|
PR INS NEW/RPLCMT PRM PM W/TRANSV ELTRD ATRIAL&VENT
|
Professional
|
$918.18
|
|
|
Service Code
|
CPT 33208
|
| Hospital Charge Code |
z33208
|
| Min. Negotiated Rate |
$470.57 |
| Max. Negotiated Rate |
$814.70 |
| Rate for Payer: Aetna Medicare |
$470.57
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$814.70
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$814.70
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$541.16
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$517.63
|
| Rate for Payer: Cash Price |
$569.27
|
| Rate for Payer: Cash Price |
$569.27
|
| Rate for Payer: Coventry All Commercial |
$564.68
|
| Rate for Payer: Frontpath All Commercial |
$680.62
|
| Rate for Payer: Humana ChoiceCare |
$627.84
|
| Rate for Payer: Humana Medicare |
$470.57
|
| Rate for Payer: Lucent All Commercial |
$799.97
|
| Rate for Payer: Lutheran Preferred All Commercial |
$753.00
|
| Rate for Payer: PHCS All Commercial |
$688.64
|
| Rate for Payer: PHP All Commercial |
$642.73
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$470.57
|
| Rate for Payer: Signature Care EPO |
$757.35
|
| Rate for Payer: Signature Care PPO |
$757.35
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$706.00
|
| Rate for Payer: United Healthcare Commercial |
$634.64
|
| Rate for Payer: United Healthcare Medicare |
$470.57
|
|
|
PR INS NEW/RPLC PRM PACEMAKER W/TRANSV ELTRD VENTR
|
Professional
|
$847.78
|
|
|
Service Code
|
CPT 33207
|
| Hospital Charge Code |
z33207
|
| Min. Negotiated Rate |
$434.48 |
| Max. Negotiated Rate |
$802.90 |
| Rate for Payer: Aetna Medicare |
$434.48
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$802.90
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$802.90
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$499.65
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$477.93
|
| Rate for Payer: Cash Price |
$525.62
|
| Rate for Payer: Cash Price |
$525.62
|
| Rate for Payer: Coventry All Commercial |
$521.38
|
| Rate for Payer: Frontpath All Commercial |
$627.21
|
| Rate for Payer: Humana ChoiceCare |
$619.11
|
| Rate for Payer: Humana Medicare |
$434.48
|
| Rate for Payer: Lucent All Commercial |
$738.62
|
| Rate for Payer: Lutheran Preferred All Commercial |
$695.00
|
| Rate for Payer: PHCS All Commercial |
$635.84
|
| Rate for Payer: PHP All Commercial |
$593.44
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$434.48
|
| Rate for Payer: Signature Care EPO |
$719.10
|
| Rate for Payer: Signature Care PPO |
$719.10
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$652.00
|
| Rate for Payer: United Healthcare Commercial |
$588.50
|
| Rate for Payer: United Healthcare Medicare |
$434.48
|
|
|
PR INTER DEVC REMOTE 30D
|
Professional
|
$246.00
|
|
|
Service Code
|
CPT G2066
|
| Hospital Charge Code |
zG2066
|
| Min. Negotiated Rate |
$32.33 |
| Max. Negotiated Rate |
$184.50 |
| Rate for Payer: Cash Price |
$152.52
|
| Rate for Payer: Cash Price |
$152.52
|
| Rate for Payer: Humana ChoiceCare |
$32.33
|
| Rate for Payer: PHCS All Commercial |
$184.50
|
| Rate for Payer: Signature Care EPO |
$45.25
|
| Rate for Payer: Signature Care PPO |
$45.25
|
| Rate for Payer: United Healthcare Commercial |
$61.11
|
|
|
PR INTERROGATION EVAL F2F IMPLANT SUBQ LEAD DEFIB
|
Professional
|
$129.98
|
|
|
Service Code
|
CPT 93261
|
| Hospital Charge Code |
z93261
|
| Min. Negotiated Rate |
$66.62 |
| Max. Negotiated Rate |
$113.25 |
| Rate for Payer: Aetna Medicare |
$66.62
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$83.83
