|
PR KNEE SCOPE,FULL SYNOVECT
|
Professional
|
$1,185.98
|
|
|
Service Code
|
CPT 29876
|
| Hospital Charge Code |
z29876
|
| Min. Negotiated Rate |
$607.81 |
| Max. Negotiated Rate |
$1,033.28 |
| Rate for Payer: Aetna Medicare |
$607.81
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$815.10
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$815.10
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$698.98
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$668.59
|
| Rate for Payer: Cash Price |
$735.31
|
| Rate for Payer: Cash Price |
$735.31
|
| Rate for Payer: Coventry All Commercial |
$729.37
|
| Rate for Payer: Frontpath All Commercial |
$847.28
|
| Rate for Payer: Humana ChoiceCare |
$649.88
|
| Rate for Payer: Humana Medicare |
$607.81
|
| Rate for Payer: Lucent All Commercial |
$1,033.28
|
| Rate for Payer: Lutheran Preferred All Commercial |
$972.00
|
| Rate for Payer: PHCS All Commercial |
$889.48
|
| Rate for Payer: PHP All Commercial |
$1,031.80
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$607.81
|
| Rate for Payer: Signature Care EPO |
$863.60
|
| Rate for Payer: Signature Care PPO |
$863.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$912.00
|
| Rate for Payer: United Healthcare Commercial |
$700.79
|
| Rate for Payer: United Healthcare Medicare |
$607.81
|
|
|
PR KNEE SCOPE,LYSIS OF ADHESNS
|
Professional
|
$1,126.64
|
|
|
Service Code
|
CPT 29884
|
| Hospital Charge Code |
z29884
|
| Min. Negotiated Rate |
$577.40 |
| Max. Negotiated Rate |
$981.58 |
| Rate for Payer: Aetna Medicare |
$577.40
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$768.70
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$768.70
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$664.01
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$635.14
|
| Rate for Payer: Cash Price |
$698.52
|
| Rate for Payer: Cash Price |
$698.52
|
| Rate for Payer: Coventry All Commercial |
$692.88
|
| Rate for Payer: Frontpath All Commercial |
$801.19
|
| Rate for Payer: Humana ChoiceCare |
$609.56
|
| Rate for Payer: Humana Medicare |
$577.40
|
| Rate for Payer: Lucent All Commercial |
$981.58
|
| Rate for Payer: Lutheran Preferred All Commercial |
$924.00
|
| Rate for Payer: PHCS All Commercial |
$844.98
|
| Rate for Payer: PHP All Commercial |
$980.18
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$577.40
|
| Rate for Payer: Signature Care EPO |
$809.20
|
| Rate for Payer: Signature Care PPO |
$809.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$866.00
|
| Rate for Payer: United Healthcare Commercial |
$660.73
|
| Rate for Payer: United Healthcare Medicare |
$577.40
|
|
|
PR KNEE SCOPE,MED+LAT MENIS REPAIR
|
Professional
|
$1,529.12
|
|
|
Service Code
|
CPT 29883
|
| Hospital Charge Code |
z29883
|
| Min. Negotiated Rate |
$783.67 |
| Max. Negotiated Rate |
$1,332.24 |
| Rate for Payer: Aetna Medicare |
$783.67
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$948.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$948.30
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$901.22
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$862.04
|
| Rate for Payer: Cash Price |
$948.05
|
| Rate for Payer: Cash Price |
$948.05
|
| Rate for Payer: Coventry All Commercial |
$940.40
|
| Rate for Payer: Frontpath All Commercial |
$1,091.06
|
| Rate for Payer: Humana ChoiceCare |
$877.64
|
| Rate for Payer: Humana Medicare |
$783.67
|
| Rate for Payer: Lucent All Commercial |
$1,332.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,254.00
|
| Rate for Payer: PHCS All Commercial |
$1,146.84
|
| Rate for Payer: PHP All Commercial |
$1,330.33
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$783.67
|
| Rate for Payer: Signature Care EPO |
$1,160.25
|
