|
PR INCISION & REMOVAL FOREIGN BODY SUBQ TISS SIMPLE
|
Professional
|
$275.76
|
|
|
Service Code
|
CPT 10120
|
| Hospital Charge Code |
z10120
|
| Min. Negotiated Rate |
$81.52 |
| Max. Negotiated Rate |
$206.82 |
| Rate for Payer: Aetna Medicare |
$98.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$172.46
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$172.46
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$112.82
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$107.91
|
| Rate for Payer: Cash Price |
$170.97
|
| Rate for Payer: Cash Price |
$170.97
|
| Rate for Payer: Coventry All Commercial |
$117.72
|
| Rate for Payer: Frontpath All Commercial |
$130.61
|
| Rate for Payer: Humana ChoiceCare |
$81.52
|
| Rate for Payer: Humana Medicare |
$98.10
|
| Rate for Payer: Lucent All Commercial |
$166.77
|
| Rate for Payer: Lutheran Preferred All Commercial |
$128.00
|
| Rate for Payer: PHCS All Commercial |
$206.82
|
| Rate for Payer: PHP All Commercial |
$134.00
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$98.10
|
| Rate for Payer: Signature Care EPO |
$122.46
|
| Rate for Payer: Signature Care PPO |
$122.46
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$118.00
|
| Rate for Payer: United Healthcare Commercial |
$98.01
|
| Rate for Payer: United Healthcare Medicare |
$98.10
|
|
|
PR INCISION SUBCUT TOE TENDON
|
Professional
|
$429.52
|
|
|
Service Code
|
CPT 28010
|
| Hospital Charge Code |
z28010
|
| Min. Negotiated Rate |
$196.36 |
| Max. Negotiated Rate |
$333.81 |
| Rate for Payer: Aetna Medicare |
$196.36
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$225.81
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$216.00
|
| Rate for Payer: Cash Price |
$266.30
|
| Rate for Payer: Cash Price |
$266.30
|
| Rate for Payer: Coventry All Commercial |
$235.63
|
| Rate for Payer: Frontpath All Commercial |
$263.39
|
| Rate for Payer: Humana ChoiceCare |
$224.97
|
| Rate for Payer: Humana Medicare |
$196.36
|
| Rate for Payer: Lucent All Commercial |
$333.81
|
| Rate for Payer: PHCS All Commercial |
$322.14
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$196.36
|
| Rate for Payer: United Healthcare Commercial |
$236.03
|
| Rate for Payer: United Healthcare Medicare |
$196.36
|
|
|
PR INCISION SUBCUT TOE TENDON,>1
|
Professional
|
$578.94
|
|
|
Service Code
|
CPT 28011
|
| Hospital Charge Code |
z28011
|
| Min. Negotiated Rate |
$263.67 |
| Max. Negotiated Rate |
$448.24 |
| Rate for Payer: Aetna Medicare |
$263.67
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$303.22
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$290.04
|
| Rate for Payer: Cash Price |
$358.94
|
| Rate for Payer: Cash Price |
$358.94
|
| Rate for Payer: Coventry All Commercial |
$316.40
|
| Rate for Payer: Frontpath All Commercial |
$357.23
|
| Rate for Payer: Humana ChoiceCare |
$322.46
|
| Rate for Payer: Humana Medicare |
$263.67
|
| Rate for Payer: Lucent All Commercial |
$448.24
|
| Rate for Payer: PHCS All Commercial |
$434.20
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$263.67
|
| Rate for Payer: United Healthcare Commercial |
$333.13
|
| Rate for Payer: United Healthcare Medicare |
$263.67
|
|
|
PR INCIS TENDON SHEATH,RADIAL STYLOID
|
Professional
|
$636.16
|
|
|
Service Code
|
CPT 25000
|
| Hospital Charge Code |
z25000
|
| Min. Negotiated Rate |
$326.03 |
| Max. Negotiated Rate |
$554.25 |
| Rate for Payer: Aetna Medicare |
$326.03
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$405.70
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$405.70
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$374.93
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$358.63
|
| Rate for Payer: Cash Price |
$394.42
|
| Rate for Payer: Cash Price |
$394.42
|
| Rate for Payer: Coventry All Commercial |
$391.24
|
| Rate for Payer: Frontpath All Commercial |
$442.34
|
| Rate for Payer: Humana ChoiceCare |
