|
PR DESTRUCTION,ANAL LESION(S),EXTENSIVE
|
Professional
|
Both
|
$1,027.16
|
|
|
Service Code
|
CPT 46924
|
| Hospital Charge Code |
z46924
|
| Min. Negotiated Rate |
$146.37 |
| Max. Negotiated Rate |
$23,600.00 |
| Rate for Payer: Aetna Commercial |
$168.78
|
| Rate for Payer: Aetna Commercial |
$168.78
|
| Rate for Payer: Aetna Medicare |
$168.78
|
| Rate for Payer: Aetna Medicare |
$168.78
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$413.47
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$413.47
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$413.47
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$413.47
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$413.47
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$413.47
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$413.47
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$413.47
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$146.37
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$146.37
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$505.20
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$505.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$194.10
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$194.10
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$185.66
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$185.66
|
| Rate for Payer: Cash Price |
$601.00
|
| Rate for Payer: Cash Price |
$616.30
|
| Rate for Payer: Centivo All Commercial |
$261.61
|
| Rate for Payer: Centivo All Commercial |
$261.61
|
| Rate for Payer: Cigna All Commercial |
$168.78
|
| Rate for Payer: Cigna All Commercial |
$168.78
|
| Rate for Payer: CORVEL All Commercial |
$168.78
|
| Rate for Payer: CORVEL All Commercial |
$168.78
|
| Rate for Payer: Coventry All Commercial |
$202.54
|
| Rate for Payer: Coventry All Commercial |
$202.54
|
| Rate for Payer: Encore All Commercial |
$168.78
|
| Rate for Payer: Encore All Commercial |
$168.78
|
| Rate for Payer: Frontpath All Commercial |
$232.52
|
| Rate for Payer: Frontpath All Commercial |
$232.52
|
| Rate for Payer: Humana ChoiceCare |
$185.83
|
| Rate for Payer: Humana ChoiceCare |
$185.83
|
| Rate for Payer: Humana Medicare |
$168.78
|
| Rate for Payer: Humana Medicare |
$168.78
|
| Rate for Payer: Lucent All Commercial |
$236.29
|
| Rate for Payer: Lucent All Commercial |
$236.29
|
| Rate for Payer: Lutheran Preferred All Commercial |
$253.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$253.00
|
| Rate for Payer: Managed Health Services Medicaid |
$505.20
|
| Rate for Payer: Managed Health Services Medicaid |
$505.20
|
| Rate for Payer: MDWise Medicaid |
$505.20
|
| Rate for Payer: MDWise Medicaid |
$505.20
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$146.37
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$146.37
|
| Rate for Payer: PHCS All Commercial |
$168.78
|
| Rate for Payer: PHCS All Commercial |
$168.78
|
| Rate for Payer: PHP All Commercial |
$287.71
|
| Rate for Payer: PHP All Commercial |
$287.71
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$168.78
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$168.78
|
| Rate for Payer: Sagamore Health Network All Products |
$168.78
|
| Rate for Payer: Sagamore Health Network All Products |
$168.78
|
| Rate for Payer: Signature Care EPO |
$621.35
|
| Rate for Payer: Signature Care EPO |
$621.35
|
| Rate for Payer: Signature Care PPO |
$621.35
|
| Rate for Payer: Signature Care PPO |
$621.35
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$23,600.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$23,600.00
|
| Rate for Payer: United Healthcare Commercial |
$195.26
|
| Rate for Payer: United Healthcare Commercial |
$195.26
|
| Rate for Payer: United Healthcare Medicare |
$500.83
|
| Rate for Payer: United Healthcare Medicare |
$500.83
|
|
|
PR DESTRUCTION BENIGN LESIONS 15 OR MORE
|
Professional
|
Both
|
$248.28
|
|
|
Service Code
|
CPT 17111
|
| Hospital Charge Code |
z17111
|
| Min. Negotiated Rate |
$44.49 |
| Max. Negotiated Rate |
$9,200.00 |
| Rate for Payer: Aetna Commercial |
$75.98
|
| Rate for Payer: Aetna Commercial |
$75.98
|
| Rate for Payer: Aetna Medicare |
$75.98
|
| Rate for Payer: Aetna Medicare |
$75.98
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$120.85
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$120.85
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$120.85
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$120.85
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$120.85
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$120.85
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$120.85
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$120.85
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$44.49
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$44.49
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$122.11
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$122.11
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$87.38
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$87.38
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$83.58
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$83.58
|
| Rate for Payer: Cash Price |
$145.54
|
| Rate for Payer: Cash Price |
$148.97
|
| Rate for Payer: Centivo All Commercial |
$117.77
|
| Rate for Payer: Centivo All Commercial |
$117.77
|
| Rate for Payer: Cigna All Commercial |
$75.98
|
| Rate for Payer: Cigna All Commercial |
$75.98
|
| Rate for Payer: CORVEL All Commercial |
$75.98
|
| Rate for Payer: CORVEL All Commercial |
$75.98
|
| Rate for Payer: Coventry All Commercial |
$91.18
|
| Rate for Payer: Coventry All Commercial |
$91.18
|
| Rate for Payer: Encore All Commercial |
$75.98
|
| Rate for Payer: Encore All Commercial |
$75.98
|
| Rate for Payer: Frontpath All Commercial |
$102.36
|
| Rate for Payer: Frontpath All Commercial |
$102.36
|
| Rate for Payer: Humana ChoiceCare |
$63.50
|
| Rate for Payer: Humana ChoiceCare |
$63.50
|
| Rate for Payer: Humana Medicare |
$75.98
|
| Rate for Payer: Humana Medicare |
$75.98
|
| Rate for Payer: Lucent All Commercial |
$106.37
|
| Rate for Payer: Lucent All Commercial |
$106.37
|
| Rate for Payer: Lutheran Preferred All Commercial |
$100.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$100.00
|
| Rate for Payer: Managed Health Services Medicaid |
$122.11
|
| Rate for Payer: Managed Health Services Medicaid |
$122.11
|
| Rate for Payer: MDWise Medicaid |
$122.11
|
| Rate for Payer: MDWise Medicaid |
$122.11
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$44.49
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$44.49
|
| Rate for Payer: PHCS All Commercial |
$75.98
|
| Rate for Payer: PHCS All Commercial |
$75.98
|
| Rate for Payer: PHP All Commercial |
$105.28
|
| Rate for Payer: PHP All Commercial |
$105.28
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$75.98
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$75.98
|
| Rate for Payer: Sagamore Health Network All Products |
$75.98
|
| Rate for Payer: Sagamore Health Network All Products |
$75.98
|
| Rate for Payer: Signature Care EPO |
$105.88
|
| Rate for Payer: Signature Care EPO |
$105.88
|
| Rate for Payer: Signature Care PPO |
$105.88
|
| Rate for Payer: Signature Care PPO |
$105.88
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$9,200.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$9,200.00
|
| Rate for Payer: United Healthcare Commercial |
$89.66
|
| Rate for Payer: United Healthcare Commercial |
$89.66
|
| Rate for Payer: United Healthcare Medicare |
$121.28
|
| Rate for Payer: United Healthcare Medicare |
$121.28
|
|
|
PR DESTRUCTION BENIGN LESIONS UP TO 14
|
Professional
|
Both
|
$212.14
|
|
|
Service Code
|
CPT 17110
|
| Hospital Charge Code |
z17110
|
| Min. Negotiated Rate |
$36.13 |
| Max. Negotiated Rate |
$7,500.00 |
| Rate for Payer: Aetna Commercial |
$61.95
|
| Rate for Payer: Aetna Commercial |
$61.95
|
| Rate for Payer: Aetna Medicare |
$61.95
|
| Rate for Payer: Aetna Medicare |
$61.95
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$106.25
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$106.25
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$106.25
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$106.25
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$106.25
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$106.25
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$106.25
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$106.25
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$36.13
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$36.13
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$104.34
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$104.34
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$71.24
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$71.24
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$68.14
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$68.14
|
| Rate for Payer: Cash Price |
$124.50
|
| Rate for Payer: Cash Price |
$127.28
|
| Rate for Payer: Centivo All Commercial |
$96.02
|
| Rate for Payer: Centivo All Commercial |
$96.02
|
| Rate for Payer: Cigna All Commercial |
$61.95
|
| Rate for Payer: Cigna All Commercial |
$61.95
|
| Rate for Payer: CORVEL All Commercial |
$61.95
|
| Rate for Payer: CORVEL All Commercial |
