|
PR EXCISION TURBINATE,SUBMUCOUS
|
Professional
|
Both
|
$549.98
|
|
|
Service Code
|
CPT 30140
|
| Hospital Charge Code |
z30140
|
| Min. Negotiated Rate |
$166.95 |
| Max. Negotiated Rate |
$25,000.00 |
| Rate for Payer: Aetna Commercial |
$166.95
|
| Rate for Payer: Aetna Commercial |
$166.95
|
| Rate for Payer: Aetna Medicare |
$166.95
|
| Rate for Payer: Aetna Medicare |
$166.95
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$1,156.62
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$1,156.62
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,156.62
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,156.62
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,156.62
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,156.62
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,156.62
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,156.62
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$180.99
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$180.99
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$270.50
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$270.50
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$191.99
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$191.99
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$183.65
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$183.65
|
| Rate for Payer: Cash Price |
$326.63
|
| Rate for Payer: Cash Price |
$329.99
|
| Rate for Payer: Centivo All Commercial |
$258.77
|
| Rate for Payer: Centivo All Commercial |
$258.77
|
| Rate for Payer: Cigna All Commercial |
$166.95
|
| Rate for Payer: Cigna All Commercial |
$166.95
|
| Rate for Payer: CORVEL All Commercial |
$166.95
|
| Rate for Payer: CORVEL All Commercial |
$166.95
|
| Rate for Payer: Coventry All Commercial |
$200.34
|
| Rate for Payer: Coventry All Commercial |
$200.34
|
| Rate for Payer: Encore All Commercial |
$166.95
|
| Rate for Payer: Encore All Commercial |
$166.95
|
| Rate for Payer: Frontpath All Commercial |
$229.98
|
| Rate for Payer: Frontpath All Commercial |
$229.98
|
| Rate for Payer: Humana ChoiceCare |
$423.56
|
| Rate for Payer: Humana ChoiceCare |
$423.56
|
| Rate for Payer: Humana Medicare |
$166.95
|
| Rate for Payer: Humana Medicare |
$166.95
|
| Rate for Payer: Lucent All Commercial |
$233.73
|
| Rate for Payer: Lucent All Commercial |
$233.73
|
| Rate for Payer: Lutheran Preferred All Commercial |
$267.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$267.00
|
| Rate for Payer: Managed Health Services Medicaid |
$270.50
|
| Rate for Payer: Managed Health Services Medicaid |
$270.50
|
| Rate for Payer: MDWise Medicaid |
$270.50
|
| Rate for Payer: MDWise Medicaid |
$270.50
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$180.99
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$180.99
|
| Rate for Payer: PHCS All Commercial |
$166.95
|
| Rate for Payer: PHCS All Commercial |
$166.95
|
| Rate for Payer: PHP All Commercial |
$228.00
|
| Rate for Payer: PHP All Commercial |
$228.00
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$166.95
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$166.95
|
| Rate for Payer: Sagamore Health Network All Products |
$166.95
|
| Rate for Payer: Sagamore Health Network All Products |
$166.95
|
| Rate for Payer: Signature Care EPO |
$386.75
|
| Rate for Payer: Signature Care EPO |
$386.75
|
| Rate for Payer: Signature Care PPO |
$386.75
|
| Rate for Payer: Signature Care PPO |
$386.75
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$25,000.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$25,000.00
|
| Rate for Payer: United Healthcare Commercial |
$449.43
|
| Rate for Payer: United Healthcare Commercial |
$449.43
|
| Rate for Payer: United Healthcare Medicare |
$272.19
|
| Rate for Payer: United Healthcare Medicare |
$272.19
|
|
|
PR EXCISISON BONE CYST BENIGN TUMOR,PELVIS/HIP,DEEP
|
Professional
|
Both
|
$1,512.24
|
|
|
Service Code
|
CPT 27066
|
| Hospital Charge Code |
z27066
|
| Min. Negotiated Rate |
$743.77 |
| Max. Negotiated Rate |
$114,400.00 |
| Rate for Payer: Aetna Commercial |
$759.57
|
| Rate for Payer: Aetna Commercial |
$759.57
|
| Rate for Payer: Aetna Medicare |
$759.57
|
| Rate for Payer: Aetna Medicare |
$759.57
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$992.90
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$992.90
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$992.90
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$992.90
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$992.90
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$992.90
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$992.90
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$992.90
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$743.77
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$743.77
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$873.51
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$873.51
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$835.53
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$835.53
|
| Rate for Payer: Cash Price |
$907.34
|
| Rate for Payer: Cash Price |
$893.36
|
| Rate for Payer: Centivo All Commercial |
$1,177.33
|
| Rate for Payer: Centivo All Commercial |
$1,177.33
|
| Rate for Payer: Cigna All Commercial |
$759.57
|
| Rate for Payer: Cigna All Commercial |
$759.57
|
| Rate for Payer: CORVEL All Commercial |
$759.57
|
| Rate for Payer: CORVEL All Commercial |
$759.57
|
| Rate for Payer: Coventry All Commercial |
$911.48
|
| Rate for Payer: Coventry All Commercial |
$911.48
|
| Rate for Payer: Encore All Commercial |
$759.57
|
| Rate for Payer: Encore All Commercial |
$759.57
|
| Rate for Payer: Frontpath All Commercial |
$1,058.53
|
| Rate for Payer: Frontpath All Commercial |
$1,058.53
|
| Rate for Payer: Humana ChoiceCare |
$818.82
|
| Rate for Payer: Humana ChoiceCare |
$818.82
|
| Rate for Payer: Humana Medicare |
$759.57
|
| Rate for Payer: Humana Medicare |
$759.57
|
| Rate for Payer: Lucent All Commercial |
$1,063.40
|
| Rate for Payer: Lucent All Commercial |
$1,063.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,220.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,220.00
|
| Rate for Payer: Managed Health Services Medicaid |
$743.77
|
| Rate for Payer: Managed Health Services Medicaid |
$743.77
|
| Rate for Payer: MDWise Medicaid |
$743.77
|
| Rate for Payer: MDWise Medicaid |
$743.77
|
| Rate for Payer: PHCS All Commercial |
$759.57
|
| Rate for Payer: PHCS All Commercial |
$759.57
|
| Rate for Payer: PHP All Commercial |
$1,295.38
|
| Rate for Payer: PHP All Commercial |
$1,295.38
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$759.57
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$759.57
|
| Rate for Payer: Sagamore Health Network All Products |
$759.57
|
| Rate for Payer: Sagamore Health Network All Products |
$759.57
|
| Rate for Payer: Signature Care EPO |
$1,099.90
|
| Rate for Payer: Signature Care EPO |
$1,099.90
|
| Rate for Payer: Signature Care PPO |
$1,099.90
|
| Rate for Payer: Signature Care PPO |
$1,099.90
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$114,400.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$114,400.00
|
| Rate for Payer: United Healthcare Commercial |
$873.76
|
| Rate for Payer: United Healthcare Commercial |
$873.76
|
| Rate for Payer: United Healthcare Medicare |
$744.47
|
| Rate for Payer: United Healthcare Medicare |
$744.47
|
|
|
PR EXCIS LESN,PALATE/UVULA
|
Professional
|
Both
|
$404.76
|
|
|
Service Code
|
CPT 42104
|
| Hospital Charge Code |
z42104
|
| Min. Negotiated Rate |
$94.97 |
| Max. Negotiated Rate |
$17,700.00 |
| Rate for Payer: Aetna Commercial |
$126.18
|
| Rate for Payer: Aetna Commercial |
$126.18
|
| Rate for Payer: Aetna Medicare |
$126.18
|
| Rate for Payer: Aetna Medicare |
$126.18
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$172.59
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$172.59
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$172.59
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$172.59
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$172.59
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$172.59
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$172.59
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$172.59
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$94.97
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$94.97
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$199.07
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$199.07
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$145.11
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$145.11
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$138.80
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$138.80
|
| Rate for Payer: Cash Price |
$239.26
|
| Rate for Payer: Cash Price |
$242.86
|
| Rate for Payer: Centivo All Commercial |
$195.58
|
| Rate for Payer: Centivo All Commercial |
$195.58
|
| Rate for Payer: Cigna All Commercial |
$126.18
|
| Rate for Payer: Cigna All Commercial |
$126.18
|
| Rate for Payer: CORVEL All Commercial |
$126.18
|
| Rate for Payer: CORVEL All Commercial |
$126.18
|
| Rate for Payer: Coventry All Commercial |
$151.42
|
| Rate for Payer: Coventry All Commercial |
$151.42
|
| Rate for Payer: Encore All Commercial |
$126.18
|
| Rate for Payer: Encore All Commercial |
$126.18
|
| Rate for Payer: Frontpath All Commercial |
$171.47
|
| Rate for Payer: Frontpath All Commercial |
$171.47
|
| Rate for Payer: Humana ChoiceCare |
$141.27
|
| Rate for Payer: Humana ChoiceCare |
$141.27
|
| Rate for Payer: Humana Medicare |
$126.18
|
| Rate for Payer: Humana Medicare |
$126.18
|
| Rate for Payer: Lucent All Commercial |
$176.65
|
| Rate for Payer: Lucent All Commercial |
$176.65
|
| Rate for Payer: Lutheran Preferred All Commercial |
$190.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$190.00
|
| Rate for Payer: Managed Health Services Medicaid |
$199.07
|
| Rate for Payer: Managed Health Services Medicaid |
$199.07
|
| Rate for Payer: MDWise Medicaid |
$199.07
|
| Rate for Payer: MDWise Medicaid |
$199.07
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$94.97
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$94.97
|
| Rate for Payer: PHCS All Commercial |
$126.18
|
| Rate for Payer: PHCS All Commercial |
$126.18
|
| Rate for Payer: PHP All Commercial |
$216.09
|
| Rate for Payer: PHP All Commercial |
$216.09
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$126.18
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$126.18
|
| Rate for Payer: Sagamore Health Network All Products |
$126.18
|
| Rate for Payer: Sagamore Health Network All Products |
$126.18
|
| Rate for Payer: Signature Care EPO |
$243.10
|
| Rate for Payer: Signature Care EPO |
$243.10
|
| Rate for Payer: Signature Care PPO |
$243.10
|
| Rate for Payer: Signature Care PPO |
$243.10
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$17,700.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$17,700.00
|
| Rate for Payer: United Healthcare Commercial |
$147.45
|
| Rate for Payer: United Healthcare Commercial |
$147.45
|
| Rate for Payer: United Healthcare Medicare |
$199.38
|
| Rate for Payer: United Healthcare Medicare |
$199.38
|
|
|
PR EXCIS MOUTH MUCOSA/SUB,NO REPAIR
|
Professional
