|
PR LAP,INGUINAL HERNIA REPR,INITIAL
|
Professional
|
$1,551.04
|
|
|
Service Code
|
CPT 49650
|
| Hospital Charge Code |
z49650
|
| Min. Negotiated Rate |
$397.46 |
| Max. Negotiated Rate |
$1,163.28 |
| Rate for Payer: Aetna Medicare |
$397.46
|
| Rate for Payer: Aetna Medicare |
$397.46
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$516.40
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$516.40
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$516.40
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$516.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$457.08
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$457.08
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$437.21
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$437.21
|
| Rate for Payer: Cash Price |
$961.64
|
| Rate for Payer: Cash Price |
$961.64
|
| Rate for Payer: Cash Price |
$480.82
|
| Rate for Payer: Cash Price |
$480.82
|
| Rate for Payer: Coventry All Commercial |
$476.95
|
| Rate for Payer: Coventry All Commercial |
$476.95
|
| Rate for Payer: Frontpath All Commercial |
$569.58
|
| Rate for Payer: Frontpath All Commercial |
$569.58
|
| Rate for Payer: Humana ChoiceCare |
$433.89
|
| Rate for Payer: Humana ChoiceCare |
$433.89
|
| Rate for Payer: Humana Medicare |
$397.46
|
| Rate for Payer: Humana Medicare |
$397.46
|
| Rate for Payer: Lucent All Commercial |
$675.68
|
| Rate for Payer: Lucent All Commercial |
$675.68
|
| Rate for Payer: Lutheran Preferred All Commercial |
$596.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$596.00
|
| Rate for Payer: PHCS All Commercial |
$581.64
|
| Rate for Payer: PHCS All Commercial |
$1,163.28
|
| Rate for Payer: PHP All Commercial |
$678.59
|
| Rate for Payer: PHP All Commercial |
$678.59
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$397.46
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$397.46
|
| Rate for Payer: Signature Care EPO |
$548.25
|
| Rate for Payer: Signature Care EPO |
$548.25
|
| Rate for Payer: Signature Care PPO |
$548.25
|
| Rate for Payer: Signature Care PPO |
$548.25
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$556.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$556.00
|
| Rate for Payer: United Healthcare Commercial |
$448.61
|
| Rate for Payer: United Healthcare Commercial |
$448.61
|
| Rate for Payer: United Healthcare Medicare |
$397.46
|
| Rate for Payer: United Healthcare Medicare |
$397.46
|
|
|
PR LAP,INGUINAL HERNIA REPR,RECUR
|
Professional
|
$1,012.16
|
|
|
Service Code
|
CPT 49651
|
| Hospital Charge Code |
z49651
|
| Min. Negotiated Rate |
$518.74 |
| Max. Negotiated Rate |
$885.65 |
| Rate for Payer: Aetna Medicare |
$518.74
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$662.20
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$662.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$596.55
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$570.61
|
| Rate for Payer: Cash Price |
$627.54
|
| Rate for Payer: Cash Price |
$627.54
|
| Rate for Payer: Coventry All Commercial |
$622.49
|
| Rate for Payer: Frontpath All Commercial |
$744.30
|
| Rate for Payer: Humana ChoiceCare |
$562.34
|
| Rate for Payer: Humana Medicare |
$518.74
|
| Rate for Payer: Lucent All Commercial |
$881.86
|
| Rate for Payer: Lutheran Preferred All Commercial |
$778.00
|
| Rate for Payer: PHCS All Commercial |
$759.12
|
| Rate for Payer: PHP All Commercial |
$885.65
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$518.74
|
| Rate for Payer: Signature Care EPO |
$712.30
|
| Rate for Payer: Signature Care PPO |
$712.30
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$726.00
|
| Rate for Payer: United Healthcare Commercial |
$580.41
|
| Rate for Payer: United Healthcare Medicare |
$518.74
|
|
|
PR LAP INSERTION TUNNELED INTRAPERITONEAL CATHETER
|
Professional
|
$689.76
|
|
|
Service Code
|
CPT 49324
|
| Hospital Charge Code |
z49324
|
| Min. Negotiated Rate |
$353.50 |
| Max. Negotiated Rate |
$603.54 |
