|
PR IMMUNIZ ADMIN THRU AGE 18 ANY ROUTE,W COUNSEL EA ADD VACCINE/TOXOID
|
Professional
|
$18.84
|
|
|
Service Code
|
CPT 90461
|
| Hospital Charge Code |
z90461
|
| Min. Negotiated Rate |
$9.66 |
| Max. Negotiated Rate |
$16.42 |
| Rate for Payer: Aetna Medicare |
$9.66
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$12.51
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$12.51
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$11.11
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$10.63
|
| Rate for Payer: Cash Price |
$11.68
|
| Rate for Payer: Cash Price |
$11.68
|
| Rate for Payer: Coventry All Commercial |
$11.59
|
| Rate for Payer: Frontpath All Commercial |
$13.42
|
| Rate for Payer: Humana ChoiceCare |
$12.99
|
| Rate for Payer: Humana Medicare |
$9.66
|
| Rate for Payer: Lucent All Commercial |
$16.42
|
| Rate for Payer: Lutheran Preferred All Commercial |
$13.00
|
| Rate for Payer: PHCS All Commercial |
$14.13
|
| Rate for Payer: PHP All Commercial |
$13.66
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$9.66
|
| Rate for Payer: Signature Care EPO |
$12.17
|
| Rate for Payer: Signature Care PPO |
$12.17
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$12.00
|
| Rate for Payer: United Healthcare Commercial |
$11.59
|
| Rate for Payer: United Healthcare Medicare |
$9.66
|
|
|
PR IMMUNOTHERAPY, 2+ INJECTIONS
|
Professional
|
$20.80
|
|
|
Service Code
|
CPT 95117
|
| Hospital Charge Code |
z95117
|
| Min. Negotiated Rate |
$10.66 |
| Max. Negotiated Rate |
$23.15 |
| Rate for Payer: Aetna Medicare |
$10.66
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$19.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$19.30
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$12.26
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$11.73
|
| Rate for Payer: Cash Price |
$12.90
|
| Rate for Payer: Cash Price |
$12.90
|
| Rate for Payer: Coventry All Commercial |
$12.79
|
| Rate for Payer: Frontpath All Commercial |
$17.99
|
| Rate for Payer: Humana ChoiceCare |
$23.15
|
| Rate for Payer: Humana Medicare |
$10.66
|
| Rate for Payer: Lucent All Commercial |
$18.12
|
| Rate for Payer: Lutheran Preferred All Commercial |
$14.00
|
| Rate for Payer: PHCS All Commercial |
$15.60
|
| Rate for Payer: PHP All Commercial |
$11.96
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$10.66
|
| Rate for Payer: Signature Care EPO |
$16.05
|
| Rate for Payer: Signature Care PPO |
$16.05
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$13.00
|
| Rate for Payer: United Healthcare Commercial |
$14.20
|
| Rate for Payer: United Healthcare Medicare |
$10.66
|
|
|
PR IMMUNOTHERAPY, ONE INJECTION
|
Professional
|
$17.78
|
|
|
Service Code
|
CPT 95115
|
| Hospital Charge Code |
z95115
|
| Min. Negotiated Rate |
$9.11 |
| Max. Negotiated Rate |
$18.15 |
| Rate for Payer: Aetna Medicare |
$9.11
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$15.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$15.00
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$10.48
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$10.02
|
| Rate for Payer: Cash Price |
$11.02
|
| Rate for Payer: Cash Price |
$11.02
|
| Rate for Payer: Coventry All Commercial |
$10.93
|
| Rate for Payer: Frontpath All Commercial |
$14.19
|
| Rate for Payer: Humana ChoiceCare |
$18.15
|
| Rate for Payer: Humana Medicare |
$9.11
|
| Rate for Payer: Lucent All Commercial |
$15.49
|
| Rate for Payer: Lutheran Preferred All Commercial |
$12.00
|
| Rate for Payer: PHCS All Commercial |
$13.34
|
| Rate for Payer: PHP All Commercial |
$10.23
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$9.11
|
| Rate for Payer: Signature Care EPO |
$11.90
|
| Rate for Payer: Signature Care PPO |
$11.90
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$11.00
|
| Rate for Payer: United Healthcare Commercial |
$11.71
|
| Rate for Payer: United Healthcare Medicare |
$9.11
|
|
|
PR IMPLANT,HORMONE,SUBCUTANEOUS
|
Professional
|
$171.44
|
|
|
Service Code
|
CPT 11980
|
| Hospital Charge Code |
z11980
|
| Min. Negotiated Rate |
$52.05 |
| Max. Negotiated Rate |
$128.58 |
| Rate for Payer: Aetna Medicare |
$52.05
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$123.13
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$123.13
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$59.86
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$57.26
|
| Rate for Payer: Cash Price |