|
Both
|
$402.94
|
|
|
Service Code
|
CPT 40810
|
| Hospital Charge Code |
z40810
|
| Min. Negotiated Rate |
$76.45 |
| Max. Negotiated Rate |
$16,100.00 |
| Rate for Payer: Aetna Commercial |
$114.58
|
| Rate for Payer: Aetna Commercial |
$114.58
|
| Rate for Payer: Aetna Medicare |
$114.58
|
| Rate for Payer: Aetna Medicare |
$114.58
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$221.88
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$221.88
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$221.88
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$221.88
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$221.88
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$221.88
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$221.88
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$221.88
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$76.45
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$76.45
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$198.18
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$198.18
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$131.77
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$131.77
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$126.04
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$126.04
|
| Rate for Payer: Cash Price |
$238.42
|
| Rate for Payer: Cash Price |
$241.76
|
| Rate for Payer: Centivo All Commercial |
$177.60
|
| Rate for Payer: Centivo All Commercial |
$177.60
|
| Rate for Payer: Cigna All Commercial |
$114.58
|
| Rate for Payer: Cigna All Commercial |
$114.58
|
| Rate for Payer: CORVEL All Commercial |
$114.58
|
| Rate for Payer: CORVEL All Commercial |
$114.58
|
| Rate for Payer: Coventry All Commercial |
$137.50
|
| Rate for Payer: Coventry All Commercial |
$137.50
|
| Rate for Payer: Encore All Commercial |
$114.58
|
| Rate for Payer: Encore All Commercial |
$114.58
|
| Rate for Payer: Frontpath All Commercial |
$154.99
|
| Rate for Payer: Frontpath All Commercial |
$154.99
|
| Rate for Payer: Humana ChoiceCare |
$130.22
|
| Rate for Payer: Humana ChoiceCare |
$130.22
|
| Rate for Payer: Humana Medicare |
$114.58
|
| Rate for Payer: Humana Medicare |
$114.58
|
| Rate for Payer: Lucent All Commercial |
$160.41
|
| Rate for Payer: Lucent All Commercial |
$160.41
|
| Rate for Payer: Lutheran Preferred All Commercial |
$173.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$173.00
|
| Rate for Payer: Managed Health Services Medicaid |
$198.18
|
| Rate for Payer: Managed Health Services Medicaid |
$198.18
|
| Rate for Payer: MDWise Medicaid |
$198.18
|
| Rate for Payer: MDWise Medicaid |
$198.18
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$76.45
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$76.45
|
| Rate for Payer: PHCS All Commercial |
$114.58
|
| Rate for Payer: PHCS All Commercial |
$114.58
|
| Rate for Payer: PHP All Commercial |
$196.95
|
| Rate for Payer: PHP All Commercial |
$196.95
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$114.58
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$114.58
|
| Rate for Payer: Sagamore Health Network All Products |
$114.58
|
| Rate for Payer: Sagamore Health Network All Products |
$114.58
|
| Rate for Payer: Signature Care EPO |
$203.15
|
| Rate for Payer: Signature Care EPO |
$203.15
|
| Rate for Payer: Signature Care PPO |
$203.15
|
| Rate for Payer: Signature Care PPO |
$203.15
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$16,100.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$16,100.00
|
| Rate for Payer: United Healthcare Commercial |
$134.24
|
| Rate for Payer: United Healthcare Commercial |
$134.24
|
| Rate for Payer: United Healthcare Medicare |
$198.68
|
| Rate for Payer: United Healthcare Medicare |
$198.68
|
|
|
PR EXCIS MOUTH MUCOSA/SUB,SIMPL REPAIR
|
Professional
|
Both
|
$516.66
|
|
|
Service Code
|
CPT 40812
|
| Hospital Charge Code |
z40812
|
| Min. Negotiated Rate |
$112.46 |
| Max. Negotiated Rate |
$24,200.00 |
| Rate for Payer: Aetna Commercial |
$174.80
|
| Rate for Payer: Aetna Commercial |
$174.80
|
| Rate for Payer: Aetna Medicare |
$174.80
|
| Rate for Payer: Aetna Medicare |
$174.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$336.32
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$336.32
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$336.32
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$336.32
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$336.32
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$336.32
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$336.32
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$336.32
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$112.46
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$112.46
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$253.82
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$253.82
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$201.02
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$201.02
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$192.28
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$192.28
|
| Rate for Payer: Cash Price |
$309.64
|
| Rate for Payer: Cash Price |
$310.00
|
| Rate for Payer: Centivo All Commercial |
$270.94
|
| Rate for Payer: Centivo All Commercial |
$270.94
|
| Rate for Payer: Cigna All Commercial |
$174.80
|
| Rate for Payer: Cigna All Commercial |
$174.80
|
| Rate for Payer: CORVEL All Commercial |
$174.80
|
| Rate for Payer: CORVEL All Commercial |
$174.80
|
| Rate for Payer: Coventry All Commercial |
$209.76
|
| Rate for Payer: Coventry All Commercial |
$209.76
|
| Rate for Payer: Encore All Commercial |
$174.80
|
| Rate for Payer: Encore All Commercial |
$174.80
|
| Rate for Payer: Frontpath All Commercial |
$235.99
|
| Rate for Payer: Frontpath All Commercial |
$235.99
|
| Rate for Payer: Humana ChoiceCare |
$209.38
|
| Rate for Payer: Humana ChoiceCare |
$209.38
|
| Rate for Payer: Humana Medicare |
$174.80
|
| Rate for Payer: Humana Medicare |
$174.80
|
| Rate for Payer: Lucent All Commercial |
$244.72
|
| Rate for Payer: Lucent All Commercial |
$244.72
|
| Rate for Payer: Lutheran Preferred All Commercial |
$260.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$260.00
|
| Rate for Payer: Managed Health Services Medicaid |
$253.82
|
| Rate for Payer: Managed Health Services Medicaid |
$253.82
|
| Rate for Payer: MDWise Medicaid |
$253.82
|
| Rate for Payer: MDWise Medicaid |
$253.82
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$112.46
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$112.46
|
| Rate for Payer: PHCS All Commercial |
$174.80
|
| Rate for Payer: PHCS All Commercial |
$174.80
|
| Rate for Payer: PHP All Commercial |
$295.53
|
| Rate for Payer: PHP All Commercial |
$295.53
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$174.80
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$174.80
|
| Rate for Payer: Sagamore Health Network All Products |
$174.80
|
| Rate for Payer: Sagamore Health Network All Products |
$174.80
|
| Rate for Payer: Signature Care EPO |
$307.70
|
| Rate for Payer: Signature Care EPO |
$307.70
|
| Rate for Payer: Signature Care PPO |
$307.70
|
| Rate for Payer: Signature Care PPO |
$307.70
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$24,200.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$24,200.00
|
| Rate for Payer: United Healthcare Commercial |
$209.45
|
| Rate for Payer: United Healthcare Commercial |
$209.45
|
| Rate for Payer: United Healthcare Medicare |
$258.33
|
| Rate for Payer: United Healthcare Medicare |
$258.33
|
|
|
PR EXCISON TUMOR SOFT TISSUE THIGH/KNEE SUBQ 3+CM
|
Professional
|
Both
|
$772.54
|
|
|
Service Code
|
CPT 27337
|
| Hospital Charge Code |
z27337
|
| Min. Negotiated Rate |
$378.17 |
| Max. Negotiated Rate |
$58,100.00 |
| Rate for Payer: Aetna Commercial |
$389.77
|
| Rate for Payer: Aetna Commercial |
$389.77
|
| Rate for Payer: Aetna Medicare |
$389.77
|
| Rate for Payer: Aetna Medicare |
$389.77
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$489.97
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$489.97
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$489.97
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$489.97
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$489.97
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$489.97
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$489.97
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$489.97
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$379.97
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$379.97
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$448.24
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$448.24
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$428.75
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$428.75
|
| Rate for Payer: Cash Price |
$463.52
|
| Rate for Payer: Cash Price |
$453.80
|
| Rate for Payer: Centivo All Commercial |
$604.14
|
| Rate for Payer: Centivo All Commercial |
$604.14
|
| Rate for Payer: Cigna All Commercial |
$389.77
|
| Rate for Payer: Cigna All Commercial |
$389.77
|
| Rate for Payer: CORVEL All Commercial |
$389.77
|
| Rate for Payer: CORVEL All Commercial |
$389.77
|
| Rate for Payer: Coventry All Commercial |
$467.72
|
| Rate for Payer: Coventry All Commercial |
$467.72
|
| Rate for Payer: Encore All Commercial |
$389.77
|
| Rate for Payer: Encore All Commercial |
$389.77
|
| Rate for Payer: Frontpath All Commercial |
$548.54
|
| Rate for Payer: Frontpath All Commercial |
$548.54
|
| Rate for Payer: Humana ChoiceCare |
$437.03
|
| Rate for Payer: Humana ChoiceCare |
$437.03
|
| Rate for Payer: Humana Medicare |
$389.77
|
| Rate for Payer: Humana Medicare |
$389.77
|
| Rate for Payer: Lucent All Commercial |
$545.68
|
| Rate for Payer: Lucent All Commercial |
$545.68
|
| Rate for Payer: Lutheran Preferred All Commercial |
$620.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$620.00
|
| Rate for Payer: Managed Health Services Medicaid |
$379.97
|
| Rate for Payer: Managed Health Services Medicaid |
$379.97
|
| Rate for Payer: MDWise Medicaid |
$379.97
|
| Rate for Payer: MDWise Medicaid |
$379.97
|
| Rate for Payer: PHCS All Commercial |
$389.77
|
| Rate for Payer: PHCS All Commercial |
$389.77
|
| Rate for Payer: PHP All Commercial |
$658.01
|
| Rate for Payer: PHP All Commercial |
$658.01
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$389.77
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$389.77
|
| Rate for Payer: Sagamore Health Network All Products |
$389.77
|
| Rate for Payer: Sagamore Health Network All Products |
$389.77
|
| Rate for Payer: Signature Care EPO |
$419.05
|
| Rate for Payer: Signature Care EPO |
$419.05
|
| Rate for Payer: Signature Care PPO |
$419.05
|
| Rate for Payer: Signature Care PPO |
$419.05
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$58,100.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$58,100.00
|
| Rate for Payer: United Healthcare Commercial |
$478.79
|
| Rate for Payer: United Healthcare Commercial |
$478.79
|
| Rate for Payer: United Healthcare Medicare |
$378.17
|
| Rate for Payer: United Healthcare Medicare |
$378.17
|
|
|
PR EXCIS PRIMARY GANGLION WRIST
|
Professional
|
Both
|
$614.82
|
|
|
Service Code
|
CPT 25111
|
| Hospital Charge Code |
