|
PROPARACAINE 0.5 % OPHT DROP
|
Facility
OP
|
$205.28
|
|
|
Service Code
|
NDC 61314001601
|
| Hospital Charge Code |
6644
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$37.28 |
| Max. Negotiated Rate |
$190.91 |
| Rate for Payer: Aetna Commercial |
$173.25
|
| Rate for Payer: Aetna Medicare |
$67.74
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$67.74
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$117.89
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$128.32
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$37.28
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$77.90
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$74.51
|
| Rate for Payer: Cash Price |
$127.27
|
| Rate for Payer: Cash Price |
$127.27
|
| Rate for Payer: Centivo All Commercial |
$104.69
|
| Rate for Payer: Cigna All Commercial |
$177.15
|
| Rate for Payer: CORVEL All Commercial |
$190.91
|
| Rate for Payer: Coventry All Commercial |
$180.64
|
| Rate for Payer: Encore All Commercial |
$188.96
|
| Rate for Payer: Frontpath All Commercial |
$188.85
|
| Rate for Payer: Humana ChoiceCare |
$177.30
|
| Rate for Payer: Humana Medicare |
$104.69
|
| Rate for Payer: Lucent All Commercial |
$104.69
|
| Rate for Payer: Lutheran Preferred All Commercial |
$184.75
|
| Rate for Payer: Managed Health Services Medicaid |
$37.28
|
| Rate for Payer: MDWise Medicaid |
$37.28
|
| Rate for Payer: PHCS All Commercial |
$153.96
|
| Rate for Payer: PHP All Commercial |
$155.68
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$80.06
|
| Rate for Payer: Sagamore Health Network All Products |
$158.47
|
| Rate for Payer: Signature Care EPO |
$170.38
|
| Rate for Payer: Signature Care PPO |
$180.64
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$174.48
|
| Rate for Payer: United Healthcare Commercial |
$161.76
|
| Rate for Payer: United Healthcare Medicare |
$67.74
|
|
|
PR OPEN FIXATN MID HUMERUS FRACTURE
|
Professional
|
$1,599.60
|
|
|
Service Code
|
CPT 24515
|
| Hospital Charge Code |
z24515
|
| Min. Negotiated Rate |
$819.80 |
| Max. Negotiated Rate |
$1,393.66 |
| Rate for Payer: Aetna Medicare |
$819.80
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,085.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,085.30
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$942.77
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$901.78
|
| Rate for Payer: Cash Price |
$991.75
|
| Rate for Payer: Cash Price |
$991.75
|
| Rate for Payer: Coventry All Commercial |
$983.76
|
| Rate for Payer: Frontpath All Commercial |
$1,143.94
|
| Rate for Payer: Humana ChoiceCare |
$918.40
|
| Rate for Payer: Humana Medicare |
$819.80
|
| Rate for Payer: Lucent All Commercial |
$1,393.66
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,312.00
|
| Rate for Payer: PHCS All Commercial |
$1,199.70
|
| Rate for Payer: PHP All Commercial |
$1,391.66
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$819.80
|
| Rate for Payer: Signature Care EPO |
$1,228.25
|
| Rate for Payer: Signature Care PPO |
$1,228.25
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,230.00
|
| Rate for Payer: United Healthcare Commercial |
$949.15
|
| Rate for Payer: United Healthcare Medicare |
$819.80
|
|
|
PR OPEN FIX INTER/SUBTROCH FX,IMPLNT
|
Professional
|
$2,213.28
|
|
|
Service Code
|
CPT 27245
|
| Hospital Charge Code |
z27245
|
| Min. Negotiated Rate |
$1,134.31 |
| Max. Negotiated Rate |
$1,936.66 |
| Rate for Payer: Aetna Medicare |
$1,134.31
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,802.80
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,802.80
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,304.46
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,247.74
|
| Rate for Payer: Cash Price |
$1,372.23
|
| Rate for Payer: Cash Price |
$1,372.23
|
| Rate for Payer: Coventry All Commercial |
$1,361.17
|
| Rate for Payer: Frontpath All Commercial |
$1,594.41
|
| Rate for Payer: Humana ChoiceCare |
$1,497.44
|
| Rate for Payer: Humana Medicare |
$1,134.31
|
| Rate for Payer: Lucent All Commercial |
$1,928.33
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,815.00
|