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$83.83
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$76.61
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$73.28
|
| Rate for Payer: Cash Price |
$80.59
|
| Rate for Payer: Cash Price |
$80.59
|
| Rate for Payer: Coventry All Commercial |
$79.94
|
| Rate for Payer: Frontpath All Commercial |
$76.82
|
| Rate for Payer: Humana ChoiceCare |
$79.66
|
| Rate for Payer: Humana Medicare |
$66.62
|
| Rate for Payer: Lucent All Commercial |
$113.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$107.00
|
| Rate for Payer: PHCS All Commercial |
$97.48
|
| Rate for Payer: PHP All Commercial |
$95.54
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$66.62
|
| Rate for Payer: Signature Care EPO |
$91.99
|
| Rate for Payer: Signature Care PPO |
$91.99
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$100.00
|
| Rate for Payer: United Healthcare Commercial |
$73.76
|
| Rate for Payer: United Healthcare Medicare |
$66.62
|
|
|
PR INTERROGATION EVAL IN PERSON WR DEFIBRILLATOR
|
Professional
|
$93.82
|
|
|
Service Code
|
CPT 93292
|
| Hospital Charge Code |
z93292
|
| Min. Negotiated Rate |
$43.91 |
| Max. Negotiated Rate |
$81.75 |
| Rate for Payer: Aetna Medicare |
$48.09
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$52.34
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$52.34
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$55.30
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$52.90
|
| Rate for Payer: Cash Price |
$58.17
|
| Rate for Payer: Cash Price |
$58.17
|
| Rate for Payer: Coventry All Commercial |
$57.71
|
| Rate for Payer: Frontpath All Commercial |
$55.15
|
| Rate for Payer: Humana ChoiceCare |
$47.74
|
| Rate for Payer: Humana Medicare |
$48.09
|
| Rate for Payer: Lucent All Commercial |
$81.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$77.00
|
| Rate for Payer: PHCS All Commercial |
$70.36
|
| Rate for Payer: PHP All Commercial |
$68.96
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$48.09
|
| Rate for Payer: Signature Care EPO |
$52.63
|
| Rate for Payer: Signature Care PPO |
$52.63
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$72.00
|
| Rate for Payer: United Healthcare Commercial |
$43.91
|
| Rate for Payer: United Healthcare Medicare |
$48.09
|
|
|
PR INTERROGATION EVAL REMOTE </90 D 1/2/MLT LD DFB
|
Professional
|
$68.26
|
|
|
Service Code
|
CPT 93295
|
| Hospital Charge Code |
z93295
|
| Min. Negotiated Rate |
$34.98 |
| Max. Negotiated Rate |
$95.24 |
| Rate for Payer: Aetna Medicare |
$34.98
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$95.24
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$95.24
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$40.23
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$38.48
|
| Rate for Payer: Cash Price |
$42.32
|
| Rate for Payer: Cash Price |
$42.32
|
| Rate for Payer: Coventry All Commercial |
$41.98
|
| Rate for Payer: Frontpath All Commercial |
$40.68
|
| Rate for Payer: Humana ChoiceCare |
$86.87
|
| Rate for Payer: Humana Medicare |
$34.98
|
| Rate for Payer: Lucent All Commercial |
$59.47
|
| Rate for Payer: Lutheran Preferred All Commercial |
$56.00
|
| Rate for Payer: PHCS All Commercial |
$51.20
|
| Rate for Payer: PHP All Commercial |
$50.17
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$34.98
|
| Rate for Payer: Signature Care EPO |
$60.79
|
| Rate for Payer: Signature Care PPO |
$60.79
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$52.00
|
| Rate for Payer: United Healthcare Commercial |