$106.29
|
| Rate for Payer: Cash Price |
$106.29
|
| Rate for Payer: Coventry All Commercial |
$62.46
|
| Rate for Payer: Frontpath All Commercial |
$71.01
|
| Rate for Payer: Humana ChoiceCare |
$76.78
|
| Rate for Payer: Humana Medicare |
$52.05
|
| Rate for Payer: Lucent All Commercial |
$88.48
|
| Rate for Payer: Lutheran Preferred All Commercial |
$68.00
|
| Rate for Payer: PHCS All Commercial |
$128.58
|
| Rate for Payer: PHP All Commercial |
$71.10
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$52.05
|
| Rate for Payer: Signature Care EPO |
$107.10
|
| Rate for Payer: Signature Care PPO |
$107.10
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$62.00
|
| Rate for Payer: United Healthcare Commercial |
$91.34
|
| Rate for Payer: United Healthcare Medicare |
$52.05
|
|
|
PR INC/DRAIN PERITONSIL ABSCESS
|
Professional
|
$353.80
|
|
|
Service Code
|
CPT 42700
|
| Hospital Charge Code |
z42700
|
| Min. Negotiated Rate |
$127.61 |
| Max. Negotiated Rate |
$265.35 |
| Rate for Payer: Aetna Medicare |
$127.61
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$162.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$162.30
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$146.75
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$140.37
|
| Rate for Payer: Cash Price |
$219.36
|
| Rate for Payer: Cash Price |
$219.36
|
| Rate for Payer: Coventry All Commercial |
$153.13
|
| Rate for Payer: Frontpath All Commercial |
$172.87
|
| Rate for Payer: Humana ChoiceCare |
$145.93
|
| Rate for Payer: Humana Medicare |
$127.61
|
| Rate for Payer: Lucent All Commercial |
$216.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$191.00
|
| Rate for Payer: PHCS All Commercial |
$265.35
|
| Rate for Payer: PHP All Commercial |
$217.86
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$127.61
|
| Rate for Payer: Signature Care EPO |
$240.55
|
| Rate for Payer: Signature Care PPO |
$240.55
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$179.00
|
| Rate for Payer: United Healthcare Commercial |
$146.98
|
| Rate for Payer: United Healthcare Medicare |
$127.61
|
|
|
PR INCIS ACHILLES TENDON+LOCAL ANESTH
|
Professional
|
$603.34
|
|
|
Service Code
|
CPT 27605
|
| Hospital Charge Code |
z27605
|
| Min. Negotiated Rate |
$173.37 |
| Max. Negotiated Rate |
$533.92 |
| Rate for Payer: Aetna Medicare |
$173.37
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$379.34
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$379.34
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$199.38
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$190.71
|
| Rate for Payer: Cash Price |
$374.07
|
| Rate for Payer: Cash Price |
$374.07
|
| Rate for Payer: Coventry All Commercial |
$208.04
|
| Rate for Payer: Frontpath All Commercial |
$234.61
|
| Rate for Payer: Humana ChoiceCare |
$225.26
|
| Rate for Payer: Humana Medicare |
$173.37
|
| Rate for Payer: Lucent All Commercial |
$294.73
|
| Rate for Payer: Lutheran Preferred All Commercial |
$277.00
|
| Rate for Payer: PHCS All Commercial |
$452.50
|
| Rate for Payer: PHP All Commercial |
$294.31
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$173.37
|
| Rate for Payer: Signature Care EPO |
$533.92
|
| Rate for Payer: Signature Care PPO |
$533.92
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$260.00
|
| Rate for Payer: United Healthcare Commercial |
$220.41
|
| Rate for Payer: United Healthcare Medicare |
$173.37
|
|
|
PR INCIS DEEP FINGR/HAND BONE LESN
|
Professional
|
$1,008.94
|
|
|
Service Code
|
CPT 26034
|
| Hospital Charge Code |
z26034
|
| Min. Negotiated Rate |
$517.08 |
| Max. Negotiated Rate |
$879.04 |
| Rate for Payer: Aetna Medicare |
$517.08
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$703.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$703.00
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$594.64
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$568.79
|
| Rate for Payer: Cash Price |
$625.54
|
| Rate for Payer: Cash Price |
$625.54
|
| Rate for Payer: Coventry All Commercial |
$620.50
|
| Rate for Payer: Frontpath All Commercial |
$712.28
|
| Rate for Payer: Humana ChoiceCare |
$542.74
|
| Rate for Payer: Humana Medicare |
$517.08
|
| Rate for Payer: Lucent All Commercial |
$879.04
|
| Rate for Payer: Lutheran Preferred All Commercial |
$827.00
|
| Rate for Payer: PHCS All Commercial |
$756.70
|
| Rate for Payer: PHP All Commercial |