| Rate for Payer: Aetna Medicare |
$353.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$528.02
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$528.02
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$406.52
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$388.85
|
| Rate for Payer: Cash Price |
$427.65
|
| Rate for Payer: Cash Price |
$427.65
|
| Rate for Payer: Coventry All Commercial |
$424.20
|
| Rate for Payer: Frontpath All Commercial |
$512.59
|
| Rate for Payer: Humana ChoiceCare |
$385.39
|
| Rate for Payer: Humana Medicare |
$353.50
|
| Rate for Payer: Lucent All Commercial |
$600.95
|
| Rate for Payer: Lutheran Preferred All Commercial |
$530.00
|
| Rate for Payer: PHCS All Commercial |
$517.32
|
| Rate for Payer: PHP All Commercial |
$603.54
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$353.50
|
| Rate for Payer: Signature Care EPO |
$484.50
|
| Rate for Payer: Signature Care PPO |
$484.50
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$495.00
|
| Rate for Payer: United Healthcare Commercial |
$420.34
|
| Rate for Payer: United Healthcare Medicare |
$353.50
|
|
|
PR LAP,LYMPH NODE BX
|
Professional
|
$932.80
|
|
|
Service Code
|
CPT 38570
|
| Hospital Charge Code |
z38570
|
| Min. Negotiated Rate |
$478.06 |
| Max. Negotiated Rate |
$812.70 |
| Rate for Payer: Aetna Medicare |
$478.06
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$741.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$741.00
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$549.77
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$525.87
|
| Rate for Payer: Cash Price |
$578.34
|
| Rate for Payer: Cash Price |
$578.34
|
| Rate for Payer: Coventry All Commercial |
$573.67
|
| Rate for Payer: Frontpath All Commercial |
$671.16
|
| Rate for Payer: Humana ChoiceCare |
$659.68
|
| Rate for Payer: Humana Medicare |
$478.06
|
| Rate for Payer: Lucent All Commercial |
$812.70
|
| Rate for Payer: Lutheran Preferred All Commercial |
$765.00
|
| Rate for Payer: PHCS All Commercial |
$699.60
|
| Rate for Payer: PHP All Commercial |
$652.95
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$478.06
|
| Rate for Payer: Signature Care EPO |
$708.05
|
| Rate for Payer: Signature Care PPO |
$708.05
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$717.00
|
| Rate for Payer: United Healthcare Commercial |
$623.95
|
| Rate for Payer: United Healthcare Medicare |
$478.06
|
|
|
PR LAP,LYSIS OF ADHESIONS
|
Professional
|
$1,238.38
|
|
|
Service Code
|
CPT 58660
|
| Hospital Charge Code |
z58660
|
| Min. Negotiated Rate |
$634.36 |
| Max. Negotiated Rate |
$1,078.41 |
| Rate for Payer: Aetna Medicare |
$634.36
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$878.14
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$878.14
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$729.51
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$697.80
|
| Rate for Payer: Cash Price |
$767.80
|
| Rate for Payer: Cash Price |
$767.80
|
| Rate for Payer: Coventry All Commercial |
$761.23
|
| Rate for Payer: Frontpath All Commercial |
$896.60
|
| Rate for Payer: Humana ChoiceCare |
$738.48
|
| Rate for Payer: Humana Medicare |
$634.36
|
| Rate for Payer: Lucent All Commercial |
$1,078.41
|
| Rate for Payer: Lutheran Preferred All Commercial |
$888.00
|
| Rate for Payer: PHCS All Commercial |
$928.78
|
| Rate for Payer: PHP All Commercial |
$817.33
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$634.36
|
| Rate for Payer: Signature Care EPO |
$885.70
|
| Rate for Payer: Signature Care PPO |
$885.70
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$825.00
|
| Rate for Payer: United Healthcare Commercial |
$758.38
|
| Rate for Payer: United Healthcare Medicare |
$634.36
|
|
|
PR LAP,MYOMECTOMY 1-4,TOT WT 250 GMS
|
Professional
|
$1,643.28
|
|
|
Service Code
|
CPT 58545
|
| Hospital Charge Code |
z58545
|
| Min. Negotiated Rate |
$842.18 |
| Max. Negotiated Rate |
$1,431.71 |
| Rate for Payer: Aetna Medicare |
