|
PR INJECT PLATELET RICH PLASMA W/IMG HARVEST/PREPARATOIN
|
Professional
|
$825.00
|
|
|
Service Code
|
CPT 0232T
|
| Hospital Charge Code |
z0232T
|
| Min. Negotiated Rate |
$38.11 |
| Max. Negotiated Rate |
$618.75 |
| Rate for Payer: Cash Price |
$511.50
|
| Rate for Payer: Cash Price |
$511.50
|
| Rate for Payer: Frontpath All Commercial |
$188.36
|
| Rate for Payer: Humana ChoiceCare |
$38.11
|
| Rate for Payer: PHCS All Commercial |
$618.75
|
| Rate for Payer: United Healthcare Commercial |
$56.25
|
|
|
PR INJECT TENDON ORIGIN/INSERT
|
Professional
|
$211.48
|
|
|
Service Code
|
CPT 20551
|
| Hospital Charge Code |
z20551
|
| Min. Negotiated Rate |
$36.60 |
| Max. Negotiated Rate |
$158.61 |
| Rate for Payer: Aetna Medicare |
$36.60
|
| Rate for Payer: Aetna Medicare |
$36.60
|
| 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 |
$42.09
|
| 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: CareSource Indiana of IN Medicare |
$40.26
|
| Rate for Payer: Cash Price |
$65.56
|
| Rate for Payer: Cash Price |
$131.12
|
| Rate for Payer: Cash Price |
$131.12
|
| Rate for Payer: Cash Price |
$65.56
|
| Rate for Payer: Coventry All Commercial |
$43.92
|
| Rate for Payer: Coventry All Commercial |
$43.92
|
| Rate for Payer: Frontpath All Commercial |
$50.91
|
| Rate for Payer: Frontpath All Commercial |
$50.91
|
| Rate for Payer: Humana ChoiceCare |
$47.32
|
| Rate for Payer: Humana ChoiceCare |
$47.32
|
| Rate for Payer: Humana Medicare |
$36.60
|
| Rate for Payer: Humana Medicare |
$36.60
|
| Rate for Payer: Lucent All Commercial |
$62.22
|
| Rate for Payer: Lucent All Commercial |
$62.22
|
| Rate for Payer: Lutheran Preferred All Commercial |
$59.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$59.00
|
| Rate for Payer: PHCS All Commercial |
$79.30
|
| Rate for Payer: PHCS All Commercial |
$158.61
|
| Rate for Payer: PHP All Commercial |
$62.12
|
| Rate for Payer: PHP All Commercial |
$62.12
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$36.60
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$36.60
|
| Rate for Payer: Signature Care EPO |
$81.60
|
| Rate for Payer: Signature Care EPO |
$81.60
|
| Rate for Payer: Signature Care PPO |
$81.60
|
| Rate for Payer: Signature Care PPO |
$81.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$55.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$55.00
|
| Rate for Payer: United Healthcare Commercial |
$48.39
|
| Rate for Payer: United Healthcare Commercial |
$48.39
|
| Rate for Payer: United Healthcare Medicare |
$36.60
|
| Rate for Payer: United Healthcare Medicare |
$36.60
|
|
|
PR INJECT TRIGGER POINT, 1 OR 2
|
Professional
|
$96.76
|
|
|
Service Code
|
CPT 20552
|
| Hospital Charge Code |
z20552
|
| Min. Negotiated Rate |
$34.77 |
| Max. Negotiated Rate |
$79.70 |
| Rate for Payer: Aetna Medicare |
$34.77
|
| 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: CareSource Indiana of IN Just 4 Me |
$39.99
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$38.25
|
| Rate for Payer: Cash Price |
$59.99
|
| Rate for Payer: Cash Price |
$59.99
|
| Rate for Payer: Coventry All Commercial |
$41.72
|
| Rate for Payer: Frontpath All Commercial |
$48.91
|
| Rate for Payer: Humana ChoiceCare |
$37.68
|
| Rate for Payer: Humana Medicare |
$34.77
|
| Rate for Payer: Lucent All Commercial |
$59.11
|
| Rate for Payer: Lutheran Preferred All Commercial |
$56.00
|
| Rate for Payer: PHCS All Commercial |
$72.57
|
| Rate for Payer: PHP All Commercial |
$54.27
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$34.77
|
| Rate for Payer: Signature Care EPO |
$79.05
|
| Rate for Payer: Signature Care PPO |