$79.90
|
| Rate for Payer: United Healthcare Medicare |
$34.98
|
|
|
PR INTERROG DEV EVAL PM/LDLS PM PHYS/QHP IN PERSON
|
Professional
|
$103.76
|
|
|
Service Code
|
CPT 93288
|
| Hospital Charge Code |
z93288
|
| Min. Negotiated Rate |
$50.54 |
| Max. Negotiated Rate |
$90.39 |
| Rate for Payer: Aetna Medicare |
$53.17
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$60.24
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$60.24
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$61.15
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$58.49
|
| Rate for Payer: Cash Price |
$64.33
|
| Rate for Payer: Cash Price |
$64.33
|
| Rate for Payer: Coventry All Commercial |
$63.80
|
| Rate for Payer: Frontpath All Commercial |
$61.75
|
| Rate for Payer: Humana ChoiceCare |
$54.94
|
| Rate for Payer: Humana Medicare |
$53.17
|
| Rate for Payer: Lucent All Commercial |
$90.39
|
| Rate for Payer: Lutheran Preferred All Commercial |
$85.00
|
| Rate for Payer: PHCS All Commercial |
$77.82
|
| Rate for Payer: PHP All Commercial |
$76.26
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$53.17
|
| Rate for Payer: Signature Care EPO |
$60.84
|
| Rate for Payer: Signature Care PPO |
$60.84
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$80.00
|
| Rate for Payer: United Healthcare Commercial |
$50.54
|
| Rate for Payer: United Healthcare Medicare |
$53.17
|
|
|
PR INTERROG DEV EVAL SCRMS PHYS/QHP IN PERSON
|
Professional
|
$91.36
|
|
|
Service Code
|
CPT 93291
|
| Hospital Charge Code |
z93291
|
| Min. Negotiated Rate |
$46.82 |
| Max. Negotiated Rate |
$79.59 |
| Rate for Payer: Aetna Medicare |
$46.82
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$57.77
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$57.77
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$53.84
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$51.50
|
| Rate for Payer: Cash Price |
$56.64
|
| Rate for Payer: Cash Price |
$56.64
|
| Rate for Payer: Coventry All Commercial |
$56.18
|
| Rate for Payer: Frontpath All Commercial |
$54.19
|
| Rate for Payer: Humana ChoiceCare |
$52.69
|
| Rate for Payer: Humana Medicare |
$46.82
|
| Rate for Payer: Lucent All Commercial |
$79.59
|
| Rate for Payer: Lutheran Preferred All Commercial |
$75.00
|
| Rate for Payer: PHCS All Commercial |
$68.52
|
| Rate for Payer: PHP All Commercial |
$67.14
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$46.82
|
| Rate for Payer: Signature Care EPO |
$58.24
|
| Rate for Payer: Signature Care PPO |
$58.24
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$70.00
|
| Rate for Payer: United Healthcare Commercial |
$48.46
|
| Rate for Payer: United Healthcare Medicare |
$46.82
|
|
|
PR INTERROG EVAL F2F 1/DUAL/MLT LEADS IMPLTBL DFB
|
Professional
|
$134.28
|
|
|
Service Code
|
CPT 93289
|
| Hospital Charge Code |
z93289
|
| Min. Negotiated Rate |
$68.82 |
| Max. Negotiated Rate |
$116.99 |
| Rate for Payer: Aetna Medicare |
$68.82
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$93.35
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$93.35
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$79.14
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$75.70
|
| Rate for Payer: Cash Price |
$83.25
|
| Rate for Payer: Cash Price |
$83.25
|
| Rate for Payer: Coventry All Commercial |
$82.58
|
| Rate for Payer: Frontpath All Commercial |
$79.64
|
| Rate for Payer: Humana ChoiceCare |
$85.14
|
| Rate for Payer: Humana Medicare |
$68.82
|
| Rate for Payer: Lucent All Commercial |
$116.99