z25111
|
| Min. Negotiated Rate |
$298.74 |
| Max. Negotiated Rate |
$45,900.00 |
| Rate for Payer: Aetna Commercial |
$303.77
|
| Rate for Payer: Aetna Commercial |
$303.77
|
| Rate for Payer: Aetna Medicare |
$303.77
|
| Rate for Payer: Aetna Medicare |
$303.77
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$379.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$379.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$379.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$379.40
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$379.40
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$379.40
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$379.40
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$379.40
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$302.39
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$302.39
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$349.34
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$349.34
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$334.15
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$334.15
|
| Rate for Payer: Cash Price |
$368.89
|
| Rate for Payer: Cash Price |
$358.49
|
| Rate for Payer: Centivo All Commercial |
$470.84
|
| Rate for Payer: Centivo All Commercial |
$470.84
|
| Rate for Payer: Cigna All Commercial |
$303.77
|
| Rate for Payer: Cigna All Commercial |
$303.77
|
| Rate for Payer: CORVEL All Commercial |
$303.77
|
| Rate for Payer: CORVEL All Commercial |
$303.77
|
| Rate for Payer: Coventry All Commercial |
$364.52
|
| Rate for Payer: Coventry All Commercial |
$364.52
|
| Rate for Payer: Encore All Commercial |
$303.77
|
| Rate for Payer: Encore All Commercial |
$303.77
|
| Rate for Payer: Frontpath All Commercial |
$416.79
|
| Rate for Payer: Frontpath All Commercial |
$416.79
|
| Rate for Payer: Humana ChoiceCare |
$343.95
|
| Rate for Payer: Humana ChoiceCare |
$343.95
|
| Rate for Payer: Humana Medicare |
$303.77
|
| Rate for Payer: Humana Medicare |
$303.77
|
| Rate for Payer: Lucent All Commercial |
$425.28
|
| Rate for Payer: Lucent All Commercial |
$425.28
|
| Rate for Payer: Lutheran Preferred All Commercial |
$490.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$490.00
|
| Rate for Payer: Managed Health Services Medicaid |
$302.39
|
| Rate for Payer: Managed Health Services Medicaid |
$302.39
|
| Rate for Payer: MDWise Medicaid |
$302.39
|
| Rate for Payer: MDWise Medicaid |
$302.39
|
| Rate for Payer: PHCS All Commercial |
$303.77
|
| Rate for Payer: PHCS All Commercial |
$303.77
|
| Rate for Payer: PHP All Commercial |
$519.81
|
| Rate for Payer: PHP All Commercial |
$519.81
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$303.77
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$303.77
|
| Rate for Payer: Sagamore Health Network All Products |
$303.77
|
| Rate for Payer: Sagamore Health Network All Products |
$303.77
|
| Rate for Payer: Signature Care EPO |
$516.41
|
| Rate for Payer: Signature Care EPO |
$516.41
|
| Rate for Payer: Signature Care PPO |
$516.41
|
| Rate for Payer: Signature Care PPO |
$516.41
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$45,900.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$45,900.00
|
| Rate for Payer: United Healthcare Commercial |
$331.64
|
| Rate for Payer: United Healthcare Commercial |
$331.64
|
| Rate for Payer: United Healthcare Medicare |
$298.74
|
| Rate for Payer: United Healthcare Medicare |
$298.74
|
|
|
PR EXCIS RECURRENT GANGLION WRIST
|
Professional
|
Both
|
$737.10
|
|
|
Service Code
|
CPT 25112
|
| Hospital Charge Code |
z25112
|
| Min. Negotiated Rate |
$358.56 |
| Max. Negotiated Rate |
$55,100.00 |
| Rate for Payer: Aetna Commercial |
$365.61
|
| Rate for Payer: Aetna Commercial |
$365.61
|
| Rate for Payer: Aetna Medicare |
$365.61
|
| Rate for Payer: Aetna Medicare |
$365.61
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$470.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$470.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$470.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$470.40
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$470.40
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$470.40
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$470.40
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$470.40
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$362.54
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$362.54
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$420.45
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$420.45
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$402.17
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$402.17
|
| Rate for Payer: Cash Price |
$442.26
|
| Rate for Payer: Cash Price |
$430.27
|
| Rate for Payer: Centivo All Commercial |
$566.70
|
| Rate for Payer: Centivo All Commercial |
$566.70
|
| Rate for Payer: Cigna All Commercial |
$365.61
|
| Rate for Payer: Cigna All Commercial |
$365.61
|
| Rate for Payer: CORVEL All Commercial |
$365.61
|
| Rate for Payer: CORVEL All Commercial |
$365.61
|
| Rate for Payer: Coventry All Commercial |
$438.73
|
| Rate for Payer: Coventry All Commercial |
$438.73
|
| Rate for Payer: Encore All Commercial |
$365.61
|
| Rate for Payer: Encore All Commercial |
$365.61
|
| Rate for Payer: Frontpath All Commercial |
$504.04
|
| Rate for Payer: Frontpath All Commercial |
$504.04
|
| Rate for Payer: Humana ChoiceCare |
$419.11
|
| Rate for Payer: Humana ChoiceCare |
$419.11
|
| Rate for Payer: Humana Medicare |
$365.61
|
| Rate for Payer: Humana Medicare |
$365.61
|
| Rate for Payer: Lucent All Commercial |
$511.85
|
| Rate for Payer: Lucent All Commercial |
$511.85
|
| Rate for Payer: Lutheran Preferred All Commercial |
$588.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$588.00
|
| Rate for Payer: Managed Health Services Medicaid |
$362.54
|
| Rate for Payer: Managed Health Services Medicaid |
$362.54
|
| Rate for Payer: MDWise Medicaid |
$362.54
|
| Rate for Payer: MDWise Medicaid |
$362.54
|
| Rate for Payer: PHCS All Commercial |
$365.61
|
| Rate for Payer: PHCS All Commercial |
$365.61
|
| Rate for Payer: PHP All Commercial |
$623.90
|
| Rate for Payer: PHP All Commercial |
$623.90
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$365.61
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$365.61
|
| Rate for Payer: Sagamore Health Network All Products |
$365.61
|
| Rate for Payer: Sagamore Health Network All Products |
$365.61
|
| Rate for Payer: Signature Care EPO |
$570.35
|
| Rate for Payer: Signature Care EPO |
$570.35
|
| Rate for Payer: Signature Care PPO |
$570.35
|
| Rate for Payer: Signature Care PPO |
$570.35
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$55,100.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$55,100.00
|
| Rate for Payer: United Healthcare Commercial |
$406.66
|
| Rate for Payer: United Healthcare Commercial |
$406.66
|
| Rate for Payer: United Healthcare Medicare |
$358.56
|
| Rate for Payer: United Healthcare Medicare |
$358.56
|
|
|
PR EXCIS SPERMATOCELE
|
Professional
|
Both
|
$590.94
|
|
|
Service Code
|
CPT 54840
|
| Hospital Charge Code |
z54840
|
| Min. Negotiated Rate |
$294.37 |
| Max. Negotiated Rate |
$470.49 |
| Rate for Payer: Aetna Commercial |
$303.54
|
| Rate for Payer: Aetna Medicare |
$303.54
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$297.15
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$349.07
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$333.89
|
| Rate for Payer: Cash Price |
$354.56
|
| Rate for Payer: Centivo All Commercial |
$470.49
|
| Rate for Payer: Cigna All Commercial |
$303.54
|
| Rate for Payer: CORVEL All Commercial |
$303.54
|
| Rate for Payer: Coventry All Commercial |
$364.25
|
| Rate for Payer: Encore All Commercial |
$303.54
|
| Rate for Payer: Frontpath All Commercial |
$414.23
|
| Rate for Payer: Humana ChoiceCare |
$378.48
|
| Rate for Payer: Humana Medicare |
$303.54
|
| Rate for Payer: Lucent All Commercial |
$424.96
|
| Rate for Payer: Managed Health Services Medicaid |
$297.15
|
| Rate for Payer: MDWise Medicaid |
$297.15
|
| Rate for Payer: PHCS All Commercial |
$303.54
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$303.54
|
| Rate for Payer: Sagamore Health Network All Products |
$303.54
|
| Rate for Payer: United Healthcare Commercial |
$396.39
|
| Rate for Payer: United Healthcare Medicare |
$294.37
|
|
|
PR EXCIS TENDN/CAPSULE LESN,FOOT
|
Professional
|
Both
|
$869.30
|
|
|
Service Code
|
CPT 28090
|
| Hospital Charge Code |
z28090
|
| Min. Negotiated Rate |
$156.25 |
| Max. Negotiated Rate |
$43,600.00 |
| Rate for Payer: Aetna Commercial |
$289.92
|
| Rate for Payer: Aetna Commercial |
$289.92
|
| Rate for Payer: Aetna Medicare |
$289.92
|
| Rate for Payer: Aetna Medicare |
$289.92
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$440.90
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$440.90
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$440.90
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$440.90
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$440.90
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$440.90
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$440.90
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$440.90
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$156.25
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$156.25
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$427.56
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$427.56
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$333.41
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$333.41
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$318.91
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$318.91
|
| Rate for Payer: Cash Price |
$508.68
|
| Rate for Payer: Cash Price |
$521.58
|
| Rate for Payer: Centivo All Commercial |
$449.38
|
| Rate for Payer: Centivo All Commercial |
$449.38
|
| Rate for Payer: Cigna All Commercial |
$289.92
|
| Rate for Payer: Cigna All Commercial |
$289.92
|
| Rate for Payer: CORVEL All Commercial |
$289.92
|
| Rate for Payer: CORVEL All Commercial |
$289.92
|
| Rate for Payer: Coventry All Commercial |
$347.90
|
| Rate for Payer: Coventry All Commercial |
$347.90
|
| Rate for Payer: Encore All Commercial |
$289.92
|
| Rate for Payer: Encore All Commercial |
$289.92
|
| Rate for Payer: Frontpath All Commercial |
$392.54
|
| Rate for Payer: Frontpath All Commercial |
$392.54
|
| Rate for Payer: Humana ChoiceCare |
$340.19
|
| Rate for Payer: Humana ChoiceCare |
$340.19
|
| Rate for Payer: Humana Medicare |
$289.92
|
| Rate for Payer: Humana Medicare |
$289.92
|
| Rate for Payer: Lucent All Commercial |
$405.89
|
| Rate for Payer: Lucent All Commercial |
$405.89
|
| Rate for Payer: Lutheran Preferred All Commercial |
$466.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$466.00
|
| Rate for Payer: Managed Health Services Medicaid |
$427.56
|
| Rate for Payer: Managed Health Services Medicaid |
$427.56
|
| Rate for Payer: MDWise Medicaid |
$427.56
|
| Rate for Payer: MDWise Medicaid |
$427.56
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$156.25
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$156.25
|
| Rate for Payer: PHCS All Commercial |
$289.92
|
| Rate for Payer: PHCS All Commercial |