$79.05
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$52.00
|
| Rate for Payer: United Healthcare Commercial |
$41.04
|
| Rate for Payer: United Healthcare Medicare |
$34.77
|
|
|
PR INJECT TRIGGER POINTS, > 3
|
Professional
|
$111.76
|
|
|
Service Code
|
CPT 20553
|
| Hospital Charge Code |
z20553
|
| Min. Negotiated Rate |
$39.68 |
| Max. Negotiated Rate |
$83.82 |
| Rate for Payer: Aetna Medicare |
$39.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$45.63
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$43.65
|
| Rate for Payer: Cash Price |
$69.29
|
| Rate for Payer: Cash Price |
$69.29
|
| Rate for Payer: Coventry All Commercial |
$47.62
|
| Rate for Payer: Frontpath All Commercial |
$55.50
|
| Rate for Payer: Humana ChoiceCare |
$42.21
|
| Rate for Payer: Humana Medicare |
$39.68
|
| Rate for Payer: Lucent All Commercial |
$67.46
|
| Rate for Payer: PHCS All Commercial |
$83.82
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$39.68
|
| Rate for Payer: United Healthcare Commercial |
$45.65
|
| Rate for Payer: United Healthcare Medicare |
$39.68
|
|
|
PR INJ, INVEGA SUSTENNA, 1 MG
|
Professional
|
$13.33
|
|
|
Service Code
|
CPT J2426
|
| Hospital Charge Code |
zJ2426
|
| Min. Negotiated Rate |
$13.10 |
| Max. Negotiated Rate |
$13.33 |
| Rate for Payer: Humana ChoiceCare |
$13.33
|
| Rate for Payer: PHP All Commercial |
$13.10
|
|
|
PR INJ,LUMB EPIDUR,BLOOD/CLOT PATCH
|
Professional
|
$309.90
|
|
|
Service Code
|
CPT 62273
|
| Hospital Charge Code |
z62273
|
| Min. Negotiated Rate |
$106.34 |
| Max. Negotiated Rate |
$272.54 |
| Rate for Payer: Aetna Medicare |
$106.34
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$164.60
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$164.60
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$122.29
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$116.97
|
| Rate for Payer: Cash Price |
$192.14
|
| Rate for Payer: Cash Price |
$192.14
|
| Rate for Payer: Coventry All Commercial |
$127.61
|
| Rate for Payer: Frontpath All Commercial |
$146.08
|
| Rate for Payer: Humana ChoiceCare |
$145.81
|
| Rate for Payer: Humana Medicare |
$106.34
|
| Rate for Payer: Lucent All Commercial |
$180.78
|
| Rate for Payer: Lutheran Preferred All Commercial |
$170.00
|
| Rate for Payer: PHCS All Commercial |
$232.42
|
| Rate for Payer: PHP All Commercial |
$166.00
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$106.34
|
| Rate for Payer: Signature Care EPO |
$272.54
|
| Rate for Payer: Signature Care PPO |
$272.54
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$160.00
|
| Rate for Payer: United Healthcare Commercial |
$126.51
|
| Rate for Payer: United Healthcare Medicare |
$106.34
|
|
|
PR INJ. ROMOSOZUMAB-AQQG 1 MG
|
Professional
|
$9.96
|
|
|
Service Code
|
CPT J3111
|
| Hospital Charge Code |
zJ3111
|
| Min. Negotiated Rate |
$9.64 |
| Max. Negotiated Rate |
$9.96 |
| Rate for Payer: Humana ChoiceCare |
$9.96
|
| Rate for Payer: PHP All Commercial |
$9.64
|
|
|
PR INJ TESTOSTERONE CYPIONATE
|
Professional
|
$0.06
|
|
|
Service Code
|
CPT J1071
|
| Hospital Charge Code |
zJ1071
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.06 |
| Rate for Payer: Humana ChoiceCare |
$0.03
|
| Rate for Payer: PHP All Commercial |
$0.06
|
| Rate for Payer: United Healthcare Commercial |
$0.03
|
|
|
PR INSERT AND REMOVE BONE PIN
|
Professional
|
$412.94
|
|
|
Service Code
|
CPT 20650
|
| Hospital Charge Code |
z20650
|
| Min. Negotiated Rate |
$152.97 |
| Max. Negotiated Rate |
$309.70 |
| Rate for Payer: Aetna Medicare |
$152.97
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$226.50