|
| Rate for Payer: Lutheran Preferred All Commercial |
$110.00
|
| Rate for Payer: PHCS All Commercial |
$100.71
|
| Rate for Payer: PHP All Commercial |
$98.70
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$68.82
|
| Rate for Payer: Signature Care EPO |
$95.85
|
| Rate for Payer: Signature Care PPO |
$95.85
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$103.00
|
| Rate for Payer: United Healthcare Commercial |
$78.31
|
| Rate for Payer: United Healthcare Medicare |
$68.82
|
|
|
PR INTRACUTANEOUS TESTS W/ALLERGENIC EXTRACTS
|
Professional
|
$14.22
|
|
|
Service Code
|
CPT 95024
|
| Hospital Charge Code |
z95024
|
| Min. Negotiated Rate |
$0.81 |
| Max. Negotiated Rate |
$10.66 |
| Rate for Payer: Aetna Medicare |
$0.81
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$5.74
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$5.74
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$0.93
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$0.89
|
| Rate for Payer: Cash Price |
$8.82
|
| Rate for Payer: Cash Price |
$8.82
|
| Rate for Payer: Coventry All Commercial |
$0.97
|
| Rate for Payer: Frontpath All Commercial |
$1.08
|
| Rate for Payer: Humana ChoiceCare |
$7.04
|
| Rate for Payer: Humana Medicare |
$0.81
|
| Rate for Payer: Lucent All Commercial |
$1.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1.00
|
| Rate for Payer: PHCS All Commercial |
$10.66
|
| Rate for Payer: PHP All Commercial |
$0.91
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$0.81
|
| Rate for Payer: Signature Care EPO |
$6.52
|
| Rate for Payer: Signature Care PPO |
$6.52
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1.00
|
| Rate for Payer: United Healthcare Commercial |
$7.76
|
| Rate for Payer: United Healthcare Medicare |
$0.81
|
|
|
PR INTRANASAL BIOPSY
|
Professional
|
$259.28
|
|
|
Service Code
|
CPT 30100
|
| Hospital Charge Code |
z30100
|
| Min. Negotiated Rate |
$63.42 |
| Max. Negotiated Rate |
$194.46 |
| Rate for Payer: Aetna Medicare |
$63.42
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$91.50
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$91.50
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$72.93
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$69.76
|
| Rate for Payer: Cash Price |
$160.75
|
| Rate for Payer: Cash Price |
$160.75
|
| Rate for Payer: Coventry All Commercial |
$76.10
|
| Rate for Payer: Frontpath All Commercial |
$85.98
|
| Rate for Payer: Humana ChoiceCare |
$78.90
|
| Rate for Payer: Humana Medicare |
$63.42
|
| Rate for Payer: Lucent All Commercial |
$107.81
|
| Rate for Payer: Lutheran Preferred All Commercial |
$101.00
|
| Rate for Payer: PHCS All Commercial |
$194.46
|
| Rate for Payer: PHP All Commercial |
$86.63
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$63.42
|
| Rate for Payer: Signature Care EPO |
$153.85
|
| Rate for Payer: Signature Care PPO |
$153.85
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$95.00
|
| Rate for Payer: United Healthcare Commercial |
$76.55
|
| Rate for Payer: United Healthcare Medicare |
$63.42
|
|
|
PR INTRAOPERATIVE SENTINEL LYMPH NODE ID W DYE INJECTION
|
Professional
|
$242.56
|
|
|
Service Code
|
CPT 38900
|
| Hospital Charge Code |
z38900
|
| Min. Negotiated Rate |
$124.31 |
| Max. Negotiated Rate |
$211.33 |
| Rate for Payer: Aetna Medicare |
$124.31
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$165.04
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$165.04
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$142.96