$842.18
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,152.75
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,152.75
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$968.51
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$926.40
|
| Rate for Payer: Cash Price |
$1,018.83
|
| Rate for Payer: Cash Price |
$1,018.83
|
| Rate for Payer: Coventry All Commercial |
$1,010.62
|
| Rate for Payer: Frontpath All Commercial |
$1,182.99
|
| Rate for Payer: Humana ChoiceCare |
$969.93
|
| Rate for Payer: Humana Medicare |
$842.18
|
| Rate for Payer: Lucent All Commercial |
$1,431.71
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,179.00
|
| Rate for Payer: PHCS All Commercial |
$1,232.46
|
| Rate for Payer: PHP All Commercial |
$1,084.57
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$842.18
|
| Rate for Payer: Signature Care EPO |
$1,089.70
|
| Rate for Payer: Signature Care PPO |
$1,089.70
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,095.00
|
| Rate for Payer: United Healthcare Commercial |
$1,009.06
|
| Rate for Payer: United Healthcare Medicare |
$842.18
|
|
|
PR LAP,MYOMECTOMY 5/>,TOTAL WT >250 GMS
|
Professional
|
$2,033.20
|
|
|
Service Code
|
CPT 58546
|
| Hospital Charge Code |
z58546
|
| Min. Negotiated Rate |
$1,042.01 |
| Max. Negotiated Rate |
$1,771.42 |
| Rate for Payer: Aetna Medicare |
$1,042.01
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,478.75
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,478.75
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,198.31
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,146.21
|
| Rate for Payer: Cash Price |
$1,260.58
|
| Rate for Payer: Cash Price |
$1,260.58
|
| Rate for Payer: Coventry All Commercial |
$1,250.41
|
| Rate for Payer: Frontpath All Commercial |
$1,465.05
|
| Rate for Payer: Humana ChoiceCare |
$1,244.74
|
| Rate for Payer: Humana Medicare |
$1,042.01
|
| Rate for Payer: Lucent All Commercial |
$1,771.42
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,459.00
|
| Rate for Payer: PHCS All Commercial |
$1,524.90
|
| Rate for Payer: PHP All Commercial |
$1,341.91
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,042.01
|
| Rate for Payer: Signature Care EPO |
$1,388.90
|
| Rate for Payer: Signature Care PPO |
$1,388.90
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,355.00
|
| Rate for Payer: United Healthcare Commercial |
$1,279.65
|
| Rate for Payer: United Healthcare Medicare |
$1,042.01
|
|
|
PR LAP,RMV ADNEXAL STRUCTURE
|
Professional
|
$1,190.24
|
|
|
Service Code
|
CPT 58661
|
| Hospital Charge Code |
z58661
|
| Min. Negotiated Rate |
$610.00 |
| Max. Negotiated Rate |
$1,037.00 |
| Rate for Payer: Aetna Medicare |
$610.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$856.61
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$856.61
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$701.50
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$671.00
|
| Rate for Payer: Cash Price |
$737.95
|
| Rate for Payer: Cash Price |
$737.95
|
| Rate for Payer: Coventry All Commercial |
$732.00
|
| Rate for Payer: Frontpath All Commercial |
$855.58
|
| Rate for Payer: Humana ChoiceCare |
$721.06
|
| Rate for Payer: Humana Medicare |
$610.00
|
| Rate for Payer: Lucent All Commercial |
$1,037.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$854.00
|
| Rate for Payer: PHCS All Commercial |
$892.68
|
| Rate for Payer: PHP All Commercial |
$785.56
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$610.00
|
| Rate for Payer: Signature Care EPO |
$866.15
|
| Rate for Payer: Signature Care PPO |
$866.15
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$793.00
|
| Rate for Payer: United Healthcare Commercial |
$729.39
|
| Rate for Payer: United Healthcare Medicare |
$610.00
|
|
|
PR LAP,SALPINGOSTOMY
|
Professional
|
$1,448.76
|
|
|
Service Code
|
CPT 58673
|
| Hospital Charge Code |
z58673
|
| Min. Negotiated Rate |
$742.49 |
| Max. Negotiated Rate |
$1,262.23 |
| Rate for Payer: Aetna Medicare |