$430.12
|
| Rate for Payer: Humana Medicare |
$326.03
|
| Rate for Payer: Lucent All Commercial |
$554.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$522.00
|
| Rate for Payer: PHCS All Commercial |
$477.12
|
| Rate for Payer: PHP All Commercial |
$553.46
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$326.03
|
| Rate for Payer: Signature Care EPO |
$542.45
|
| Rate for Payer: Signature Care PPO |
$542.45
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$489.00
|
| Rate for Payer: United Healthcare Commercial |
$366.11
|
| Rate for Payer: United Healthcare Medicare |
$326.03
|
|
|
PR INDUCED AB BY VAG SUPPOS
|
Professional
|
$755.64
|
|
|
Service Code
|
CPT 59855
|
| Hospital Charge Code |
z59855
|
| Min. Negotiated Rate |
$377.40 |
| Max. Negotiated Rate |
$658.34 |
| Rate for Payer: Aetna Medicare |
$387.26
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$543.82
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$543.82
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$445.35
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$425.99
|
| Rate for Payer: Cash Price |
$468.50
|
| Rate for Payer: Cash Price |
$468.50
|
| Rate for Payer: Coventry All Commercial |
$464.71
|
| Rate for Payer: Frontpath All Commercial |
$551.13
|
| Rate for Payer: Humana ChoiceCare |
$377.40
|
| Rate for Payer: Humana Medicare |
$387.26
|
| Rate for Payer: Lucent All Commercial |
$658.34
|
| Rate for Payer: Lutheran Preferred All Commercial |
$542.00
|
| Rate for Payer: PHCS All Commercial |
$566.73
|
| Rate for Payer: PHP All Commercial |
$498.72
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$387.26
|
| Rate for Payer: Signature Care EPO |
$485.35
|
| Rate for Payer: Signature Care PPO |
$485.35
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$503.00
|
| Rate for Payer: United Healthcare Commercial |
$462.13
|
| Rate for Payer: United Healthcare Medicare |
$387.26
|
|
|
PR INDUCED ABORTN BY DIL/EVAC
|
Professional
|
$762.16
|
|
|
Service Code
|
CPT 59841
|
| Hospital Charge Code |
z59841
|
| Min. Negotiated Rate |
$321.01 |
| Max. Negotiated Rate |
$576.38 |
| Rate for Payer: Aetna Medicare |
$339.05
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$500.90
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$500.90
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$389.91
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$372.96
|
| Rate for Payer: Cash Price |
$472.54
|
| Rate for Payer: Cash Price |
$472.54
|
| Rate for Payer: Coventry All Commercial |
$406.86
|
| Rate for Payer: Frontpath All Commercial |
$484.16
|
| Rate for Payer: Humana ChoiceCare |
$321.01
|
| Rate for Payer: Humana Medicare |
$339.05
|
| Rate for Payer: Lucent All Commercial |
$576.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$475.00
|
| Rate for Payer: PHCS All Commercial |
$571.62
|
| Rate for Payer: PHP All Commercial |
$436.63
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$339.05
|
| Rate for Payer: Signature Care EPO |
$394.40
|
| Rate for Payer: Signature Care PPO |
$394.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$441.00
|
| Rate for Payer: United Healthcare Commercial |
$397.18
|
| Rate for Payer: United Healthcare Medicare |
$339.05
|
|
|
PR INGESTION CHALLENGE TEST INITIAL 120 MINUTES
|
Professional
|
$223.94
|
|
|
Service Code
|
CPT 95076
|
| Hospital Charge Code |
z95076
|
| Min. Negotiated Rate |
$70.63 |
| Max. Negotiated Rate |
$167.96 |
| Rate for Payer: Aetna Medicare |
$70.63
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$121.18
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$121.18
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$81.22
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$77.69
|
| Rate for Payer: Cash Price |
$138.84
|
| Rate for Payer: Cash Price |
$138.84
|
| Rate for Payer: Coventry All Commercial |
$84.76
|