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$226.50
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$175.92
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$168.27
|
| Rate for Payer: Cash Price |
$256.02
|
| Rate for Payer: Cash Price |
$256.02
|
| Rate for Payer: Coventry All Commercial |
$183.56
|
| Rate for Payer: Frontpath All Commercial |
$207.21
|
| Rate for Payer: Humana ChoiceCare |
$164.56
|
| Rate for Payer: Humana Medicare |
$152.97
|
| Rate for Payer: Lucent All Commercial |
$260.05
|
| Rate for Payer: Lutheran Preferred All Commercial |
$245.00
|
| Rate for Payer: PHCS All Commercial |
$309.70
|
| Rate for Payer: PHP All Commercial |
$259.68
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$152.97
|
| Rate for Payer: Signature Care EPO |
$267.75
|
| Rate for Payer: Signature Care PPO |
$267.75
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$229.00
|
| Rate for Payer: United Healthcare Commercial |
$171.06
|
| Rate for Payer: United Healthcare Medicare |
$152.97
|
|
|
PR INSERT CERVICAL DILATOR
|
Professional
|
$190.46
|
|
|
Service Code
|
CPT 59200
|
| Hospital Charge Code |
z59200
|
| Min. Negotiated Rate |
$39.88 |
| Max. Negotiated Rate |
$142.84 |
| Rate for Payer: Aetna Medicare |
$39.88
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$106.22
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$106.22
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$45.86
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$43.87
|
| Rate for Payer: Cash Price |
$118.09
|
| Rate for Payer: Cash Price |
$118.09
|
| Rate for Payer: Coventry All Commercial |
$47.86
|
| Rate for Payer: Frontpath All Commercial |
$57.79
|
| Rate for Payer: Humana ChoiceCare |
$43.38
|
| Rate for Payer: Humana Medicare |
$39.88
|
| Rate for Payer: Lucent All Commercial |
$67.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$56.00
|
| Rate for Payer: PHCS All Commercial |
$142.84
|
| Rate for Payer: PHP All Commercial |
$51.36
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$39.88
|
| Rate for Payer: Signature Care EPO |
$96.05
|
| Rate for Payer: Signature Care PPO |
$96.05
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$52.00
|
| Rate for Payer: United Healthcare Commercial |
$51.09
|
| Rate for Payer: United Healthcare Medicare |
$39.88
|
|
|
PR INSERT EMERGENCY ENDOTRACH AIRWAY
|
Professional
|
$256.44
|
|
|
Service Code
|
CPT 31500
|
| Hospital Charge Code |
z31500
|
| Min. Negotiated Rate |
$128.68 |
| Max. Negotiated Rate |
$223.43 |
| Rate for Payer: Aetna Medicare |
$131.43
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$159.50
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$159.50
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$151.14
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$144.57
|
| Rate for Payer: Cash Price |
$158.99
|
| Rate for Payer: Cash Price |
$158.99
|
| Rate for Payer: Coventry All Commercial |
$157.72
|
| Rate for Payer: Frontpath All Commercial |
$185.61
|
| Rate for Payer: Humana ChoiceCare |
$133.64
|
| Rate for Payer: Humana Medicare |
$131.43
|
| Rate for Payer: Lucent All Commercial |
$223.43
|
| Rate for Payer: Lutheran Preferred All Commercial |
$210.00
|
| Rate for Payer: PHCS All Commercial |
$192.33
|
| Rate for Payer: PHP All Commercial |
$179.51
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$131.43
|
| Rate for Payer: Signature Care EPO |
$156.40
|
| Rate for Payer: Signature Care PPO |
$156.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$197.00
|
| Rate for Payer: United Healthcare Commercial |
$128.68
|
| Rate for Payer: United Healthcare Medicare |
$131.43