| Rate for Payer: PHCS All Commercial |
$1,659.96
|
| Rate for Payer: PHP All Commercial |
$1,925.56
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,134.31
|
| Rate for Payer: Signature Care EPO |
$1,936.66
|
| Rate for Payer: Signature Care PPO |
$1,936.66
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,701.00
|
| Rate for Payer: United Healthcare Commercial |
$1,386.08
|
| Rate for Payer: United Healthcare Medicare |
$1,134.31
|
|
|
PR OPEN PROX HUMERAL FRACTURE PROSHETIC REPLACEMENT
|
Professional
|
$2,232.84
|
|
|
Service Code
|
CPT 23616
|
| Hospital Charge Code |
z23616
|
| Min. Negotiated Rate |
$1,144.33 |
| Max. Negotiated Rate |
$2,019.50 |
| Rate for Payer: Aetna Medicare |
$1,144.33
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,019.50
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,019.50
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,315.98
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,258.76
|
| Rate for Payer: Cash Price |
$1,384.36
|
| Rate for Payer: Cash Price |
$1,384.36
|
| Rate for Payer: Coventry All Commercial |
$1,373.20
|
| Rate for Payer: Frontpath All Commercial |
$1,605.34
|
| Rate for Payer: Humana ChoiceCare |
$1,558.41
|
| Rate for Payer: Humana Medicare |
$1,144.33
|
| Rate for Payer: Lucent All Commercial |
$1,945.36
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,831.00
|
| Rate for Payer: PHCS All Commercial |
$1,674.63
|
| Rate for Payer: PHP All Commercial |
$1,942.57
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,144.33
|
| Rate for Payer: Signature Care EPO |
$1,951.26
|
| Rate for Payer: Signature Care PPO |
$1,951.26
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,716.00
|
| Rate for Payer: United Healthcare Commercial |
$1,405.03
|
| Rate for Payer: United Healthcare Medicare |
$1,144.33
|
|
|
PR OPEN ROD FIXATN HUMERAL SHAFT FX
|
Professional
|
$1,559.08
|
|
|
Service Code
|
CPT 24516
|
| Hospital Charge Code |
z24516
|
| Min. Negotiated Rate |
$799.03 |
| Max. Negotiated Rate |
$1,358.35 |
| Rate for Payer: Aetna Medicare |
$799.03
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,097.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,097.00
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$918.88
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$878.93
|
| Rate for Payer: Cash Price |
$966.63
|
| Rate for Payer: Cash Price |
$966.63
|
| Rate for Payer: Coventry All Commercial |
$958.84
|
| Rate for Payer: Frontpath All Commercial |
$1,117.35
|
| Rate for Payer: Humana ChoiceCare |
$907.72
|
| Rate for Payer: Humana Medicare |
$799.03
|
| Rate for Payer: Lucent All Commercial |
$1,358.35
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,278.00
|
| Rate for Payer: PHCS All Commercial |
$1,169.31
|
| Rate for Payer: PHP All Commercial |
$1,356.40
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$799.03
|
| Rate for Payer: Signature Care EPO |
$1,215.50
|
| Rate for Payer: Signature Care PPO |
$1,215.50
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,199.00
|
| Rate for Payer: United Healthcare Commercial |
$939.59
|
| Rate for Payer: United Healthcare Medicare |
$799.03
|
|
|
PR OPEN RX A-C JT DISLOC
|
Professional
|
$1,046.16
|
|
|
Service Code
|
CPT 23550
|
| Hospital Charge Code |
z23550
|
| Min. Negotiated Rate |
$536.16 |
| Max. Negotiated Rate |
$911.47 |
| Rate for Payer: Aetna Medicare |
$536.16
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$747.10
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$747.10
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$616.58
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$589.78
|
| Rate for Payer: Cash Price |
$648.62
|
| Rate for Payer: Cash Price |
$648.62
|
| Rate for Payer: Coventry All Commercial |
$643.39
|
| Rate for Payer: Frontpath All Commercial |
$742.81
|
| Rate for Payer: Humana ChoiceCare |
$592.19
|
| Rate for Payer: Humana Medicare |
$536.16
|
| Rate for Payer: Lucent All Commercial |
$911.47
|
| Rate for Payer: Lutheran Preferred All Commercial |
$858.00
|
| Rate for Payer: PHCS All Commercial |
$784.62
|
| Rate for Payer: PHP All Commercial |
$910.16
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$536.16