| Rate for Payer: Signature Care PPO |
$1,160.25
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,176.00
|
| Rate for Payer: United Healthcare Commercial |
$914.08
|
| Rate for Payer: United Healthcare Medicare |
$783.67
|
|
|
PR KNEE SCOPE,MED OR LAT MENIS REPAIR
|
Professional
|
$1,253.06
|
|
|
Service Code
|
CPT 29882
|
| Hospital Charge Code |
z29882
|
| Min. Negotiated Rate |
$642.20 |
| Max. Negotiated Rate |
$1,091.74 |
| Rate for Payer: Aetna Medicare |
$642.20
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$872.80
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$872.80
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$738.53
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$706.42
|
| Rate for Payer: Cash Price |
$776.90
|
| Rate for Payer: Cash Price |
$776.90
|
| Rate for Payer: Coventry All Commercial |
$770.64
|
| Rate for Payer: Frontpath All Commercial |
$893.59
|
| Rate for Payer: Humana ChoiceCare |
$692.92
|
| Rate for Payer: Humana Medicare |
$642.20
|
| Rate for Payer: Lucent All Commercial |
$1,091.74
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,028.00
|
| Rate for Payer: PHCS All Commercial |
$939.80
|
| Rate for Payer: PHP All Commercial |
$1,090.17
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$642.20
|
| Rate for Payer: Signature Care EPO |
$917.15
|
| Rate for Payer: Signature Care PPO |
$917.15
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$963.00
|
| Rate for Payer: United Healthcare Commercial |
$748.39
|
| Rate for Payer: United Healthcare Medicare |
$642.20
|
|
|
PR KNEE SCOPE,PART SYNOVECT
|
Professional
|
$904.58
|
|
|
Service Code
|
CPT 29875
|
| Hospital Charge Code |
z29875
|
| Min. Negotiated Rate |
$463.60 |
| Max. Negotiated Rate |
$788.12 |
| Rate for Payer: Aetna Medicare |
$463.60
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$657.10
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$657.10
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$533.14
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$509.96
|
| Rate for Payer: Cash Price |
$560.84
|
| Rate for Payer: Cash Price |
$560.84
|
| Rate for Payer: Coventry All Commercial |
$556.32
|
| Rate for Payer: Frontpath All Commercial |
$642.82
|
| Rate for Payer: Humana ChoiceCare |
$527.97
|
| Rate for Payer: Humana Medicare |
$463.60
|
| Rate for Payer: Lucent All Commercial |
$788.12
|
| Rate for Payer: Lutheran Preferred All Commercial |
$742.00
|
| Rate for Payer: PHCS All Commercial |
$678.44
|
| Rate for Payer: PHP All Commercial |
$786.98
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$463.60
|
| Rate for Payer: Signature Care EPO |
$701.25
|
| Rate for Payer: Signature Care PPO |
$701.25
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$695.00
|
| Rate for Payer: United Healthcare Commercial |
$532.20
|
| Rate for Payer: United Healthcare Medicare |
$463.60
|
|
|
PR KNEE SCOPE,REMV LOOSE BODY
|
Professional
|
$976.24
|
|
|
Service Code
|
CPT 29874
|
| Hospital Charge Code |
z29874
|
| Min. Negotiated Rate |
$500.32 |
| Max. Negotiated Rate |
$850.54 |
| Rate for Payer: Aetna Medicare |
$500.32
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$720.40
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$720.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$575.37
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$550.35
|
| Rate for Payer: Cash Price |
$605.27
|
| Rate for Payer: Cash Price |
$605.27
|
| Rate for Payer: Coventry All Commercial |
$600.38
|
| Rate for Payer: Frontpath All Commercial |
$695.25
|
| Rate for Payer: Humana ChoiceCare |
$569.36
|
| Rate for Payer: Humana Medicare |
$500.32
|
| Rate for Payer: Lucent All Commercial |
$850.54
|
| Rate for Payer: Lutheran Preferred All Commercial |
$801.00
|