|
|
|
PR INSERT INTRAUTERINE DEVICE
|
Professional
|
$203.04
|
|
|
Service Code
|
CPT 58300
|
| Hospital Charge Code |
z58300
|
| Min. Negotiated Rate |
$61.65 |
| Max. Negotiated Rate |
$152.28 |
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$124.82
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$124.82
|
| Rate for Payer: Cash Price |
$125.88
|
| Rate for Payer: Cash Price |
$125.88
|
| Rate for Payer: Frontpath All Commercial |
$63.95
|
| Rate for Payer: Humana ChoiceCare |
$62.37
|
| Rate for Payer: Lutheran Preferred All Commercial |
$67.00
|
| Rate for Payer: PHCS All Commercial |
$152.28
|
| Rate for Payer: PHP All Commercial |
$61.65
|
| Rate for Payer: Signature Care EPO |
$117.30
|
| Rate for Payer: Signature Care PPO |
$117.30
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$62.00
|
| Rate for Payer: United Healthcare Commercial |
$63.26
|
|
|
PR INSERTION DRUG DELIVERY IMPLANT
|
Professional
|
$182.26
|
|
|
Service Code
|
CPT 11981
|
| Hospital Charge Code |
z11981
|
| Min. Negotiated Rate |
$57.90 |
| Max. Negotiated Rate |
$150.10 |
| Rate for Payer: Aetna Medicare |
$57.90
|
| 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 |
$66.58
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$63.69
|
| Rate for Payer: Cash Price |
$113.00
|
| Rate for Payer: Cash Price |
$113.00
|
| Rate for Payer: Coventry All Commercial |
$69.48
|
| Rate for Payer: Frontpath All Commercial |
$83.06
|
| Rate for Payer: Humana ChoiceCare |
$81.42
|
| Rate for Payer: Humana Medicare |
$57.90
|
| Rate for Payer: Lucent All Commercial |
$98.43
|
| Rate for Payer: Lutheran Preferred All Commercial |
$75.00
|
| Rate for Payer: PHCS All Commercial |
$136.70
|
| Rate for Payer: PHP All Commercial |
$79.09
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$57.90
|
| Rate for Payer: Signature Care EPO |
$132.60
|
| Rate for Payer: Signature Care PPO |
$132.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$69.00
|
| Rate for Payer: United Healthcare Commercial |
$96.04
|
| Rate for Payer: United Healthcare Medicare |
$57.90
|
|
|
PR INSERTION INDWELLING TUNNELED PLEURAL CATHETER
|
Professional
|
$1,438.12
|
|
|
Service Code
|
CPT 32550
|
| Hospital Charge Code |
z32550
|
| Min. Negotiated Rate |
$189.07 |
| Max. Negotiated Rate |
$1,165.75 |
| Rate for Payer: Aetna Medicare |
$189.07
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,165.75
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,165.75
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$217.43
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$207.98
|
| Rate for Payer: Cash Price |
$891.63
|
| Rate for Payer: Cash Price |
$891.63
|
| Rate for Payer: Coventry All Commercial |
$226.88
|
| Rate for Payer: Frontpath All Commercial |
$265.77
|
| Rate for Payer: Humana ChoiceCare |
$246.50
|
| Rate for Payer: Humana Medicare |
$189.07
|
| Rate for Payer: Lucent All Commercial |
$321.42
|
| Rate for Payer: Lutheran Preferred All Commercial |
$303.00
|
| Rate for Payer: PHCS All Commercial |
$1,078.59
|
| Rate for Payer: PHP All Commercial |
$258.24
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$189.07
|
| Rate for Payer: Signature Care EPO |
$981.66
|
| Rate for Payer: Signature Care PPO |
$981.66
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$284.00
|
| Rate for Payer: United Healthcare Commercial |
$267.21
|
| Rate for Payer: United Healthcare Medicare |
$189.07
|
|
|
PR INSERTION SUBQ CARDIAC RHYTHM MONITOR W/PRGRMG
|
Professional
|
$7,856.78
|
|
|
Service Code
|
CPT 33285
|
| Hospital Charge Code |
z33285
|
| Min. Negotiated Rate |
$79.40 |
| Max. Negotiated Rate |