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$136.74
|
| Rate for Payer: Cash Price |
$150.39
|
| Rate for Payer: Cash Price |
$150.39
|
| Rate for Payer: Coventry All Commercial |
$149.17
|
| Rate for Payer: Frontpath All Commercial |
$182.25
|
| Rate for Payer: Humana ChoiceCare |
$167.88
|
| Rate for Payer: Humana Medicare |
$124.31
|
| Rate for Payer: Lucent All Commercial |
$211.33
|
| Rate for Payer: Lutheran Preferred All Commercial |
$199.00
|
| Rate for Payer: PHCS All Commercial |
$181.92
|
| Rate for Payer: PHP All Commercial |
$169.79
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$124.31
|
| Rate for Payer: Signature Care EPO |
$142.15
|
| Rate for Payer: Signature Care PPO |
$142.15
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$186.00
|
| Rate for Payer: United Healthcare Commercial |
$168.83
|
| Rate for Payer: United Healthcare Medicare |
$124.31
|
|
|
PR INTRAUT COPPER CONTRACEPTIVE
|
Professional
|
$1,050.63
|
|
|
Service Code
|
CPT J7300
|
| Hospital Charge Code |
zJ7300
|
| Min. Negotiated Rate |
$984.00 |
| Max. Negotiated Rate |
$1,050.63 |
| Rate for Payer: Humana ChoiceCare |
$1,050.63
|
| Rate for Payer: PHP All Commercial |
$984.00
|
|
|
PR IP/OBS CONSLTJ NEW/EST PT HIGH MDM 80 MINUTES
|
Professional
|
$348.88
|
|
|
Service Code
|
CPT 99255
|
| Hospital Charge Code |
z99255
|
| Min. Negotiated Rate |
$179.67 |
| Max. Negotiated Rate |
$261.66 |
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$208.20
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$208.20
|
| Rate for Payer: Cash Price |
$216.31
|
| Rate for Payer: Cash Price |
$216.31
|
| Rate for Payer: Frontpath All Commercial |
$198.27
|
| Rate for Payer: Humana ChoiceCare |
$222.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$188.00
|
| Rate for Payer: PHCS All Commercial |
$261.66
|
| Rate for Payer: PHP All Commercial |
$179.67
|
| Rate for Payer: Signature Care EPO |
$204.85
|
| Rate for Payer: Signature Care PPO |
$204.85
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$184.00
|
| Rate for Payer: United Healthcare Commercial |
$204.93
|
|
|
PR IP/OBS CONSLTJ NEW/EST PT LOW MDM 45 MINUTES
|
Professional
|
$186.62
|
|
|
Service Code
|
CPT 99253
|
| Hospital Charge Code |
z99253
|
| Min. Negotiated Rate |
$96.10 |
| Max. Negotiated Rate |
$139.96 |
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$116.27
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$116.27
|
| Rate for Payer: Cash Price |
$115.70
|
| Rate for Payer: Cash Price |
$115.70
|
| Rate for Payer: Frontpath All Commercial |
$113.73
|
| Rate for Payer: Humana ChoiceCare |
$111.79
|
| Rate for Payer: Lutheran Preferred All Commercial |
$100.00
|
| Rate for Payer: PHCS All Commercial |
$139.96
|
| Rate for Payer: PHP All Commercial |
$96.10
|
| Rate for Payer: Signature Care EPO |
$102.85
|
| Rate for Payer: Signature Care PPO |
$102.85
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$99.00
|
| Rate for Payer: United Healthcare Commercial |
$116.27
|
|
|
PR IP/OBS CONSLTJ NEW/EST PT MOD MDM 60 MINUTES
|
Professional
|
$259.28
|
|
|
Service Code
|
CPT 99254
|
| Hospital Charge Code |
z99254
|
| Min. Negotiated Rate |
$133.53 |
| Max. Negotiated Rate |
$194.46 |
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$168.22
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$168.22
|
| Rate for Payer: Cash Price |
$160.75
|
| Rate for Payer: Cash Price |
$160.75
|
| Rate for Payer: Frontpath All Commercial |
$163.72
|
| Rate for Payer: Humana ChoiceCare |
$161.32
|