| Rate for Payer: PHCS All Commercial |
$732.18
|
| Rate for Payer: PHP All Commercial |
$849.33
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$500.32
|
| Rate for Payer: Signature Care EPO |
$756.50
|
| Rate for Payer: Signature Care PPO |
$756.50
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$750.00
|
| Rate for Payer: United Healthcare Commercial |
$577.69
|
| Rate for Payer: United Healthcare Medicare |
$500.32
|
|
|
PR KNEE SCOPE,SHAVE ARTICULAR CART
|
Professional
|
$1,129.48
|
|
|
Service Code
|
CPT 29877
|
| Hospital Charge Code |
z29877
|
| Min. Negotiated Rate |
$578.86 |
| Max. Negotiated Rate |
$984.06 |
| Rate for Payer: Aetna Medicare |
$578.86
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$753.70
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$753.70
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$665.69
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$636.75
|
| Rate for Payer: Cash Price |
$700.28
|
| Rate for Payer: Cash Price |
$700.28
|
| Rate for Payer: Coventry All Commercial |
$694.63
|
| Rate for Payer: Frontpath All Commercial |
$805.62
|
| Rate for Payer: Humana ChoiceCare |
$612.20
|
| Rate for Payer: Humana Medicare |
$578.86
|
| Rate for Payer: Lucent All Commercial |
$984.06
|
| Rate for Payer: Lutheran Preferred All Commercial |
$926.00
|
| Rate for Payer: PHCS All Commercial |
$847.11
|
| Rate for Payer: PHP All Commercial |
$982.65
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$578.86
|
| Rate for Payer: Signature Care EPO |
$812.60
|
| Rate for Payer: Signature Care PPO |
$812.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$868.00
|
| Rate for Payer: United Healthcare Commercial |
$662.73
|
| Rate for Payer: United Healthcare Medicare |
$578.86
|
|
|
PR KNEE SCOPE/SURG/INCOND FX AID+FIXAT
|
Professional
|
$1,716.72
|
|
|
Service Code
|
CPT 29851
|
| Hospital Charge Code |
z29851
|
| Min. Negotiated Rate |
$862.16 |
| Max. Negotiated Rate |
$1,465.67 |
| Rate for Payer: Aetna Medicare |
$862.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$991.48
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$948.38
|
| Rate for Payer: Cash Price |
$1,064.37
|
| Rate for Payer: Cash Price |
$1,064.37
|
| Rate for Payer: Coventry All Commercial |
$1,034.59
|
| Rate for Payer: Frontpath All Commercial |
$1,206.87
|
| Rate for Payer: Humana ChoiceCare |
$1,004.00
|
| Rate for Payer: Humana Medicare |
$862.16
|
| Rate for Payer: Lucent All Commercial |
$1,465.67
|
| Rate for Payer: PHCS All Commercial |
$1,287.54
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$862.16
|
| Rate for Payer: United Healthcare Commercial |
$1,019.43
|
| Rate for Payer: United Healthcare Medicare |
$862.16
|
|
|
PR KNEE SCOPE, W/LATERAL RELEASE
|
Professional
|
$978.28
|
|
|
Service Code
|
CPT 29873
|
| Hospital Charge Code |
z29873
|
| Min. Negotiated Rate |
$501.36 |
| Max. Negotiated Rate |
$1,294.10 |
| Rate for Payer: Aetna Medicare |
$501.36
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,294.10
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,294.10
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$576.56
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$551.50
|
| Rate for Payer: Cash Price |
$606.53
|
| Rate for Payer: Cash Price |
$606.53
|
| Rate for Payer: Coventry All Commercial |
$601.63
|
| Rate for Payer: Frontpath All Commercial |
$692.77
|
| Rate for Payer: Humana ChoiceCare |
$541.97
|
| Rate for Payer: Humana Medicare |
$501.36
|
| Rate for Payer: Lucent All Commercial |
$852.31
|
| Rate for Payer: Lutheran Preferred All Commercial |
$802.00
|
| Rate for Payer: PHCS All Commercial |
$733.71
|
| Rate for Payer: PHP All Commercial |
$851.10
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$501.36
|