$6,822.59 |
| Rate for Payer: Aetna Medicare |
$79.40
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$4,835.29
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4,835.29
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$91.31
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$87.34
|
| Rate for Payer: Cash Price |
$4,871.20
|
| Rate for Payer: Cash Price |
$4,871.20
|
| Rate for Payer: Coventry All Commercial |
$95.28
|
| Rate for Payer: Frontpath All Commercial |
$114.72
|
| Rate for Payer: Humana ChoiceCare |
$108.63
|
| Rate for Payer: Humana Medicare |
$79.40
|
| Rate for Payer: Lucent All Commercial |
$134.98
|
| Rate for Payer: Lutheran Preferred All Commercial |
$127.00
|
| Rate for Payer: PHCS All Commercial |
$5,892.58
|
| Rate for Payer: PHP All Commercial |
$108.45
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$79.40
|
| Rate for Payer: Signature Care EPO |
$6,822.59
|
| Rate for Payer: Signature Care PPO |
$6,822.59
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$119.00
|
| Rate for Payer: United Healthcare Commercial |
$107.68
|
| Rate for Payer: United Healthcare Medicare |
$79.40
|
|
|
PR INSERT,NON-INDWELLING BLADDER CATHETER
|
Professional
|
$81.04
|
|
|
Service Code
|
CPT 51701
|
| Hospital Charge Code |
z51701
|
| Min. Negotiated Rate |
$23.63 |
| Max. Negotiated Rate |
$125.17 |
| Rate for Payer: Aetna Medicare |
$23.63
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$125.17
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$125.17
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$27.17
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$25.99
|
| Rate for Payer: Cash Price |
$50.24
|
| Rate for Payer: Cash Price |
$50.24
|
| Rate for Payer: Coventry All Commercial |
$28.36
|
| Rate for Payer: Frontpath All Commercial |
$33.83
|
| Rate for Payer: Humana ChoiceCare |
$26.34
|
| Rate for Payer: Humana Medicare |
$23.63
|
| Rate for Payer: Lucent All Commercial |
$40.17
|
| Rate for Payer: Lutheran Preferred All Commercial |
$33.00
|
| Rate for Payer: PHCS All Commercial |
$60.78
|
| Rate for Payer: PHP All Commercial |
$42.64
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$23.63
|
| Rate for Payer: Signature Care EPO |
$71.32
|
| Rate for Payer: Signature Care PPO |
$71.32
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$31.00
|
| Rate for Payer: United Healthcare Commercial |
$33.55
|
| Rate for Payer: United Healthcare Medicare |
$23.63
|
|
|
PR INSERT NON-TUNNEL CV CATH
|
Professional
|
$390.08
|
|
|
Service Code
|
CPT 36556
|
| Hospital Charge Code |
z36556
|
| Min. Negotiated Rate |
$78.59 |
| Max. Negotiated Rate |
$358.80 |
| Rate for Payer: Aetna Medicare |
$78.59
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$358.80
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$358.80
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$90.38
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$86.45
|
| Rate for Payer: Cash Price |
$241.85
|
| Rate for Payer: Cash Price |
$241.85
|
| Rate for Payer: Coventry All Commercial |
$94.31
|
| Rate for Payer: Frontpath All Commercial |
$110.10
|
| Rate for Payer: Humana ChoiceCare |
$160.89
|
| Rate for Payer: Humana Medicare |
$78.59
|
| Rate for Payer: Lucent All Commercial |
$133.60
|
| Rate for Payer: Lutheran Preferred All Commercial |
$126.00
|
| Rate for Payer: PHCS All Commercial |
$292.56
|
| Rate for Payer: PHP All Commercial |
$130.34
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$78.59
|
| Rate for Payer: Signature Care EPO |
$348.82
|
| Rate for Payer: Signature Care PPO |
$348.82
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$118.00