$61.95
|
| Rate for Payer: Coventry All Commercial |
$74.34
|
| Rate for Payer: Coventry All Commercial |
$74.34
|
| Rate for Payer: Encore All Commercial |
$61.95
|
| Rate for Payer: Encore All Commercial |
$61.95
|
| Rate for Payer: Frontpath All Commercial |
$83.49
|
| Rate for Payer: Frontpath All Commercial |
$83.49
|
| Rate for Payer: Humana ChoiceCare |
$49.49
|
| Rate for Payer: Humana ChoiceCare |
$49.49
|
| Rate for Payer: Humana Medicare |
$61.95
|
| Rate for Payer: Humana Medicare |
$61.95
|
| Rate for Payer: Lucent All Commercial |
$86.73
|
| Rate for Payer: Lucent All Commercial |
$86.73
|
| Rate for Payer: Lutheran Preferred All Commercial |
$82.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$82.00
|
| Rate for Payer: Managed Health Services Medicaid |
$104.34
|
| Rate for Payer: Managed Health Services Medicaid |
$104.34
|
| Rate for Payer: MDWise Medicaid |
$104.34
|
| Rate for Payer: MDWise Medicaid |
$104.34
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$36.13
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$36.13
|
| Rate for Payer: PHCS All Commercial |
$61.95
|
| Rate for Payer: PHCS All Commercial |
$61.95
|
| Rate for Payer: PHP All Commercial |
$85.80
|
| Rate for Payer: PHP All Commercial |
$85.80
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$61.95
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$61.95
|
| Rate for Payer: Sagamore Health Network All Products |
$61.95
|
| Rate for Payer: Sagamore Health Network All Products |
$61.95
|
| Rate for Payer: Signature Care EPO |
$90.95
|
| Rate for Payer: Signature Care EPO |
$90.95
|
| Rate for Payer: Signature Care PPO |
$90.95
|
| Rate for Payer: Signature Care PPO |
$90.95
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$7,500.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$7,500.00
|
| Rate for Payer: United Healthcare Commercial |
$71.70
|
| Rate for Payer: United Healthcare Commercial |
$71.70
|
| Rate for Payer: United Healthcare Medicare |
$103.75
|
| Rate for Payer: United Healthcare Medicare |
$103.75
|
|
|
PR DESTRUCTION,LESION(S),VULVA;EXTENSIVE
|
Professional
|
Both
|
$516.44
|
|
|
Service Code
|
CPT 56515
|
| Hospital Charge Code |
z56515
|
| Min. Negotiated Rate |
$109.70 |
| Max. Negotiated Rate |
$25,900.00 |
| Rate for Payer: Aetna Commercial |
$200.59
|
| Rate for Payer: Aetna Commercial |
$200.59
|
| Rate for Payer: Aetna Medicare |
$200.59
|
| Rate for Payer: Aetna Medicare |
$200.59
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$276.07
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$276.07
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$276.07
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$276.07
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$276.07
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$276.07
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$276.07
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$276.07
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$109.70
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$109.70
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$254.01
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$254.01
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$230.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$230.68
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$220.65
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$220.65
|
| Rate for Payer: Cash Price |
$305.10
|
| Rate for Payer: Cash Price |
$309.86
|
| Rate for Payer: Centivo All Commercial |
$310.91
|
| Rate for Payer: Centivo All Commercial |
$310.91
|
| Rate for Payer: Cigna All Commercial |
$200.59
|
| Rate for Payer: Cigna All Commercial |
$200.59
|
| Rate for Payer: CORVEL All Commercial |
$200.59
|
| Rate for Payer: CORVEL All Commercial |
$200.59
|
| Rate for Payer: Coventry All Commercial |
$240.71
|
| Rate for Payer: Coventry All Commercial |
$240.71
|
| Rate for Payer: Encore All Commercial |
$200.59
|
| Rate for Payer: Encore All Commercial |
$200.59
|
| Rate for Payer: Frontpath All Commercial |
$276.54
|
| Rate for Payer: Frontpath All Commercial |
$276.54
|
| Rate for Payer: Humana ChoiceCare |
$201.87
|
| Rate for Payer: Humana ChoiceCare |
$201.87
|
| Rate for Payer: Humana Medicare |
$200.59
|
| Rate for Payer: Humana Medicare |
$200.59
|
| Rate for Payer: Lucent All Commercial |
$280.83
|
| Rate for Payer: Lucent All Commercial |
$280.83
|
| Rate for Payer: Lutheran Preferred All Commercial |
$279.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$279.00
|
| Rate for Payer: Managed Health Services Medicaid |
$254.01
|
| Rate for Payer: Managed Health Services Medicaid |
$254.01
|
| Rate for Payer: MDWise Medicaid |
$254.01
|
| Rate for Payer: MDWise Medicaid |
$254.01
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$109.70
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$109.70
|
| Rate for Payer: PHCS All Commercial |
$200.59
|
| Rate for Payer: PHCS All Commercial |
$200.59
|
| Rate for Payer: PHP All Commercial |
$256.89
|
| Rate for Payer: PHP All Commercial |
$256.89
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$200.59
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$200.59
|
| Rate for Payer: Sagamore Health Network All Products |
$200.59
|
| Rate for Payer: Sagamore Health Network All Products |
$200.59
|
| Rate for Payer: Signature Care EPO |
$258.40
|
| Rate for Payer: Signature Care EPO |
$258.40
|
| Rate for Payer: Signature Care PPO |
$258.40
|
| Rate for Payer: Signature Care PPO |
$258.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$25,900.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$25,900.00
|
| Rate for Payer: United Healthcare Commercial |
$220.01
|
| Rate for Payer: United Healthcare Commercial |
$220.01
|
| Rate for Payer: United Healthcare Medicare |
$254.25
|
| Rate for Payer: United Healthcare Medicare |
$254.25
|
|
|
PR DESTRUCTION,LESION(S),VULVA,SIMPLE
|
Professional
|
Both
|
$358.46
|
|
|
Service Code
|
CPT 56501
|
| Hospital Charge Code |
z56501
|
| Min. Negotiated Rate |
$68.70 |
| Max. Negotiated Rate |
$16,300.00 |
| Rate for Payer: Aetna Commercial |
$125.50
|
| Rate for Payer: Aetna Commercial |
$125.50
|
| Rate for Payer: Aetna Medicare |
$125.50
|
| Rate for Payer: Aetna Medicare |
$125.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$171.32
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$171.32
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$171.32
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$171.32
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$171.32
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$171.32
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$171.32
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$171.32
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$68.70
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$68.70
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$176.31
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$176.31
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$144.32
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$144.32
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$138.05
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$138.05
|
| Rate for Payer: Cash Price |
$212.33
|
| Rate for Payer: Cash Price |
$215.08
|
| Rate for Payer: Centivo All Commercial |
$194.53
|
| Rate for Payer: Centivo All Commercial |
$194.53
|
| Rate for Payer: Cigna All Commercial |
$125.50
|
| Rate for Payer: Cigna All Commercial |
$125.50
|
| Rate for Payer: CORVEL All Commercial |
$125.50
|
| Rate for Payer: CORVEL All Commercial |
$125.50
|
| Rate for Payer: Coventry All Commercial |
$150.60
|
| Rate for Payer: Coventry All Commercial |
$150.60
|
| Rate for Payer: Encore All Commercial |
$125.50
|
| Rate for Payer: Encore All Commercial |
$125.50
|
| Rate for Payer: Frontpath All Commercial |
$171.20
|
| Rate for Payer: Frontpath All Commercial |
$171.20
|
| Rate for Payer: Humana ChoiceCare |
$121.13
|
| Rate for Payer: Humana ChoiceCare |
$121.13
|
| Rate for Payer: Humana Medicare |
$125.50
|
| Rate for Payer: Humana Medicare |
$125.50
|
| Rate for Payer: Lucent All Commercial |
$175.70
|
| Rate for Payer: Lucent All Commercial |
$175.70
|
| Rate for Payer: Lutheran Preferred All Commercial |
$176.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$176.00
|
| Rate for Payer: Managed Health Services Medicaid |
$176.31
|
| Rate for Payer: Managed Health Services Medicaid |
$176.31
|
| Rate for Payer: MDWise Medicaid |
$176.31
|
| Rate for Payer: MDWise Medicaid |
$176.31
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$68.70
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$68.70
|
| Rate for Payer: PHCS All Commercial |
$125.50
|
| Rate for Payer: PHCS All Commercial |
$125.50
|
| Rate for Payer: PHP All Commercial |
$161.60
|
| Rate for Payer: PHP All Commercial |
$161.60
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$125.50
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$125.50
|
| Rate for Payer: Sagamore Health Network All Products |
$125.50
|
| Rate for Payer: Sagamore Health Network All Products |
$125.50
|
| Rate for Payer: Signature Care EPO |
$161.50
|
| Rate for Payer: Signature Care EPO |
$161.50
|
| Rate for Payer: Signature Care PPO |
$161.50
|
| Rate for Payer: Signature Care PPO |
$161.50