| Rate for Payer: Signature Care EPO |
$851.82
|
| Rate for Payer: Signature Care PPO |
$851.82
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$752.00
|
| Rate for Payer: United Healthcare Commercial |
$547.65
|
| Rate for Payer: United Healthcare Medicare |
$501.36
|
|
|
PR KYLEENA, 19.5 MG
|
Professional
|
$1,070.23
|
|
|
Service Code
|
CPT J7296
|
| Hospital Charge Code |
zJ7296
|
| Min. Negotiated Rate |
$1,007.27 |
| Max. Negotiated Rate |
$1,070.23 |
| Rate for Payer: Humana ChoiceCare |
$1,070.23
|
| Rate for Payer: PHP All Commercial |
$1,007.27
|
|
|
PR LABYRINTHOTOMY W PERFUSION VESTIBULOACTIVE DRUGS,TRANSCRANIAL
|
Professional
|
$418.80
|
|
|
Service Code
|
CPT 69801
|
| Hospital Charge Code |
z69801
|
| Min. Negotiated Rate |
$116.46 |
| Max. Negotiated Rate |
$804.94 |
| Rate for Payer: Aetna Medicare |
$116.46
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$385.80
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$385.80
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$133.93
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$128.11
|
| Rate for Payer: Cash Price |
$259.66
|
| Rate for Payer: Cash Price |
$259.66
|
| Rate for Payer: Coventry All Commercial |
$139.75
|
| Rate for Payer: Frontpath All Commercial |
$160.26
|
| Rate for Payer: Humana ChoiceCare |
$732.03
|
| Rate for Payer: Humana Medicare |
$116.46
|
| Rate for Payer: Lucent All Commercial |
$197.98
|
| Rate for Payer: Lutheran Preferred All Commercial |
$186.00
|
| Rate for Payer: PHCS All Commercial |
$314.10
|
| Rate for Payer: PHP All Commercial |
$147.71
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$116.46
|
| Rate for Payer: Signature Care EPO |
$318.22
|
| Rate for Payer: Signature Care PPO |
$318.22
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$175.00
|
| Rate for Payer: United Healthcare Commercial |
$804.94
|
| Rate for Payer: United Healthcare Medicare |
$116.46
|
|
|
PR LAP,ABDOMEN,ASPIRATE CYST
|
Professional
|
$672.62
|
|
|
Service Code
|
CPT 49322
|
| Hospital Charge Code |
z49322
|
| Min. Negotiated Rate |
$344.72 |
| Max. Negotiated Rate |
$588.54 |
| Rate for Payer: Aetna Medicare |
$344.72
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$490.10
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$490.10
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$396.43
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$379.19
|
| Rate for Payer: Cash Price |
$417.02
|
| Rate for Payer: Cash Price |
$417.02
|
| Rate for Payer: Coventry All Commercial |
$413.66
|
| Rate for Payer: Frontpath All Commercial |
$493.88
|
| Rate for Payer: Humana ChoiceCare |
$395.45
|
| Rate for Payer: Humana Medicare |
$344.72
|
| Rate for Payer: Lucent All Commercial |
$586.02
|
| Rate for Payer: Lutheran Preferred All Commercial |
$517.00
|
| Rate for Payer: PHCS All Commercial |
$504.46
|
| Rate for Payer: PHP All Commercial |
$588.54
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$344.72
|
| Rate for Payer: Signature Care EPO |
$500.65
|
| Rate for Payer: Signature Care PPO |
$500.65
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$483.00
|
| Rate for Payer: United Healthcare Commercial |
$403.75
|
| Rate for Payer: United Healthcare Medicare |
$344.72
|
|
|
PR LAP,ABD/PERIT/OMENTUM,UNLIST
|
Professional
|
$735.00
|
|
|
Service Code
|
CPT 49329
|
| Hospital Charge Code |
z49329
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$624.75 |
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$0.01
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$0.01
|
| Rate for Payer: Cash Price |
$455.70
|
| Rate for Payer: Cash Price |
$455.70
|
| Rate for Payer: Lutheran Preferred All Commercial |
$624.75
|
| Rate for Payer: PHCS All Commercial |
$551.25
|
| Rate for Payer: Signature Care EPO |