| Rate for Payer: Frontpath All Commercial |
$76.13
|
| Rate for Payer: Humana ChoiceCare |
$147.42
|
| Rate for Payer: Humana Medicare |
$70.63
|
| Rate for Payer: Lucent All Commercial |
$120.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$92.00
|
| Rate for Payer: PHCS All Commercial |
$167.96
|
| Rate for Payer: PHP All Commercial |
$79.24
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$70.63
|
| Rate for Payer: Signature Care EPO |
$127.87
|
| Rate for Payer: Signature Care PPO |
$127.87
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$85.00
|
| Rate for Payer: United Healthcare Commercial |
$92.15
|
| Rate for Payer: United Healthcare Medicare |
$70.63
|
|
|
PR INITIAL HOSP NEONATE 28 DAY OR LESS, CRITICALLY ILL
|
Professional
|
$1,663.42
|
|
|
Service Code
|
CPT 99468
|
| Hospital Charge Code |
z99468
|
| Min. Negotiated Rate |
$852.66 |
| Max. Negotiated Rate |
$3,140.00 |
| Rate for Payer: Aetna Medicare |
$852.66
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$974.10
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$974.10
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$980.56
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$937.93
|
| Rate for Payer: Cash Price |
$1,031.32
|
| Rate for Payer: Cash Price |
$1,031.32
|
| Rate for Payer: Coventry All Commercial |
$1,023.19
|
| Rate for Payer: Frontpath All Commercial |
$936.64
|
| Rate for Payer: Humana ChoiceCare |
$1,277.56
|
| Rate for Payer: Humana Medicare |
$852.66
|
| Rate for Payer: Lucent All Commercial |
$1,449.52
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,140.00
|
| Rate for Payer: PHCS All Commercial |
$1,247.56
|
| Rate for Payer: PHP All Commercial |
$856.66
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$852.66
|
| Rate for Payer: Signature Care EPO |
$914.46
|
| Rate for Payer: Signature Care PPO |
$914.46
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,140.00
|
| Rate for Payer: United Healthcare Commercial |
$882.53
|
| Rate for Payer: United Healthcare Medicare |
$852.66
|
|
|
PR INITIAL HOSP NEONATE 28 DAY OR LESS, NOT CRITICALLY ILL
|
Professional
|
$630.90
|
|
|
Service Code
|
CPT 99477
|
| Hospital Charge Code |
z99477
|
| Min. Negotiated Rate |
$296.95 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Medicare |
$323.34
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$442.71
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$442.71
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$371.84
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$355.67
|
| Rate for Payer: Cash Price |
$391.16
|
| Rate for Payer: Cash Price |
$391.16
|
| Rate for Payer: Coventry All Commercial |
$388.01
|
| Rate for Payer: Frontpath All Commercial |
$354.43
|
| Rate for Payer: Humana ChoiceCare |
$329.48
|
| Rate for Payer: Humana Medicare |
$323.34
|
| Rate for Payer: Lucent All Commercial |
$549.68
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,200.00
|
| Rate for Payer: PHCS All Commercial |
$473.18
|
| Rate for Payer: PHP All Commercial |
$324.91
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$323.34
|
| Rate for Payer: Signature Care EPO |
$296.95
|
| Rate for Payer: Signature Care PPO |
$296.95
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,200.00
|
| Rate for Payer: United Healthcare Commercial |
$343.61
|
| Rate for Payer: United Healthcare Medicare |
$323.34
|
|
|
PR INITIAL NORMAL NEWBORN CARE, HOSPITAL OR BIRTH CENTER
|
Professional
|
$172.88
|
|
|
Service Code
|
CPT 99460
|
| Hospital Charge Code |
z99460
|
| Min. Negotiated Rate |
$57.27 |
| Max. Negotiated Rate |
$325.00 |
| Rate for Payer: Aetna Medicare |
$88.60
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$106.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$106.00
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$101.89
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$97.46
|