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$16,300.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$16,300.00
|
| Rate for Payer: United Healthcare Commercial |
$126.06
|
| Rate for Payer: United Healthcare Commercial |
$126.06
|
| Rate for Payer: United Healthcare Medicare |
$176.94
|
| Rate for Payer: United Healthcare Medicare |
$176.94
|
|
|
PR DESTRUCTION MALIGNANT LESION F/E/E/N/L/M 0.5CM/<
|
Professional
|
Both
|
$263.42
|
|
|
Service Code
|
CPT 17280
|
| Hospital Charge Code |
z17280
|
| Min. Negotiated Rate |
$58.12 |
| Max. Negotiated Rate |
$9,700.00 |
| Rate for Payer: Aetna Commercial |
$80.43
|
| Rate for Payer: Aetna Commercial |
$80.43
|
| Rate for Payer: Aetna Medicare |
$80.43
|
| Rate for Payer: Aetna Medicare |
$80.43
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$141.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$141.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$141.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$141.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$141.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$141.50
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$141.50
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$141.50
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$58.12
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$58.12
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$129.56
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$129.56
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$92.49
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$92.49
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$88.47
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$88.47
|
| Rate for Payer: Cash Price |
$154.03
|
| Rate for Payer: Cash Price |
$158.05
|
| Rate for Payer: Centivo All Commercial |
$124.67
|
| Rate for Payer: Centivo All Commercial |
$124.67
|
| Rate for Payer: Cigna All Commercial |
$80.43
|
| Rate for Payer: Cigna All Commercial |
$80.43
|
| Rate for Payer: CORVEL All Commercial |
$80.43
|
| Rate for Payer: CORVEL All Commercial |
$80.43
|
| Rate for Payer: Coventry All Commercial |
$96.52
|
| Rate for Payer: Coventry All Commercial |
$96.52
|
| Rate for Payer: Encore All Commercial |
$80.43
|
| Rate for Payer: Encore All Commercial |
$80.43
|
| Rate for Payer: Frontpath All Commercial |
$108.35
|
| Rate for Payer: Frontpath All Commercial |
$108.35
|
| Rate for Payer: Humana ChoiceCare |
$72.98
|
| Rate for Payer: Humana ChoiceCare |
$72.98
|
| Rate for Payer: Humana Medicare |
$80.43
|
| Rate for Payer: Humana Medicare |
$80.43
|
| Rate for Payer: Lucent All Commercial |
$112.60
|
| Rate for Payer: Lucent All Commercial |
$112.60
|
| Rate for Payer: Lutheran Preferred All Commercial |
$105.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$105.00
|
| Rate for Payer: Managed Health Services Medicaid |
$129.56
|
| Rate for Payer: Managed Health Services Medicaid |
$129.56
|
| Rate for Payer: MDWise Medicaid |
$129.56
|
| Rate for Payer: MDWise Medicaid |
$129.56
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$58.12
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$58.12
|
| Rate for Payer: PHCS All Commercial |
$80.43
|
| Rate for Payer: PHCS All Commercial |
$80.43
|
| Rate for Payer: PHP All Commercial |
$110.55
|
| Rate for Payer: PHP All Commercial |
$110.55
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$80.43
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$80.43
|
| Rate for Payer: Sagamore Health Network All Products |
$80.43
|
| Rate for Payer: Sagamore Health Network All Products |
$80.43
|
| Rate for Payer: Signature Care EPO |
$113.05
|
| Rate for Payer: Signature Care EPO |
$113.05
|
| Rate for Payer: Signature Care PPO |
$113.05
|
| Rate for Payer: Signature Care PPO |
$113.05
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$9,700.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$9,700.00
|
| Rate for Payer: United Healthcare Commercial |
$95.98
|
| Rate for Payer: United Healthcare Commercial |
$95.98
|
| Rate for Payer: United Healthcare Medicare |
$128.36
|
| Rate for Payer: United Healthcare Medicare |
$128.36
|
|
|
PR DESTRUCTION MAL LESION F/E/E/N/L/M 0.6-1.0CM
|
Professional
|
Both
|
$336.96
|
|
|
Service Code
|
CPT 17281
|
| Hospital Charge Code |
z17281
|
| Min. Negotiated Rate |
$77.32 |
| Max. Negotiated Rate |
$13,300.00 |
| Rate for Payer: Aetna Commercial |
$110.24
|
| Rate for Payer: Aetna Commercial |
$110.24
|
| Rate for Payer: Aetna Medicare |
$110.24
|
| Rate for Payer: Aetna Medicare |
$110.24
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$178.07
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$178.07
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$178.07
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$178.07
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$178.07
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$178.07
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$178.07
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$178.07
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$77.32
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$77.32
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$165.73
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$165.73
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$126.78
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$126.78
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$121.26
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$121.26
|
| Rate for Payer: Cash Price |
$198.13
|
| Rate for Payer: Cash Price |
$202.18
|
| Rate for Payer: Centivo All Commercial |
$170.87
|
| Rate for Payer: Centivo All Commercial |
$170.87
|
| Rate for Payer: Cigna All Commercial |
$110.24
|
| Rate for Payer: Cigna All Commercial |
$110.24
|
| Rate for Payer: CORVEL All Commercial |
$110.24
|
| Rate for Payer: CORVEL All Commercial |
$110.24
|
| Rate for Payer: Coventry All Commercial |
$132.29
|
| Rate for Payer: Coventry All Commercial |
$132.29
|
| Rate for Payer: Encore All Commercial |
$110.24
|
| Rate for Payer: Encore All Commercial |
$110.24
|
| Rate for Payer: Frontpath All Commercial |
$149.28
|
| Rate for Payer: Frontpath All Commercial |
$149.28
|
| Rate for Payer: Humana ChoiceCare |
$103.77
|
| Rate for Payer: Humana ChoiceCare |
$103.77
|
| Rate for Payer: Humana Medicare |
$110.24
|
| Rate for Payer: Humana Medicare |
$110.24
|
| Rate for Payer: Lucent All Commercial |
$154.34
|
| Rate for Payer: Lucent All Commercial |
$154.34
|
| Rate for Payer: Lutheran Preferred All Commercial |
$144.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$144.00
|
| Rate for Payer: Managed Health Services Medicaid |
$165.73
|
| Rate for Payer: Managed Health Services Medicaid |
$165.73
|
| Rate for Payer: MDWise Medicaid |
$165.73
|
| Rate for Payer: MDWise Medicaid |
$165.73
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$77.32
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$77.32
|
| Rate for Payer: PHCS All Commercial |
$110.24
|
| Rate for Payer: PHCS All Commercial |
$110.24
|
| Rate for Payer: PHP All Commercial |
$151.46
|
| Rate for Payer: PHP All Commercial |
$151.46
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$110.24
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$110.24
|
| Rate for Payer: Sagamore Health Network All Products |
$110.24
|
| Rate for Payer: Sagamore Health Network All Products |
$110.24
|
| Rate for Payer: Signature Care EPO |
$147.05
|
| Rate for Payer: Signature Care EPO |
$147.05
|
| Rate for Payer: Signature Care PPO |
$147.05
|
| Rate for Payer: Signature Care PPO |
$147.05
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$13,300.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$13,300.00
|
| Rate for Payer: United Healthcare Commercial |
$134.14
|
| Rate for Payer: United Healthcare Commercial |
$134.14
|
| Rate for Payer: United Healthcare Medicare |
$165.11
|
| Rate for Payer: United Healthcare Medicare |
$165.11
|
|
|
PR DESTRUCTION MAL LESION F/E/E/N/L/M 1.1-2.0CM
|
Professional
|
Both
|
$385.02
|
|
|
Service Code
|
CPT 17282
|
| Hospital Charge Code |
z17282
|
| Min. Negotiated Rate |
$93.54 |
| Max. Negotiated Rate |
$15,400.00 |
| Rate for Payer: Aetna Commercial |
$127.41
|
| Rate for Payer: Aetna Commercial |
$127.41
|
| Rate for Payer: Aetna Medicare |
$127.41
|
| Rate for Payer: Aetna Medicare |
$127.41
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$204.23
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$204.23
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$204.23
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$204.23
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$204.23
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$204.23
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$204.23
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$204.23
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$93.54
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$93.54
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$189.37
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$189.37
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$146.52
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$146.52
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$140.15
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$140.15
|
| Rate for Payer: Cash Price |