$877.77
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$517.08
|
| Rate for Payer: Signature Care EPO |
$722.50
|
| Rate for Payer: Signature Care PPO |
$722.50
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$776.00
|
| Rate for Payer: United Healthcare Commercial |
$562.39
|
| Rate for Payer: United Healthcare Medicare |
$517.08
|
|
|
PR INCIS/DRAIN ARM,DEEP ABSC/HEMATOMA
|
Professional
|
$654.52
|
|
|
Service Code
|
CPT 23930
|
| Hospital Charge Code |
z23930
|
| Min. Negotiated Rate |
$199.61 |
| Max. Negotiated Rate |
$490.89 |
| Rate for Payer: Aetna Medicare |
$199.61
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$365.65
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$365.65
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$229.55
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$219.57
|
| Rate for Payer: Cash Price |
$405.80
|
| Rate for Payer: Cash Price |
$405.80
|
| Rate for Payer: Coventry All Commercial |
$239.53
|
| Rate for Payer: Frontpath All Commercial |
$279.63
|
| Rate for Payer: Humana ChoiceCare |
$228.30
|
| Rate for Payer: Humana Medicare |
$199.61
|
| Rate for Payer: Lucent All Commercial |
$339.34
|
| Rate for Payer: Lutheran Preferred All Commercial |
$319.00
|
| Rate for Payer: PHCS All Commercial |
$490.89
|
| Rate for Payer: PHP All Commercial |
$338.85
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$199.61
|
| Rate for Payer: Signature Care EPO |
$326.40
|
| Rate for Payer: Signature Care PPO |
$326.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$299.00
|
| Rate for Payer: United Healthcare Commercial |
$232.39
|
| Rate for Payer: United Healthcare Medicare |
$199.61
|
|
|
PR INCIS/DRAIN ARM/ELBOW INFECT BURSA
|
Professional
|
$553.70
|
|
|
Service Code
|
CPT 23931
|
| Hospital Charge Code |
z23931
|
| Min. Negotiated Rate |
$150.41 |
| Max. Negotiated Rate |
$415.28 |
| Rate for Payer: Aetna Medicare |
$150.41
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$283.68
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$283.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$172.97
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$165.45
|
| Rate for Payer: Cash Price |
$343.29
|
| Rate for Payer: Cash Price |
$343.29
|
| Rate for Payer: Coventry All Commercial |
$180.49
|
| Rate for Payer: Frontpath All Commercial |
$205.48
|
| Rate for Payer: Humana ChoiceCare |
$169.70
|
| Rate for Payer: Humana Medicare |
$150.41
|
| Rate for Payer: Lucent All Commercial |
$255.70
|
| Rate for Payer: Lutheran Preferred All Commercial |
$241.00
|
| Rate for Payer: PHCS All Commercial |
$415.28
|
| Rate for Payer: PHP All Commercial |
$255.33
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$150.41
|
| Rate for Payer: Signature Care EPO |
$243.56
|
| Rate for Payer: Signature Care PPO |
$243.56
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$226.00
|
| Rate for Payer: United Healthcare Commercial |
$166.55
|
| Rate for Payer: United Healthcare Medicare |
$150.41
|
|
|
PR INCIS/DRAIN FOREARM DEEP ABSCESS
|
Professional
|
$1,266.12
|
|
|
Service Code
|
CPT 25028
|
| Hospital Charge Code |
z25028
|
| Min. Negotiated Rate |
$524.30 |
| Max. Negotiated Rate |
$1,103.11 |
| Rate for Payer: Aetna Medicare |
$648.89
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$524.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$524.30
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$746.22
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$713.78
|
| Rate for Payer: Cash Price |
$784.99
|
| Rate for Payer: Cash Price |
$784.99
|
| Rate for Payer: Coventry All Commercial |
$778.67
|
| Rate for Payer: Frontpath All Commercial |
$898.52
|
| Rate for Payer: Humana ChoiceCare |
$567.74
|
| Rate for Payer: Humana Medicare |
$648.89
|
| Rate for Payer: Lucent All Commercial |
$1,103.11
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,038.00
|
| Rate for Payer: PHCS All Commercial |
$949.59
|
| Rate for Payer: PHP All Commercial |
$1,101.53
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$648.89
|
| Rate for Payer: Signature Care EPO |
$777.75
|
| Rate for Payer: Signature Care PPO |
$777.75
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$973.00
|
| Rate for Payer: United Healthcare Commercial |
$541.00
|
| Rate for Payer: United Healthcare Medicare |
$648.89
|
|
|
PR INCIS/DRAIN PELVIS/HIP,OPEN BONE
|
Professional
|
$1,825.80
|
|
|
Service Code