| Rate for Payer: Cash Price |
$107.19
|
| Rate for Payer: Cash Price |
$107.19
|
| Rate for Payer: Coventry All Commercial |
$106.32
|
| Rate for Payer: Frontpath All Commercial |
$97.16
|
| Rate for Payer: Humana ChoiceCare |
$82.90
|
| Rate for Payer: Humana Medicare |
$88.60
|
| Rate for Payer: Lucent All Commercial |
$150.62
|
| Rate for Payer: Lutheran Preferred All Commercial |
$325.00
|
| Rate for Payer: PHCS All Commercial |
$129.66
|
| Rate for Payer: PHP All Commercial |
$89.04
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$88.60
|
| Rate for Payer: Signature Care EPO |
$81.97
|
| Rate for Payer: Signature Care PPO |
$81.97
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$325.00
|
| Rate for Payer: United Healthcare Commercial |
$57.27
|
| Rate for Payer: United Healthcare Medicare |
$88.60
|
|
|
PR INITIAL NORMAL NEWBORN CARE, SAME DAY DISCHARGE
|
Professional
|
$201.60
|
|
|
Service Code
|
CPT 99463
|
| Hospital Charge Code |
z99463
|
| Min. Negotiated Rate |
$76.59 |
| Max. Negotiated Rate |
$380.00 |
| Rate for Payer: Aetna Medicare |
$103.32
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$135.60
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$135.60
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$118.82
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$113.65
|
| Rate for Payer: Cash Price |
$124.99
|
| Rate for Payer: Cash Price |
$124.99
|
| Rate for Payer: Coventry All Commercial |
$123.98
|
| Rate for Payer: Frontpath All Commercial |
$111.61
|
| Rate for Payer: Humana ChoiceCare |
$110.87
|
| Rate for Payer: Humana Medicare |
$103.32
|
| Rate for Payer: Lucent All Commercial |
$175.64
|
| Rate for Payer: Lutheran Preferred All Commercial |
$380.00
|
| Rate for Payer: PHCS All Commercial |
$151.20
|
| Rate for Payer: PHP All Commercial |
$103.82
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$103.32
|
| Rate for Payer: Signature Care EPO |
$98.34
|
| Rate for Payer: Signature Care PPO |
$98.34
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$380.00
|
| Rate for Payer: United Healthcare Commercial |
$76.59
|
| Rate for Payer: United Healthcare Medicare |
$103.32
|
|
|
PR INITIAL NURSING FACILITY CARE HI MDM 50 MINUTES
|
Professional
|
$338.32
|
|
|
Service Code
|
CPT 99306
|
| Hospital Charge Code |
z99306
|
| Min. Negotiated Rate |
$108.59 |
| Max. Negotiated Rate |
$294.76 |
| Rate for Payer: Aetna Medicare |
$173.39
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$108.59
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$108.59
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$199.40
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$190.73
|
| Rate for Payer: Cash Price |
$209.76
|
| Rate for Payer: Cash Price |
$209.76
|
| Rate for Payer: Coventry All Commercial |
$208.07
|
| Rate for Payer: Frontpath All Commercial |
$167.29
|
| Rate for Payer: Humana ChoiceCare |
$110.03
|
| Rate for Payer: Humana Medicare |
$173.39
|
| Rate for Payer: Lucent All Commercial |
$294.76
|
| Rate for Payer: Lutheran Preferred All Commercial |
$182.00
|
| Rate for Payer: PHCS All Commercial |
$253.74
|
| Rate for Payer: PHP All Commercial |
$174.24
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$173.39
|
| Rate for Payer: Signature Care EPO |
$136.87
|
| Rate for Payer: Signature Care PPO |
$136.87
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$179.00
|
| Rate for Payer: United Healthcare Commercial |
$146.59
|
| Rate for Payer: United Healthcare Medicare |
$173.39
|
|
|
PR INITIAL NURSING FACILITY CARE MOD MDM 35 MINUTES
|
Professional
|
$246.86
|
|
|
Service Code
|
CPT 99305
|
| Hospital Charge Code |
z99305
|
| Min. Negotiated Rate |
$88.00 |
| Max. Negotiated Rate |
$215.07 |
| Rate for Payer: Aetna Medicare |
$126.51
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$88.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$88.00