$468.56
|
| Rate for Payer: Signature Care PPO |
$468.56
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$441.00
|
|
|
PR LAP,APPENDECTOMY
|
Professional
|
$1,077.46
|
|
|
Service Code
|
CPT 44970
|
| Hospital Charge Code |
z44970
|
| Min. Negotiated Rate |
$552.20 |
| Max. Negotiated Rate |
$942.78 |
| Rate for Payer: Aetna Medicare |
$552.20
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$673.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$673.00
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$635.03
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$607.42
|
| Rate for Payer: Cash Price |
$668.03
|
| Rate for Payer: Cash Price |
$668.03
|
| Rate for Payer: Coventry All Commercial |
$662.64
|
| Rate for Payer: Frontpath All Commercial |
$795.54
|
| Rate for Payer: Humana ChoiceCare |
$584.85
|
| Rate for Payer: Humana Medicare |
$552.20
|
| Rate for Payer: Lucent All Commercial |
$938.74
|
| Rate for Payer: Lutheran Preferred All Commercial |
$828.00
|
| Rate for Payer: PHCS All Commercial |
$808.10
|
| Rate for Payer: PHP All Commercial |
$942.78
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$552.20
|
| Rate for Payer: Signature Care EPO |
$747.15
|
| Rate for Payer: Signature Care PPO |
$747.15
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$773.00
|
| Rate for Payer: United Healthcare Commercial |
$629.04
|
| Rate for Payer: United Healthcare Medicare |
$552.20
|
|
|
PR LAPAROSCOPY TOTAL HYSTERECTOMY UTERUS > 250 GRAM
|
Professional
|
$1,892.82
|
|
|
Service Code
|
CPT 58572
|
| Hospital Charge Code |
z58572
|
| Min. Negotiated Rate |
$970.07 |
| Max. Negotiated Rate |
$1,649.12 |
| Rate for Payer: Aetna Medicare |
$970.07
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,115.58
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,067.08
|
| Rate for Payer: Cash Price |
$1,173.55
|
| Rate for Payer: Cash Price |
$1,173.55
|
| Rate for Payer: Coventry All Commercial |
$1,164.08
|
| Rate for Payer: Frontpath All Commercial |
$1,357.60
|
| Rate for Payer: Humana ChoiceCare |
$1,145.17
|
| Rate for Payer: Humana Medicare |
$970.07
|
| Rate for Payer: Lucent All Commercial |
$1,649.12
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,358.00
|
| Rate for Payer: PHCS All Commercial |
$1,419.62
|
| Rate for Payer: PHP All Commercial |
$1,249.26
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$970.07
|
| Rate for Payer: Signature Care EPO |
$1,264.59
|
| Rate for Payer: Signature Care PPO |
$1,264.59
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,261.00
|
| Rate for Payer: United Healthcare Commercial |
$1,290.85
|
| Rate for Payer: United Healthcare Medicare |
$970.07
|
|
|
PR LAPAROSCOPY TOT HYSTERECTOMY UTERUS >250 GRAM W TUBE/OVARY
|
Professional
|
$2,217.26
|
|
|
Service Code
|
CPT 58573
|
| Hospital Charge Code |
z58573
|
| Min. Negotiated Rate |
$1,136.34 |
| Max. Negotiated Rate |
$1,931.78 |
| Rate for Payer: Aetna Medicare |
$1,136.34
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,306.79
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,249.97
|
| Rate for Payer: Cash Price |
$1,374.70
|
| Rate for Payer: Cash Price |
$1,374.70
|
| Rate for Payer: Coventry All Commercial |
$1,363.61
|
| Rate for Payer: Frontpath All Commercial |
$1,593.80
|
| Rate for Payer: Humana ChoiceCare |
$1,296.35
|
| Rate for Payer: Humana Medicare |
$1,136.34
|
| Rate for Payer: Lucent All Commercial |
$1,931.78
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,591.00
|
| Rate for Payer: PHCS All Commercial |
$1,662.94
|
| Rate for Payer: PHP All Commercial |
$1,463.39
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,136.34
|
| Rate for Payer: Signature Care EPO |
$1,431.52
|
| Rate for Payer: Signature Care PPO |
$1,431.52