$742.49
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,076.88
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,076.88
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$853.86
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$816.74
|
| Rate for Payer: Cash Price |
$898.23
|
| Rate for Payer: Cash Price |
$898.23
|
| Rate for Payer: Coventry All Commercial |
$890.99
|
| Rate for Payer: Frontpath All Commercial |
$1,042.95
|
| Rate for Payer: Humana ChoiceCare |
$905.76
|
| Rate for Payer: Humana Medicare |
$742.49
|
| Rate for Payer: Lucent All Commercial |
$1,262.23
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,039.00
|
| Rate for Payer: PHCS All Commercial |
$1,086.57
|
| Rate for Payer: PHP All Commercial |
$956.19
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$742.49
|
| Rate for Payer: Signature Care EPO |
$1,020.00
|
| Rate for Payer: Signature Care PPO |
$1,020.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$965.00
|
| Rate for Payer: United Healthcare Commercial |
$912.94
|
| Rate for Payer: United Healthcare Medicare |
$742.49
|
|
|
PR LAP,SPERMATIC CORD PROC,UNLIST
|
Professional
|
$735.00
|
|
|
Service Code
|
CPT 55559
|
| Hospital Charge Code |
z55559
|
| 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,STOMACH,OTHER,W/O TUBE
|
Professional
|
$1,081.86
|
|
|
Service Code
|
CPT 43659
|
| Hospital Charge Code |
z43659
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$919.58 |
| 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 |
$670.75
|
| Rate for Payer: Cash Price |
$670.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$919.58
|
| Rate for Payer: PHCS All Commercial |
$811.40
|
| Rate for Payer: Signature Care EPO |
$689.69
|
| Rate for Payer: Signature Care PPO |
$689.69
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$649.12
|
|
|
PR LAP, SUPRACERVIAL HYSTERECTOMY, <250G
|
Professional
|
$1,337.90
|
|
|
Service Code
|
CPT 58541
|
| Hospital Charge Code |
z58541
|
| Min. Negotiated Rate |
$685.68 |
| Max. Negotiated Rate |
$1,165.66 |
| Rate for Payer: Aetna Medicare |
$685.68
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,014.37
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,014.37
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$788.53
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$754.25
|
| Rate for Payer: Cash Price |
$829.50
|
| Rate for Payer: Cash Price |
$829.50
|
| Rate for Payer: Coventry All Commercial |
$822.82
|
| Rate for Payer: Frontpath All Commercial |
$955.29
|
| Rate for Payer: Humana ChoiceCare |
$860.01
|
| Rate for Payer: Humana Medicare |
$685.68
|
| Rate for Payer: Lucent All Commercial |
$1,165.66
|
| Rate for Payer: Lutheran Preferred All Commercial |
$960.00
|
| Rate for Payer: PHCS All Commercial |
$1,003.42
|
| Rate for Payer: PHP All Commercial |
$883.02
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$685.68
|
| Rate for Payer: Signature Care EPO |
$950.30
|
| Rate for Payer: Signature Care PPO |
$950.30
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$891.00
|
| Rate for Payer: United Healthcare Commercial |
$965.86
|
| Rate for Payer: United Healthcare Medicare |
$685.68
|
|
|
PR LAP, SUPRACERVIAL HYSTERECTOMY W/ TUBE&OV, <250G
|
Professional
|
$1,519.30
|
|
|
Service Code
|
CPT 58542
|
| Hospital Charge Code |
z58542
|
| Min. Negotiated Rate |
$778.64 |
| Max. Negotiated Rate |
$1,323.69 |
| Rate for Payer: Aetna Medicare |
$778.64
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,127.15
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,127.15
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$895.44
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$856.50
|
| Rate for Payer: Cash Price |
$941.97
|
| Rate for Payer: Cash Price |
$941.97
|
| Rate for Payer: Coventry All Commercial |
$934.37
|
| Rate for Payer: Frontpath All Commercial |
$1,090.32
|
| Rate for Payer: Humana ChoiceCare |
$955.63
|
| Rate for Payer: Humana Medicare |
$778.64
|