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$145.49
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$139.16
|
| Rate for Payer: Cash Price |
$153.05
|
| Rate for Payer: Cash Price |
$153.05
|
| Rate for Payer: Coventry All Commercial |
$151.81
|
| Rate for Payer: Frontpath All Commercial |
$130.18
|
| Rate for Payer: Humana ChoiceCare |
$89.16
|
| Rate for Payer: Humana Medicare |
$126.51
|
| Rate for Payer: Lucent All Commercial |
$215.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$133.00
|
| Rate for Payer: PHCS All Commercial |
$185.14
|
| Rate for Payer: PHP All Commercial |
$127.13
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$126.51
|
| Rate for Payer: Signature Care EPO |
$107.26
|
| Rate for Payer: Signature Care PPO |
$107.26
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$130.00
|
| Rate for Payer: United Healthcare Commercial |
$114.07
|
| Rate for Payer: United Healthcare Medicare |
$126.51
|
|
|
PR INITIAL NURSING FACILITY CARE SF/LOW MDM 25 MIN
|
Professional
|
$149.02
|
|
|
Service Code
|
CPT 99304
|
| Hospital Charge Code |
z99304
|
| Min. Negotiated Rate |
$66.29 |
| Max. Negotiated Rate |
$129.83 |
| Rate for Payer: Aetna Medicare |
$76.37
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$66.29
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$66.29
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$87.83
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$84.01
|
| Rate for Payer: Cash Price |
$92.39
|
| Rate for Payer: Cash Price |
$92.39
|
| Rate for Payer: Coventry All Commercial |
$91.64
|
| Rate for Payer: Frontpath All Commercial |
$90.30
|
| Rate for Payer: Humana ChoiceCare |
$67.17
|
| Rate for Payer: Humana Medicare |
$76.37
|
| Rate for Payer: Lucent All Commercial |
$129.83
|
| Rate for Payer: Lutheran Preferred All Commercial |
$80.00
|
| Rate for Payer: PHCS All Commercial |
$111.76
|
| Rate for Payer: PHP All Commercial |
$76.74
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$76.37
|
| Rate for Payer: Signature Care EPO |
$75.14
|
| Rate for Payer: Signature Care PPO |
$75.14
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$79.00
|
| Rate for Payer: United Healthcare Commercial |
$81.57
|
| Rate for Payer: United Healthcare Medicare |
$76.37
|
|
|
PR INITIAL PREVENTIVE EXAM
|
Professional
|
$359.00
|
|
|
Service Code
|
CPT G0402
|
| Hospital Charge Code |
zG0402
|
| Min. Negotiated Rate |
$87.90 |
| Max. Negotiated Rate |
$269.25 |
| Rate for Payer: Aetna Medicare |
$124.96
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$87.90
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$87.90
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$143.70
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$137.46
|
| Rate for Payer: Cash Price |
$222.58
|
| Rate for Payer: Cash Price |
$222.58
|
| Rate for Payer: Coventry All Commercial |
$149.95
|
| Rate for Payer: Humana ChoiceCare |
$106.22
|
| Rate for Payer: Humana Medicare |
$124.96
|
| Rate for Payer: Lucent All Commercial |
$212.43
|
| Rate for Payer: PHCS All Commercial |
$269.25
|
| Rate for Payer: PHP All Commercial |
$125.57
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$124.96
|
| Rate for Payer: Signature Care EPO |
$135.19
|
| Rate for Payer: Signature Care PPO |
$135.19
|
| Rate for Payer: United Healthcare Commercial |
$92.30
|
| Rate for Payer: United Healthcare Medicare |
$124.96
|
|
|
PR INITIAL RX BURN(S) 1ST DEGREE
|
Professional
|
$142.76
|
|
|
Service Code
|
CPT 16000
|
| Hospital Charge Code |
z16000
|
| Min. Negotiated Rate |
$42.60 |
| Max. Negotiated Rate |
$107.07 |
| Rate for Payer: Aetna Medicare |
$42.60
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$83.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$83.00
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$48.99
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$46.86
|
| Rate for Payer: Cash Price |