| Rate for Payer: Lutheran Preferred All Commercial |
$140.00
|
| Rate for Payer: PHCS All Commercial |
$194.46
|
| Rate for Payer: PHP All Commercial |
$133.53
|
| Rate for Payer: Signature Care EPO |
$148.75
|
| Rate for Payer: Signature Care PPO |
$148.75
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$137.00
|
| Rate for Payer: United Healthcare Commercial |
$168.22
|
|
|
PR IP/OBS CONSLTJ NEW/EST PT SF MDM 35 MINUTES
|
Professional
|
$133.64
|
|
|
Service Code
|
CPT 99252
|
| Hospital Charge Code |
z99252
|
| Min. Negotiated Rate |
$68.83 |
| Max. Negotiated Rate |
$100.23 |
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$85.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$85.00
|
| Rate for Payer: Cash Price |
$82.86
|
| Rate for Payer: Cash Price |
$82.86
|
| Rate for Payer: Frontpath All Commercial |
$73.19
|
| Rate for Payer: Humana ChoiceCare |
$81.56
|
| Rate for Payer: Lutheran Preferred All Commercial |
$72.00
|
| Rate for Payer: PHCS All Commercial |
$100.23
|
| Rate for Payer: PHP All Commercial |
$68.83
|
| Rate for Payer: Signature Care EPO |
$75.65
|
| Rate for Payer: Signature Care PPO |
$75.65
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$71.00
|
| Rate for Payer: United Healthcare Commercial |
$76.58
|
|
|
PR IRRIGATION MAXILLARY SINUS
|
Professional
|
$339.80
|
|
|
Service Code
|
CPT 31000
|
| Hospital Charge Code |
z31000
|
| Min. Negotiated Rate |
$103.45 |
| Max. Negotiated Rate |
$254.85 |
| Rate for Payer: Aetna Medicare |
$103.45
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$115.40
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$115.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$118.97
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$113.80
|
| Rate for Payer: Cash Price |
$210.68
|
| Rate for Payer: Cash Price |
$210.68
|
| Rate for Payer: Coventry All Commercial |
$124.14
|
| Rate for Payer: Frontpath All Commercial |
$138.83
|
| Rate for Payer: Humana ChoiceCare |
$113.17
|
| Rate for Payer: Humana Medicare |
$103.45
|
| Rate for Payer: Lucent All Commercial |
$175.86
|
| Rate for Payer: Lutheran Preferred All Commercial |
$166.00
|
| Rate for Payer: PHCS All Commercial |
$254.85
|
| Rate for Payer: PHP All Commercial |
$141.30
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$103.45
|
| Rate for Payer: Signature Care EPO |
$208.25
|
| Rate for Payer: Signature Care PPO |
$208.25
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$155.00
|
| Rate for Payer: United Healthcare Commercial |
$111.46
|
| Rate for Payer: United Healthcare Medicare |
$103.45
|
|
|
PR KETOROLAC TROMETHAMINE INJ
|
Professional
|
$1.58
|
|
|
Service Code
|
CPT J1885
|
| Hospital Charge Code |
zJ1885
|
| Min. Negotiated Rate |
$0.59 |
| Max. Negotiated Rate |
$1.58 |
| Rate for Payer: Humana ChoiceCare |
$0.59
|
| Rate for Payer: PHP All Commercial |
$1.58
|
|
|
PR KNEE ARTHROSCOPY/SURGERY MED AND LAT
|
Professional
|
$1,023.30
|
|
|
Service Code
|
CPT 29880
|
| Hospital Charge Code |
z29880
|
| Min. Negotiated Rate |
$524.44 |
| Max. Negotiated Rate |
$891.55 |
| Rate for Payer: Aetna Medicare |
$524.44
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$860.60
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$860.60
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$603.11
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$576.88
|
| Rate for Payer: Cash Price |
$634.45
|
| Rate for Payer: Cash Price |
$634.45
|
| Rate for Payer: Coventry All Commercial |
$629.33
|
| Rate for Payer: Frontpath All Commercial |
$728.14
|