|
| Rate for Payer: United Healthcare Commercial |
$143.50
|
| Rate for Payer: United Healthcare Medicare |
$78.59
|
|
|
PR INSJ 1 TRANSVNS ELTRD PERM PACEMAKER/IMPLTBL DFB
|
Professional
|
$661.44
|
|
|
Service Code
|
CPT 33216
|
| Hospital Charge Code |
z33216
|
| Min. Negotiated Rate |
$338.99 |
| Max. Negotiated Rate |
$576.28 |
| Rate for Payer: Aetna Medicare |
$338.99
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$540.80
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$540.80
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$389.84
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$372.89
|
| Rate for Payer: Cash Price |
$410.09
|
| Rate for Payer: Cash Price |
$410.09
|
| Rate for Payer: Coventry All Commercial |
$406.79
|
| Rate for Payer: Frontpath All Commercial |
$485.55
|
| Rate for Payer: Humana ChoiceCare |
$481.77
|
| Rate for Payer: Humana Medicare |
$338.99
|
| Rate for Payer: Lucent All Commercial |
$576.28
|
| Rate for Payer: Lutheran Preferred All Commercial |
$542.00
|
| Rate for Payer: PHCS All Commercial |
$496.08
|
| Rate for Payer: PHP All Commercial |
$463.01
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$338.99
|
| Rate for Payer: Signature Care EPO |
$561.00
|
| Rate for Payer: Signature Care PPO |
$561.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$508.00
|
| Rate for Payer: United Healthcare Commercial |
$456.65
|
| Rate for Payer: United Healthcare Medicare |
$338.99
|
|
|
PR INSJ ELTRD CAR VEN SYS ATTCH PREV PM/DFB PLS GEN
|
Professional
|
$905.42
|
|
|
Service Code
|
CPT 33224
|
| Hospital Charge Code |
z33224
|
| Min. Negotiated Rate |
$464.03 |
| Max. Negotiated Rate |
$788.85 |
| Rate for Payer: Aetna Medicare |
$464.03
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$625.50
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$625.50
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$533.63
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$510.43
|
| Rate for Payer: Cash Price |
$561.36
|
| Rate for Payer: Cash Price |
$561.36
|
| Rate for Payer: Coventry All Commercial |
$556.84
|
| Rate for Payer: Frontpath All Commercial |
$675.34
|
| Rate for Payer: Humana ChoiceCare |
$638.41
|
| Rate for Payer: Humana Medicare |
$464.03
|
| Rate for Payer: Lucent All Commercial |
$788.85
|
| Rate for Payer: Lutheran Preferred All Commercial |
$742.00
|
| Rate for Payer: PHCS All Commercial |
$679.06
|
| Rate for Payer: PHP All Commercial |
$633.80
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$464.03
|
| Rate for Payer: Signature Care EPO |
$731.00
|
| Rate for Payer: Signature Care PPO |
$731.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$696.00
|
| Rate for Payer: United Healthcare Commercial |
$617.89
|
| Rate for Payer: United Healthcare Medicare |
$464.03
|
|
|
PR INSJ ELTRD CAR VEN SYS TM INSJ DFB/PM PLS GEN
|
Professional
|
$818.24
|
|
|
Service Code
|
CPT 33225
|
| Hospital Charge Code |
z33225
|
| Min. Negotiated Rate |
$313.80 |
| Max. Negotiated Rate |
$712.88 |
| Rate for Payer: Aetna Medicare |
$419.34
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$313.80
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$313.80
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$482.24
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$461.27
|
| Rate for Payer: Cash Price |
$507.31
|
| Rate for Payer: Cash Price |
$507.31
|
| Rate for Payer: Coventry All Commercial |
$503.21
|
| Rate for Payer: Frontpath All Commercial |
$614.41
|
| Rate for Payer: Humana ChoiceCare |
$567.74
|
| Rate for Payer: Humana Medicare |
$419.34
|
| Rate for Payer: Lucent All Commercial |