$88.51
|
| Rate for Payer: Cash Price |
$88.51
|
| Rate for Payer: Coventry All Commercial |
$51.12
|
| Rate for Payer: Frontpath All Commercial |
$58.68
|
| Rate for Payer: Humana ChoiceCare |
$43.98
|
| Rate for Payer: Humana Medicare |
$42.60
|
| Rate for Payer: Lucent All Commercial |
$72.42
|
| Rate for Payer: Lutheran Preferred All Commercial |
$55.00
|
| Rate for Payer: PHCS All Commercial |
$107.07
|
| Rate for Payer: PHP All Commercial |
$58.19
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$42.60
|
| Rate for Payer: Signature Care EPO |
$72.25
|
| Rate for Payer: Signature Care PPO |
$72.25
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$51.00
|
| Rate for Payer: United Healthcare Commercial |
$52.21
|
| Rate for Payer: United Healthcare Medicare |
$42.60
|
|
|
PR INJ ARIPIPRAZOLE EXT REL 1MG
|
Professional
|
$6.42
|
|
|
Service Code
|
CPT J0401
|
| Hospital Charge Code |
zJ0401
|
| Min. Negotiated Rate |
$6.13 |
| Max. Negotiated Rate |
$6.42 |
| Rate for Payer: Humana ChoiceCare |
$6.42
|
| Rate for Payer: PHP All Commercial |
$6.13
|
|
|
PR INJECT CARPAL TUNNEL
|
Professional
|
$148.52
|
|
|
Service Code
|
CPT 20526
|
| Hospital Charge Code |
z20526
|
| Min. Negotiated Rate |
$52.66 |
| Max. Negotiated Rate |
$111.39 |
| Rate for Payer: Aetna Medicare |
$52.66
|
| Rate for Payer: Aetna Medicare |
$52.66
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$79.70
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$79.70
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$79.70
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$79.70
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$60.56
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$60.56
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$57.93
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$57.93
|
| Rate for Payer: Cash Price |
$92.08
|
| Rate for Payer: Cash Price |
$92.08
|
| Rate for Payer: Cash Price |
$184.16
|
| Rate for Payer: Cash Price |
$184.16
|
| Rate for Payer: Coventry All Commercial |
$63.19
|
| Rate for Payer: Coventry All Commercial |
$63.19
|
| Rate for Payer: Frontpath All Commercial |
$74.56
|
| Rate for Payer: Frontpath All Commercial |
$74.56
|
| Rate for Payer: Humana ChoiceCare |
$64.09
|
| Rate for Payer: Humana ChoiceCare |
$64.09
|
| Rate for Payer: Humana Medicare |
$52.66
|
| Rate for Payer: Humana Medicare |
$52.66
|
| Rate for Payer: Lucent All Commercial |
$89.52
|
| Rate for Payer: Lucent All Commercial |
$89.52
|
| Rate for Payer: Lutheran Preferred All Commercial |
$84.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$84.00
|
| Rate for Payer: PHCS All Commercial |
$222.78
|
| Rate for Payer: PHCS All Commercial |
$111.39
|
| Rate for Payer: PHP All Commercial |
$89.39
|
| Rate for Payer: PHP All Commercial |
$89.39
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$52.66
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$52.66
|
| Rate for Payer: Signature Care EPO |
$108.80
|
| Rate for Payer: Signature Care EPO |
$108.80
|
| Rate for Payer: Signature Care PPO |
$108.80
|
| Rate for Payer: Signature Care PPO |
$108.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$79.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$79.00
|
| Rate for Payer: United Healthcare Commercial |
$64.51
|
| Rate for Payer: United Healthcare Commercial |
$64.51
|
| Rate for Payer: United Healthcare Medicare |
$52.66
|
| Rate for Payer: United Healthcare Medicare |
$52.66
|
|
|
PR INJECTION 1 TENDON SHEATH/LIGAMENT APONEUROSIS
|
Professional
|
$105.74
|
|
|
Service Code
|
CPT 20550
|
| Hospital Charge Code |
z20550
|
| Min. Negotiated Rate |
$36.60 |
| Max. Negotiated Rate |
$83.30 |
| Rate for Payer: Aetna Medicare |
$36.60
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$77.76
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$77.76
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$42.09