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,477.00
|
| Rate for Payer: United Healthcare Commercial |
$1,462.61
|
| Rate for Payer: United Healthcare Medicare |
$1,136.34
|
|
|
PR LAPAROSCOPY W TOT HYSTERECT UTERUS 250 GRAM OR LESS
|
Professional
|
$1,473.56
|
|
|
Service Code
|
CPT 58570
|
| Hospital Charge Code |
z58570
|
| Min. Negotiated Rate |
$755.36 |
| Max. Negotiated Rate |
$1,284.11 |
| Rate for Payer: Aetna Medicare |
$755.36
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$868.66
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$830.90
|
| Rate for Payer: Cash Price |
$913.61
|
| Rate for Payer: Cash Price |
$913.61
|
| Rate for Payer: Coventry All Commercial |
$906.43
|
| Rate for Payer: Frontpath All Commercial |
$1,054.09
|
| Rate for Payer: Humana ChoiceCare |
$922.30
|
| Rate for Payer: Humana Medicare |
$755.36
|
| Rate for Payer: Lucent All Commercial |
$1,284.11
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,057.00
|
| Rate for Payer: PHCS All Commercial |
$1,105.17
|
| Rate for Payer: PHP All Commercial |
$972.54
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$755.36
|
| Rate for Payer: Signature Care EPO |
$1,018.47
|
| Rate for Payer: Signature Care PPO |
$1,018.47
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$982.00
|
| Rate for Payer: United Healthcare Commercial |
$1,037.33
|
| Rate for Payer: United Healthcare Medicare |
$755.36
|
|
|
PR LAPAROSCOPY W TOT HYSTERECTUTERUS <=250 GRAM W TUBE/OVARY
|
Professional
|
$1,655.50
|
|
|
Service Code
|
CPT 58571
|
| Hospital Charge Code |
z58571
|
| Min. Negotiated Rate |
$848.44 |
| Max. Negotiated Rate |
$1,442.35 |
| Rate for Payer: Aetna Medicare |
$848.44
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$975.71
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$933.28
|
| Rate for Payer: Cash Price |
$1,026.41
|
| Rate for Payer: Cash Price |
$1,026.41
|
| Rate for Payer: Coventry All Commercial |
$1,018.13
|
| Rate for Payer: Frontpath All Commercial |
$1,187.33
|
| Rate for Payer: Humana ChoiceCare |
$1,012.83
|
| Rate for Payer: Humana Medicare |
$848.44
|
| Rate for Payer: Lucent All Commercial |
$1,442.35
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,188.00
|
| Rate for Payer: PHCS All Commercial |
$1,241.62
|
| Rate for Payer: PHP All Commercial |
$1,092.63
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$848.44
|
| Rate for Payer: Signature Care EPO |
$1,118.45
|
| Rate for Payer: Signature Care PPO |
$1,118.45
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,103.00
|
| Rate for Payer: United Healthcare Commercial |
$1,140.59
|
| Rate for Payer: United Healthcare Medicare |
$848.44
|
|
|
PR LAP,CHOLECYSTECTOMY
|
Professional
|
$1,178.08
|
|
|
Service Code
|
CPT 47562
|
| Hospital Charge Code |
z47562
|
| Min. Negotiated Rate |
$603.77 |
| Max. Negotiated Rate |
$1,030.83 |
| Rate for Payer: Aetna Medicare |
$603.77
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$892.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$892.00
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$694.34
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$664.15
|
| Rate for Payer: Cash Price |
$730.41
|
| Rate for Payer: Cash Price |
$730.41
|
| Rate for Payer: Coventry All Commercial |
$724.52
|
| Rate for Payer: Frontpath All Commercial |
$873.86
|
| Rate for Payer: Humana ChoiceCare |
$736.13
|
| Rate for Payer: Humana Medicare |
$603.77
|
| Rate for Payer: Lucent All Commercial |
$1,026.41
|
| Rate for Payer: Lutheran Preferred All Commercial |
$906.00
|
| Rate for Payer: PHCS All Commercial |
$883.56
|
| Rate for Payer: PHP All Commercial |
$1,030.83
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$603.77
|
| Rate for Payer: Signature Care EPO |