$226.57
|
| Rate for Payer: Cash Price |
$231.01
|
| Rate for Payer: Centivo All Commercial |
$197.49
|
| Rate for Payer: Centivo All Commercial |
$197.49
|
| Rate for Payer: Cigna All Commercial |
$127.41
|
| Rate for Payer: Cigna All Commercial |
$127.41
|
| Rate for Payer: CORVEL All Commercial |
$127.41
|
| Rate for Payer: CORVEL All Commercial |
$127.41
|
| Rate for Payer: Coventry All Commercial |
$152.89
|
| Rate for Payer: Coventry All Commercial |
$152.89
|
| Rate for Payer: Encore All Commercial |
$127.41
|
| Rate for Payer: Encore All Commercial |
$127.41
|
| Rate for Payer: Frontpath All Commercial |
$172.55
|
| Rate for Payer: Frontpath All Commercial |
$172.55
|
| Rate for Payer: Humana ChoiceCare |
$121.21
|
| Rate for Payer: Humana ChoiceCare |
$121.21
|
| Rate for Payer: Humana Medicare |
$127.41
|
| Rate for Payer: Humana Medicare |
$127.41
|
| Rate for Payer: Lucent All Commercial |
$178.37
|
| Rate for Payer: Lucent All Commercial |
$178.37
|
| Rate for Payer: Lutheran Preferred All Commercial |
$167.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$167.00
|
| Rate for Payer: Managed Health Services Medicaid |
$189.37
|
| Rate for Payer: Managed Health Services Medicaid |
$189.37
|
| Rate for Payer: MDWise Medicaid |
$189.37
|
| Rate for Payer: MDWise Medicaid |
$189.37
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$93.54
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$93.54
|
| Rate for Payer: PHCS All Commercial |
$127.41
|
| Rate for Payer: PHCS All Commercial |
$127.41
|
| Rate for Payer: PHP All Commercial |
$174.94
|
| Rate for Payer: PHP All Commercial |
$174.94
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$127.41
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$127.41
|
| Rate for Payer: Sagamore Health Network All Products |
$127.41
|
| Rate for Payer: Sagamore Health Network All Products |
$127.41
|
| Rate for Payer: Signature Care EPO |
$171.70
|
| Rate for Payer: Signature Care EPO |
$171.70
|
| Rate for Payer: Signature Care PPO |
$171.70
|
| Rate for Payer: Signature Care PPO |
$171.70
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$15,400.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$15,400.00
|
| Rate for Payer: United Healthcare Commercial |
$155.88
|
| Rate for Payer: United Healthcare Commercial |
$155.88
|
| Rate for Payer: United Healthcare Medicare |
$188.81
|
| Rate for Payer: United Healthcare Medicare |
$188.81
|
|
|
PR DESTRUCTION MAL LESION F/E/E/N/L/M 2.1-3.0CM
|
Professional
|
Both
|
$455.46
|
|
|
Service Code
|
CPT 17283
|
| Hospital Charge Code |
z17283
|
| Min. Negotiated Rate |
$114.94 |
| Max. Negotiated Rate |
$19,200.00 |
| Rate for Payer: Aetna Commercial |
$159.09
|
| Rate for Payer: Aetna Commercial |
$159.09
|
| Rate for Payer: Aetna Medicare |
$159.09
|
| Rate for Payer: Aetna Medicare |
$159.09
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$244.23
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$244.23
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$244.23
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$244.23
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$244.23
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$244.23
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$244.23
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$244.23
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$114.94
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$114.94
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$224.01
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$224.01
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$182.95
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$182.95
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$175.00
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$175.00
|
| Rate for Payer: Cash Price |
$267.94
|
| Rate for Payer: Cash Price |
$273.28
|
| Rate for Payer: Centivo All Commercial |
$246.59
|
| Rate for Payer: Centivo All Commercial |
$246.59
|
| Rate for Payer: Cigna All Commercial |
$159.09
|
| Rate for Payer: Cigna All Commercial |
$159.09
|
| Rate for Payer: CORVEL All Commercial |
$159.09
|
| Rate for Payer: CORVEL All Commercial |
$159.09
|
| Rate for Payer: Coventry All Commercial |
$190.91
|
| Rate for Payer: Coventry All Commercial |
$190.91
|
| Rate for Payer: Encore All Commercial |
$159.09
|
| Rate for Payer: Encore All Commercial |
$159.09
|
| Rate for Payer: Frontpath All Commercial |
$215.06
|
| Rate for Payer: Frontpath All Commercial |
$215.06
|
| Rate for Payer: Humana ChoiceCare |
$153.03
|
| Rate for Payer: Humana ChoiceCare |
$153.03
|
| Rate for Payer: Humana Medicare |
$159.09
|
| Rate for Payer: Humana Medicare |
$159.09
|
| Rate for Payer: Lucent All Commercial |
$222.73
|
| Rate for Payer: Lucent All Commercial |
$222.73
|
| Rate for Payer: Lutheran Preferred All Commercial |
$208.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$208.00
|
| Rate for Payer: Managed Health Services Medicaid |
$224.01
|
| Rate for Payer: Managed Health Services Medicaid |
$224.01
|
| Rate for Payer: MDWise Medicaid |
$224.01
|
| Rate for Payer: MDWise Medicaid |
$224.01
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$114.94
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$114.94
|
| Rate for Payer: PHCS All Commercial |
$159.09
|
| Rate for Payer: PHCS All Commercial |
$159.09
|
| Rate for Payer: PHP All Commercial |
$218.15
|
| Rate for Payer: PHP All Commercial |
$218.15
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$159.09
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$159.09
|
| Rate for Payer: Sagamore Health Network All Products |
$159.09
|
| Rate for Payer: Sagamore Health Network All Products |
$159.09
|
| Rate for Payer: Signature Care EPO |
$211.65
|
| Rate for Payer: Signature Care EPO |
$211.65
|
| Rate for Payer: Signature Care PPO |
$211.65
|
| Rate for Payer: Signature Care PPO |
$211.65
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$19,200.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$19,200.00
|
| Rate for Payer: United Healthcare Commercial |
$195.31
|
| Rate for Payer: United Healthcare Commercial |
$195.31
|
| Rate for Payer: United Healthcare Medicare |
$223.28
|
| Rate for Payer: United Healthcare Medicare |
$223.28
|
|
|
PR DESTRUCTION MAL LESION TRUNK/ARM/LEG 1.1-2.0CM
|
Professional
|
Both
|
$333.76
|
|
|
Service Code
|
CPT 17262
|
| Hospital Charge Code |
z17262
|
| Min. Negotiated Rate |
$69.39 |
| Max. Negotiated Rate |
$164.15 |
| Rate for Payer: Aetna Commercial |
$102.75
|
| Rate for Payer: Aetna Medicare |
$102.75
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$69.39
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$164.15
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$118.16
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$113.03
|
| Rate for Payer: Cash Price |
$200.26
|
| Rate for Payer: Centivo All Commercial |
$159.26
|
| Rate for Payer: Cigna All Commercial |
$102.75
|
| Rate for Payer: CORVEL All Commercial |
$102.75
|
| Rate for Payer: Coventry All Commercial |
$123.30
|
| Rate for Payer: Encore All Commercial |
$102.75
|
| Rate for Payer: Frontpath All Commercial |
$139.20
|
| Rate for Payer: Humana ChoiceCare |
$95.89
|
| Rate for Payer: Humana Medicare |
$102.75
|
| Rate for Payer: Lucent All Commercial |
$143.85
|
| Rate for Payer: Managed Health Services Medicaid |
$164.15
|
| Rate for Payer: MDWise Medicaid |
$164.15
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$69.39
|
| Rate for Payer: PHCS All Commercial |
$102.75
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$102.75
|
| Rate for Payer: Sagamore Health Network All Products |
$102.75
|
| Rate for Payer: United Healthcare Commercial |
$125.08
|
| Rate for Payer: United Healthcare Medicare |
$163.64
|
|
|
PR DESTRUCT,VAGINAL LESION(S),EXTENSIVE
|
Professional
|
Both
|
$459.82
|
|
|
Service Code
|
CPT 57065
|
| Hospital Charge Code |
z57065
|
| Min. Negotiated Rate |
$127.68 |
| Max. Negotiated Rate |
$22,700.00 |
| Rate for Payer: Aetna Commercial |
$175.43
|
| Rate for Payer: Aetna Commercial |
$175.43
|
| Rate for Payer: Aetna Medicare |
$175.43
|
| Rate for Payer: Aetna Medicare |
$175.43
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$255.51
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$255.51
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$255.51
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$255.51
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$255.51
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$255.51
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$255.51
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$255.51
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$127.68
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$127.68
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$226.16
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$226.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$201.74
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$201.74
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$192.97
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$192.97
|
| Rate for Payer: Cash Price |
$271.93
|
| Rate for Payer: Cash Price |
$275.89
|
| Rate for Payer: Centivo All Commercial |
$271.92
|
| Rate for Payer: Centivo All Commercial |
$271.92
|