|
| Rate for Payer: Signature Care EPO |
$791.35
|
| Rate for Payer: Signature Care PPO |
$791.35
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$804.00
|
| Rate for Payer: United Healthcare Commercial |
$613.91
|
| Rate for Payer: United Healthcare Medicare |
$536.16
|
|
|
PR OPEN RX A-C JT DISLOC,FASCIAL GRFT
|
Professional
|
$1,182.58
|
|
|
Service Code
|
CPT 23552
|
| Hospital Charge Code |
z23552
|
| Min. Negotiated Rate |
$606.08 |
| Max. Negotiated Rate |
$1,030.34 |
| Rate for Payer: Aetna Medicare |
$606.08
|
| 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 |
$696.99
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$666.69
|
| Rate for Payer: Cash Price |
$733.20
|
| Rate for Payer: Cash Price |
$733.20
|
| Rate for Payer: Coventry All Commercial |
$727.30
|
| Rate for Payer: Frontpath All Commercial |
$849.55
|
| Rate for Payer: Humana ChoiceCare |
$686.59
|
| Rate for Payer: Humana Medicare |
$606.08
|
| Rate for Payer: Lucent All Commercial |
$1,030.34
|
| Rate for Payer: Lutheran Preferred All Commercial |
$970.00
|
| Rate for Payer: PHCS All Commercial |
$886.94
|
| Rate for Payer: PHP All Commercial |
$1,028.85
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$606.08
|
| Rate for Payer: Signature Care EPO |
$917.15
|
| Rate for Payer: Signature Care PPO |
$917.15
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$909.00
|
| Rate for Payer: United Healthcare Commercial |
$707.29
|
| Rate for Payer: United Healthcare Medicare |
$606.08
|
|
|
PR OPEN RX BILAT TIB PLAT FX
|
Professional
|
$2,143.10
|
|
|
Service Code
|
CPT 27536
|
| Hospital Charge Code |
z27536
|
| Min. Negotiated Rate |
$1,098.50 |
| Max. Negotiated Rate |
$1,867.45 |
| Rate for Payer: Aetna Medicare |
$1,098.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,366.20
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,366.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,263.28
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,208.35
|
| Rate for Payer: Cash Price |
$1,328.72
|
| Rate for Payer: Cash Price |
$1,328.72
|
| Rate for Payer: Coventry All Commercial |
$1,318.20
|
| Rate for Payer: Frontpath All Commercial |
$1,542.03
|
| Rate for Payer: Humana ChoiceCare |
$1,194.75
|
| Rate for Payer: Humana Medicare |
$1,098.50
|
| Rate for Payer: Lucent All Commercial |
$1,867.45
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,758.00
|
| Rate for Payer: PHCS All Commercial |
$1,607.32
|
| Rate for Payer: PHP All Commercial |
$1,864.50
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,098.50
|
| Rate for Payer: Signature Care EPO |
$1,592.90
|
| Rate for Payer: Signature Care PPO |
$1,592.90
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,648.00
|
| Rate for Payer: United Healthcare Commercial |
$1,298.85
|
| Rate for Payer: United Healthcare Medicare |
$1,098.50
|
|
|
PR OPEN RX C-MC DISLOC,COMPLEX
|
Professional
|
$1,135.98
|
|
|
Service Code
|
CPT 26686
|
| Hospital Charge Code |
z26686
|
| Min. Negotiated Rate |
$582.18 |
| Max. Negotiated Rate |
$989.71 |
| Rate for Payer: Aetna Medicare |
$582.18
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$756.50
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$756.50
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$669.51
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$640.40
|
| Rate for Payer: Cash Price |
$704.31
|
| Rate for Payer: Cash Price |
$704.31
|
| Rate for Payer: Coventry All Commercial |
$698.62
|
| Rate for Payer: Frontpath All Commercial |
$810.46
|
| Rate for Payer: Humana ChoiceCare |
$643.53
|
| Rate for Payer: Humana Medicare |
$582.18
|
| Rate for Payer: Lucent All Commercial |
$989.71
|
| Rate for Payer: Lutheran Preferred All Commercial |
$931.00
|
| Rate for Payer: PHCS All Commercial |
$851.98
|
| Rate for Payer: PHP All Commercial |
$988.29
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$582.18
|
| Rate for Payer: Signature Care EPO |
$871.25
|
| Rate for Payer: Signature Care PPO |
$871.25
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$873.00
|
| Rate for Payer: United Healthcare Commercial |
$660.49
|