| Rate for Payer: Humana ChoiceCare |
$690.54
|
| Rate for Payer: Humana Medicare |
$524.44
|
| Rate for Payer: Lucent All Commercial |
$891.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$839.00
|
| Rate for Payer: PHCS All Commercial |
$767.48
|
| Rate for Payer: PHP All Commercial |
$890.27
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$524.44
|
| Rate for Payer: Signature Care EPO |
$891.41
|
| Rate for Payer: Signature Care PPO |
$891.41
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$787.00
|
| Rate for Payer: United Healthcare Commercial |
$741.23
|
| Rate for Payer: United Healthcare Medicare |
$524.44
|
|
|
PR KNEE ARTHROSCOPY/SURGERY MED OR LAT
|
Professional
|
$985.82
|
|
|
Service Code
|
CPT 29881
|
| Hospital Charge Code |
z29881
|
| Min. Negotiated Rate |
$505.24 |
| Max. Negotiated Rate |
$858.91 |
| Rate for Payer: Aetna Medicare |
$505.24
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$791.70
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$791.70
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$581.03
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$555.76
|
| Rate for Payer: Cash Price |
$611.21
|
| Rate for Payer: Cash Price |
$611.21
|
| Rate for Payer: Coventry All Commercial |
$606.29
|
| Rate for Payer: Frontpath All Commercial |
$701.12
|
| Rate for Payer: Humana ChoiceCare |
$639.95
|
| Rate for Payer: Humana Medicare |
$505.24
|
| Rate for Payer: Lucent All Commercial |
$858.91
|
| Rate for Payer: Lutheran Preferred All Commercial |
$808.00
|
| Rate for Payer: PHCS All Commercial |
$739.36
|
| Rate for Payer: PHP All Commercial |
$857.67
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$505.24
|
| Rate for Payer: Signature Care EPO |
$850.00
|
| Rate for Payer: Signature Care PPO |
$850.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$758.00
|
| Rate for Payer: United Healthcare Commercial |
$690.29
|
| Rate for Payer: United Healthcare Medicare |
$505.24
|
|
|
PR KNEE SCOPE,ABRASN ARTHROPLASTY
|
Professional
|
$1,201.80
|
|
|
Service Code
|
CPT 29879
|
| Hospital Charge Code |
z29879
|
| Min. Negotiated Rate |
$615.92 |
| Max. Negotiated Rate |
$1,047.06 |
| Rate for Payer: Aetna Medicare |
$615.92
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$817.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$817.00
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$708.31
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$677.51
|
| Rate for Payer: Cash Price |
$745.12
|
| Rate for Payer: Cash Price |
$745.12
|
| Rate for Payer: Coventry All Commercial |
$739.10
|
| Rate for Payer: Frontpath All Commercial |
$857.94
|
| Rate for Payer: Humana ChoiceCare |
$659.45
|
| Rate for Payer: Humana Medicare |
$615.92
|
| Rate for Payer: Lucent All Commercial |
$1,047.06
|
| Rate for Payer: Lutheran Preferred All Commercial |
$985.00
|
| Rate for Payer: PHCS All Commercial |
$901.35
|
| Rate for Payer: PHP All Commercial |
$1,045.56
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$615.92
|
| Rate for Payer: Signature Care EPO |
$875.50
|
| Rate for Payer: Signature Care PPO |
$875.50
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$924.00
|
| Rate for Payer: United Healthcare Commercial |
$709.64
|
| Rate for Payer: United Healthcare Medicare |
$615.92
|
|
|
PR KNEE SCOPE,AID ANT CRUCIATE REPAIR
|
Professional
|
$1,767.34
|
|
|
Service Code
|
CPT 29888
|
| Hospital Charge Code |
z29888
|
| Min. Negotiated Rate |
$905.76 |
| Max. Negotiated Rate |
$1,539.79 |
| Rate for Payer: Aetna Medicare |