| Rate for Payer: Cigna All Commercial |
$175.43
|
| Rate for Payer: Cigna All Commercial |
$175.43
|
| Rate for Payer: CORVEL All Commercial |
$175.43
|
| Rate for Payer: CORVEL All Commercial |
$175.43
|
| Rate for Payer: Coventry All Commercial |
$210.52
|
| Rate for Payer: Coventry All Commercial |
$210.52
|
| Rate for Payer: Encore All Commercial |
$175.43
|
| Rate for Payer: Encore All Commercial |
$175.43
|
| Rate for Payer: Frontpath All Commercial |
$241.38
|
| Rate for Payer: Frontpath All Commercial |
$241.38
|
| Rate for Payer: Humana ChoiceCare |
$188.80
|
| Rate for Payer: Humana ChoiceCare |
$188.80
|
| Rate for Payer: Humana Medicare |
$175.43
|
| Rate for Payer: Humana Medicare |
$175.43
|
| Rate for Payer: Lucent All Commercial |
$245.60
|
| Rate for Payer: Lucent All Commercial |
$245.60
|
| Rate for Payer: Lutheran Preferred All Commercial |
$244.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$244.00
|
| Rate for Payer: Managed Health Services Medicaid |
$226.16
|
| Rate for Payer: Managed Health Services Medicaid |
$226.16
|
| Rate for Payer: MDWise Medicaid |
$226.16
|
| Rate for Payer: MDWise Medicaid |
$226.16
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$127.68
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$127.68
|
| Rate for Payer: PHCS All Commercial |
$175.43
|
| Rate for Payer: PHCS All Commercial |
$175.43
|
| Rate for Payer: PHP All Commercial |
$224.78
|
| Rate for Payer: PHP All Commercial |
$224.78
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$175.43
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$175.43
|
| Rate for Payer: Sagamore Health Network All Products |
$175.43
|
| Rate for Payer: Sagamore Health Network All Products |
$175.43
|
| Rate for Payer: Signature Care EPO |
$241.40
|
| Rate for Payer: Signature Care EPO |
$241.40
|
| Rate for Payer: Signature Care PPO |
$241.40
|
| Rate for Payer: Signature Care PPO |
$241.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$22,700.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$22,700.00
|
| Rate for Payer: United Healthcare Commercial |
$191.50
|
| Rate for Payer: United Healthcare Commercial |
$191.50
|
| Rate for Payer: United Healthcare Medicare |
$226.61
|
| Rate for Payer: United Healthcare Medicare |
$226.61
|
|
|
PR DESTRUCT,VAGINAL LESION(S),SIMPLE
|
Professional
|
Both
|
$311.56
|
|
|
Service Code
|
CPT 57061
|
| Hospital Charge Code |
z57061
|
| Min. Negotiated Rate |
$59.35 |
| Max. Negotiated Rate |
$14,100.00 |
| Rate for Payer: Aetna Commercial |
$108.17
|
| Rate for Payer: Aetna Commercial |
$108.17
|
| Rate for Payer: Aetna Medicare |
$108.17
|
| Rate for Payer: Aetna Medicare |
$108.17
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$149.29
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$149.29
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$149.29
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$149.29
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$149.29
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$149.29
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$149.29
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$149.29
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$59.35
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$59.35
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$153.24
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$153.24
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$124.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$124.40
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$118.99
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$118.99
|
| Rate for Payer: Cash Price |
$184.02
|
| Rate for Payer: Cash Price |
$186.94
|
| Rate for Payer: Centivo All Commercial |
$167.66
|
| Rate for Payer: Centivo All Commercial |
$167.66
|
| Rate for Payer: Cigna All Commercial |
$108.17
|
| Rate for Payer: Cigna All Commercial |
$108.17
|
| Rate for Payer: CORVEL All Commercial |
$108.17
|
| Rate for Payer: CORVEL All Commercial |
$108.17
|
| Rate for Payer: Coventry All Commercial |
$129.80
|
| Rate for Payer: Coventry All Commercial |
$129.80
|
| Rate for Payer: Encore All Commercial |
$108.17
|
| Rate for Payer: Encore All Commercial |
$108.17
|
| Rate for Payer: Frontpath All Commercial |
$147.68
|
| Rate for Payer: Frontpath All Commercial |
$147.68
|
| Rate for Payer: Humana ChoiceCare |
$103.32
|
| Rate for Payer: Humana ChoiceCare |
$103.32
|
| Rate for Payer: Humana Medicare |
$108.17
|
| Rate for Payer: Humana Medicare |
$108.17
|
| Rate for Payer: Lucent All Commercial |
$151.44
|
| Rate for Payer: Lucent All Commercial |
$151.44
|
| Rate for Payer: Lutheran Preferred All Commercial |
$151.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$151.00
|
| Rate for Payer: Managed Health Services Medicaid |
$153.24
|
| Rate for Payer: Managed Health Services Medicaid |
$153.24
|
| Rate for Payer: MDWise Medicaid |
$153.24
|
| Rate for Payer: MDWise Medicaid |
$153.24
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$59.35
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$59.35
|
| Rate for Payer: PHCS All Commercial |
$108.17
|
| Rate for Payer: PHCS All Commercial |
$108.17
|
| Rate for Payer: PHP All Commercial |
$139.21
|
| Rate for Payer: PHP All Commercial |
$139.21
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$108.17
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$108.17
|
| Rate for Payer: Sagamore Health Network All Products |
$108.17
|
| Rate for Payer: Sagamore Health Network All Products |
$108.17
|
| Rate for Payer: Signature Care EPO |
$141.10
|
| Rate for Payer: Signature Care EPO |
$141.10
|
| Rate for Payer: Signature Care PPO |
$141.10
|
| Rate for Payer: Signature Care PPO |
$141.10
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$14,100.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$14,100.00
|
| Rate for Payer: United Healthcare Commercial |
$107.66
|
| Rate for Payer: United Healthcare Commercial |
$107.66
|
| Rate for Payer: United Healthcare Medicare |
$153.35
|
| Rate for Payer: United Healthcare Medicare |
$153.35
|
|
|
PR DEVELOPMENTAL SCREEN W/SCORING & DOC STD INSTRM
|
Professional
|
Both
|
$21.20
|
|
|
Service Code
|
CPT 96110
|
| Hospital Charge Code |
z96110
|
| Min. Negotiated Rate |
$9.22 |
| Max. Negotiated Rate |
$12.31 |
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$10.42
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$10.42
|
| Rate for Payer: Cash Price |
$12.72
|
| Rate for Payer: Cash Price |
$11.39
|
| Rate for Payer: Frontpath All Commercial |
$10.52
|
| Rate for Payer: Frontpath All Commercial |
$10.52
|
| Rate for Payer: Humana ChoiceCare |
$9.22
|
| Rate for Payer: Humana ChoiceCare |
$9.22
|
| Rate for Payer: Managed Health Services Medicaid |
$10.42
|
| Rate for Payer: Managed Health Services Medicaid |
$10.42
|
| Rate for Payer: MDWise Medicaid |
$10.42
|
| Rate for Payer: MDWise Medicaid |
$10.42
|
| Rate for Payer: United Healthcare Commercial |
$12.31
|
| Rate for Payer: United Healthcare Commercial |
$12.31
|
| Rate for Payer: United Healthcare Medicare |
$9.49
|
| Rate for Payer: United Healthcare Medicare |
$9.49
|
|
|
PR DEVELOPMENTAL TST ADMIN PHYS/QHP 1ST HOUR
|
Professional
|
Both
|
$237.28
|
|
|
Service Code
|
CPT 96112
|
| Hospital Charge Code |
z96112
|
| Min. Negotiated Rate |
$63.85 |
| Max. Negotiated Rate |
$189.07 |
| Rate for Payer: Aetna Commercial |
$121.98
|
| Rate for Payer: Aetna Medicare |
$121.98
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$63.85
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$116.70
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$140.28
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$134.18
|
| Rate for Payer: Cash Price |
$142.37
|
| Rate for Payer: Centivo All Commercial |
$189.07
|
| Rate for Payer: Cigna All Commercial |
$121.98
|
| Rate for Payer: CORVEL All Commercial |
$121.98
|
| Rate for Payer: Coventry All Commercial |
$146.38
|
| Rate for Payer: Encore All Commercial |
$121.98
|
| Rate for Payer: Frontpath All Commercial |
$137.56
|
| Rate for Payer: Humana ChoiceCare |
$125.30
|
| Rate for Payer: Humana Medicare |
$121.98
|
| Rate for Payer: Lucent All Commercial |
$170.77
|
| Rate for Payer: Managed Health Services Medicaid |
$116.70
|
| Rate for Payer: MDWise Medicaid |
$116.70
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$63.85
|
| Rate for Payer: PHCS All Commercial |
$121.98
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$121.98
|
| Rate for Payer: Sagamore Health Network All Products |
$121.98
|
| Rate for Payer: United Healthcare Commercial |
$156.85
|
| Rate for Payer: United Healthcare Medicare |
$118.16
|
|
|
PR DEVELOPMENTAL TST ADMIN PHYS/QHP EA ADDL 30 MIN
|
Professional
|
Both
|
$114.48
|
|
|
Service Code
|
CPT 96113
|
| Hospital Charge Code |
z96113
|
| Min. Negotiated Rate |
$28.55 |
| Max. Negotiated Rate |
$84.24 |
| Rate for Payer: Aetna Commercial |
$54.35
|
| Rate for Payer: Aetna Medicare |
$54.35
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$28.55
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$56.30
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$62.50
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$59.78
|
| Rate for Payer: Cash Price |
$68.69
|
| Rate for Payer: Centivo All Commercial |
$84.24
|
| Rate for Payer: Cigna All Commercial |
$54.35
|