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$40.26
|
| Rate for Payer: Cash Price |
$65.56
|
| Rate for Payer: Cash Price |
$65.56
|
| Rate for Payer: Coventry All Commercial |
$43.92
|
| Rate for Payer: Frontpath All Commercial |
$50.99
|
| Rate for Payer: Humana ChoiceCare |
$43.56
|
| Rate for Payer: Humana Medicare |
$36.60
|
| Rate for Payer: Lucent All Commercial |
$62.22
|
| Rate for Payer: Lutheran Preferred All Commercial |
$59.00
|
| Rate for Payer: PHCS All Commercial |
$79.30
|
| Rate for Payer: PHP All Commercial |
$57.12
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$36.60
|
| Rate for Payer: Signature Care EPO |
$83.30
|
| Rate for Payer: Signature Care PPO |
$83.30
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$55.00
|
| Rate for Payer: United Healthcare Commercial |
$47.41
|
| Rate for Payer: United Healthcare Medicare |
$36.60
|
|
|
PR INJECTION AA&/STRD OTHER PERIPHERAL NERVE/BRANCH
|
Professional
|
$137.04
|
|
|
Service Code
|
CPT 64450
|
| Hospital Charge Code |
z64450
|
| Min. Negotiated Rate |
$39.36 |
| Max. Negotiated Rate |
$121.77 |
| Rate for Payer: Aetna Medicare |
$39.36
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$113.50
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$113.50
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$45.26
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$43.30
|
| Rate for Payer: Cash Price |
$84.96
|
| Rate for Payer: Cash Price |
$84.96
|
| Rate for Payer: Coventry All Commercial |
$47.23
|
| Rate for Payer: Frontpath All Commercial |
$54.60
|
| Rate for Payer: Humana ChoiceCare |
$90.13
|
| Rate for Payer: Humana Medicare |
$39.36
|
| Rate for Payer: Lucent All Commercial |
$66.91
|
| Rate for Payer: Lutheran Preferred All Commercial |
$63.00
|
| Rate for Payer: PHCS All Commercial |
$102.78
|
| Rate for Payer: PHP All Commercial |
$61.44
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$39.36
|
| Rate for Payer: Signature Care EPO |
$121.77
|
| Rate for Payer: Signature Care PPO |
$121.77
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$59.00
|
| Rate for Payer: United Healthcare Commercial |
$81.05
|
| Rate for Payer: United Healthcare Medicare |
$39.36
|
|
|
PR INJECTION AA&/STRD PARACERVICAL NERVE
|
Professional
|
$147.32
|
|
|
Service Code
|
CPT 64435
|
| Hospital Charge Code |
z64435
|
| Min. Negotiated Rate |
$40.31 |
| Max. Negotiated Rate |
$148.20 |
| Rate for Payer: Aetna Medicare |
$40.31
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$148.20
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$148.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$46.36
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$44.34
|
| Rate for Payer: Cash Price |
$91.34
|
| Rate for Payer: Cash Price |
$91.34
|
| Rate for Payer: Coventry All Commercial |
$48.37
|
| Rate for Payer: Frontpath All Commercial |
$55.99
|
| Rate for Payer: Humana ChoiceCare |
$109.74
|
| Rate for Payer: Humana Medicare |
$40.31
|
| Rate for Payer: Lucent All Commercial |
$68.53
|
| Rate for Payer: Lutheran Preferred All Commercial |
$65.00
|
| Rate for Payer: PHCS All Commercial |
$110.49
|
| Rate for Payer: PHP All Commercial |
$62.93
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$40.31
|
| Rate for Payer: Signature Care EPO |
$105.62
|
| Rate for Payer: Signature Care PPO |
$105.62
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$60.00
|
| Rate for Payer: United Healthcare Commercial |
$94.94
|
| Rate for Payer: United Healthcare Medicare |
$40.31
|
|
|
PR INJECTION AA&/STRD PUDENDAL NERVE
|
Professional
|
$180.12
|
|
|
Service Code
|
CPT 64430
|
| Hospital Charge Code |
z64430
|
| Min. Negotiated Rate |
$51.25 |
| Max. Negotiated Rate |
$158.73 |
| Rate for Payer: Aetna Medicare |
$51.25
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$150.10
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$150.10