| Rate for Payer: Lucent All Commercial |
$1,323.69
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,090.00
|
| Rate for Payer: PHCS All Commercial |
$1,139.48
|
| Rate for Payer: PHP All Commercial |
$1,002.74
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$778.64
|
| Rate for Payer: Signature Care EPO |
$1,054.85
|
| Rate for Payer: Signature Care PPO |
$1,054.85
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,012.00
|
| Rate for Payer: United Healthcare Commercial |
$1,073.58
|
| Rate for Payer: United Healthcare Medicare |
$778.64
|
|
|
PR LAP, SUPRACERVIAL HYSTERECTOMY W/ TUBE&OV, >250G
|
Professional
|
$1,659.14
|
|
|
Service Code
|
CPT 58544
|
| Hospital Charge Code |
z58544
|
| Min. Negotiated Rate |
$850.31 |
| Max. Negotiated Rate |
$1,445.53 |
| Rate for Payer: Aetna Medicare |
$850.31
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,240.63
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,240.63
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$977.86
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$935.34
|
| Rate for Payer: Cash Price |
$1,028.67
|
| Rate for Payer: Cash Price |
$1,028.67
|
| Rate for Payer: Coventry All Commercial |
$1,020.37
|
| Rate for Payer: Frontpath All Commercial |
$1,189.51
|
| Rate for Payer: Humana ChoiceCare |
$1,051.84
|
| Rate for Payer: Humana Medicare |
$850.31
|
| Rate for Payer: Lucent All Commercial |
$1,445.53
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,190.00
|
| Rate for Payer: PHCS All Commercial |
$1,244.36
|
| Rate for Payer: PHP All Commercial |
$1,095.03
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$850.31
|
| Rate for Payer: Signature Care EPO |
$1,161.10
|
| Rate for Payer: Signature Care PPO |
$1,161.10
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,105.00
|
| Rate for Payer: United Healthcare Commercial |
$1,180.03
|
| Rate for Payer: United Healthcare Medicare |
$850.31
|
|
|
PR LAP, SURG CLOSE ENTEROSTOMY RESECT ANAST
|
Professional
|
$2,956.26
|
|
|
Service Code
|
CPT 44227
|
| Hospital Charge Code |
z44227
|
| Min. Negotiated Rate |
$1,515.08 |
| Max. Negotiated Rate |
$2,586.73 |
| Rate for Payer: Aetna Medicare |
$1,515.08
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,701.14
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,701.14
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,742.34
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,666.59
|
| Rate for Payer: Cash Price |
$1,832.88
|
| Rate for Payer: Cash Price |
$1,832.88
|
| Rate for Payer: Coventry All Commercial |
$1,818.10
|
| Rate for Payer: Frontpath All Commercial |
$2,185.07
|
| Rate for Payer: Humana ChoiceCare |
$1,706.49
|
| Rate for Payer: Humana Medicare |
$1,515.08
|
| Rate for Payer: Lucent All Commercial |
$2,575.64
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,273.00
|
| Rate for Payer: PHCS All Commercial |
$2,217.20
|
| Rate for Payer: PHP All Commercial |
$2,586.73
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,515.08
|
| Rate for Payer: Signature Care EPO |
$2,144.55
|
| Rate for Payer: Signature Care PPO |
$2,144.55
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,121.00
|
| Rate for Payer: United Healthcare Commercial |
$1,799.50
|
| Rate for Payer: United Healthcare Medicare |
$1,515.08
|
|
|
PR LAP,SURG,COLECTOMY, PARTIAL, W/ANAST
|
Professional
|
$2,741.42
|
|
|
Service Code
|
CPT 44204
|
| Hospital Charge Code |
z44204
|
| Min. Negotiated Rate |
$1,405.14 |
| Max. Negotiated Rate |
$2,398.75 |
| Rate for Payer: Aetna Medicare |
$1,405.14
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,752.70
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,752.70
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,615.91
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,545.65
|
| Rate for Payer: Cash Price |
$1,699.68
|
| Rate for Payer: Cash Price |
$1,699.68
|
| Rate for Payer: Coventry All Commercial |
$1,686.17
|
| Rate for Payer: Frontpath All Commercial |
$2,020.67
|