| Rate for Payer: United Healthcare Medicare |
$582.18
|
|
|
PR OPEN RX DISTAL RADIUS FX, EXTRA-ARTICULAR
|
Professional
|
$1,350.42
|
|
|
Service Code
|
CPT 25607
|
| Hospital Charge Code |
z25607
|
| Min. Negotiated Rate |
$680.43 |
| Max. Negotiated Rate |
$1,176.55 |
| Rate for Payer: Aetna Medicare |
$692.09
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$819.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$819.30
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$795.90
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$761.30
|
| Rate for Payer: Cash Price |
$837.26
|
| Rate for Payer: Cash Price |
$837.26
|
| Rate for Payer: Coventry All Commercial |
$830.51
|
| Rate for Payer: Frontpath All Commercial |
$955.29
|
| Rate for Payer: Humana ChoiceCare |
$680.43
|
| Rate for Payer: Humana Medicare |
$692.09
|
| Rate for Payer: Lucent All Commercial |
$1,176.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,107.00
|
| Rate for Payer: PHCS All Commercial |
$1,012.82
|
| Rate for Payer: PHP All Commercial |
$1,174.86
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$692.09
|
| Rate for Payer: Signature Care EPO |
$923.95
|
| Rate for Payer: Signature Care PPO |
$923.95
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,038.00
|
| Rate for Payer: United Healthcare Commercial |
$763.28
|
| Rate for Payer: United Healthcare Medicare |
$692.09
|
|
|
PR OPEN RX DISTAL RADIUS FX, INTRA-ARTICULAR, 2 FRAG
|
Professional
|
$1,507.84
|
|
|
Service Code
|
CPT 25608
|
| Hospital Charge Code |
z25608
|
| Min. Negotiated Rate |
$772.77 |
| Max. Negotiated Rate |
$1,313.71 |
| Rate for Payer: Aetna Medicare |
$772.77
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$980.14
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$980.14
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$888.69
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$850.05
|
| Rate for Payer: Cash Price |
$934.86
|
| Rate for Payer: Cash Price |
$934.86
|
| Rate for Payer: Coventry All Commercial |
$927.32
|
| Rate for Payer: Frontpath All Commercial |
$1,071.42
|
| Rate for Payer: Humana ChoiceCare |
$773.37
|
| Rate for Payer: Humana Medicare |
$772.77
|
| Rate for Payer: Lucent All Commercial |
$1,313.71
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,236.00
|
| Rate for Payer: PHCS All Commercial |
$1,130.88
|
| Rate for Payer: PHP All Commercial |
$1,311.83
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$772.77
|
| Rate for Payer: Signature Care EPO |
$1,049.75
|
| Rate for Payer: Signature Care PPO |
$1,049.75
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,159.00
|
| Rate for Payer: United Healthcare Commercial |
$871.21
|
| Rate for Payer: United Healthcare Medicare |
$772.77
|
|
|
PR OPEN RX DISTAL RADIUS FX, INTRA-ARTICULAR, 3+ FRAG
|
Professional
|
$1,913.02
|
|
|
Service Code
|
CPT 25609
|
| Hospital Charge Code |
z25609
|
| Min. Negotiated Rate |
$980.42 |
| Max. Negotiated Rate |
$1,666.71 |
| Rate for Payer: Aetna Medicare |
$980.42
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,250.03
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,250.03
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,127.48
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,078.46
|
| Rate for Payer: Cash Price |
$1,186.07
|
| Rate for Payer: Cash Price |
$1,186.07
|
| Rate for Payer: Coventry All Commercial |
$1,176.50
|
| Rate for Payer: Frontpath All Commercial |
$1,361.26
|
| Rate for Payer: Humana ChoiceCare |
$986.33
|
| Rate for Payer: Humana Medicare |
$980.42
|
| Rate for Payer: Lucent All Commercial |
$1,666.71
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,569.00
|
| Rate for Payer: PHCS All Commercial |
$1,434.76
|
| Rate for Payer: PHP All Commercial |
$1,664.32
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$980.42
|
| Rate for Payer: Signature Care EPO |
$1,338.75
|
| Rate for Payer: Signature Care PPO |
$1,338.75
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,471.00
|
| Rate for Payer: United Healthcare Commercial |
$1,113.05
|
| Rate for Payer: United Healthcare Medicare |
$980.42
|
|
|
PR OPEN RX FEMUR FX+INTRAMED ROD
|
Professional
|
$2,414.82