|
CPT 26992
|
| Hospital Charge Code |
z26992
|
| Min. Negotiated Rate |
$935.72 |
| Max. Negotiated Rate |
$1,590.72 |
| Rate for Payer: Aetna Medicare |
$935.72
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,221.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,221.30
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,076.08
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,029.29
|
| Rate for Payer: Cash Price |
$1,132.00
|
| Rate for Payer: Cash Price |
$1,132.00
|
| Rate for Payer: Coventry All Commercial |
$1,122.86
|
| Rate for Payer: Frontpath All Commercial |
$1,310.58
|
| Rate for Payer: Humana ChoiceCare |
$1,020.43
|
| Rate for Payer: Humana Medicare |
$935.72
|
| Rate for Payer: Lucent All Commercial |
$1,590.72
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,497.00
|
| Rate for Payer: PHCS All Commercial |
$1,369.35
|
| Rate for Payer: PHP All Commercial |
$1,588.44
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$935.72
|
| Rate for Payer: Signature Care EPO |
$1,393.15
|
| Rate for Payer: Signature Care PPO |
$1,393.15
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,404.00
|
| Rate for Payer: United Healthcare Commercial |
$1,041.70
|
| Rate for Payer: United Healthcare Medicare |
$935.72
|
|
|
PR INCIS/DRAIN SHLDR ABSC/HEMA,DEEP
|
Professional
|
$800.48
|
|
|
Service Code
|
CPT 23030
|
| Hospital Charge Code |
z23030
|
| Min. Negotiated Rate |
$236.44 |
| Max. Negotiated Rate |
$600.36 |
| Rate for Payer: Aetna Medicare |
$236.44
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$439.90
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$439.90
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$271.91
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$260.08
|
| Rate for Payer: Cash Price |
$496.30
|
| Rate for Payer: Cash Price |
$496.30
|
| Rate for Payer: Coventry All Commercial |
$283.73
|
| Rate for Payer: Frontpath All Commercial |
$331.20
|
| Rate for Payer: Humana ChoiceCare |
$275.26
|
| Rate for Payer: Humana Medicare |
$236.44
|
| Rate for Payer: Lucent All Commercial |
$401.95
|
| Rate for Payer: Lutheran Preferred All Commercial |
$378.00
|
| Rate for Payer: PHCS All Commercial |
$600.36
|
| Rate for Payer: PHP All Commercial |
$401.36
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$236.44
|
| Rate for Payer: Signature Care EPO |
$373.15
|
| Rate for Payer: Signature Care PPO |
$373.15
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$355.00
|
| Rate for Payer: United Healthcare Commercial |
$276.43
|
| Rate for Payer: United Healthcare Medicare |
$236.44
|
|
|
PR INCIS/DRAIN THIGH/KNEE ABSCESS,DEEP
|
Professional
|
$1,224.14
|
|
|
Service Code
|
CPT 27301
|
| Hospital Charge Code |
z27301
|
| Min. Negotiated Rate |
$472.24 |
| Max. Negotiated Rate |
$918.10 |
| Rate for Payer: Aetna Medicare |
$472.24
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$711.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$711.00
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$543.08
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$519.46
|
| Rate for Payer: Cash Price |
$758.97
|
| Rate for Payer: Cash Price |
$758.97
|
| Rate for Payer: Coventry All Commercial |
$566.69
|
| Rate for Payer: Frontpath All Commercial |
$658.40
|
| Rate for Payer: Humana ChoiceCare |
$506.41
|
| Rate for Payer: Humana Medicare |
$472.24
|
| Rate for Payer: Lucent All Commercial |
$802.81
|
| Rate for Payer: Lutheran Preferred All Commercial |
$756.00
|
| Rate for Payer: PHCS All Commercial |
$918.10
|
| Rate for Payer: PHP All Commercial |
$801.93
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$472.24
|
| Rate for Payer: Signature Care EPO |
$794.75
|
| Rate for Payer: Signature Care PPO |
$794.75
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$708.00
|
| Rate for Payer: United Healthcare Commercial |
$530.75
|
| Rate for Payer: United Healthcare Medicare |
$472.24
|
|
|
PR INCISE EXTERNAL HEMORRHOID
|
Professional
|
$378.44
|
|
|
Service Code
|
CPT 46083
|
| Hospital Charge Code |
z46083
|
| Min. Negotiated Rate |
$101.95 |
| Max. Negotiated Rate |
$283.83 |
| Rate for Payer: Aetna Medicare |
$101.95
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$235.89
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$235.89
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$117.24
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$112.14
|
