.36
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$142.98
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$142.98
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$59.06
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$56.50
|
| Rate for Payer: Cash Price |
$115.16
|
| Rate for Payer: Cash Price |
$115.16
|
| Rate for Payer: Coventry All Commercial |
$61.63
|
| Rate for Payer: Frontpath All Commercial |
$70.73
|
| Rate for Payer: Humana ChoiceCare |
$68.32
|
| Rate for Payer: Humana Medicare |
$51.36
|
| Rate for Payer: Lucent All Commercial |
$87.31
|
| Rate for Payer: Lutheran Preferred All Commercial |
$67.00
|
| Rate for Payer: PHCS All Commercial |
$139.30
|
| Rate for Payer: PHP All Commercial |
$70.15
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$51.36
|
| Rate for Payer: Signature Care EPO |
$139.40
|
| Rate for Payer: Signature Care PPO |
$139.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$62.00
|
| Rate for Payer: United Healthcare Commercial |
$77.75
|
| Rate for Payer: United Healthcare Medicare |
$51.36
|
|
|
PR FIT/INSERT INTRAVAG SUPPORT DEVICE
|
Professional
|
$136.14
|
|
|
Service Code
|
CPT 57160
|
| Hospital Charge Code |
z57160
|
| Min. Negotiated Rate |
$42.91 |
| Max. Negotiated Rate |
$102.10 |
| Rate for Payer: Aetna Medicare |
$42.91
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$97.90
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$97.90
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$49.35
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$47.20
|
| Rate for Payer: Cash Price |
$84.41
|
| Rate for Payer: Cash Price |
$84.41
|
| Rate for Payer: Coventry All Commercial |
$51.49
|
| Rate for Payer: Frontpath All Commercial |
$59.50
|
| Rate for Payer: Humana ChoiceCare |
$55.06
|
| Rate for Payer: Humana Medicare |
$42.91
|
| Rate for Payer: Lucent All Commercial |
$72.95
|
| Rate for Payer: Lutheran Preferred All Commercial |
$60.00
|
| Rate for Payer: PHCS All Commercial |
$102.10
|
| Rate for Payer: PHP All Commercial |
$55.26
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$42.91
|
| Rate for Payer: Signature Care EPO |
$96.05
|
| Rate for Payer: Signature Care PPO |
$96.05
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$56.00
|
| Rate for Payer: United Healthcare Commercial |
$54.83
|
| Rate for Payer: United Healthcare Medicare |
$42.91
|
|
|
PR FIX INFRAPATELLA TENDON,PRIMARY
|
Professional
|
$1,139.64
|
|
|
Service Code
|
CPT 27380
|
| Hospital Charge Code |
z27380
|
| Min. Negotiated Rate |
$583.76 |
| Max. Negotiated Rate |
$992.39 |
| Rate for Payer: Aetna Medicare |
$583.76
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$744.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$744.30
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$671.32
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$642.14
|
| Rate for Payer: Cash Price |
$706.58
|
| Rate for Payer: Cash Price |
$706.58
|
| Rate for Payer: Coventry All Commercial |
$700.51
|
| Rate for Payer: Frontpath All Commercial |
$809.04
|
| Rate for Payer: Humana ChoiceCare |
$624.50
|
| Rate for Payer: Humana Medicare |
$583.76
|
| Rate for Payer: Lucent All Commercial |
$992.39
|
| Rate for Payer: Lutheran Preferred All Commercial |
$934.00
|
| Rate for Payer: PHCS All Commercial |
$854.73
|
| Rate for Payer: PHP All Commercial |
$991.49
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$583.76
|
| Rate for Payer: Signature Care EPO |
$835.55
|
| Rate for Payer: Signature Care PPO |
$835.55
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$876.00
|
| Rate for Payer: United Healthcare Commercial |
$631.75
|
| Rate for Payer: United Healthcare Medicare |
$583.76
|
|
|
PR FIX QUAD/HAMSTR MUSC RUPT,PRIMARY
|
Professional
|
$1,109.90
|
|
|
Service Code
|
CPT 27385
|
| Hospital Charge Code |
z27385
|
| Min. Negotiated Rate |
$568.82 |
| Max. Negotiated Rate |
$966.99 |
| Rate for Payer: Aetna Medicare |
$568.82
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$802.90
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$802.90
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$654.14
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$625.70
|
| Rate for Payer: Cash Price |
$688.14
|
| Rate for Payer: Cash Price |
$688.14
|
| Rate for Payer: Coventry All Commercial |
$682.58
|
| Rate for Payer: Frontpath All Commercial |
$786.40
|
| Rate for Payer: Humana ChoiceCare |
$666.82
|
| Rate for Payer: Humana Medicare |
$568.82
|
| Rate for Payer: Lucent All Commercial |
$966.99
|
| Rate for Payer: Lutheran Preferred All Commercial |
$910.00
|
| Rate for Payer: PHCS All Commercial |
$832.42
|
| Rate for Payer: PHP All Commercial |
$965.61
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$568.82
|
| Rate for Payer: Signature Care EPO |
$891.65
|
| Rate for Payer: Signature Care PPO |
$891.65
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$853.00
|
| Rate for Payer: United Healthcare Commercial |
$677.16
|
| Rate for Payer: United Healthcare Medicare |
$568.82
|
|