| Rate for Payer: Humana ChoiceCare |
$1,607.38
|
| Rate for Payer: Humana Medicare |
$1,405.14
|
| Rate for Payer: Lucent All Commercial |
$2,388.74
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,108.00
|
| Rate for Payer: PHCS All Commercial |
$2,056.06
|
| Rate for Payer: PHP All Commercial |
$2,398.75
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,405.14
|
| Rate for Payer: Signature Care EPO |
$2,038.30
|
| Rate for Payer: Signature Care PPO |
$2,038.30
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,967.00
|
| Rate for Payer: United Healthcare Commercial |
$1,661.98
|
| Rate for Payer: United Healthcare Medicare |
$1,405.14
|
|
|
PR LAP,SURG,COLECTOMY,W/ANAST
|
Professional
|
$3,239.94
|
|
|
Service Code
|
CPT 44207
|
| Hospital Charge Code |
z44207
|
| Min. Negotiated Rate |
$1,660.46 |
| Max. Negotiated Rate |
$2,834.94 |
| Rate for Payer: Aetna Medicare |
$1,660.46
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,915.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,915.30
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,909.53
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,826.51
|
| Rate for Payer: Cash Price |
$2,008.76
|
| Rate for Payer: Cash Price |
$2,008.76
|
| Rate for Payer: Coventry All Commercial |
$1,992.55
|
| Rate for Payer: Frontpath All Commercial |
$2,376.08
|
| Rate for Payer: Humana ChoiceCare |
$1,904.52
|
| Rate for Payer: Humana Medicare |
$1,660.46
|
| Rate for Payer: Lucent All Commercial |
$2,822.78
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,491.00
|
| Rate for Payer: PHCS All Commercial |
$2,429.96
|
| Rate for Payer: PHP All Commercial |
$2,834.94
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,660.46
|
| Rate for Payer: Signature Care EPO |
$2,391.90
|
| Rate for Payer: Signature Care PPO |
$2,391.90
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,325.00
|
| Rate for Payer: United Healthcare Commercial |
$1,982.18
|
| Rate for Payer: United Healthcare Medicare |
$1,660.46
|
|
|
PR LAP,SURG,COLECTOMY,W/REMVL TERM ILEUM
|
Professional
|
$2,385.84
|
|
|
Service Code
|
CPT 44205
|
| Hospital Charge Code |
z44205
|
| Min. Negotiated Rate |
$1,222.75 |
| Max. Negotiated Rate |
$2,087.62 |
| Rate for Payer: Aetna Medicare |
$1,222.75
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,551.90
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,551.90
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,406.16
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,345.02
|
| Rate for Payer: Cash Price |
$1,479.22
|
| Rate for Payer: Cash Price |
$1,479.22
|
| Rate for Payer: Coventry All Commercial |
$1,467.30
|
| Rate for Payer: Frontpath All Commercial |
$1,753.31
|
| Rate for Payer: Humana ChoiceCare |
$1,425.81
|
| Rate for Payer: Humana Medicare |
$1,222.75
|
| Rate for Payer: Lucent All Commercial |
$2,078.68
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,834.00
|
| Rate for Payer: PHCS All Commercial |
$1,789.38
|
| Rate for Payer: PHP All Commercial |
$2,087.62
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,222.75
|
| Rate for Payer: Signature Care EPO |
$1,806.25
|
| Rate for Payer: Signature Care PPO |
$1,806.25
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,712.00
|
| Rate for Payer: United Healthcare Commercial |
$1,450.86
|
| Rate for Payer: United Healthcare Medicare |
$1,222.75
|
|
|
PR LAP,SURG,ENTERECTOMY,RESECT & ANAST
|
Professional
|
$2,470.68
|
|
|
Service Code
|
CPT 44202
|
| Hospital Charge Code |
z44202
|
| Min. Negotiated Rate |
$1,266.22 |
| Max. Negotiated Rate |
$2,161.85 |
| Rate for Payer: Aetna Medicare |
$1,266.22
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,709.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,709.00
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,456.15
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,392.84
|
| Rate for Payer: Cash Price |
$1,531.82
|
| Rate for Payer: Cash Price |
$1,531.82
|
| Rate for Payer: Coventry All Commercial |