| Rate for Payer: Cash Price |
$234.63
|
| Rate for Payer: Cash Price |
$234.63
|
| Rate for Payer: Coventry All Commercial |
$122.34
|
| Rate for Payer: Frontpath All Commercial |
$142.18
|
| Rate for Payer: Humana ChoiceCare |
$104.28
|
| Rate for Payer: Humana Medicare |
$101.95
|
| Rate for Payer: Lucent All Commercial |
$173.32
|
| Rate for Payer: Lutheran Preferred All Commercial |
$153.00
|
| Rate for Payer: PHCS All Commercial |
$283.83
|
| Rate for Payer: PHP All Commercial |
$174.06
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$101.95
|
| Rate for Payer: Signature Care EPO |
$215.05
|
| Rate for Payer: Signature Care PPO |
$215.05
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$143.00
|
| Rate for Payer: United Healthcare Commercial |
$112.35
|
| Rate for Payer: United Healthcare Medicare |
$101.95
|
|
|
PR INCISE FINGER TENDON SHEATH
|
Professional
|
$1,081.62
|
|
|
Service Code
|
CPT 26055
|
| Hospital Charge Code |
z26055
|
| Min. Negotiated Rate |
$274.33 |
| Max. Negotiated Rate |
$1,000.00 |
| Rate for Payer: Aetna Medicare |
$274.33
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,000.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,000.00
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$315.48
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$301.76
|
| Rate for Payer: Cash Price |
$670.60
|
| Rate for Payer: Cash Price |
$670.60
|
| Rate for Payer: Coventry All Commercial |
$329.20
|
| Rate for Payer: Frontpath All Commercial |
$374.00
|
| Rate for Payer: Humana ChoiceCare |
$281.86
|
| Rate for Payer: Humana Medicare |
$274.33
|
| Rate for Payer: Lucent All Commercial |
$466.36
|
| Rate for Payer: Lutheran Preferred All Commercial |
$439.00
|
| Rate for Payer: PHCS All Commercial |
$811.22
|
| Rate for Payer: PHP All Commercial |
$465.69
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$274.33
|
| Rate for Payer: Signature Care EPO |
$891.89
|
| Rate for Payer: Signature Care PPO |
$891.89
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$411.00
|
| Rate for Payer: United Healthcare Commercial |
$307.03
|
| Rate for Payer: United Healthcare Medicare |
$274.33
|
|
|
PR INCISE WRIST/FOREARM TENDON
|
Professional
|
$800.64
|
|
|
Service Code
|
CPT 25290
|
| Hospital Charge Code |
z25290
|
| Min. Negotiated Rate |
$410.32 |
| Max. Negotiated Rate |
$840.61 |
| Rate for Payer: Aetna Medicare |
$410.32
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$661.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$661.30
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$471.87
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$451.35
|
| Rate for Payer: Cash Price |
$496.40
|
| Rate for Payer: Cash Price |
$496.40
|
| Rate for Payer: Coventry All Commercial |
$492.38
|
| Rate for Payer: Frontpath All Commercial |
$564.17
|
| Rate for Payer: Humana ChoiceCare |
$840.61
|
| Rate for Payer: Humana Medicare |
$410.32
|
| Rate for Payer: Lucent All Commercial |
$697.54
|
| Rate for Payer: Lutheran Preferred All Commercial |
$657.00
|
| Rate for Payer: PHCS All Commercial |
$600.48
|
| Rate for Payer: PHP All Commercial |
$696.55
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$410.32
|
| Rate for Payer: Signature Care EPO |
$695.73
|
| Rate for Payer: Signature Care PPO |
$695.73
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$615.00
|
| Rate for Payer: United Healthcare Commercial |
$561.29
|
| Rate for Payer: United Healthcare Medicare |
$410.32
|
|
|
PR INCISION & DRAINAGE ABSCESS COMPLICATED/MULTIPLE
|
Professional
|
$389.48
|
|
|
Service Code
|
CPT 10061
|
| Hospital Charge Code |
z10061
|
| Min. Negotiated Rate |
$146.75 |
| Max. Negotiated Rate |
$292.11 |
| Rate for Payer: Aetna Medicare |
$171.82
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$201.56
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$201.56
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$197.59
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$189.00
|
| Rate for Payer: Cash Price |
$241.48
|
| Rate for Payer: Cash Price |
$241.48
|
| Rate for Payer: Coventry All Commercial |
$206.18
|
| Rate for Payer: Frontpath All Commercial |
$234.00
|
| Rate for Payer: Humana ChoiceCare |
$146.75
|
| Rate for Payer: Humana Medicare |
$171.82
|
| Rate for Payer: Lucent All Commercial |
$292.09
|
| Rate for Payer: Lutheran Preferred All Commercial |
$223.00
|
| Rate for Payer: PHCS All Commercial |
$292.11