| Rate for Payer: CORVEL All Commercial |
$54.35
|
| Rate for Payer: Coventry All Commercial |
$65.22
|
| Rate for Payer: Encore All Commercial |
$54.35
|
| Rate for Payer: Frontpath All Commercial |
$61.67
|
| Rate for Payer: Humana ChoiceCare |
$57.12
|
| Rate for Payer: Humana Medicare |
$54.35
|
| Rate for Payer: Lucent All Commercial |
$76.09
|
| Rate for Payer: Managed Health Services Medicaid |
$56.30
|
| Rate for Payer: MDWise Medicaid |
$56.30
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$28.55
|
| Rate for Payer: PHCS All Commercial |
$54.35
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$54.35
|
| Rate for Payer: Sagamore Health Network All Products |
$54.35
|
| Rate for Payer: United Healthcare Commercial |
$71.58
|
| Rate for Payer: United Healthcare Medicare |
$55.86
|
|
|
PR DIAB MANAGE TRN IND/GROUP
|
Professional
|
Both
|
$25.02
|
|
|
Service Code
|
CPT G0109
|
| Hospital Charge Code |
zG0109
|
| Min. Negotiated Rate |
$7.34 |
| Max. Negotiated Rate |
$23.31 |
| Rate for Payer: Aetna Commercial |
$15.04
|
| Rate for Payer: Aetna Medicare |
$15.04
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$7.34
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$17.30
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$16.54
|
| Rate for Payer: Cash Price |
$15.01
|
| Rate for Payer: Centivo All Commercial |
$23.31
|
| Rate for Payer: Cigna All Commercial |
$15.04
|
| Rate for Payer: CORVEL All Commercial |
$15.04
|
| Rate for Payer: Coventry All Commercial |
$18.05
|
| Rate for Payer: Encore All Commercial |
$15.04
|
| Rate for Payer: Humana ChoiceCare |
$12.59
|
| Rate for Payer: Humana Medicare |
$15.04
|
| Rate for Payer: Lucent All Commercial |
$21.06
|
| Rate for Payer: Managed Health Services Medicaid |
$7.34
|
| Rate for Payer: MDWise Medicaid |
$7.34
|
| Rate for Payer: PHCS All Commercial |
$15.04
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$15.04
|
| Rate for Payer: Sagamore Health Network All Products |
$15.04
|
| Rate for Payer: United Healthcare Commercial |
$14.75
|
|
|
PR DIAB MANAGE TRN PER INDIV
|
Professional
|
Both
|
$51.82
|
|
|
Service Code
|
CPT G0108
|
| Hospital Charge Code |
zG0108
|
| Min. Negotiated Rate |
$25.47 |
| Max. Negotiated Rate |
$81.87 |
| Rate for Payer: Aetna Commercial |
$52.82
|
| Rate for Payer: Aetna Medicare |
$52.82
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$25.47
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$60.74
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$58.10
|
| Rate for Payer: Cash Price |
$31.09
|
| Rate for Payer: Centivo All Commercial |
$81.87
|
| Rate for Payer: Cigna All Commercial |
$52.82
|
| Rate for Payer: CORVEL All Commercial |
$52.82
|
| Rate for Payer: Coventry All Commercial |
$63.38
|
| Rate for Payer: Encore All Commercial |
$52.82
|
| Rate for Payer: Humana ChoiceCare |
$44.31
|
| Rate for Payer: Humana Medicare |
$52.82
|
| Rate for Payer: Lucent All Commercial |
$73.95
|
| Rate for Payer: Managed Health Services Medicaid |
$25.47
|
| Rate for Payer: MDWise Medicaid |
$25.47
|
| Rate for Payer: PHCS All Commercial |
$52.82
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$52.82
|
| Rate for Payer: Sagamore Health Network All Products |
$52.82
|
| Rate for Payer: United Healthcare Commercial |
$26.34
|
|
|
PR DIAGNOSTIC LUMBAR SPINAL PUNCTURE
|
Professional
|
Both
|
$267.94
|
|
|
Service Code
|
CPT 62270
|
| Hospital Charge Code |
z62270
|
| Min. Negotiated Rate |
$31.49 |
| Max. Negotiated Rate |
$8,700.00 |
| Rate for Payer: Aetna Commercial |
$57.90
|
| Rate for Payer: Aetna Commercial |
$57.90
|
| Rate for Payer: Aetna Medicare |
$57.90
|
| Rate for Payer: Aetna Medicare |
$57.90
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$177.35
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$177.35
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$177.35
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$177.35
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$177.35
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$177.35
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$177.35
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$177.35
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$31.49
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$31.49
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$131.79
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$131.79
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$66.58
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$66.58
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$63.69
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$63.69
|
| Rate for Payer: Cash Price |
$144.18
|
| Rate for Payer: Cash Price |
$160.76
|
| Rate for Payer: Centivo All Commercial |
$89.75
|
| Rate for Payer: Centivo All Commercial |
$89.75
|
| Rate for Payer: Cigna All Commercial |
$57.90
|
| Rate for Payer: Cigna All Commercial |
$57.90
|
| Rate for Payer: CORVEL All Commercial |
$57.90
|
| Rate for Payer: CORVEL All Commercial |
$57.90
|
| Rate for Payer: Coventry All Commercial |
$69.48
|
| Rate for Payer: Coventry All Commercial |
$69.48
|
| Rate for Payer: Encore All Commercial |
$57.90
|
| Rate for Payer: Encore All Commercial |
$57.90
|
| Rate for Payer: Frontpath All Commercial |
$81.16
|
| Rate for Payer: Frontpath All Commercial |
$81.16
|
| Rate for Payer: Humana ChoiceCare |
$85.55
|
| Rate for Payer: Humana ChoiceCare |
$85.55
|
| Rate for Payer: Humana Medicare |
$57.90
|
| Rate for Payer: Humana Medicare |
$57.90
|
| Rate for Payer: Lucent All Commercial |
$81.06
|
| Rate for Payer: Lucent All Commercial |
$81.06
|
| Rate for Payer: Lutheran Preferred All Commercial |
$92.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$92.00
|
| Rate for Payer: Managed Health Services Medicaid |
$131.79
|
| Rate for Payer: Managed Health Services Medicaid |
$131.79
|
| Rate for Payer: MDWise Medicaid |
$131.79
|
| Rate for Payer: MDWise Medicaid |
$131.79
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$31.49
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$31.49
|
| Rate for Payer: PHCS All Commercial |
$57.90
|
| Rate for Payer: PHCS All Commercial |
$57.90
|
| Rate for Payer: PHP All Commercial |
$98.52
|
| Rate for Payer: PHP All Commercial |
$98.52
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$57.90
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$57.90
|
| Rate for Payer: Sagamore Health Network All Products |
$57.90
|
| Rate for Payer: Sagamore Health Network All Products |
$57.90
|
| Rate for Payer: Signature Care EPO |
$201.67
|
| Rate for Payer: Signature Care EPO |
$201.67
|
| Rate for Payer: Signature Care PPO |
$201.67
|
| Rate for Payer: Signature Care PPO |
$201.67
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$8,700.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$8,700.00
|
| Rate for Payer: United Healthcare Commercial |
$88.34
|
| Rate for Payer: United Healthcare Commercial |
$88.34
|
| Rate for Payer: United Healthcare Medicare |
$120.15
|
| Rate for Payer: United Healthcare Medicare |
$120.15
|
|
|
PR DILATION/CURETTAGE,DIAGNOSTIC
|
Professional
|
Both
|
$554.86
|
|
|
Service Code
|
CPT 58120
|
| Hospital Charge Code |
z58120
|
| Min. Negotiated Rate |
$135.00 |
| Max. Negotiated Rate |
$28,400.00 |
| Rate for Payer: Aetna Commercial |
$220.48
|
| Rate for Payer: Aetna Commercial |
$220.48
|
| Rate for Payer: Aetna Medicare |
$220.48
|
| Rate for Payer: Aetna Medicare |
$220.48
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$292.22
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$292.22
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$292.22
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$292.22
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$292.22
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$292.22
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$292.22
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$292.22
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$135.00
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$135.00
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$272.90
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$272.90
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$253.55
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$253.55
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$242.53
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$242.53
|
| Rate for Payer: Cash Price |
$327.02
|
| Rate for Payer: Cash Price |
$332.92
|
| Rate for Payer: Centivo All Commercial |
$341.74
|
| Rate for Payer: Centivo All Commercial |
$341.74
|
| Rate for Payer: Cigna All Commercial |
$220.48
|
| Rate for Payer: Cigna All Commercial |
$220.48
|
| Rate for Payer: CORVEL All Commercial |
$220.48
|
| Rate for Payer: CORVEL All Commercial |
$220.48
|
| Rate for Payer: Coventry All Commercial |
$264.58
|
| Rate for Payer: Coventry All Commercial |
$264.58
|
| Rate for Payer: Encore All Commercial |
$220.48
|
| Rate for Payer: Encore All Commercial |
$220.48
|
| Rate for Payer: Frontpath All Commercial |
$305.23
|
| Rate for Payer: Frontpath All Commercial |
$305.23
|
| Rate for Payer: Humana ChoiceCare |
$228.06
|
| Rate for Payer: Humana ChoiceCare |
$228.06
|
| Rate for Payer: Humana Medicare |
$220.48
|
| Rate for Payer: Humana Medicare |
$220.48
|
| Rate for Payer: Lucent All Commercial |
$308.67