|
|
|
Service Code
|
CPT 27506
|
| Hospital Charge Code |
z27506
|
| Min. Negotiated Rate |
$1,237.59 |
| Max. Negotiated Rate |
$2,103.90 |
| Rate for Payer: Aetna Medicare |
$1,237.59
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,621.80
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,621.80
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,423.23
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,361.35
|
| Rate for Payer: Cash Price |
$1,497.19
|
| Rate for Payer: Cash Price |
$1,497.19
|
| Rate for Payer: Coventry All Commercial |
$1,485.11
|
| Rate for Payer: Frontpath All Commercial |
$1,736.84
|
| Rate for Payer: Humana ChoiceCare |
$1,325.28
|
| Rate for Payer: Humana Medicare |
$1,237.59
|
| Rate for Payer: Lucent All Commercial |
$2,103.90
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,980.00
|
| Rate for Payer: PHCS All Commercial |
$1,811.12
|
| Rate for Payer: PHP All Commercial |
$2,100.89
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,237.59
|
| Rate for Payer: Signature Care EPO |
$1,766.30
|
| Rate for Payer: Signature Care PPO |
$1,766.30
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,856.00
|
| Rate for Payer: United Healthcare Commercial |
$1,457.98
|
| Rate for Payer: United Healthcare Medicare |
$1,237.59
|
|
|
PR OPEN RX GR TUBEROSITY FX
|
Professional
|
$1,419.90
|
|
|
Service Code
|
CPT 23630
|
| Hospital Charge Code |
z23630
|
| Min. Negotiated Rate |
$607.66 |
| Max. Negotiated Rate |
$1,237.09 |
| Rate for Payer: Aetna Medicare |
$727.70
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$758.80
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$758.80
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$836.86
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$800.47
|
| Rate for Payer: Cash Price |
$880.34
|
| Rate for Payer: Cash Price |
$880.34
|
| Rate for Payer: Coventry All Commercial |
$873.24
|
| Rate for Payer: Frontpath All Commercial |
$1,009.67
|
| Rate for Payer: Humana ChoiceCare |
$607.66
|
| Rate for Payer: Humana Medicare |
$727.70
|
| Rate for Payer: Lucent All Commercial |
$1,237.09
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,164.00
|
| Rate for Payer: PHCS All Commercial |
$1,064.92
|
| Rate for Payer: PHP All Commercial |
$1,235.31
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$727.70
|
| Rate for Payer: Signature Care EPO |
$812.60
|
| Rate for Payer: Signature Care PPO |
$812.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,092.00
|
| Rate for Payer: United Healthcare Commercial |
$807.73
|
| Rate for Payer: United Healthcare Medicare |
$727.70
|
|
|
PR OPEN RX PATELLA FX
|
Professional
|
$1,369.30
|
|
|
Service Code
|
CPT 27524
|
| Hospital Charge Code |
z27524
|
| Min. Negotiated Rate |
$701.76 |
| Max. Negotiated Rate |
$1,192.99 |
| Rate for Payer: Aetna Medicare |
$701.76
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$969.90
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$969.90
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$807.02
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$771.94
|
| Rate for Payer: Cash Price |
$848.97
|
| Rate for Payer: Cash Price |
$848.97
|
| Rate for Payer: Coventry All Commercial |
$842.11
|
| Rate for Payer: Frontpath All Commercial |
$979.06
|
| Rate for Payer: Humana ChoiceCare |
$795.58
|
| Rate for Payer: Humana Medicare |
$701.76
|
| Rate for Payer: Lucent All Commercial |
$1,192.99
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,123.00
|
| Rate for Payer: PHCS All Commercial |
$1,026.98
|
| Rate for Payer: PHP All Commercial |
$1,191.29
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$701.76
|
| Rate for Payer: Signature Care EPO |
$1,060.80
|
| Rate for Payer: Signature Care PPO |
$1,060.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,053.00
|
| Rate for Payer: United Healthcare Commercial |
$816.86
|
| Rate for Payer: United Healthcare Medicare |
$701.76
|
|
|
PR OPEN RX TIBIA SHAFT FX,SCREWS
|
Professional
|
$1,624.76
|
|
|
Service Code
|
CPT 27758
|
| Hospital Charge Code |
z27758
|
| Min. Negotiated Rate |
$832.85 |
| Max. Negotiated Rate |
$1,415.84 |