$289.92
|
| Rate for Payer: PHP All Commercial |
$493.89
|
| Rate for Payer: PHP All Commercial |
$493.89
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$289.92
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$289.92
|
| Rate for Payer: Sagamore Health Network All Products |
$289.92
|
| Rate for Payer: Sagamore Health Network All Products |
$289.92
|
| Rate for Payer: Signature Care EPO |
$596.70
|
| Rate for Payer: Signature Care EPO |
$596.70
|
| Rate for Payer: Signature Care PPO |
$596.70
|
| Rate for Payer: Signature Care PPO |
$596.70
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$43,600.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$43,600.00
|
| Rate for Payer: United Healthcare Commercial |
$350.26
|
| Rate for Payer: United Healthcare Commercial |
$350.26
|
| Rate for Payer: United Healthcare Medicare |
$423.90
|
| Rate for Payer: United Healthcare Medicare |
$423.90
|
|
|
PR EXCIS TENDON SHEATH LESION, HAND/FINGER
|
Professional
|
Both
|
$1,140.46
|
|
|
Service Code
|
CPT 26160
|
| Hospital Charge Code |
z26160
|
| Min. Negotiated Rate |
$162.82 |
| Max. Negotiated Rate |
$44,700.00 |
| Rate for Payer: Aetna Commercial |
$295.50
|
| Rate for Payer: Aetna Commercial |
$295.50
|
| Rate for Payer: Aetna Medicare |
$295.50
|
| Rate for Payer: Aetna Medicare |
$295.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$1,050.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$1,050.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,050.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,050.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,050.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,050.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,050.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,050.00
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$162.82
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$162.82
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$560.92
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$560.92
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$339.82
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$339.82
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$325.05
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$325.05
|
| Rate for Payer: Cash Price |
$676.32
|
| Rate for Payer: Cash Price |
$684.28
|
| Rate for Payer: Centivo All Commercial |
$458.02
|
| Rate for Payer: Centivo All Commercial |
$458.02
|
| Rate for Payer: Cigna All Commercial |
$295.50
|
| Rate for Payer: Cigna All Commercial |
$295.50
|
| Rate for Payer: CORVEL All Commercial |
$295.50
|
| Rate for Payer: CORVEL All Commercial |
$295.50
|
| Rate for Payer: Coventry All Commercial |
$354.60
|
| Rate for Payer: Coventry All Commercial |
$354.60
|
| Rate for Payer: Encore All Commercial |
$295.50
|
| Rate for Payer: Encore All Commercial |
$295.50
|
| Rate for Payer: Frontpath All Commercial |
$405.86
|
| Rate for Payer: Frontpath All Commercial |
$405.86
|
| Rate for Payer: Humana ChoiceCare |
$310.21
|
| Rate for Payer: Humana ChoiceCare |
$310.21
|
| Rate for Payer: Humana Medicare |
$295.50
|
| Rate for Payer: Humana Medicare |
$295.50
|
| Rate for Payer: Lucent All Commercial |
$413.70
|
| Rate for Payer: Lucent All Commercial |
$413.70
|
| Rate for Payer: Lutheran Preferred All Commercial |
$476.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$476.00
|
| Rate for Payer: Managed Health Services Medicaid |
$560.92
|
| Rate for Payer: Managed Health Services Medicaid |
$560.92
|
| Rate for Payer: MDWise Medicaid |
$560.92
|
| Rate for Payer: MDWise Medicaid |
$560.92
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$162.82
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$162.82
|
| Rate for Payer: PHCS All Commercial |
$295.50
|
| Rate for Payer: PHCS All Commercial |
$295.50
|
| Rate for Payer: PHP All Commercial |
$505.34
|
| Rate for Payer: PHP All Commercial |
$505.34
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$295.50
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$295.50
|
| Rate for Payer: Sagamore Health Network All Products |
$295.50
|
| Rate for Payer: Sagamore Health Network All Products |
$295.50
|
| Rate for Payer: Signature Care EPO |
$874.65
|
| Rate for Payer: Signature Care EPO |
$874.65
|
| Rate for Payer: Signature Care PPO |
$874.65
|
| Rate for Payer: Signature Care PPO |
$874.65
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$44,700.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$44,700.00
|
| Rate for Payer: United Healthcare Commercial |
$335.18
|
| Rate for Payer: United Healthcare Commercial |
$335.18
|
| Rate for Payer: United Healthcare Medicare |
$563.60
|
| Rate for Payer: United Healthcare Medicare |
$563.60
|
|
|
PR EXCIS TENDON SHEATH LESN,WRIST/FORE
|
Professional
|
Both
|
$652.92
|
|
|
Service Code
|
CPT 25110
|
| Hospital Charge Code |
z25110
|
| Min. Negotiated Rate |
$319.13 |
| Max. Negotiated Rate |
$49,100.00 |
| Rate for Payer: Aetna Commercial |
$325.37
|
| Rate for Payer: Aetna Commercial |
$325.37
|
| Rate for Payer: Aetna Medicare |
$325.37
|
| Rate for Payer: Aetna Medicare |
$325.37
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$433.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$433.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$433.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$433.40
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$433.40
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$433.40
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$433.40
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$433.40
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$321.13
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$321.13
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$374.18
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$374.18
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$357.91
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$357.91
|
| Rate for Payer: Cash Price |
$391.75
|
| Rate for Payer: Cash Price |
$382.96
|
| Rate for Payer: Centivo All Commercial |
$504.32
|
| Rate for Payer: Centivo All Commercial |
$504.32
|
| Rate for Payer: Cigna All Commercial |
$325.37
|
| Rate for Payer: Cigna All Commercial |
$325.37
|
| Rate for Payer: CORVEL All Commercial |
$325.37
|
| Rate for Payer: CORVEL All Commercial |
$325.37
|
| Rate for Payer: Coventry All Commercial |
$390.44
|
| Rate for Payer: Coventry All Commercial |
$390.44
|
| Rate for Payer: Encore All Commercial |
$325.37
|
| Rate for Payer: Encore All Commercial |
$325.37
|
| Rate for Payer: Frontpath All Commercial |
$448.02
|
| Rate for Payer: Frontpath All Commercial |
$448.02
|
| Rate for Payer: Humana ChoiceCare |
$462.15
|
| Rate for Payer: Humana ChoiceCare |
$462.15
|
| Rate for Payer: Humana Medicare |
$325.37
|
| Rate for Payer: Humana Medicare |
$325.37
|
| Rate for Payer: Lucent All Commercial |
$455.52
|
| Rate for Payer: Lucent All Commercial |
$455.52
|
| Rate for Payer: Lutheran Preferred All Commercial |
$523.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$523.00
|
| Rate for Payer: Managed Health Services Medicaid |
$321.13
|
| Rate for Payer: Managed Health Services Medicaid |
$321.13
|
| Rate for Payer: MDWise Medicaid |
$321.13
|
| Rate for Payer: MDWise Medicaid |
$321.13
|
| Rate for Payer: PHCS All Commercial |
$325.37
|
| Rate for Payer: PHCS All Commercial |
$325.37
|
| Rate for Payer: PHP All Commercial |
$555.28
|
| Rate for Payer: PHP All Commercial |
$555.28
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$325.37
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$325.37
|
| Rate for Payer: Sagamore Health Network All Products |
$325.37
|
| Rate for Payer: Sagamore Health Network All Products |
$325.37
|
| Rate for Payer: Signature Care EPO |
$550.61
|
| Rate for Payer: Signature Care EPO |
$550.61
|
| Rate for Payer: Signature Care PPO |
$550.61
|
| Rate for Payer: Signature Care PPO |
$550.61
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$49,100.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$49,100.00
|
| Rate for Payer: United Healthcare Commercial |
$382.34
|
| Rate for Payer: United Healthcare Commercial |
$382.34
|
| Rate for Payer: United Healthcare Medicare |
$319.13
|
| Rate for Payer: United Healthcare Medicare |
$319.13
|
|
|
PR EXCIS TONGUE FOLD
|
Professional
|
Both
|
$485.10
|
|
|
Service Code
|
CPT 41115
|
| Hospital Charge Code |
z41115
|
| Min. Negotiated Rate |
$102.24 |
| Max. Negotiated Rate |
$19,300.00 |
| Rate for Payer: Aetna Commercial |
$137.29
|
| Rate for Payer: Aetna Commercial |
$137.29
|
| Rate for Payer: Aetna Medicare |
$137.29
|
| Rate for Payer: Aetna Medicare |
$137.29
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$200.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$200.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$200.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$200.80
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$200.80
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$200.80
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$200.80
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$200.80
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$102.24
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$102.24
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$238.59
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$238.59
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$157.88
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$157.88
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$151.02
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$151.02
|
| Rate for Payer: Cash Price |
$288.24
|
| Rate for Payer: Cash Price |
$291.06
|
| Rate for Payer: Centivo All Commercial |
$212.80
|
| Rate for Payer: Centivo All Commercial |
$212.80
|
| Rate for Payer: Cigna All Commercial |
$137.29
|
| Rate for Payer: Cigna All Commercial |
$137.29
|
| Rate for Payer: CORVEL All Commercial |
$137.29
|
| Rate for Payer: CORVEL All Commercial |
$137.29
|
| Rate for Payer: Coventry All Commercial |
$164.75
|
| Rate for Payer: Coventry All Commercial |
$164.75
|
| Rate for Payer: Encore All Commercial |
$137.29
|
| Rate for Payer: Encore All Commercial |
$137.29
|
| Rate for Payer: Frontpath All Commercial |
$186.89
|
| Rate for Payer: Frontpath All Commercial |
$186.89
|
| Rate for Payer: Humana ChoiceCare |
$158.94
|
| Rate for Payer: Humana ChoiceCare |
$158.94
|
| Rate for Payer: Humana Medicare |
$137.29
|
| Rate for Payer: Humana Medicare |
$137.29
|
| Rate for Payer: Lucent All Commercial |
$192.21
|
| Rate for Payer: Lucent All Commercial |
$192.21
|
| Rate for Payer: Lutheran Preferred All Commercial |
$206.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$206.00
|
| Rate for Payer: Managed Health Services Medicaid |
$238.59
|
| Rate for Payer: Managed Health Services Medicaid |
$238.59
|
| Rate for Payer: MDWise Medicaid |
$238.59
|
| Rate for Payer: MDWise Medicaid |
$238.59
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$102.24
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$102.24
|
| Rate for Payer: PHCS All Commercial |
$137.29
|
| Rate for Payer: PHCS All Commercial |
$137.29
|
| Rate for Payer: PHP All Commercial |
$234.82
|
| Rate for Payer: PHP All Commercial |
$234.82