|
| Rate for Payer: PHP All Commercial |
$234.68
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$171.82
|
| Rate for Payer: Signature Care EPO |
$174.25
|
| Rate for Payer: Signature Care PPO |
$174.25
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$206.00
|
| Rate for Payer: United Healthcare Commercial |
$178.20
|
| Rate for Payer: United Healthcare Medicare |
$171.82
|
|
|
PR INCISION & DRAINAGE ABSCESS SIMPLE/SINGLE
|
Professional
|
$230.20
|
|
|
Service Code
|
CPT 10060
|
| Hospital Charge Code |
z10060
|
| Min. Negotiated Rate |
$78.25 |
| Max. Negotiated Rate |
$172.65 |
| Rate for Payer: Aetna Medicare |
$98.84
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$112.64
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$112.64
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$113.67
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$108.72
|
| Rate for Payer: Cash Price |
$142.72
|
| Rate for Payer: Cash Price |
$142.72
|
| Rate for Payer: Coventry All Commercial |
$118.61
|
| Rate for Payer: Frontpath All Commercial |
$132.26
|
| Rate for Payer: Humana ChoiceCare |
$78.25
|
| Rate for Payer: Humana Medicare |
$98.84
|
| Rate for Payer: Lucent All Commercial |
$168.03
|
| Rate for Payer: Lutheran Preferred All Commercial |
$128.00
|
| Rate for Payer: PHCS All Commercial |
$172.65
|
| Rate for Payer: PHP All Commercial |
$135.00
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$98.84
|
| Rate for Payer: Signature Care EPO |
$99.74
|
| Rate for Payer: Signature Care PPO |
$99.74
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$119.00
|
| Rate for Payer: United Healthcare Commercial |
$99.94
|
| Rate for Payer: United Healthcare Medicare |
$98.84
|
|
|
PR INCISION & DRAINAGE COMPLEX PO WOUND INFECTION
|
Professional
|
$475.30
|
|
|
Service Code
|
CPT 10180
|
| Hospital Charge Code |
z10180
|
| Min. Negotiated Rate |
$159.38 |
| Max. Negotiated Rate |
$356.48 |
| Rate for Payer: Aetna Medicare |
$164.25
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$233.27
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$233.27
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$188.89
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$180.68
|
| Rate for Payer: Cash Price |
$294.69
|
| Rate for Payer: Cash Price |
$294.69
|
| Rate for Payer: Coventry All Commercial |
$197.10
|
| Rate for Payer: Frontpath All Commercial |
$229.12
|
| Rate for Payer: Humana ChoiceCare |
$159.38
|
| Rate for Payer: Humana Medicare |
$164.25
|
| Rate for Payer: Lucent All Commercial |
$279.22
|
| Rate for Payer: Lutheran Preferred All Commercial |
$214.00
|
| Rate for Payer: PHCS All Commercial |
$356.48
|
| Rate for Payer: PHP All Commercial |
$224.35
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$164.25
|
| Rate for Payer: Signature Care EPO |
$225.25
|
| Rate for Payer: Signature Care PPO |
$225.25
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$197.00
|
| Rate for Payer: United Healthcare Commercial |
$188.78
|
| Rate for Payer: United Healthcare Medicare |
$164.25
|
|
|
PR INCISION & DRAINAGE PILONIDAL CYST COMPLICATED
|
Professional
|
$625.48
|
|
|
Service Code
|
CPT 10081
|
| Hospital Charge Code |
z10081
|
| Min. Negotiated Rate |
$148.32 |
| Max. Negotiated Rate |
$469.11 |
| Rate for Payer: Signature Care PPO |
$279.28
|
| Rate for Payer: Aetna Medicare |
$158.48
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$257.75
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$257.75
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$182.25
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$174.33
|
| Rate for Payer: Cash Price |
$387.80
|
| Rate for Payer: Cash Price |
$387.80
|
| Rate for Payer: Coventry All Commercial |
$190.18
|
| Rate for Payer: Frontpath All Commercial |
$220.54
|
| Rate for Payer: Humana ChoiceCare |
$148.32
|
| Rate for Payer: Humana Medicare |
$158.48
|
| Rate for Payer: Lucent All Commercial |
$269.42
|
| Rate for Payer: Lutheran Preferred All Commercial |
$206.00
|
| Rate for Payer: PHCS All Commercial |
$469.11
|
| Rate for Payer: PHP All Commercial |
$216.46
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$158.48
|
| Rate for Payer: Signature Care EPO |
$279.28
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$190.00
|
| Rate for Payer: United Healthcare Commercial |
$179.09
|
| Rate for Payer: United Healthcare Medicare |
$158.48
|
|
|