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$58.94
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$56.38
|
| Rate for Payer: Cash Price |
$111.67
|
| Rate for Payer: Cash Price |
$111.67
|
| Rate for Payer: Coventry All Commercial |
$61.50
|
| Rate for Payer: Frontpath All Commercial |
$70.12
|
| Rate for Payer: Humana ChoiceCare |
$102.42
|
| Rate for Payer: Humana Medicare |
$51.25
|
| Rate for Payer: Lucent All Commercial |
$87.12
|
| Rate for Payer: Lutheran Preferred All Commercial |
$82.00
|
| Rate for Payer: PHCS All Commercial |
$135.09
|
| Rate for Payer: PHP All Commercial |
$80.01
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$51.25
|
| Rate for Payer: Signature Care EPO |
$158.73
|
| Rate for Payer: Signature Care PPO |
$158.73
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$77.00
|
| Rate for Payer: United Healthcare Commercial |
$99.15
|
| Rate for Payer: United Healthcare Medicare |
$51.25
|
|
|
PR INJECTION AA&/STRD TRIGEMINAL NERVE EACH BRANCH
|
Professional
|
$201.34
|
|
|
Service Code
|
CPT 64400
|
| Hospital Charge Code |
z64400
|
| Min. Negotiated Rate |
$45.76 |
| Max. Negotiated Rate |
$174.25 |
| Rate for Payer: Aetna Medicare |
$45.76
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$117.70
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$117.70
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$52.62
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$50.34
|
| Rate for Payer: Cash Price |
$124.83
|
| Rate for Payer: Cash Price |
$124.83
|
| Rate for Payer: Coventry All Commercial |
$54.91
|
| Rate for Payer: Frontpath All Commercial |
$65.77
|
| Rate for Payer: Humana ChoiceCare |
$78.29
|
| Rate for Payer: Humana Medicare |
$45.76
|
| Rate for Payer: Lucent All Commercial |
$77.79
|
| Rate for Payer: Lutheran Preferred All Commercial |
$73.00
|
| Rate for Payer: PHCS All Commercial |
$151.00
|
| Rate for Payer: PHP All Commercial |
$71.43
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$45.76
|
| Rate for Payer: Signature Care EPO |
$174.25
|
| Rate for Payer: Signature Care PPO |
$174.25
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$69.00
|
| Rate for Payer: United Healthcare Commercial |
$70.56
|
| Rate for Payer: United Healthcare Medicare |
$45.76
|
|
|
PR INJECTION, BUPIVICAINE HYDRO
|
Professional
|
$2.96
|
|
|
Service Code
|
CPT S0020
|
| Hospital Charge Code |
zS0020
|
| Min. Negotiated Rate |
$2.70 |
| Max. Negotiated Rate |
$2.96 |
| Rate for Payer: Humana ChoiceCare |
$2.70
|
| Rate for Payer: PHP All Commercial |
$2.96
|
|
|
PR INJECTION,THERAP/PROPH/DIAGNOST, IM OR SUBCUT
|
Professional
|
$52.04
|
|
|
Service Code
|
CPT 96372
|
| Hospital Charge Code |
z96372
|
| Min. Negotiated Rate |
$13.33 |
| Max. Negotiated Rate |
$39.03 |
| Rate for Payer: Aetna Medicare |
$13.33
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$15.87
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$15.87
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$15.33
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$14.66
|
| Rate for Payer: Cash Price |
$32.26
|
| Rate for Payer: Cash Price |
$32.26
|
| Rate for Payer: Coventry All Commercial |
$16.00
|
| Rate for Payer: Frontpath All Commercial |
$15.22
|
| Rate for Payer: Humana ChoiceCare |
$23.63
|
| Rate for Payer: Humana Medicare |
$13.33
|
| Rate for Payer: Lucent All Commercial |
$22.66
|
| Rate for Payer: Lutheran Preferred All Commercial |
$17.00
|
| Rate for Payer: PHCS All Commercial |
$39.03
|
| Rate for Payer: PHP All Commercial |
$19.51
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$13.33
|
| Rate for Payer: Signature Care EPO |
$22.98
|
| Rate for Payer: Signature Care PPO |
$22.98
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$16.00
|
| Rate for Payer: United Healthcare Commercial |
$24.49
|
| Rate for Payer: United Healthcare Medicare |
$13.33
|
|