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$137.29
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$137.29
|
| Rate for Payer: Sagamore Health Network All Products |
$137.29
|
| Rate for Payer: Sagamore Health Network All Products |
$137.29
|
| Rate for Payer: Signature Care EPO |
$283.90
|
| Rate for Payer: Signature Care EPO |
$283.90
|
| Rate for Payer: Signature Care PPO |
$283.90
|
| Rate for Payer: Signature Care PPO |
$283.90
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$19,300.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$19,300.00
|
| Rate for Payer: United Healthcare Commercial |
$159.11
|
| Rate for Payer: United Healthcare Commercial |
$159.11
|
| Rate for Payer: United Healthcare Medicare |
$240.20
|
| Rate for Payer: United Healthcare Medicare |
$240.20
|
|
|
PR EXCIS TONGUE LESN,ANT 2/3+CLOS
|
Professional
|
Both
|
$630.94
|
|
|
Service Code
|
CPT 41112
|
| Hospital Charge Code |
z41112
|
| Min. Negotiated Rate |
$147.53 |
| Max. Negotiated Rate |
$390.50 |
| Rate for Payer: Aetna Commercial |
$228.30
|
| Rate for Payer: Aetna Commercial |
$228.30
|
| Rate for Payer: Aetna Medicare |
$228.30
|
| Rate for Payer: Aetna Medicare |
$228.30
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$147.53
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$147.53
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$310.32
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$310.32
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$262.55
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$262.55
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$251.13
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$251.13
|
| Rate for Payer: Cash Price |
$373.67
|
| Rate for Payer: Cash Price |
$378.56
|
| Rate for Payer: Centivo All Commercial |
$353.87
|
| Rate for Payer: Centivo All Commercial |
$353.87
|
| Rate for Payer: Cigna All Commercial |
$228.30
|
| Rate for Payer: Cigna All Commercial |
$228.30
|
| Rate for Payer: CORVEL All Commercial |
$228.30
|
| Rate for Payer: CORVEL All Commercial |
$228.30
|
| Rate for Payer: Coventry All Commercial |
$273.96
|
| Rate for Payer: Coventry All Commercial |
$273.96
|
| Rate for Payer: Encore All Commercial |
$228.30
|
| Rate for Payer: Encore All Commercial |
$228.30
|
| Rate for Payer: Frontpath All Commercial |
$308.76
|
| Rate for Payer: Frontpath All Commercial |
$308.76
|
| Rate for Payer: Humana ChoiceCare |
$262.13
|
| Rate for Payer: Humana ChoiceCare |
$262.13
|
| Rate for Payer: Humana Medicare |
$228.30
|
| Rate for Payer: Humana Medicare |
$228.30
|
| Rate for Payer: Lucent All Commercial |
$319.62
|
| Rate for Payer: Lucent All Commercial |
$319.62
|
| Rate for Payer: Managed Health Services Medicaid |
$310.32
|
| Rate for Payer: Managed Health Services Medicaid |
$310.32
|
| Rate for Payer: MDWise Medicaid |
$310.32
|
| Rate for Payer: MDWise Medicaid |
$310.32
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$147.53
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$147.53
|
| Rate for Payer: PHCS All Commercial |
$228.30
|
| Rate for Payer: PHCS All Commercial |
$228.30
|
| Rate for Payer: PHP All Commercial |
$390.50
|
| Rate for Payer: PHP All Commercial |
$390.50
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$228.30
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$228.30
|
| Rate for Payer: Sagamore Health Network All Products |
$228.30
|
| Rate for Payer: Sagamore Health Network All Products |
$228.30
|
| Rate for Payer: Signature Care EPO |
$385.90
|
| Rate for Payer: Signature Care EPO |
$385.90
|
| Rate for Payer: Signature Care PPO |
$385.90
|
| Rate for Payer: Signature Care PPO |
$385.90
|
| Rate for Payer: United Healthcare Commercial |
$266.95
|
| Rate for Payer: United Healthcare Commercial |
$266.95
|
| Rate for Payer: United Healthcare Medicare |
$311.39
|
| Rate for Payer: United Healthcare Medicare |
$311.39
|
|
|
PR EXCIS UTERINE FIBROID,VAG APPRCH
|
Professional
|
Both
|
$1,059.04
|
|
|
Service Code
|
CPT 58145
|
| Hospital Charge Code |
z58145
|
| Min. Negotiated Rate |
$519.30 |
| Max. Negotiated Rate |
$69,200.00 |
| Rate for Payer: Aetna Commercial |
$538.01
|
| Rate for Payer: Aetna Commercial |
$538.01
|
| Rate for Payer: Aetna Medicare |
$538.01
|
| Rate for Payer: Aetna Medicare |
$538.01
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$675.59
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$675.59
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$675.59
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$675.59
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$675.59
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$675.59
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$675.59
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$675.59
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$520.88
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$520.88
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$618.71
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$618.71
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$591.81
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$591.81
|
| Rate for Payer: Cash Price |
$635.42
|
| Rate for Payer: Cash Price |
$623.16
|
| Rate for Payer: Centivo All Commercial |
$833.92
|
| Rate for Payer: Centivo All Commercial |
$833.92
|
| Rate for Payer: Cigna All Commercial |
$538.01
|
| Rate for Payer: Cigna All Commercial |
$538.01
|
| Rate for Payer: CORVEL All Commercial |
$538.01
|
| Rate for Payer: CORVEL All Commercial |
$538.01
|
| Rate for Payer: Coventry All Commercial |
$645.61
|
| Rate for Payer: Coventry All Commercial |
$645.61
|
| Rate for Payer: Encore All Commercial |
$538.01
|
| Rate for Payer: Encore All Commercial |
$538.01
|
| Rate for Payer: Frontpath All Commercial |
$744.04
|
| Rate for Payer: Frontpath All Commercial |
$744.04
|
| Rate for Payer: Humana ChoiceCare |
$567.63
|
| Rate for Payer: Humana ChoiceCare |
$567.63
|
| Rate for Payer: Humana Medicare |
$538.01
|
| Rate for Payer: Humana Medicare |
$538.01
|
| Rate for Payer: Lucent All Commercial |
$753.21
|
| Rate for Payer: Lucent All Commercial |
$753.21
|
| Rate for Payer: Lutheran Preferred All Commercial |
$745.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$745.00
|
| Rate for Payer: Managed Health Services Medicaid |
$520.88
|
| Rate for Payer: Managed Health Services Medicaid |
$520.88
|
| Rate for Payer: MDWise Medicaid |
$520.88
|
| Rate for Payer: MDWise Medicaid |
$520.88
|
| Rate for Payer: PHCS All Commercial |
$538.01
|
| Rate for Payer: PHCS All Commercial |
$538.01
|
| Rate for Payer: PHP All Commercial |
$685.48
|
| Rate for Payer: PHP All Commercial |
$685.48
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$538.01
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$538.01
|
| Rate for Payer: Sagamore Health Network All Products |
$538.01
|
| Rate for Payer: Sagamore Health Network All Products |
$538.01
|
| Rate for Payer: Signature Care EPO |
$640.05
|
| Rate for Payer: Signature Care EPO |
$640.05
|
| Rate for Payer: Signature Care PPO |
$640.05
|
| Rate for Payer: Signature Care PPO |
$640.05
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$69,200.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$69,200.00
|
| Rate for Payer: United Healthcare Commercial |
$608.79
|
| Rate for Payer: United Healthcare Commercial |
$608.79
|
| Rate for Payer: United Healthcare Medicare |
$519.30
|
| Rate for Payer: United Healthcare Medicare |
$519.30
|
|
|
PR EXC SKIN BENIG <0.5 CM FACE,FACIAL
|
Professional
|
Both
|
$268.04
|
|
|
Service Code
|
CPT 11440
|
| Hospital Charge Code |
z11440
|
| Min. Negotiated Rate |
$55.18 |
| Max. Negotiated Rate |
$11,900.00 |
| Rate for Payer: Aetna Commercial |
$98.22
|
| Rate for Payer: Aetna Commercial |
$98.22
|
| Rate for Payer: Aetna Medicare |
$98.22
|
| Rate for Payer: Aetna Medicare |
$98.22
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$156.87
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$156.87
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$156.87
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$156.87
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$156.87
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$156.87
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$156.87
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$156.87
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$55.18
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$55.18
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$131.83
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$131.83
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$112.95
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$112.95
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$108.04
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$108.04
|
| Rate for Payer: Cash Price |
$157.57
|
| Rate for Payer: Cash Price |
$160.82
|
| Rate for Payer: Centivo All Commercial |
$152.24
|
| Rate for Payer: Centivo All Commercial |
$152.24
|
| Rate for Payer: Cigna All Commercial |
$98.22
|
| Rate for Payer: Cigna All Commercial |
$98.22
|
| Rate for Payer: CORVEL All Commercial |
$98.22
|
| Rate for Payer: CORVEL All Commercial |
$98.22
|
| Rate for Payer: Coventry All Commercial |
$117.86
|
| Rate for Payer: Coventry All Commercial |
$117.86
|
| Rate for Payer: Encore All Commercial |
$98.22
|
| Rate for Payer: Encore All Commercial |
$98.22
|
| Rate for Payer: Frontpath All Commercial |
$131.92
|
| Rate for Payer: Frontpath All Commercial |
$131.92
|
| Rate for Payer: Humana ChoiceCare |
$86.47
|
| Rate for Payer: Humana ChoiceCare |
$86.47
|
| Rate for Payer: Humana Medicare |
$98.22
|
| Rate for Payer: Humana Medicare |
$98.22
|
| Rate for Payer: Lucent All Commercial |
$137.51
|
| Rate for Payer: Lucent All Commercial |
$137.51
|
| Rate for Payer: Lutheran Preferred All Commercial |
$129.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$129.00
|
| Rate for Payer: Managed Health Services Medicaid |
$131.83
|
| Rate for Payer: Managed Health Services Medicaid |
$131.83
|
| Rate for Payer: MDWise Medicaid |
$131.83
|
| Rate for Payer: MDWise Medicaid |
$131.83
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$55.18
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$55.18
|
| Rate for Payer: PHCS All Commercial |
$98.22
|
| Rate for Payer: PHCS All Commercial |
$98.22
|
| Rate for Payer: PHP All Commercial |
$135.77
|
| Rate for Payer: PHP All Commercial |
$135.77
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$98.22
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$98.22
|
| Rate for Payer: Sagamore Health Network All Products |
$98.22
|
| Rate for Payer: Sagamore Health Network All Products |
$98.22
|
| Rate for Payer: Signature Care EPO |
$134.30
|
| Rate for Payer: Signature Care EPO |
$134.30
|
| Rate for Payer: Signature Care PPO |
$134.30
|
| Rate for Payer: Signature Care PPO |
$134.30
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$11,900.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$11,900.00
|
| Rate for Payer: United Healthcare Commercial |
$102.78
|
| Rate for Payer: United Healthcare Commercial |
$102.78
|
| Rate for Payer: United Healthcare Medicare |
$131.31
|
| Rate for Payer: United Healthcare Medicare |
$131.31
|
|
|
PR EXC SKIN BENIG <0.5 CM REMAINDER BODY