$905.76
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,381.20
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,381.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,041.62
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$996.34
|
| Rate for Payer: Cash Price |
$1,095.75
|
| Rate for Payer: Cash Price |
$1,095.75
|
| Rate for Payer: Coventry All Commercial |
$1,086.91
|
| Rate for Payer: Frontpath All Commercial |
$1,269.50
|
| Rate for Payer: Humana ChoiceCare |
$1,056.49
|
| Rate for Payer: Humana Medicare |
$905.76
|
| Rate for Payer: Lucent All Commercial |
$1,539.79
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,449.00
|
| Rate for Payer: PHCS All Commercial |
$1,325.50
|
| Rate for Payer: PHP All Commercial |
$1,537.59
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$905.76
|
| Rate for Payer: Signature Care EPO |
$1,409.30
|
| Rate for Payer: Signature Care PPO |
$1,409.30
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,359.00
|
| Rate for Payer: United Healthcare Commercial |
$1,084.83
|
| Rate for Payer: United Healthcare Medicare |
$905.76
|
|
|
PR KNEE SCOPE,AID POST CRUC REPAIR
|
Professional
|
$2,213.12
|
|
|
Service Code
|
CPT 29889
|
| Hospital Charge Code |
z29889
|
| Min. Negotiated Rate |
$1,134.23 |
| Max. Negotiated Rate |
$1,928.19 |
| Rate for Payer: Aetna Medicare |
$1,134.23
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,304.36
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,247.65
|
| Rate for Payer: Cash Price |
$1,372.13
|
| Rate for Payer: Cash Price |
$1,372.13
|
| Rate for Payer: Coventry All Commercial |
$1,361.08
|
| Rate for Payer: Frontpath All Commercial |
$1,588.86
|
| Rate for Payer: Humana ChoiceCare |
$1,243.81
|
| Rate for Payer: Humana Medicare |
$1,134.23
|
| Rate for Payer: Lucent All Commercial |
$1,928.19
|
| Rate for Payer: PHCS All Commercial |
$1,659.84
|
| Rate for Payer: PHP All Commercial |
$1,925.42
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,134.23
|
| Rate for Payer: Signature Care EPO |
$1,650.70
|
| Rate for Payer: Signature Care PPO |
$1,650.70
|
| Rate for Payer: United Healthcare Commercial |
$1,324.88
|
| Rate for Payer: United Healthcare Medicare |
$1,134.23
|
|
|
PR KNEE SCOPE,CLEAN/DRAIN
|
Professional
|
$939.20
|
|
|
Service Code
|
CPT 29871
|
| Hospital Charge Code |
z29871
|
| Min. Negotiated Rate |
$481.34 |
| Max. Negotiated Rate |
$818.28 |
| Rate for Payer: Aetna Medicare |
$481.34
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$672.10
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$672.10
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$553.54
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$529.47
|
| Rate for Payer: Cash Price |
$582.30
|
| Rate for Payer: Cash Price |
$582.30
|
| Rate for Payer: Coventry All Commercial |
$577.61
|
| Rate for Payer: Frontpath All Commercial |
$666.35
|
| Rate for Payer: Humana ChoiceCare |
$540.20
|
| Rate for Payer: Humana Medicare |
$481.34
|
| Rate for Payer: Lucent All Commercial |
$818.28
|
| Rate for Payer: Lutheran Preferred All Commercial |
$770.00
|
| Rate for Payer: PHCS All Commercial |
$704.40
|
| Rate for Payer: PHP All Commercial |
$817.10
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$481.34
|
| Rate for Payer: Signature Care EPO |
$716.55
|
| Rate for Payer: Signature Care PPO |
$716.55
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$722.00
|
| Rate for Payer: United Healthcare Commercial |
$550.16
|
| Rate for Payer: United Healthcare Medicare |
$481.34
|
|