$1,519.46
|
| Rate for Payer: Frontpath All Commercial |
$1,830.63
|
| Rate for Payer: Humana ChoiceCare |
$1,422.45
|
| Rate for Payer: Humana Medicare |
$1,266.22
|
| Rate for Payer: Lucent All Commercial |
$2,152.57
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,899.00
|
| Rate for Payer: PHCS All Commercial |
$1,853.01
|
| Rate for Payer: PHP All Commercial |
$2,161.85
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,266.22
|
| Rate for Payer: Signature Care EPO |
$1,798.60
|
| Rate for Payer: Signature Care PPO |
$1,798.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,773.00
|
| Rate for Payer: United Healthcare Commercial |
$1,487.74
|
| Rate for Payer: United Healthcare Medicare |
$1,266.22
|
|
|
PR LAP, SURG ENTEROLYSIS
|
Professional
|
$1,638.74
|
|
|
Service Code
|
CPT 44180
|
| Hospital Charge Code |
z44180
|
| Min. Negotiated Rate |
$839.85 |
| Max. Negotiated Rate |
$1,433.89 |
| Rate for Payer: Aetna Medicare |
$839.85
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$944.63
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$944.63
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$965.83
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$923.84
|
| Rate for Payer: Cash Price |
$1,016.02
|
| Rate for Payer: Cash Price |
$1,016.02
|
| Rate for Payer: Coventry All Commercial |
$1,007.82
|
| Rate for Payer: Frontpath All Commercial |
$1,216.40
|
| Rate for Payer: Humana ChoiceCare |
$947.59
|
| Rate for Payer: Humana Medicare |
$839.85
|
| Rate for Payer: Lucent All Commercial |
$1,427.74
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,260.00
|
| Rate for Payer: PHCS All Commercial |
$1,229.06
|
| Rate for Payer: PHP All Commercial |
$1,433.89
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$839.85
|
| Rate for Payer: Signature Care EPO |
$1,190.85
|
| Rate for Payer: Signature Care PPO |
$1,190.85
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,176.00
|
| Rate for Payer: United Healthcare Commercial |
$987.09
|
| Rate for Payer: United Healthcare Medicare |
$839.85
|
|
|
PR LAP, SURG MOBIL SPLENIC FL DUR PTL COLECTOMY
|
Professional
|
$331.40
|
|
|
Service Code
|
CPT 44213
|
| Hospital Charge Code |
z44213
|
| Min. Negotiated Rate |
$169.84 |
| Max. Negotiated Rate |
$289.98 |
| Rate for Payer: Aetna Medicare |
$169.84
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$216.93
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$216.93
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$195.32
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$186.82
|
| Rate for Payer: Cash Price |
$205.47
|
| Rate for Payer: Cash Price |
$205.47
|
| Rate for Payer: Coventry All Commercial |
$203.81
|
| Rate for Payer: Frontpath All Commercial |
$246.28
|
| Rate for Payer: Humana ChoiceCare |
$217.61
|
| Rate for Payer: Humana Medicare |
$169.84
|
| Rate for Payer: Lucent All Commercial |
$288.73
|
| Rate for Payer: Lutheran Preferred All Commercial |
$255.00
|
| Rate for Payer: PHCS All Commercial |
$248.55
|
| Rate for Payer: PHP All Commercial |
$289.98
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$169.84
|
| Rate for Payer: Signature Care EPO |
$273.70
|
| Rate for Payer: Signature Care PPO |
$273.70
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$238.00
|
| Rate for Payer: United Healthcare Commercial |
$211.06
|
| Rate for Payer: United Healthcare Medicare |
$169.84
|
|
|
PR LAP,TUBAL CAUTERY
|
Professional
|
$680.26
|
|
|
Service Code
|
CPT 58670
|
| Hospital Charge Code |
z58670
|
| Min. Negotiated Rate |
$348.63 |
| Max. Negotiated Rate |
$592.67 |
| Rate for Payer: Aetna Medicare |
$348.63
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$466.97
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$466.97
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$400.92
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$383.49
|
| Rate for Payer: Cash Price |
$421.76
|
| Rate for Payer: Cash Price |
$421.76
|
| Rate for Payer: Coventry All Commercial |