|
Professional
|
Both
|
$236.92
|
|
|
Service Code
|
CPT 11420
|
| Hospital Charge Code |
z11420
|
| Min. Negotiated Rate |
$46.65 |
| Max. Negotiated Rate |
$9,300.00 |
| Rate for Payer: Aetna Commercial |
$77.12
|
| Rate for Payer: Aetna Commercial |
$77.12
|
| Rate for Payer: Aetna Medicare |
$77.12
|
| Rate for Payer: Aetna Medicare |
$77.12
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$138.84
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$138.84
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$138.84
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$138.84
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$138.84
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$138.84
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$138.84
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$138.84
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$46.65
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$46.65
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$116.53
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$116.53
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$88.69
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$88.69
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$84.83
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$84.83
|
| Rate for Payer: Cash Price |
$140.16
|
| Rate for Payer: Cash Price |
$142.15
|
| Rate for Payer: Centivo All Commercial |
$119.54
|
| Rate for Payer: Centivo All Commercial |
$119.54
|
| Rate for Payer: Cigna All Commercial |
$77.12
|
| Rate for Payer: Cigna All Commercial |
$77.12
|
| Rate for Payer: CORVEL All Commercial |
$77.12
|
| Rate for Payer: CORVEL All Commercial |
$77.12
|
| Rate for Payer: Coventry All Commercial |
$92.54
|
| Rate for Payer: Coventry All Commercial |
$92.54
|
| Rate for Payer: Encore All Commercial |
$77.12
|
| Rate for Payer: Encore All Commercial |
$77.12
|
| Rate for Payer: Frontpath All Commercial |
$103.83
|
| Rate for Payer: Frontpath All Commercial |
$103.83
|
| Rate for Payer: Humana ChoiceCare |
$70.56
|
| Rate for Payer: Humana ChoiceCare |
$70.56
|
| Rate for Payer: Humana Medicare |
$77.12
|
| Rate for Payer: Humana Medicare |
$77.12
|
| Rate for Payer: Lucent All Commercial |
$107.97
|
| Rate for Payer: Lucent All Commercial |
$107.97
|
| 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 |
$116.53
|
| Rate for Payer: Managed Health Services Medicaid |
$116.53
|
| Rate for Payer: MDWise Medicaid |
$116.53
|
| Rate for Payer: MDWise Medicaid |
$116.53
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$46.65
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$46.65
|
| Rate for Payer: PHCS All Commercial |
$77.12
|
| Rate for Payer: PHCS All Commercial |
$77.12
|
| Rate for Payer: PHP All Commercial |
$105.33
|
| Rate for Payer: PHP All Commercial |
$105.33
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$77.12
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$77.12
|
| Rate for Payer: Sagamore Health Network All Products |
$77.12
|
| Rate for Payer: Sagamore Health Network All Products |
$77.12
|
| Rate for Payer: Signature Care EPO |
$111.35
|
| Rate for Payer: Signature Care EPO |
$111.35
|
| Rate for Payer: Signature Care PPO |
$111.35
|
| Rate for Payer: Signature Care PPO |
$111.35
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$9,300.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$9,300.00
|
| Rate for Payer: United Healthcare Commercial |
$86.00
|
| Rate for Payer: United Healthcare Commercial |
$86.00
|
| Rate for Payer: United Healthcare Medicare |
$116.80
|
| Rate for Payer: United Healthcare Medicare |
$116.80
|
|
|
PR EXC SKIN BENIG <0.5 CM TRUNK,ARM,LEG
|
Professional
|
Both
|
$238.74
|
|
|
Service Code
|
CPT 11400
|
| Hospital Charge Code |
z11400
|
| Min. Negotiated Rate |
$47.22 |
| Max. Negotiated Rate |
$9,400.00 |
| Rate for Payer: Aetna Commercial |
$77.77
|
| Rate for Payer: Aetna Commercial |
$77.77
|
| Rate for Payer: Aetna Medicare |
$77.77
|
| Rate for Payer: Aetna Medicare |
$77.77
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$139.86
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$139.86
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$139.86
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$139.86
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$139.86
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$139.86
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$139.86
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$139.86
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$47.22
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$47.22
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$117.42
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$117.42
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$89.44
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$89.44
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$85.55
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$85.55
|
| Rate for Payer: Cash Price |
$140.24
|
| Rate for Payer: Cash Price |
$143.24
|
| Rate for Payer: Centivo All Commercial |
$120.54
|
| Rate for Payer: Centivo All Commercial |
$120.54
|
| Rate for Payer: Cigna All Commercial |
$77.77
|
| Rate for Payer: Cigna All Commercial |
$77.77
|
| Rate for Payer: CORVEL All Commercial |
$77.77
|
| Rate for Payer: CORVEL All Commercial |
$77.77
|
| Rate for Payer: Coventry All Commercial |
$93.32
|
| Rate for Payer: Coventry All Commercial |
$93.32
|
| Rate for Payer: Encore All Commercial |
$77.77
|
| Rate for Payer: Encore All Commercial |
$77.77
|
| Rate for Payer: Frontpath All Commercial |
$105.05
|
| Rate for Payer: Frontpath All Commercial |
$105.05
|
| Rate for Payer: Humana ChoiceCare |
$63.42
|
| Rate for Payer: Humana ChoiceCare |
$63.42
|
| Rate for Payer: Humana Medicare |
$77.77
|
| Rate for Payer: Humana Medicare |
$77.77
|
| Rate for Payer: Lucent All Commercial |
$108.88
|
| Rate for Payer: Lucent All Commercial |
$108.88
|
| Rate for Payer: Lutheran Preferred All Commercial |
$102.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$102.00
|
| Rate for Payer: Managed Health Services Medicaid |
$117.42
|
| Rate for Payer: Managed Health Services Medicaid |
$117.42
|
| Rate for Payer: MDWise Medicaid |
$117.42
|
| Rate for Payer: MDWise Medicaid |
$117.42
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$47.22
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$47.22
|
| Rate for Payer: PHCS All Commercial |
$77.77
|
| Rate for Payer: PHCS All Commercial |
$77.77
|
| Rate for Payer: PHP All Commercial |
$107.12
|
| Rate for Payer: PHP All Commercial |
$107.12
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$77.77
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$77.77
|
| Rate for Payer: Sagamore Health Network All Products |
$77.77
|
| Rate for Payer: Sagamore Health Network All Products |
$77.77
|
| Rate for Payer: Signature Care EPO |
$113.90
|
| Rate for Payer: Signature Care EPO |
$113.90
|
| Rate for Payer: Signature Care PPO |
$113.90
|
| Rate for Payer: Signature Care PPO |
$113.90
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$9,400.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$9,400.00
|
| Rate for Payer: United Healthcare Commercial |
$79.34
|
| Rate for Payer: United Healthcare Commercial |
$79.34
|
| Rate for Payer: United Healthcare Medicare |
$116.87
|
| Rate for Payer: United Healthcare Medicare |
$116.87
|
|
|
PR EXC SKIN BENIG 0.6-1 CM FACE,FACIAL
|
Professional
|
Both
|
$325.00
|
|
|
Service Code
|
CPT 11441
|
| Hospital Charge Code |
z11441
|
| Min. Negotiated Rate |
$67.37 |
| Max. Negotiated Rate |
$14,900.00 |
| Rate for Payer: Aetna Commercial |
$123.44
|
| Rate for Payer: Aetna Commercial |
$123.44
|
| Rate for Payer: Aetna Medicare |
$123.44
|
| Rate for Payer: Aetna Medicare |
$123.44
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$182.87
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$182.87
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$182.87
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$182.87
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$182.87
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$182.87
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$182.87
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$182.87
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$67.37
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$67.37
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$159.85
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$159.85
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$141.96
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$141.96
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$135.78
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$135.78
|
| Rate for Payer: Cash Price |
$191.14
|
| Rate for Payer: Cash Price |
$195.00
|
| Rate for Payer: Centivo All Commercial |
$191.33
|
| Rate for Payer: Centivo All Commercial |
$191.33
|
| Rate for Payer: Cigna All Commercial |
$123.44
|
| Rate for Payer: Cigna All Commercial |
$123.44
|
| Rate for Payer: CORVEL All Commercial |
$123.44
|
| Rate for Payer: CORVEL All Commercial |
$123.44
|
| Rate for Payer: Coventry All Commercial |
$148.13
|
| Rate for Payer: Coventry All Commercial |
$148.13
|
| Rate for Payer: Encore All Commercial |
$123.44
|
| Rate for Payer: Encore All Commercial |
$123.44
|
| Rate for Payer: Frontpath All Commercial |
$167.40
|
| Rate for Payer: Frontpath All Commercial |
$167.40
|
| Rate for Payer: Humana ChoiceCare |
$109.40
|
| Rate for Payer: Humana ChoiceCare |
$109.40
|
| Rate for Payer: Humana Medicare |
$123.44
|
| Rate for Payer: Humana Medicare |
$123.44
|
| Rate for Payer: Lucent All Commercial |
$172.82
|
| Rate for Payer: Lucent All Commercial |
$172.82
|
| Rate for Payer: Lutheran Preferred All Commercial |
$162.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$162.00
|
| Rate for Payer: Managed Health Services Medicaid |
$159.85
|
| Rate for Payer: Managed Health Services Medicaid |
$159.85
|
| Rate for Payer: MDWise Medicaid |
$159.85
|
| Rate for Payer: MDWise Medicaid |
$159.85
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$67.37
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$67.37
|
| Rate for Payer: PHCS All Commercial |
$123.44
|
| Rate for Payer: PHCS All Commercial |
$123.44
|
| Rate for Payer: PHP All Commercial |
$169.87
|
| Rate for Payer: PHP All Commercial |
$169.87
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$123.44
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$123.44
|
| Rate for Payer: Sagamore Health Network All Products |
$123.44
|
| Rate for Payer: Sagamore Health Network All Products |
$123.44
|
| Rate for Payer: Signature Care EPO |
$157.25
|
| Rate for Payer: Signature Care EPO |
$157.25
|
| Rate for Payer: Signature Care PPO |
$157.25
|
| Rate for Payer: Signature Care PPO |
$157.25
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$14,900.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$14,900.00
|
| Rate for Payer: United Healthcare Commercial |
$135.29
|
| Rate for Payer: United Healthcare Commercial |
$135.29
|
| Rate for Payer: United Healthcare Medicare |
$159.28
|
| Rate for Payer: United Healthcare Medicare |
$159.28
|
|
|
PR EXC SKIN BENIG 0.6-1 CM REMAINDR BODY
|