| Rate for Payer: Aetna Medicare |
$832.85
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,188.40
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,188.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$957.78
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$916.14
|
| Rate for Payer: Cash Price |
$1,007.35
|
| Rate for Payer: Cash Price |
$1,007.35
|
| Rate for Payer: Coventry All Commercial |
$999.42
|
| Rate for Payer: Frontpath All Commercial |
$1,164.48
|
| Rate for Payer: Humana ChoiceCare |
$911.54
|
| Rate for Payer: Humana Medicare |
$832.85
|
| Rate for Payer: Lucent All Commercial |
$1,415.84
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,333.00
|
| Rate for Payer: PHCS All Commercial |
$1,218.57
|
| Rate for Payer: PHP All Commercial |
$1,413.54
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$832.85
|
| Rate for Payer: Signature Care EPO |
$1,217.20
|
| Rate for Payer: Signature Care PPO |
$1,217.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,249.00
|
| Rate for Payer: United Healthcare Commercial |
$966.74
|
| Rate for Payer: United Healthcare Medicare |
$832.85
|
|
|
PR OPEN RX ULNAR STYLOID FX
|
Professional
|
$1,139.42
|
|
|
Service Code
|
CPT 25652
|
| Hospital Charge Code |
z25652
|
| Min. Negotiated Rate |
$583.95 |
| Max. Negotiated Rate |
$992.72 |
| Rate for Payer: Aetna Medicare |
$583.95
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$725.50
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$725.50
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$671.54
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$642.34
|
| Rate for Payer: Cash Price |
$706.44
|
| Rate for Payer: Cash Price |
$706.44
|
| Rate for Payer: Coventry All Commercial |
$700.74
|
| Rate for Payer: Frontpath All Commercial |
$806.91
|
| Rate for Payer: Humana ChoiceCare |
$632.07
|
| Rate for Payer: Humana Medicare |
$583.95
|
| Rate for Payer: Lucent All Commercial |
$992.72
|
| Rate for Payer: Lutheran Preferred All Commercial |
$934.00
|
| Rate for Payer: PHCS All Commercial |
$854.56
|
| Rate for Payer: PHP All Commercial |
$991.29
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$583.95
|
| Rate for Payer: Signature Care EPO |
$840.65
|
| Rate for Payer: Signature Care PPO |
$840.65
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$876.00
|
| Rate for Payer: United Healthcare Commercial |
$658.75
|
| Rate for Payer: United Healthcare Medicare |
$583.95
|
|
|
PR OPEN STOMACH,REULCER,SUTURE
|
Professional
|
$2,395.10
|
|
|
Service Code
|
CPT 43501
|
| Hospital Charge Code |
z43501
|
| Min. Negotiated Rate |
$1,178.10 |
| Max. Negotiated Rate |
$2,095.72 |
| Rate for Payer: Aetna Medicare |
$1,227.33
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,178.10
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,178.10
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,411.43
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,350.06
|
| Rate for Payer: Cash Price |
$1,484.96
|
| Rate for Payer: Cash Price |
$1,484.96
|
| Rate for Payer: Coventry All Commercial |
$1,472.80
|
| Rate for Payer: Frontpath All Commercial |
$1,789.10
|
| Rate for Payer: Humana ChoiceCare |
$1,301.88
|
| Rate for Payer: Humana Medicare |
$1,227.33
|
| Rate for Payer: Lucent All Commercial |
$2,086.46
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,841.00
|
| Rate for Payer: PHCS All Commercial |
$1,796.32
|
| Rate for Payer: PHP All Commercial |
$2,095.72
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,227.33
|
| Rate for Payer: Signature Care EPO |
$1,632.85
|
| Rate for Payer: Signature Care PPO |
$1,632.85
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,718.00
|
| Rate for Payer: United Healthcare Commercial |
$1,433.06
|
| Rate for Payer: United Healthcare Medicare |
$1,227.33
|
|
|
PR OPEN TREATMENT BIMALLEOLAR ANKLE FRACTURE
|
Professional
|
$1,391.20
|
|
|
Service Code
|
CPT 27814
|
| Hospital Charge Code |
z27814
|
| Min. Negotiated Rate |
$712.99 |
| Max. Negotiated Rate |
$1,212.08 |
| Rate for Payer: Aetna Medicare |
$712.99
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,035.60
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,035.60