|
| Rate for Payer: Lucent All Commercial |
$308.67
|
| Rate for Payer: Lutheran Preferred All Commercial |
$306.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$306.00
|
| Rate for Payer: Managed Health Services Medicaid |
$272.90
|
| Rate for Payer: Managed Health Services Medicaid |
$272.90
|
| Rate for Payer: MDWise Medicaid |
$272.90
|
| Rate for Payer: MDWise Medicaid |
$272.90
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$135.00
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$135.00
|
| Rate for Payer: PHCS All Commercial |
$220.48
|
| Rate for Payer: PHCS All Commercial |
$220.48
|
| Rate for Payer: PHP All Commercial |
$281.41
|
| Rate for Payer: PHP All Commercial |
$281.41
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$220.48
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$220.48
|
| Rate for Payer: Sagamore Health Network All Products |
$220.48
|
| Rate for Payer: Sagamore Health Network All Products |
$220.48
|
| Rate for Payer: Signature Care EPO |
$276.25
|
| Rate for Payer: Signature Care EPO |
$276.25
|
| Rate for Payer: Signature Care PPO |
$276.25
|
| Rate for Payer: Signature Care PPO |
$276.25
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$28,400.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$28,400.00
|
| Rate for Payer: United Healthcare Commercial |
$242.55
|
| Rate for Payer: United Healthcare Commercial |
$242.55
|
| Rate for Payer: United Healthcare Medicare |
$272.52
|
| Rate for Payer: United Healthcare Medicare |
$272.52
|
|
|
PR DILATION OF CERVICAL CANAL
|
Professional
|
Both
|
$144.46
|
|
|
Service Code
|
CPT 57800
|
| Hospital Charge Code |
z57800
|
| Min. Negotiated Rate |
$31.85 |
| Max. Negotiated Rate |
$5,800.00 |
| Rate for Payer: Aetna Commercial |
$44.46
|
| Rate for Payer: Aetna Commercial |
$44.46
|
| Rate for Payer: Aetna Medicare |
$44.46
|
| Rate for Payer: Aetna Medicare |
$44.46
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$79.30
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$79.30
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$79.30
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$79.30
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$79.30
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$79.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$79.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$79.30
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$31.85
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$31.85
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$71.05
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$71.05
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$51.13
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$51.13
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$48.91
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$48.91
|
| Rate for Payer: Cash Price |
$85.21
|
| Rate for Payer: Cash Price |
$86.68
|
| Rate for Payer: Centivo All Commercial |
$68.91
|
| Rate for Payer: Centivo All Commercial |
$68.91
|
| Rate for Payer: Cigna All Commercial |
$44.46
|
| Rate for Payer: Cigna All Commercial |
$44.46
|
| Rate for Payer: CORVEL All Commercial |
$44.46
|
| Rate for Payer: CORVEL All Commercial |
$44.46
|
| Rate for Payer: Coventry All Commercial |
$53.35
|
| Rate for Payer: Coventry All Commercial |
$53.35
|
| Rate for Payer: Encore All Commercial |
$44.46
|
| Rate for Payer: Encore All Commercial |
$44.46
|
| Rate for Payer: Frontpath All Commercial |
$61.49
|
| Rate for Payer: Frontpath All Commercial |
$61.49
|
| Rate for Payer: Humana ChoiceCare |
$54.77
|
| Rate for Payer: Humana ChoiceCare |
$54.77
|
| Rate for Payer: Humana Medicare |
$44.46
|
| Rate for Payer: Humana Medicare |
$44.46
|
| Rate for Payer: Lucent All Commercial |
$62.24
|
| Rate for Payer: Lucent All Commercial |
$62.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$62.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$62.00
|
| Rate for Payer: Managed Health Services Medicaid |
$71.05
|
| Rate for Payer: Managed Health Services Medicaid |
$71.05
|
| Rate for Payer: MDWise Medicaid |
$71.05
|
| Rate for Payer: MDWise Medicaid |
$71.05
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$31.85
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$31.85
|
| Rate for Payer: PHCS All Commercial |
$44.46
|
| Rate for Payer: PHCS All Commercial |
$44.46
|
| Rate for Payer: PHP All Commercial |
$57.16
|
| Rate for Payer: PHP All Commercial |
$57.16
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$44.46
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$44.46
|
| Rate for Payer: Sagamore Health Network All Products |
$44.46
|
| Rate for Payer: Sagamore Health Network All Products |
$44.46
|
| Rate for Payer: Signature Care EPO |
$74.80
|
| Rate for Payer: Signature Care EPO |
$74.80
|
| Rate for Payer: Signature Care PPO |
$74.80
|
| Rate for Payer: Signature Care PPO |
$74.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5,800.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5,800.00
|
| Rate for Payer: United Healthcare Commercial |
$54.94
|
| Rate for Payer: United Healthcare Commercial |
$54.94
|
| Rate for Payer: United Healthcare Medicare |
$71.01
|
| Rate for Payer: United Healthcare Medicare |
$71.01
|
|
|
PR DILATION OF SALIVARY DUCT
|
Professional
|
Both
|
$138.90
|
|
|
Service Code
|
CPT 42650
|
| Hospital Charge Code |
z42650
|
| Min. Negotiated Rate |
$50.96 |
| Max. Negotiated Rate |
$7,700.00 |
| Rate for Payer: Aetna Commercial |
$54.27
|
| Rate for Payer: Aetna Commercial |
$54.27
|
| Rate for Payer: Aetna Medicare |
$54.27
|
| Rate for Payer: Aetna Medicare |
$54.27
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$117.36
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$117.36
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$117.36
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$117.36
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$117.36
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$117.36
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$117.36
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$117.36
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$50.96
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$50.96
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$68.32
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$68.32
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$62.41
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$62.41
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$59.70
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$59.70
|
| Rate for Payer: Cash Price |
$82.14
|
| Rate for Payer: Cash Price |
$83.34
|
| Rate for Payer: Centivo All Commercial |
$84.12
|
| Rate for Payer: Centivo All Commercial |
$84.12
|
| Rate for Payer: Cigna All Commercial |
$54.27
|
| Rate for Payer: Cigna All Commercial |
$54.27
|
| Rate for Payer: CORVEL All Commercial |
$54.27
|
| Rate for Payer: CORVEL All Commercial |
$54.27
|
| Rate for Payer: Coventry All Commercial |
$65.12
|
| Rate for Payer: Coventry All Commercial |
$65.12
|
| Rate for Payer: Encore All Commercial |
$54.27
|
| Rate for Payer: Encore All Commercial |
$54.27
|
| Rate for Payer: Frontpath All Commercial |
$74.15
|
| Rate for Payer: Frontpath All Commercial |
$74.15
|
| Rate for Payer: Humana ChoiceCare |
$65.50
|
| Rate for Payer: Humana ChoiceCare |
$65.50
|
| Rate for Payer: Humana Medicare |
$54.27
|
| Rate for Payer: Humana Medicare |
$54.27
|
| Rate for Payer: Lucent All Commercial |
$75.98
|
| Rate for Payer: Lucent All Commercial |
$75.98
|
| Rate for Payer: Lutheran Preferred All Commercial |
$83.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$83.00
|
| Rate for Payer: Managed Health Services Medicaid |
$68.32
|
| Rate for Payer: Managed Health Services Medicaid |
$68.32
|
| Rate for Payer: MDWise Medicaid |
$68.32
|
| Rate for Payer: MDWise Medicaid |
$68.32
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$50.96
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$50.96
|
| Rate for Payer: PHCS All Commercial |
$54.27
|
| Rate for Payer: PHCS All Commercial |
$54.27
|
| Rate for Payer: PHP All Commercial |
$93.95
|
| Rate for Payer: PHP All Commercial |
$93.95
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$54.27
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$54.27
|
| Rate for Payer: Sagamore Health Network All Products |
$54.27
|
| Rate for Payer: Sagamore Health Network All Products |
$54.27
|
| Rate for Payer: Signature Care EPO |
$107.10
|
| Rate for Payer: Signature Care EPO |
$107.10
|
| Rate for Payer: Signature Care PPO |
$107.10
|
| Rate for Payer: Signature Care PPO |
$107.10
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$7,700.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$7,700.00
|
| Rate for Payer: United Healthcare Commercial |
$64.75
|
| Rate for Payer: United Healthcare Commercial |
$64.75
|
| Rate for Payer: United Healthcare Medicare |
$68.45
|
| Rate for Payer: United Healthcare Medicare |
$68.45
|
|
|
PR DISPENSING FEE BINAURAL
|
Professional
|
Both
|
$800.00
|
|
|
Service Code
|
CPT V5160
|
| Hospital Charge Code |
zV5160
|
| Min. Negotiated Rate |
$239.05 |
| Max. Negotiated Rate |
$680.00 |
| Rate for Payer: Buckeye Health Medicaid OOS |
$305.55
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$459.10
|
| Rate for Payer: Cash Price |