Professional
|
Both
|
$298.54
|
|
|
Service Code
|
CPT 11421
|
| Hospital Charge Code |
z11421
|
| Min. Negotiated Rate |
$57.96 |
| Max. Negotiated Rate |
$12,300.00 |
| Rate for Payer: Aetna Commercial |
$102.19
|
| Rate for Payer: Aetna Commercial |
$102.19
|
| Rate for Payer: Aetna Medicare |
$102.19
|
| Rate for Payer: Aetna Medicare |
$102.19
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$165.54
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$165.54
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$165.54
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$165.54
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$165.54
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$165.54
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$165.54
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$165.54
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$57.96
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$57.96
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$146.84
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$146.84
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$117.52
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$117.52
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$112.41
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$112.41
|
| Rate for Payer: Cash Price |
$175.92
|
| Rate for Payer: Cash Price |
$179.12
|
| Rate for Payer: Centivo All Commercial |
$158.39
|
| Rate for Payer: Centivo All Commercial |
$158.39
|
| Rate for Payer: Cigna All Commercial |
$102.19
|
| Rate for Payer: Cigna All Commercial |
$102.19
|
| Rate for Payer: CORVEL All Commercial |
$102.19
|
| Rate for Payer: CORVEL All Commercial |
$102.19
|
| Rate for Payer: Coventry All Commercial |
$122.63
|
| Rate for Payer: Coventry All Commercial |
$122.63
|
| Rate for Payer: Encore All Commercial |
$102.19
|
| Rate for Payer: Encore All Commercial |
$102.19
|
| Rate for Payer: Frontpath All Commercial |
$138.58
|
| Rate for Payer: Frontpath All Commercial |
$138.58
|
| Rate for Payer: Humana ChoiceCare |
$94.07
|
| Rate for Payer: Humana ChoiceCare |
$94.07
|
| Rate for Payer: Humana Medicare |
$102.19
|
| Rate for Payer: Humana Medicare |
$102.19
|
| Rate for Payer: Lucent All Commercial |
$143.07
|
| Rate for Payer: Lucent All Commercial |
$143.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$134.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$134.00
|
| Rate for Payer: Managed Health Services Medicaid |
$146.84
|
| Rate for Payer: Managed Health Services Medicaid |
$146.84
|
| Rate for Payer: MDWise Medicaid |
$146.84
|
| Rate for Payer: MDWise Medicaid |
$146.84
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$57.96
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$57.96
|
| Rate for Payer: PHCS All Commercial |
$102.19
|
| Rate for Payer: PHCS All Commercial |
$102.19
|
| Rate for Payer: PHP All Commercial |
$140.30
|
| Rate for Payer: PHP All Commercial |
$140.30
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$102.19
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$102.19
|
| Rate for Payer: Sagamore Health Network All Products |
$102.19
|
| Rate for Payer: Sagamore Health Network All Products |
$102.19
|
| Rate for Payer: Signature Care EPO |
$141.95
|
| Rate for Payer: Signature Care EPO |
$141.95
|
| Rate for Payer: Signature Care PPO |
$141.95
|
| Rate for Payer: Signature Care PPO |
$141.95
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$12,300.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$12,300.00
|
| Rate for Payer: United Healthcare Commercial |
$116.44
|
| Rate for Payer: United Healthcare Commercial |
$116.44
|
| Rate for Payer: United Healthcare Medicare |
$146.60
|
| Rate for Payer: United Healthcare Medicare |
$146.60
|
|
|
PR EXC SKIN BENIG 0.6-1 CM TRUNK,ARM,LEG983
|
Professional
|
Both
|
$291.10
|
|
|
Service Code
|
CPT 11401
|
| Hospital Charge Code |
z11401
|
| Min. Negotiated Rate |
$58.63 |
| Max. Negotiated Rate |
$11,900.00 |
| Rate for Payer: Aetna Commercial |
$98.42
|
| Rate for Payer: Aetna Commercial |
$98.42
|
| Rate for Payer: Aetna Medicare |
$98.42
|
| Rate for Payer: Aetna Medicare |
$98.42
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$168.46
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$168.46
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$168.46
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$168.46
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$168.46
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$168.46
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$168.46
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$168.46
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$58.63
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$58.63
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$143.18
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$143.18
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$113.18
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$113.18
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$108.26
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$108.26
|
| Rate for Payer: Cash Price |
$171.28
|
| Rate for Payer: Cash Price |
$174.66
|
| Rate for Payer: Centivo All Commercial |
$152.55
|
| Rate for Payer: Centivo All Commercial |
$152.55
|
| Rate for Payer: Cigna All Commercial |
$98.42
|
| Rate for Payer: Cigna All Commercial |
$98.42
|
| Rate for Payer: CORVEL All Commercial |
$98.42
|
| Rate for Payer: CORVEL All Commercial |
$98.42
|
| Rate for Payer: Coventry All Commercial |
$118.10
|
| Rate for Payer: Coventry All Commercial |
$118.10
|
| Rate for Payer: Encore All Commercial |
$98.42
|
| Rate for Payer: Encore All Commercial |
$98.42
|
| Rate for Payer: Frontpath All Commercial |
$133.72
|
| Rate for Payer: Frontpath All Commercial |
$133.72
|
| Rate for Payer: Humana ChoiceCare |
$83.29
|
| Rate for Payer: Humana ChoiceCare |
$83.29
|
| Rate for Payer: Humana Medicare |
$98.42
|
| Rate for Payer: Humana Medicare |
$98.42
|
| Rate for Payer: Lucent All Commercial |
$137.79
|
| Rate for Payer: Lucent All Commercial |
$137.79
|
| Rate for Payer: Lutheran Preferred All Commercial |
$129.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$129.00
|
| Rate for Payer: Managed Health Services Medicaid |
$143.18
|
| Rate for Payer: Managed Health Services Medicaid |
$143.18
|
| Rate for Payer: MDWise Medicaid |
$143.18
|
| Rate for Payer: MDWise Medicaid |
$143.18
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$58.63
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$58.63
|
| Rate for Payer: PHCS All Commercial |
$98.42
|
| Rate for Payer: PHCS All Commercial |
$98.42
|
| Rate for Payer: PHP All Commercial |
$135.31
|
| Rate for Payer: PHP All Commercial |
$135.31
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$98.42
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$98.42
|
| Rate for Payer: Sagamore Health Network All Products |
$98.42
|
| Rate for Payer: Sagamore Health Network All Products |
$98.42
|
| Rate for Payer: Signature Care EPO |
$133.45
|
| Rate for Payer: Signature Care EPO |
$133.45
|
| Rate for Payer: Signature Care PPO |
$133.45
|
| Rate for Payer: Signature Care PPO |
$133.45
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$11,900.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$11,900.00
|
| Rate for Payer: United Healthcare Commercial |
$105.83
|
| Rate for Payer: United Healthcare Commercial |
$105.83
|
| Rate for Payer: United Healthcare Medicare |
$142.73
|
| Rate for Payer: United Healthcare Medicare |
$142.73
|
|
|
PR EXC SKIN BENIG 1.1-2 CM FACE,FACIAL
|
Professional
|
Both
|
$360.68
|
|
|
Service Code
|
CPT 11442
|
| Hospital Charge Code |
z11442
|
| Min. Negotiated Rate |
$74.23 |
| Max. Negotiated Rate |
$16,500.00 |
| Rate for Payer: Aetna Commercial |
$136.13
|
| Rate for Payer: Aetna Commercial |
$136.13
|
| Rate for Payer: Aetna Medicare |
$136.13
|
| Rate for Payer: Aetna Medicare |
$136.13
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$185.30
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$185.30
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$185.30
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$185.30
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$185.30
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$185.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$185.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$185.30
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$74.23
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$74.23
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$177.40
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$177.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$156.55
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$156.55
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$149.74
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$149.74
|
| Rate for Payer: Cash Price |
$212.26
|
| Rate for Payer: Cash Price |
$216.41
|
| Rate for Payer: Centivo All Commercial |
$211.00
|
| Rate for Payer: Centivo All Commercial |
$211.00
|
| Rate for Payer: Cigna All Commercial |
$136.13
|
| Rate for Payer: Cigna All Commercial |
$136.13
|
| Rate for Payer: CORVEL All Commercial |
$136.13
|
| Rate for Payer: CORVEL All Commercial |
$136.13
|
| Rate for Payer: Coventry All Commercial |
$163.36
|
| Rate for Payer: Coventry All Commercial |
$163.36
|
| Rate for Payer: Encore All Commercial |
$136.13
|
| Rate for Payer: Encore All Commercial |
$136.13
|
| Rate for Payer: Frontpath All Commercial |
$185.09
|
| Rate for Payer: Frontpath All Commercial |
$185.09
|
| Rate for Payer: Humana ChoiceCare |
$121.73
|
| Rate for Payer: Humana ChoiceCare |
$121.73
|
| Rate for Payer: Humana Medicare |
$136.13
|
| Rate for Payer: Humana Medicare |
$136.13
|
| Rate for Payer: Lucent All Commercial |
$190.58
|
| Rate for Payer: Lucent All Commercial |
$190.58
|
| Rate for Payer: Lutheran Preferred All Commercial |
$178.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$178.00
|
| Rate for Payer: Managed Health Services Medicaid |
$177.40
|
| Rate for Payer: Managed Health Services Medicaid |
$177.40
|
| Rate for Payer: MDWise Medicaid |
$177.40
|
| Rate for Payer: MDWise Medicaid |
$177.40
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$74.23
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$74.23
|
| Rate for Payer: PHCS All Commercial |
$136.13
|
| Rate for Payer: PHCS All Commercial |
$136.13
|
| Rate for Payer: PHP All Commercial |
$187.34
|
| Rate for Payer: PHP All Commercial |
$187.34
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$136.13
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$136.13
|
| Rate for Payer: Sagamore Health Network All Products |
$136.13
|
| Rate for Payer: Sagamore Health Network All Products |
$136.13
|
| Rate for Payer: Signature Care EPO |
$175.10
|
| Rate for Payer: Signature Care EPO |
$175.10
|
| Rate for Payer: Signature Care PPO |
$175.10
|
| Rate for Payer: Signature Care PPO |
$175.10
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$16,500.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$16,500.00
|
| Rate for Payer: United Healthcare Commercial |
$151.05
|
| Rate for Payer: United Healthcare Commercial |
$151.05
|
| Rate for Payer: United Healthcare Medicare |