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$819.94
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$784.29
|
| Rate for Payer: Cash Price |
$862.54
|
| Rate for Payer: Cash Price |
$862.54
|
| Rate for Payer: Coventry All Commercial |
$855.59
|
| Rate for Payer: Frontpath All Commercial |
$992.29
|
| Rate for Payer: Humana ChoiceCare |
$839.98
|
| Rate for Payer: Humana Medicare |
$712.99
|
| Rate for Payer: Lucent All Commercial |
$1,212.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,141.00
|
| Rate for Payer: PHCS All Commercial |
$1,043.40
|
| Rate for Payer: PHP All Commercial |
$1,210.34
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$712.99
|
| Rate for Payer: Signature Care EPO |
$1,125.40
|
| Rate for Payer: Signature Care PPO |
$1,125.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,069.00
|
| Rate for Payer: United Healthcare Commercial |
$842.13
|
| Rate for Payer: United Healthcare Medicare |
$712.99
|
|
|
PR OPEN TREATMENT CALCANEAL FRACTURE
|
Professional
|
$2,051.26
|
|
|
Service Code
|
CPT 28415
|
| Hospital Charge Code |
z28415
|
| Min. Negotiated Rate |
$1,051.27 |
| Max. Negotiated Rate |
$1,787.16 |
| Rate for Payer: Aetna Medicare |
$1,051.27
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,208.96
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,156.40
|
| Rate for Payer: Cash Price |
$1,271.78
|
| Rate for Payer: Cash Price |
$1,271.78
|
| Rate for Payer: Coventry All Commercial |
$1,261.52
|
| Rate for Payer: Frontpath All Commercial |
$1,459.37
|
| Rate for Payer: Humana ChoiceCare |
$1,273.84
|
| Rate for Payer: Humana Medicare |
$1,051.27
|
| Rate for Payer: Lucent All Commercial |
$1,787.16
|
| Rate for Payer: PHCS All Commercial |
$1,538.44
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,051.27
|
| Rate for Payer: United Healthcare Commercial |
$1,250.61
|
| Rate for Payer: United Healthcare Medicare |
$1,051.27
|
|
|
PR OPEN TREATMENT CLAVICULAR FRACTURE INTERNAL FX
|
Professional
|
$1,312.10
|
|
|
Service Code
|
CPT 23515
|
| Hospital Charge Code |
z23515
|
| Min. Negotiated Rate |
$607.30 |
| Max. Negotiated Rate |
$1,143.16 |
| Rate for Payer: Aetna Medicare |
$672.45
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$733.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$733.00
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$773.32
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$739.70
|
| Rate for Payer: Cash Price |
$813.50
|
| Rate for Payer: Cash Price |
$813.50
|
| Rate for Payer: Coventry All Commercial |
$806.94
|
| Rate for Payer: Frontpath All Commercial |
$933.95
|
| Rate for Payer: Humana ChoiceCare |
$607.30
|
| Rate for Payer: Humana Medicare |
$672.45
|
| Rate for Payer: Lucent All Commercial |
$1,143.16
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,076.00
|
| Rate for Payer: PHCS All Commercial |
$984.08
|
| Rate for Payer: PHP All Commercial |
$1,141.53
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$672.45
|
| Rate for Payer: Signature Care EPO |
$811.75
|
| Rate for Payer: Signature Care PPO |
$811.75
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,009.00
|
| Rate for Payer: United Healthcare Commercial |
$756.40
|
| Rate for Payer: United Healthcare Medicare |
$672.45
|
|
|
PR OPEN TREATMENT FRACTURE DISTAL TIBIA & FIBULA
|
Professional
|
$2,407.18
|
|
|
Service Code
|
CPT 27828
|
| Hospital Charge Code |
z27828
|
| Min. Negotiated Rate |
$1,233.67 |
| Max. Negotiated Rate |
$2,097.24 |
| Rate for Payer: Aetna Medicare |
$1,233.67
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,418.72
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,357.04
|
| Rate for Payer: Cash Price |
$1,492.45
|
| Rate for Payer: Cash Price |
$1,492.45
|
| Rate for Payer: Coventry All Commercial |
$1,480.40
|
| Rate for Payer: Frontpath All Commercial |
$1,728.96
|
| Rate for Payer: Humana ChoiceCare |
$1,313.75
|
| Rate for Payer: Humana Medicare |
$1,233.67
|
| Rate for Payer: Lucent All Commercial |
$2,097.24
|
| Rate for Payer: PHCS All Commercial |
$1,805.38
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,233.67
|