$931.60
|
| Rate for Payer: Signature Care PPO |
$931.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$845.00
|
| Rate for Payer: United Healthcare Commercial |
$783.93
|
| Rate for Payer: United Healthcare Medicare |
$603.77
|
|
|
PR LAP,CHOLECYSTECTOMY/EXPLORE
|
Professional
|
$1,991.60
|
|
|
Service Code
|
CPT 47564
|
| Hospital Charge Code |
z47564
|
| Min. Negotiated Rate |
$926.74 |
| Max. Negotiated Rate |
$1,742.66 |
| Rate for Payer: Aetna Medicare |
$1,020.86
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,139.20
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,139.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,173.99
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,122.95
|
| Rate for Payer: Cash Price |
$1,234.79
|
| Rate for Payer: Cash Price |
$1,234.79
|
| Rate for Payer: Coventry All Commercial |
$1,225.03
|
| Rate for Payer: Frontpath All Commercial |
$1,476.92
|
| Rate for Payer: Humana ChoiceCare |
$926.74
|
| Rate for Payer: Humana Medicare |
$1,020.86
|
| Rate for Payer: Lucent All Commercial |
$1,735.46
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,531.00
|
| Rate for Payer: PHCS All Commercial |
$1,493.70
|
| Rate for Payer: PHP All Commercial |
$1,742.66
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,020.86
|
| Rate for Payer: Signature Care EPO |
$1,172.15
|
| Rate for Payer: Signature Care PPO |
$1,172.15
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,429.00
|
| Rate for Payer: United Healthcare Commercial |
$928.40
|
| Rate for Payer: United Healthcare Medicare |
$1,020.86
|
|
|
PR LAP,CHOLECYSTECTOMY/GRAPH
|
Professional
|
$1,283.40
|
|
|
Service Code
|
CPT 47563
|
| Hospital Charge Code |
z47563
|
| Min. Negotiated Rate |
$657.75 |
| Max. Negotiated Rate |
$1,122.98 |
| Rate for Payer: Aetna Medicare |
$657.75
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$965.28
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$965.28
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$756.41
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$723.52
|
| Rate for Payer: Cash Price |
$795.71
|
| Rate for Payer: Cash Price |
$795.71
|
| Rate for Payer: Coventry All Commercial |
$789.30
|
| Rate for Payer: Frontpath All Commercial |
$951.20
|
| Rate for Payer: Humana ChoiceCare |
$790.21
|
| Rate for Payer: Humana Medicare |
$657.75
|
| Rate for Payer: Lucent All Commercial |
$1,118.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$987.00
|
| Rate for Payer: PHCS All Commercial |
$962.55
|
| Rate for Payer: PHP All Commercial |
$1,122.98
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$657.75
|
| Rate for Payer: Signature Care EPO |
$999.60
|
| Rate for Payer: Signature Care PPO |
$999.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$921.00
|
| Rate for Payer: United Healthcare Commercial |
$802.71
|
| Rate for Payer: United Healthcare Medicare |
$657.75
|
|
|
PR LAP,DIAGNOSTIC ABDOMEN
|
Professional
|
$588.96
|
|
|
Service Code
|
CPT 49320
|
| Hospital Charge Code |
z49320
|
| Min. Negotiated Rate |
$301.84 |
| Max. Negotiated Rate |
$515.34 |
| Rate for Payer: Aetna Medicare |
$301.84
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$442.70
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$442.70
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$347.12
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$332.02
|
| Rate for Payer: Cash Price |
$365.16
|
| Rate for Payer: Cash Price |
$365.16
|
| Rate for Payer: Coventry All Commercial |
$362.21
|
| Rate for Payer: Frontpath All Commercial |
$431.85
|
| Rate for Payer: Humana ChoiceCare |
$352.25
|
| Rate for Payer: Humana Medicare |
$301.84
|
| Rate for Payer: Lucent All Commercial |
$513.13
|
| Rate for Payer: Lutheran Preferred All Commercial |