$480.00
|
| Rate for Payer: Humana ChoiceCare |
$239.05
|
| Rate for Payer: Managed Health Services Medicaid |
$459.10
|
| Rate for Payer: MDWise Medicaid |
$459.10
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$305.55
|
| Rate for Payer: Signature Care EPO |
$680.00
|
| Rate for Payer: Signature Care PPO |
$680.00
|
| Rate for Payer: United Healthcare Commercial |
$409.73
|
|
|
PR DISPENSING FEE, MONAURAL
|
Professional
|
Both
|
$400.00
|
|
|
Service Code
|
CPT V5241
|
| Hospital Charge Code |
zV5241
|
| Min. Negotiated Rate |
$203.70 |
| Max. Negotiated Rate |
$340.00 |
| Rate for Payer: Buckeye Health Medicaid OOS |
$203.70
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$262.34
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Managed Health Services Medicaid |
$262.34
|
| Rate for Payer: MDWise Medicaid |
$262.34
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$203.70
|
| Rate for Payer: Signature Care EPO |
$340.00
|
| Rate for Payer: Signature Care PPO |
$340.00
|
|
|
PR DOPPLER COLOR FLOW VELOCITY MAP
|
Professional
|
Both
|
$5.58
|
|
|
Service Code
|
CPT 93325
|
| Hospital Charge Code |
z93325
|
| Min. Negotiated Rate |
$7.10 |
| Max. Negotiated Rate |
$3,300.00 |
| Rate for Payer: Aetna Commercial |
$22.36
|
| Rate for Payer: Aetna Commercial |
$22.36
|
| Rate for Payer: Aetna Commercial |
$22.36
|
| Rate for Payer: Aetna Medicare |
$22.36
|
| Rate for Payer: Aetna Medicare |
$22.36
|
| Rate for Payer: Aetna Medicare |
$22.36
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$68.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$68.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$68.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$68.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$68.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$68.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$68.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$68.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$68.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$68.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$68.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$68.00
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$21.31
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$21.31
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$21.31
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$25.71
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$25.71
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$25.71
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$24.60
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$24.60
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$24.60
|
| Rate for Payer: Cash Price |
$3.35
|
| Rate for Payer: Cash Price |
$3.50
|
| Rate for Payer: Cash Price |
$13.00
|
| Rate for Payer: Centivo All Commercial |
$34.66
|
| Rate for Payer: Centivo All Commercial |
$34.66
|
| Rate for Payer: Centivo All Commercial |
$34.66
|
| Rate for Payer: Cigna All Commercial |
$22.36
|
| Rate for Payer: Cigna All Commercial |
$22.36
|
| Rate for Payer: Cigna All Commercial |
$22.36
|
| Rate for Payer: CORVEL All Commercial |
$22.36
|
| Rate for Payer: CORVEL All Commercial |
$22.36
|
| Rate for Payer: CORVEL All Commercial |
$22.36
|
| Rate for Payer: Coventry All Commercial |
$26.83
|
| Rate for Payer: Coventry All Commercial |
$26.83
|
| Rate for Payer: Coventry All Commercial |
$26.83
|
| Rate for Payer: Encore All Commercial |
$22.36
|
| Rate for Payer: Encore All Commercial |
$22.36
|
| Rate for Payer: Encore All Commercial |
$22.36
|
| Rate for Payer: Frontpath All Commercial |
$24.90
|
| Rate for Payer: Frontpath All Commercial |
$24.90
|
| Rate for Payer: Frontpath All Commercial |
$24.90
|
| Rate for Payer: Humana ChoiceCare |
$145.73
|
| Rate for Payer: Humana ChoiceCare |
$145.73
|
| Rate for Payer: Humana ChoiceCare |
$145.73
|
| Rate for Payer: Humana Medicare |
$22.36
|
| Rate for Payer: Humana Medicare |
$22.36
|
| Rate for Payer: Humana Medicare |
$22.36
|
| Rate for Payer: Lucent All Commercial |
$31.30
|
| Rate for Payer: Lucent All Commercial |
$31.30
|
| Rate for Payer: Lucent All Commercial |
$31.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$35.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$35.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$35.00
|
| Rate for Payer: Managed Health Services Medicaid |
$21.31
|
| Rate for Payer: Managed Health Services Medicaid |
$21.31
|
| Rate for Payer: Managed Health Services Medicaid |
$21.31
|
| Rate for Payer: MDWise Medicaid |
$21.31
|
| Rate for Payer: MDWise Medicaid |
$21.31
|
| Rate for Payer: MDWise Medicaid |
$21.31
|
| Rate for Payer: PHCS All Commercial |
$22.36
|
| Rate for Payer: PHCS All Commercial |
$22.36
|
| Rate for Payer: PHCS All Commercial |
$22.36
|
| Rate for Payer: PHP All Commercial |
$31.29
|
| Rate for Payer: PHP All Commercial |
$31.29
|
| Rate for Payer: PHP All Commercial |
$31.29
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$22.36
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$22.36
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$22.36
|
| Rate for Payer: Sagamore Health Network All Products |
$22.36
|
| Rate for Payer: Sagamore Health Network All Products |
$22.36
|
| Rate for Payer: Sagamore Health Network All Products |
$22.36
|
| Rate for Payer: Signature Care EPO |
$7.10
|
| Rate for Payer: Signature Care EPO |
$7.10
|
| Rate for Payer: Signature Care EPO |
$7.10
|
| Rate for Payer: Signature Care PPO |
$7.10
|
| Rate for Payer: Signature Care PPO |
$7.10
|
| Rate for Payer: Signature Care PPO |
$7.10
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,300.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,300.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,300.00
|
| Rate for Payer: United Healthcare Commercial |
$59.18
|
| Rate for Payer: United Healthcare Commercial |
$59.18
|
| Rate for Payer: United Healthcare Commercial |
$59.18
|
|
|
PR DOPPLER ECHO HEART,COMPLETE
|
Professional
|
Both
|
$47.35
|
|
|
Service Code
|
CPT 93320
|
| Hospital Charge Code |
z93320
|
| Min. Negotiated Rate |
$34.72 |
| Max. Negotiated Rate |
$7,100.00 |
| Rate for Payer: Aetna Commercial |
$48.67
|
| Rate for Payer: Aetna Commercial |
$48.67
|
| Rate for Payer: Aetna Medicare |
$48.67
|
| Rate for Payer: Aetna Medicare |
$48.67
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$114.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$114.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$114.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$114.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$114.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$114.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$114.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$114.00
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$46.57
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$46.57
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$55.97
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$55.97
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$53.54
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$53.54
|
| Rate for Payer: Cash Price |
$19.97
|
| Rate for Payer: Cash Price |
$28.41
|
| Rate for Payer: Centivo All Commercial |
$75.44
|
| Rate for Payer: Centivo All Commercial |
$75.44
|
| Rate for Payer: Cigna All Commercial |
$48.67
|
| Rate for Payer: Cigna All Commercial |
$48.67
|
| Rate for Payer: CORVEL All Commercial |
$48.67
|
| Rate for Payer: CORVEL All Commercial |
$48.67
|
| Rate for Payer: Coventry All Commercial |
$58.40
|
| Rate for Payer: Coventry All Commercial |
$58.40
|
| Rate for Payer: Encore All Commercial |
$48.67
|
| Rate for Payer: Encore All Commercial |
$48.67
|
| Rate for Payer: Frontpath All Commercial |
$54.57
|
| Rate for Payer: Frontpath All Commercial |
$54.57
|
| Rate for Payer: Humana ChoiceCare |
$109.28
|
| Rate for Payer: Humana ChoiceCare |
$109.28
|
| Rate for Payer: Humana Medicare |
$48.67
|
| Rate for Payer: Humana Medicare |
$48.67
|
| Rate for Payer: Lucent All Commercial |
$68.14
|
| Rate for Payer: Lucent All Commercial |
$68.14
|
| Rate for Payer: Lutheran Preferred All Commercial |
$76.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$76.00
|
| Rate for Payer: Managed Health Services Medicaid |
$46.57
|
| Rate for Payer: Managed Health Services Medicaid |
$46.57
|
| Rate for Payer: MDWise Medicaid |
$46.57
|
| Rate for Payer: MDWise Medicaid |
$46.57
|
| Rate for Payer: PHCS All Commercial |
$48.67
|
| Rate for Payer: PHCS All Commercial |
$48.67
|
| Rate for Payer: PHP All Commercial |
$68.07
|
| Rate for Payer: PHP All Commercial |
$68.07
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$48.67
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$48.67
|
| Rate for Payer: Sagamore Health Network All Products |
$48.67
|
| Rate for Payer: Sagamore Health Network All Products |
$48.67
|
| Rate for Payer: Signature Care EPO |
$34.72
|
| Rate for Payer: Signature Care EPO |
$34.72
|
| Rate for Payer: Signature Care PPO |
$34.72
|
| Rate for Payer: Signature Care PPO |
$34.72
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$7,100.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$7,100.00
|
| Rate for Payer: United Healthcare Commercial |
$89.34
|
| Rate for Payer: United Healthcare Commercial |
$89.34
|
|