$712.88
|
| Rate for Payer: Lutheran Preferred All Commercial |
$671.00
|
| Rate for Payer: PHCS All Commercial |
$613.68
|
| Rate for Payer: PHP All Commercial |
$572.76
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$419.34
|
| Rate for Payer: Signature Care EPO |
$650.25
|
| Rate for Payer: Signature Care PPO |
$650.25
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$629.00
|
| Rate for Payer: United Healthcare Commercial |
$557.80
|
| Rate for Payer: United Healthcare Medicare |
$419.34
|
|
|
PR INSJ INTRAPERITONEAL CATHETER W/IMG GUID
|
Professional
|
$1,804.16
|
|
|
Service Code
|
CPT 49418
|
| Hospital Charge Code |
z49418
|
| Min. Negotiated Rate |
$187.42 |
| Max. Negotiated Rate |
$1,964.36 |
| Rate for Payer: Aetna Medicare |
$187.42
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,964.36
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,964.36
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$215.53
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$206.16
|
| Rate for Payer: Cash Price |
$1,118.58
|
| Rate for Payer: Cash Price |
$1,118.58
|
| Rate for Payer: Coventry All Commercial |
$224.90
|
| Rate for Payer: Frontpath All Commercial |
$259.04
|
| Rate for Payer: Humana ChoiceCare |
$267.23
|
| Rate for Payer: Humana Medicare |
$187.42
|
| Rate for Payer: Lucent All Commercial |
$318.61
|
| Rate for Payer: Lutheran Preferred All Commercial |
$281.00
|
| Rate for Payer: PHCS All Commercial |
$1,353.12
|
| Rate for Payer: PHP All Commercial |
$319.99
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$187.42
|
| Rate for Payer: Signature Care EPO |
$1,604.83
|
| Rate for Payer: Signature Care PPO |
$1,604.83
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$262.00
|
| Rate for Payer: United Healthcare Commercial |
$292.49
|
| Rate for Payer: United Healthcare Medicare |
$187.42
|
|
|
PR INSJ NON-TUNNELED CENTRAL VENOUS CATH AGE < 5 Y
|
Professional
|
$348.60
|
|
|
Service Code
|
CPT 36555
|
| Hospital Charge Code |
z36555
|
| Min. Negotiated Rate |
$80.18 |
| Max. Negotiated Rate |
$418.30 |
| Rate for Payer: Aetna Medicare |
$80.18
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$418.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$418.30
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$92.21
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$88.20
|
| Rate for Payer: Cash Price |
$216.13
|
| Rate for Payer: Cash Price |
$216.13
|
| Rate for Payer: Coventry All Commercial |
$96.22
|
| Rate for Payer: Frontpath All Commercial |
$110.80
|
| Rate for Payer: Humana ChoiceCare |
$170.76
|
| Rate for Payer: Humana Medicare |
$80.18
|
| Rate for Payer: Lucent All Commercial |
$136.31
|
| Rate for Payer: Lutheran Preferred All Commercial |
$128.00
|
| Rate for Payer: PHCS All Commercial |
$261.45
|
| Rate for Payer: PHP All Commercial |
$132.98
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$80.18
|
| Rate for Payer: Signature Care EPO |
$310.93
|
| Rate for Payer: Signature Care PPO |
$310.93
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$120.00
|
| Rate for Payer: United Healthcare Commercial |
$151.53
|
| Rate for Payer: United Healthcare Medicare |
$80.18
|
|
|
PR INSJ/RPLCMT PERM DFB W/TRNSVNS LDS 1/DUAL CHMBR
|
Professional
|
$1,618.76
|
|
|
Service Code
|
CPT 33249
|
| Hospital Charge Code |
z33249
|
| Min. Negotiated Rate |
$829.62 |
| Max. Negotiated Rate |
$1,410.35 |
| Rate for Payer: Aetna Medicare |
$829.62
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,354.90
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,354.90
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$954.06