$418.36
|
| Rate for Payer: Frontpath All Commercial |
$486.46
|
| Rate for Payer: Humana ChoiceCare |
$392.58
|
| Rate for Payer: Humana Medicare |
$348.63
|
| Rate for Payer: Lucent All Commercial |
$592.67
|
| Rate for Payer: Lutheran Preferred All Commercial |
$488.00
|
| Rate for Payer: PHCS All Commercial |
$510.20
|
| Rate for Payer: PHP All Commercial |
$448.97
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$348.63
|
| Rate for Payer: Signature Care EPO |
$471.75
|
| Rate for Payer: Signature Care PPO |
$471.75
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$453.00
|
| Rate for Payer: United Healthcare Commercial |
$410.58
|
| Rate for Payer: United Healthcare Medicare |
$348.63
|
|
|
PR LAP,UTERUS,UNLISTED PROCEDURE
|
Professional
|
$2,157.53
|
|
|
Service Code
|
CPT 58578
|
| Hospital Charge Code |
z58578
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$1,833.90 |
| 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 |
$1,337.67
|
| Rate for Payer: Cash Price |
$1,337.67
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,833.90
|
| Rate for Payer: PHCS All Commercial |
$1,618.15
|
| Rate for Payer: Signature Care EPO |
$1,375.43
|
| Rate for Payer: Signature Care PPO |
$1,375.43
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,294.52
|
|
|
PR LAP,VAG HYST,UTERUS >250GMS
|
Professional
|
$2,044.16
|
|
|
Service Code
|
CPT 58553
|
| Hospital Charge Code |
z58553
|
| Min. Negotiated Rate |
$1,047.63 |
| Max. Negotiated Rate |
$1,780.97 |
| Rate for Payer: Aetna Medicare |
$1,047.63
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,478.75
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,478.75
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,204.77
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,152.39
|
| Rate for Payer: Cash Price |
$1,267.38
|
| Rate for Payer: Cash Price |
$1,267.38
|
| Rate for Payer: Coventry All Commercial |
$1,257.16
|
| Rate for Payer: Frontpath All Commercial |
$1,473.07
|
| Rate for Payer: Humana ChoiceCare |
$1,244.74
|
| Rate for Payer: Humana Medicare |
$1,047.63
|
| Rate for Payer: Lucent All Commercial |
$1,780.97
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,467.00
|
| Rate for Payer: PHCS All Commercial |
$1,533.12
|
| Rate for Payer: PHP All Commercial |
$1,349.15
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,047.63
|
| Rate for Payer: Signature Care EPO |
$1,382.10
|
| Rate for Payer: Signature Care PPO |
$1,382.10
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,362.00
|
| Rate for Payer: United Healthcare Commercial |
$1,286.30
|
| Rate for Payer: United Healthcare Medicare |
$1,047.63
|
|
|
PR LAP,VAG HYST,UTERUS 250GMS/<
|
Professional
|
$1,610.30
|
|
|
Service Code
|
CPT 58550
|
| Hospital Charge Code |
z58550
|
| Min. Negotiated Rate |
$825.44 |
| Max. Negotiated Rate |
$1,403.25 |
| Rate for Payer: Aetna Medicare |
$825.44
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,213.60
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,213.60
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$949.26
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$907.98
|
| Rate for Payer: Cash Price |
$998.39
|
| Rate for Payer: Cash Price |
$998.39
|
| Rate for Payer: Coventry All Commercial |
$990.53
|
| Rate for Payer: Frontpath All Commercial |
$1,156.18
|
| Rate for Payer: Humana ChoiceCare |
$955.21
|
| Rate for Payer: Humana Medicare |
$825.44
|
| Rate for Payer: Lucent All Commercial |
$1,403.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,156.00
|
| Rate for Payer: PHCS All Commercial |
$1,207.72
|
| Rate for Payer: PHP All Commercial |
$1,062.80
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$825.44
|
| Rate for Payer: Signature Care EPO |
$1,074.40
|
| Rate for Payer: Signature Care PPO |
$1,074.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,073.00
|
| Rate for Payer: United Healthcare Commercial |
$995.59
|
| Rate for Payer: United Healthcare Medicare |
$825.44
|
|