| Rate for Payer: United Healthcare Commercial |
$1,413.59
|
| Rate for Payer: United Healthcare Medicare |
$1,233.67
|
|
|
PR OPEN TREATMENT FRACTURE DISTAL TIBIA ONLY
|
Professional
|
$2,035.14
|
|
|
Service Code
|
CPT 27827
|
| Hospital Charge Code |
z27827
|
| Min. Negotiated Rate |
$1,043.33 |
| Max. Negotiated Rate |
$1,887.30 |
| Rate for Payer: Aetna Medicare |
$1,043.33
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,887.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,887.30
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,199.83
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,147.66
|
| Rate for Payer: Cash Price |
$1,261.79
|
| Rate for Payer: Cash Price |
$1,261.79
|
| Rate for Payer: Coventry All Commercial |
$1,252.00
|
| Rate for Payer: Frontpath All Commercial |
$1,454.04
|
| Rate for Payer: Humana ChoiceCare |
$1,165.50
|
| Rate for Payer: Humana Medicare |
$1,043.33
|
| Rate for Payer: Lucent All Commercial |
$1,773.66
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,669.00
|
| Rate for Payer: PHCS All Commercial |
$1,526.36
|
| Rate for Payer: PHP All Commercial |
$1,770.57
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,043.33
|
| Rate for Payer: Signature Care EPO |
$1,558.90
|
| Rate for Payer: Signature Care PPO |
$1,558.90
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,565.00
|
| Rate for Payer: United Healthcare Commercial |
$1,179.63
|
| Rate for Payer: United Healthcare Medicare |
$1,043.33
|
|
|
PR OPEN TREATMENT GREATER TROCHANTERIC FRACTURE
|
Professional
|
$1,350.16
|
|
|
Service Code
|
CPT 27248
|
| Hospital Charge Code |
z27248
|
| Min. Negotiated Rate |
$691.95 |
| Max. Negotiated Rate |
$1,176.32 |
| Rate for Payer: Aetna Medicare |
$691.95
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,044.90
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,044.90
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$795.74
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$761.14
|
| Rate for Payer: Cash Price |
$837.10
|
| Rate for Payer: Cash Price |
$837.10
|
| Rate for Payer: Coventry All Commercial |
$830.34
|
| Rate for Payer: Frontpath All Commercial |
$971.96
|
| Rate for Payer: Humana ChoiceCare |
$815.34
|
| Rate for Payer: Humana Medicare |
$691.95
|
| Rate for Payer: Lucent All Commercial |
$1,176.32
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,107.00
|
| Rate for Payer: PHCS All Commercial |
$1,012.62
|
| Rate for Payer: PHP All Commercial |
$1,174.63
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$691.95
|
| Rate for Payer: Signature Care EPO |
$1,090.55
|
| Rate for Payer: Signature Care PPO |
$1,090.55
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,038.00
|
| Rate for Payer: United Healthcare Commercial |
$820.61
|
| Rate for Payer: United Healthcare Medicare |
$691.95
|
|
|
PR OPEN TREATMENT INTERPHALANGEAL JOINT DISLOCATION
|
Professional
|
$1,049.88
|
|
|
Service Code
|
CPT 28675
|
| Hospital Charge Code |
z28675
|
| Min. Negotiated Rate |
$268.95 |
| Max. Negotiated Rate |
$787.41 |
| Rate for Payer: Aetna Medicare |
$388.03
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$438.01
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$438.01
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$446.23
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$426.83
|
| Rate for Payer: Cash Price |
$650.93
|
| Rate for Payer: Cash Price |
$650.93
|
| Rate for Payer: Coventry All Commercial |
$465.64
|
| Rate for Payer: Frontpath All Commercial |
$526.58
|
| Rate for Payer: Humana ChoiceCare |
$268.95
|
| Rate for Payer: Humana Medicare |
$388.03
|
| Rate for Payer: Lucent All Commercial |
$659.65
|
| Rate for Payer: Lutheran Preferred All Commercial |
$621.00
|
| Rate for Payer: PHCS All Commercial |
$787.41
|
| Rate for Payer: PHP All Commercial |
$658.70
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$388.03
|
| Rate for Payer: Signature Care EPO |
$654.50
|
| Rate for Payer: Signature Care PPO |
$654.50
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$582.00
|
| Rate for Payer: United Healthcare Commercial |
$433.38
|
| Rate for Payer: United Healthcare Medicare |
$388.03
|
|