PR INCISION & DRAINAGE PILONIDAL CYST SIMPLE
|
Professional
|
$458.30
|
|
|
Service Code
|
CPT 10080
|
| Hospital Charge Code |
z10080
|
| Min. Negotiated Rate |
$84.27 |
| Max. Negotiated Rate |
$343.72 |
| Rate for Payer: Aetna Medicare |
$97.19
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$163.21
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$163.21
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$111.77
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$106.91
|
| Rate for Payer: Cash Price |
$284.15
|
| Rate for Payer: Cash Price |
$284.15
|
| Rate for Payer: Coventry All Commercial |
$116.63
|
| Rate for Payer: Frontpath All Commercial |
$133.33
|
| Rate for Payer: Humana ChoiceCare |
$84.27
|
| Rate for Payer: Humana Medicare |
$97.19
|
| Rate for Payer: Lucent All Commercial |
$165.22
|
| Rate for Payer: Lutheran Preferred All Commercial |
$126.00
|
| Rate for Payer: PHCS All Commercial |
$343.72
|
| Rate for Payer: PHP All Commercial |
$132.75
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$97.19
|
| Rate for Payer: Signature Care EPO |
$205.14
|
| Rate for Payer: Signature Care PPO |
$205.14
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$117.00
|
| Rate for Payer: United Healthcare Commercial |
$102.15
|
| Rate for Payer: United Healthcare Medicare |
$97.19
|
|
|
PR INCISION EARDRUM,ASPIR
|
Professional
|
$350.82
|
|
|
Service Code
|
CPT 69420
|
| Hospital Charge Code |
z69420
|
| Min. Negotiated Rate |
$113.11 |
| Max. Negotiated Rate |
$263.12 |
| Rate for Payer: Aetna Medicare |
$113.11
|
| Rate for Payer: Aetna Medicare |
$113.11
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$204.41
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$204.41
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$204.41
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$204.41
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$130.08
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$130.08
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$124.42
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$124.42
|
| Rate for Payer: Cash Price |
$217.51
|
| Rate for Payer: Cash Price |
$435.02
|
| Rate for Payer: Cash Price |
$217.51
|
| Rate for Payer: Cash Price |
$435.02
|
| Rate for Payer: Coventry All Commercial |
$135.73
|
| Rate for Payer: Coventry All Commercial |
$135.73
|
| Rate for Payer: Frontpath All Commercial |
$152.84
|
| Rate for Payer: Frontpath All Commercial |
$152.84
|
| Rate for Payer: Humana ChoiceCare |
$118.24
|
| Rate for Payer: Humana ChoiceCare |
$118.24
|
| Rate for Payer: Humana Medicare |
$113.11
|
| Rate for Payer: Humana Medicare |
$113.11
|
| Rate for Payer: Lucent All Commercial |
$192.29
|
| Rate for Payer: Lucent All Commercial |
$192.29
|
| Rate for Payer: Lutheran Preferred All Commercial |
$181.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$181.00
|
| Rate for Payer: PHCS All Commercial |
$263.12
|
| Rate for Payer: PHCS All Commercial |
$526.23
|
| Rate for Payer: PHP All Commercial |
$143.46
|
| Rate for Payer: PHP All Commercial |
$143.46
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$113.11
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$113.11
|
| Rate for Payer: Signature Care EPO |
$190.96
|
| Rate for Payer: Signature Care EPO |
$190.96
|
| Rate for Payer: Signature Care PPO |
$190.96
|
| Rate for Payer: Signature Care PPO |
$190.96
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$170.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$170.00
|
| Rate for Payer: United Healthcare Commercial |
$128.81
|
| Rate for Payer: United Healthcare Commercial |
$128.81
|
| Rate for Payer: United Healthcare Medicare |
$113.11
|
| Rate for Payer: United Healthcare Medicare |
$113.11
|
|
|
PR INCISION EARDRUM,ASPIR,GEN ANESTH
|
Professional
|
$558.32
|
|
|
Service Code
|
CPT 69421
|
| Hospital Charge Code |
z69421
|
| Min. Negotiated Rate |
$143.06 |
| Max. Negotiated Rate |
$418.74 |
| Rate for Payer: Aetna Medicare |
$143.06
|
| Rate for Payer: Aetna Medicare |
$143.06
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$165.60
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$165.60
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$165.60
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$165.60
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$164.52
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$164.52