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$912.58
|
| Rate for Payer: Cash Price |
$1,003.63
|
| Rate for Payer: Cash Price |
$1,003.63
|
| Rate for Payer: Coventry All Commercial |
$995.54
|
| Rate for Payer: Frontpath All Commercial |
$1,201.32
|
| Rate for Payer: Humana ChoiceCare |
$1,094.86
|
| Rate for Payer: Humana Medicare |
$829.62
|
| Rate for Payer: Lucent All Commercial |
$1,410.35
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,327.00
|
| Rate for Payer: PHCS All Commercial |
$1,214.07
|
| Rate for Payer: PHP All Commercial |
$1,133.14
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$829.62
|
| Rate for Payer: Signature Care EPO |
$1,320.05
|
| Rate for Payer: Signature Care PPO |
$1,320.05
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,244.00
|
| Rate for Payer: United Healthcare Commercial |
$1,098.56
|
| Rate for Payer: United Healthcare Medicare |
$829.62
|
|
|
PR INSJ TUNNELED CTR VAD W/SUBQ PORT AGE 5 YR/>
|
Professional
|
$1,793.60
|
|
|
Service Code
|
CPT 36561
|
| Hospital Charge Code |
z36561
|
| Min. Negotiated Rate |
$306.42 |
| Max. Negotiated Rate |
$1,681.40 |
| Rate for Payer: Aetna Medicare |
$306.42
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,681.40
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,681.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$352.38
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$337.06
|
| Rate for Payer: Cash Price |
$1,112.03
|
| Rate for Payer: Cash Price |
$1,112.03
|
| Rate for Payer: Coventry All Commercial |
$367.70
|
| Rate for Payer: Frontpath All Commercial |
$433.33
|
| Rate for Payer: Humana ChoiceCare |
$441.17
|
| Rate for Payer: Humana Medicare |
$306.42
|
| Rate for Payer: Lucent All Commercial |
$520.91
|
| Rate for Payer: Lutheran Preferred All Commercial |
$490.00
|
| Rate for Payer: PHCS All Commercial |
$1,345.20
|
| Rate for Payer: PHP All Commercial |
$508.21
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$306.42
|
| Rate for Payer: Signature Care EPO |
$1,632.60
|
| Rate for Payer: Signature Care PPO |
$1,632.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$460.00
|
| Rate for Payer: United Healthcare Commercial |
$403.05
|
| Rate for Payer: United Healthcare Medicare |
$306.42
|
|
|
PR INSJ TUNNELED CTR VAD W/SUBQ PUMP
|
Professional
|
$2,045.22
|
|
|
Service Code
|
CPT 36563
|
| Hospital Charge Code |
z36563
|
| Min. Negotiated Rate |
$331.96 |
| Max. Negotiated Rate |
$1,624.72 |
| Rate for Payer: Aetna Medicare |
$331.96
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,574.90
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,574.90
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$381.75
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$365.16
|
| Rate for Payer: Cash Price |
$1,268.04
|
| Rate for Payer: Cash Price |
$1,268.04
|
| Rate for Payer: Coventry All Commercial |
$398.35
|
| Rate for Payer: Frontpath All Commercial |
$478.44
|
| Rate for Payer: Humana ChoiceCare |
$458.22
|
| Rate for Payer: Humana Medicare |
$331.96
|
| Rate for Payer: Lucent All Commercial |
$564.33
|
| Rate for Payer: Lutheran Preferred All Commercial |
$531.00
|
| Rate for Payer: PHCS All Commercial |
$1,533.92
|
| Rate for Payer: PHP All Commercial |
$550.57
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$331.96
|
| Rate for Payer: Signature Care EPO |
$1,624.72
|
| Rate for Payer: Signature Care PPO |
$1,624.72
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$498.00
|
| Rate for Payer: United Healthcare Commercial |
$418.13
|
| Rate for Payer: United Healthcare Medicare |
$331.96
|
|