$176.88
|
| Rate for Payer: United Healthcare Medicare |
$176.88
|
|
|
PR EXC SKIN BENIG 1.1-2 CM REMAINDR BODY
|
Professional
|
Both
|
$334.70
|
|
|
Service Code
|
CPT 11422
|
| Hospital Charge Code |
z11422
|
| Min. Negotiated Rate |
$68.70 |
| Max. Negotiated Rate |
$15,200.00 |
| Rate for Payer: Aetna Commercial |
$126.30
|
| Rate for Payer: Aetna Commercial |
$126.30
|
| Rate for Payer: Aetna Medicare |
$126.30
|
| Rate for Payer: Aetna Medicare |
$126.30
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$169.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$169.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$169.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$169.80
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$169.80
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$169.80
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$169.80
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$169.80
|
| 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 |
$164.61
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$164.61
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$145.25
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$145.25
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$138.93
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$138.93
|
| Rate for Payer: Cash Price |
$196.93
|
| Rate for Payer: Cash Price |
$200.82
|
| Rate for Payer: Centivo All Commercial |
$195.76
|
| Rate for Payer: Centivo All Commercial |
$195.76
|
| Rate for Payer: Cigna All Commercial |
$126.30
|
| Rate for Payer: Cigna All Commercial |
$126.30
|
| Rate for Payer: CORVEL All Commercial |
$126.30
|
| Rate for Payer: CORVEL All Commercial |
$126.30
|
| Rate for Payer: Coventry All Commercial |
$151.56
|
| Rate for Payer: Coventry All Commercial |
$151.56
|
| Rate for Payer: Encore All Commercial |
$126.30
|
| Rate for Payer: Encore All Commercial |
$126.30
|
| Rate for Payer: Frontpath All Commercial |
$171.35
|
| Rate for Payer: Frontpath All Commercial |
$171.35
|
| Rate for Payer: Humana ChoiceCare |
$110.08
|
| Rate for Payer: Humana ChoiceCare |
$110.08
|
| Rate for Payer: Humana Medicare |
$126.30
|
| Rate for Payer: Humana Medicare |
$126.30
|
| Rate for Payer: Lucent All Commercial |
$176.82
|
| Rate for Payer: Lucent All Commercial |
$176.82
|
| Rate for Payer: Lutheran Preferred All Commercial |
$165.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$165.00
|
| Rate for Payer: Managed Health Services Medicaid |
$164.61
|
| Rate for Payer: Managed Health Services Medicaid |
$164.61
|
| Rate for Payer: MDWise Medicaid |
$164.61
|
| Rate for Payer: MDWise Medicaid |
$164.61
|
| 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 |
$126.30
|
| Rate for Payer: PHCS All Commercial |
$126.30
|
| Rate for Payer: PHP All Commercial |
$173.25
|
| Rate for Payer: PHP All Commercial |
$173.25
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$126.30
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$126.30
|
| Rate for Payer: Sagamore Health Network All Products |
$126.30
|
| Rate for Payer: Sagamore Health Network All Products |
$126.30
|
| Rate for Payer: Signature Care EPO |
$158.95
|
| Rate for Payer: Signature Care EPO |
$158.95
|
| Rate for Payer: Signature Care PPO |
$158.95
|
| Rate for Payer: Signature Care PPO |
$158.95
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$15,200.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$15,200.00
|
| Rate for Payer: United Healthcare Commercial |
$140.38
|
| Rate for Payer: United Healthcare Commercial |
$140.38
|
| Rate for Payer: United Healthcare Medicare |
$164.11
|
| Rate for Payer: United Healthcare Medicare |
$164.11
|
|
|
PR EXC SKIN BENIG 1.1-2 CM TRUNK,ARM,LEG
|
Professional
|
Both
|
$320.58
|
|
|
Service Code
|
CPT 11402
|
| Hospital Charge Code |
z11402
|
| Min. Negotiated Rate |
$59.70 |
| Max. Negotiated Rate |
$13,000.00 |
| Rate for Payer: Aetna Commercial |
$107.90
|
| Rate for Payer: Aetna Commercial |
$107.90
|
| Rate for Payer: Aetna Medicare |
$107.90
|
| Rate for Payer: Aetna Medicare |
$107.90
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$187.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$187.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$187.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$187.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$187.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$187.10
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$187.10
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$187.10
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$59.70
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$59.70
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$157.67
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$157.67
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$124.08
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$124.08
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$118.69
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$118.69
|
| Rate for Payer: Cash Price |
$188.33
|
| Rate for Payer: Cash Price |
$192.35
|
| Rate for Payer: Centivo All Commercial |
$167.25
|
| Rate for Payer: Centivo All Commercial |
$167.25
|
| Rate for Payer: Cigna All Commercial |
$107.90
|
| Rate for Payer: Cigna All Commercial |
$107.90
|
| Rate for Payer: CORVEL All Commercial |
$107.90
|
| Rate for Payer: CORVEL All Commercial |
$107.90
|
| Rate for Payer: Coventry All Commercial |
$129.48
|
| Rate for Payer: Coventry All Commercial |
$129.48
|
| Rate for Payer: Encore All Commercial |
$107.90
|
| Rate for Payer: Encore All Commercial |
$107.90
|
| Rate for Payer: Frontpath All Commercial |
$146.95
|
| Rate for Payer: Frontpath All Commercial |
$146.95
|
| Rate for Payer: Humana ChoiceCare |
$96.46
|
| Rate for Payer: Humana ChoiceCare |
$96.46
|
| Rate for Payer: Humana Medicare |
$107.90
|
| Rate for Payer: Humana Medicare |
$107.90
|
| Rate for Payer: Lucent All Commercial |
$151.06
|
| Rate for Payer: Lucent All Commercial |
$151.06
|
| Rate for Payer: Lutheran Preferred All Commercial |
$140.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$140.00
|
| Rate for Payer: Managed Health Services Medicaid |
$157.67
|
| Rate for Payer: Managed Health Services Medicaid |
$157.67
|
| Rate for Payer: MDWise Medicaid |
$157.67
|
| Rate for Payer: MDWise Medicaid |
$157.67
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$59.70
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$59.70
|
| Rate for Payer: PHCS All Commercial |
$107.90
|
| Rate for Payer: PHCS All Commercial |
$107.90
|
| Rate for Payer: PHP All Commercial |
$147.61
|
| Rate for Payer: PHP All Commercial |
$147.61
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$107.90
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$107.90
|
| Rate for Payer: Sagamore Health Network All Products |
$107.90
|
| Rate for Payer: Sagamore Health Network All Products |
$107.90
|
| Rate for Payer: Signature Care EPO |
$153.00
|
| Rate for Payer: Signature Care EPO |
$153.00
|
| Rate for Payer: Signature Care PPO |
$153.00
|
| Rate for Payer: Signature Care PPO |
$153.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$13,000.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$13,000.00
|
| Rate for Payer: United Healthcare Commercial |
$117.19
|
| Rate for Payer: United Healthcare Commercial |
$117.19
|
| Rate for Payer: United Healthcare Medicare |
$156.94
|
| Rate for Payer: United Healthcare Medicare |
$156.94
|
|
|
PR EXC SKIN BENIG 2.1-3 CM FACE,FACIAL
|
Professional
|
Both
|
$425.16
|
|
|
Service Code
|
CPT 11443
|
| Hospital Charge Code |
z11443
|
| Min. Negotiated Rate |
$91.56 |
| Max. Negotiated Rate |
$20,000.00 |
| Rate for Payer: Aetna Commercial |
$166.48
|
| Rate for Payer: Aetna Commercial |
$166.48
|
| Rate for Payer: Aetna Medicare |
$166.48
|
| Rate for Payer: Aetna Medicare |
$166.48
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$235.90
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$235.90
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$235.90
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$235.90
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$235.90
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$235.90
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$235.90
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$235.90
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$91.56
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$91.56
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$209.11
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$209.11
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$191.45
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$191.45
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$183.13
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$183.13
|
| Rate for Payer: Cash Price |
$250.48
|
| Rate for Payer: Cash Price |
$255.10
|
| Rate for Payer: Centivo All Commercial |
$258.04
|
| Rate for Payer: Centivo All Commercial |
$258.04
|
| Rate for Payer: Cigna All Commercial |
$166.48
|
| Rate for Payer: Cigna All Commercial |
$166.48
|
| Rate for Payer: CORVEL All Commercial |
$166.48
|
| Rate for Payer: CORVEL All Commercial |
$166.48
|
| Rate for Payer: Coventry All Commercial |
$199.78
|
| Rate for Payer: Coventry All Commercial |
$199.78
|
| Rate for Payer: Encore All Commercial |
$166.48
|
| Rate for Payer: Encore All Commercial |
$166.48
|
| Rate for Payer: Frontpath All Commercial |
$226.99
|
| Rate for Payer: Frontpath All Commercial |
$226.99
|
| Rate for Payer: Humana ChoiceCare |
$152.91
|
| Rate for Payer: Humana ChoiceCare |
$152.91
|
| Rate for Payer: Humana Medicare |
$166.48
|
| Rate for Payer: Humana Medicare |
$166.48
|
| Rate for Payer: Lucent All Commercial |
$233.07
|
| Rate for Payer: Lucent All Commercial |
$233.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$217.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$217.00
|
| Rate for Payer: Managed Health Services Medicaid |
$209.11
|
| Rate for Payer: Managed Health Services Medicaid |
$209.11
|
| Rate for Payer: MDWise Medicaid |
$209.11
|
| Rate for Payer: MDWise Medicaid |
$209.11
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$91.56
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$91.56
|
| Rate for Payer: PHCS All Commercial |
$166.48
|
| Rate for Payer: PHCS All Commercial |
$166.48
|
| Rate for Payer: PHP All Commercial |
$228.13
|
| Rate for Payer: PHP All Commercial |
$228.13
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$166.48
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$166.48
|
| Rate for Payer: Sagamore Health Network All Products |
$166.48
|
| Rate for Payer: Sagamore Health Network All Products |
$166.48
|
| Rate for Payer: Signature Care EPO |
$215.05
|
| Rate for Payer: Signature Care EPO |
$215.05
|
| Rate for Payer: Signature Care PPO |
$215.05
|
| Rate for Payer: Signature Care PPO |
$215.05
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$20,000.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$20,000.00
|
| Rate for Payer: United Healthcare Commercial |
$187.06
|
| Rate for Payer: United Healthcare Commercial |
$187.06
|
| Rate for Payer: United Healthcare Medicare |
$208.73
|
| Rate for Payer: United Healthcare Medicare |
$208.73
|
|