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$157.37
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$157.37
|
| Rate for Payer: Cash Price |
$173.08
|
| Rate for Payer: Cash Price |
$173.08
|
| Rate for Payer: Cash Price |
$346.16
|
| Rate for Payer: Cash Price |
$346.16
|
| Rate for Payer: Coventry All Commercial |
$171.67
|
| Rate for Payer: Coventry All Commercial |
$171.67
|
| Rate for Payer: Frontpath All Commercial |
$193.83
|
| Rate for Payer: Frontpath All Commercial |
$193.83
|
| Rate for Payer: Humana ChoiceCare |
$157.80
|
| Rate for Payer: Humana ChoiceCare |
$157.80
|
| Rate for Payer: Humana Medicare |
$143.06
|
| Rate for Payer: Humana Medicare |
$143.06
|
| Rate for Payer: Lucent All Commercial |
$243.20
|
| Rate for Payer: Lucent All Commercial |
$243.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$229.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$229.00
|
| Rate for Payer: PHCS All Commercial |
$209.37
|
| Rate for Payer: PHCS All Commercial |
$418.74
|
| Rate for Payer: PHP All Commercial |
$181.45
|
| Rate for Payer: PHP All Commercial |
$181.45
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$143.06
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$143.06
|
| Rate for Payer: Signature Care EPO |
$183.60
|
| Rate for Payer: Signature Care EPO |
$183.60
|
| Rate for Payer: Signature Care PPO |
$183.60
|
| Rate for Payer: Signature Care PPO |
$183.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$215.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$215.00
|
| Rate for Payer: United Healthcare Commercial |
$163.24
|
| Rate for Payer: United Healthcare Commercial |
$163.24
|
| Rate for Payer: United Healthcare Medicare |
$143.06
|
| Rate for Payer: United Healthcare Medicare |
$143.06
|
|
|
PR INCISION OF TONGUE FOLD
|
Professional
|
$398.60
|
|
|
Service Code
|
CPT 41010
|
| Hospital Charge Code |
z41010
|
| Min. Negotiated Rate |
$103.33 |
| Max. Negotiated Rate |
$298.95 |
| Rate for Payer: Aetna Medicare |
$103.33
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$165.29
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$165.29
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$118.83
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$113.66
|
| Rate for Payer: Cash Price |
$247.13
|
| Rate for Payer: Cash Price |
$247.13
|
| Rate for Payer: Coventry All Commercial |
$124.00
|
| Rate for Payer: Frontpath All Commercial |
$139.63
|
| Rate for Payer: Humana ChoiceCare |
$115.22
|
| Rate for Payer: Humana Medicare |
$103.33
|
| Rate for Payer: Lucent All Commercial |
$175.66
|
| Rate for Payer: Lutheran Preferred All Commercial |
$155.00
|
| Rate for Payer: PHCS All Commercial |
$298.95
|
| Rate for Payer: PHP All Commercial |
$176.41
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$103.33
|
| Rate for Payer: Signature Care EPO |
$244.80
|
| Rate for Payer: Signature Care PPO |
$244.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$145.00
|
| Rate for Payer: United Healthcare Commercial |
$115.98
|
| Rate for Payer: United Healthcare Medicare |
$103.33
|
|
|
PR INCISION & REMOVAL FOREIGN BODY SUBQ TISS COMP
|
Professional
|
$482.84
|
|
|
Service Code
|
CPT 10121
|
| Hospital Charge Code |
z10121
|
| Min. Negotiated Rate |
$168.86 |
| Max. Negotiated Rate |
$362.13 |
| Rate for Payer: Aetna Medicare |
$171.51
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$311.54
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$311.54
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$197.24
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$188.66
|
| Rate for Payer: Cash Price |
$299.36
|
| Rate for Payer: Cash Price |
$299.36
|
| Rate for Payer: Coventry All Commercial |
$205.81
|
| Rate for Payer: Frontpath All Commercial |
$236.11
|
| Rate for Payer: Humana ChoiceCare |
$168.86
|
| Rate for Payer: Humana Medicare |
$171.51
|
| Rate for Payer: Lucent All Commercial |
$291.57
|
| Rate for Payer: Lutheran Preferred All Commercial |
$223.00
|
| Rate for Payer: PHCS All Commercial |
$362.13
|
| Rate for Payer: PHP All Commercial |
$234.26
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$171.51
|
| Rate for Payer: Signature Care EPO |
$247.35
|
| Rate for Payer: Signature Care PPO |
$247.35
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$206.00
|
| Rate for Payer: United Healthcare Commercial |
$200.61
|
| Rate for Payer: United Healthcare Medicare |
$171.51
|
|