$453.00
|
| Rate for Payer: PHCS All Commercial |
$441.72
|
| Rate for Payer: PHP All Commercial |
$515.34
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$301.84
|
| Rate for Payer: Signature Care EPO |
$445.40
|
| Rate for Payer: Signature Care PPO |
$445.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$423.00
|
| Rate for Payer: United Healthcare Commercial |
$352.56
|
| Rate for Payer: United Healthcare Medicare |
$301.84
|
|
|
PR LAP,DX SURGICAL ABD W/BIOPSY
|
Professional
|
$618.46
|
|
|
Service Code
|
CPT 49321
|
| Hospital Charge Code |
z49321
|
| Min. Negotiated Rate |
$316.96 |
| Max. Negotiated Rate |
$541.15 |
| Rate for Payer: Aetna Medicare |
$316.96
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$471.80
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$471.80
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$364.50
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$348.66
|
| Rate for Payer: Cash Price |
$383.45
|
| Rate for Payer: Cash Price |
$383.45
|
| Rate for Payer: Coventry All Commercial |
$380.35
|
| Rate for Payer: Frontpath All Commercial |
$452.48
|
| Rate for Payer: Humana ChoiceCare |
$367.26
|
| Rate for Payer: Humana Medicare |
$316.96
|
| Rate for Payer: Lucent All Commercial |
$538.83
|
| Rate for Payer: Lutheran Preferred All Commercial |
$475.00
|
| Rate for Payer: PHCS All Commercial |
$463.84
|
| Rate for Payer: PHP All Commercial |
$541.15
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$316.96
|
| Rate for Payer: Signature Care EPO |
$464.10
|
| Rate for Payer: Signature Care PPO |
$464.10
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$444.00
|
| Rate for Payer: United Healthcare Commercial |
$371.16
|
| Rate for Payer: United Healthcare Medicare |
$316.96
|
|
|
PR LAP,FULGURATE/EXCISE LESIONS
|
Professional
|
$1,299.02
|
|
|
Service Code
|
CPT 58662
|
| Hospital Charge Code |
z58662
|
| Min. Negotiated Rate |
$665.75 |
| Max. Negotiated Rate |
$1,131.78 |
| Rate for Payer: Aetna Medicare |
$665.75
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$930.03
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$930.03
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$765.61
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$732.32
|
| Rate for Payer: Cash Price |
$805.39
|
| Rate for Payer: Cash Price |
$805.39
|
| Rate for Payer: Coventry All Commercial |
$798.90
|
| Rate for Payer: Frontpath All Commercial |
$932.63
|
| Rate for Payer: Humana ChoiceCare |
$782.53
|
| Rate for Payer: Humana Medicare |
$665.75
|
| Rate for Payer: Lucent All Commercial |
$1,131.78
|
| Rate for Payer: Lutheran Preferred All Commercial |
$932.00
|
| Rate for Payer: PHCS All Commercial |
$974.26
|
| Rate for Payer: PHP All Commercial |
$857.36
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$665.75
|
| Rate for Payer: Signature Care EPO |
$879.75
|
| Rate for Payer: Signature Care PPO |
$879.75
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$865.00
|
| Rate for Payer: United Healthcare Commercial |
$797.19
|
| Rate for Payer: United Healthcare Medicare |
$665.75
|
|
|
PR LAP,HERNIA REPAIR PROC,UNLIST
|
Professional
|
$735.00
|
|
|
Service Code
|
CPT 49659
|
| Hospital Charge Code |
z49659
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$624.75 |
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$0.01
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$0.01
|
| Rate for Payer: Cash Price |
$455.70
|
| Rate for Payer: Cash Price |
$455.70
|
| Rate for Payer: Lutheran Preferred All Commercial |
$624.75
|
| Rate for Payer: PHCS All Commercial |
$551.25
|
| Rate for Payer: Signature Care EPO |
$468.56
|
| Rate for Payer: Signature Care PPO |
$468.56
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$441.00
|
|
