|
PR LABYRINTHOTOMY W PERFUSION VESTIBULOACTIVE DRUGS,TRANSCRANIAL
|
Professional
|
Both
|
$423.66
|
|
|
Service Code
|
CPT 69801
|
| Hospital Charge Code |
z69801
|
| Min. Negotiated Rate |
$101.26 |
| Max. Negotiated Rate |
$17,500.00 |
| Rate for Payer: Aetna Commercial |
$116.60
|
| Rate for Payer: Aetna Commercial |
$116.60
|
| Rate for Payer: Aetna Medicare |
$116.60
|
| Rate for Payer: Aetna Medicare |
$116.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$385.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$385.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$385.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$385.80
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$385.80
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$385.80
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$385.80
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$385.80
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$101.26
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$101.26
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$208.37
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$208.37
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$134.09
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$134.09
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$128.26
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$128.26
|
| Rate for Payer: Cash Price |
$259.66
|
| Rate for Payer: Cash Price |
$262.67
|
| Rate for Payer: Centivo All Commercial |
$180.73
|
| Rate for Payer: Centivo All Commercial |
$180.73
|
| Rate for Payer: Cigna All Commercial |
$116.60
|
| Rate for Payer: Cigna All Commercial |
$116.60
|
| Rate for Payer: CORVEL All Commercial |
$116.60
|
| Rate for Payer: CORVEL All Commercial |
$116.60
|
| Rate for Payer: Coventry All Commercial |
$139.92
|
| Rate for Payer: Coventry All Commercial |
$139.92
|
| Rate for Payer: Encore All Commercial |
$116.60
|
| Rate for Payer: Encore All Commercial |
$116.60
|
| Rate for Payer: Frontpath All Commercial |
$160.26
|
| Rate for Payer: Frontpath All Commercial |
$160.26
|
| Rate for Payer: Humana ChoiceCare |
$732.03
|
| Rate for Payer: Humana ChoiceCare |
$732.03
|
| Rate for Payer: Humana Medicare |
$116.60
|
| Rate for Payer: Humana Medicare |
$116.60
|
| Rate for Payer: Lucent All Commercial |
$163.24
|
| Rate for Payer: Lucent All Commercial |
$163.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$186.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$186.00
|
| Rate for Payer: Managed Health Services Medicaid |
$208.37
|
| Rate for Payer: Managed Health Services Medicaid |
$208.37
|
| Rate for Payer: MDWise Medicaid |
$208.37
|
| Rate for Payer: MDWise Medicaid |
$208.37
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$101.26
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$101.26
|
| Rate for Payer: PHCS All Commercial |
$116.60
|
| Rate for Payer: PHCS All Commercial |
$116.60
|
| Rate for Payer: PHP All Commercial |
$147.71
|
| Rate for Payer: PHP All Commercial |
$147.71
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$116.60
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$116.60
|
| Rate for Payer: Sagamore Health Network All Products |
$116.60
|
| Rate for Payer: Sagamore Health Network All Products |
$116.60
|
| Rate for Payer: Signature Care EPO |
$318.22
|
| Rate for Payer: Signature Care EPO |
$318.22
|
| Rate for Payer: Signature Care PPO |
$318.22
|
| Rate for Payer: Signature Care PPO |
$318.22
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$17,500.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$17,500.00
|
| Rate for Payer: United Healthcare Commercial |
$804.94
|
| Rate for Payer: United Healthcare Commercial |
$804.94
|
| Rate for Payer: United Healthcare Medicare |
$209.40
|
| Rate for Payer: United Healthcare Medicare |
$209.40
|
|
|
PR LAP,ABDOMEN,ASPIRATE CYST
|
Professional
|
Both
|
$684.38
|
|
|
Service Code
|
CPT 49322
|
| Hospital Charge Code |
z49322
|
| Min. Negotiated Rate |
$336.31 |
| Max. Negotiated Rate |
$48,300.00 |
| Rate for Payer: Aetna Commercial |
$348.38
|
| Rate for Payer: Aetna Commercial |
$348.38
|
| Rate for Payer: Aetna Medicare |
$348.38
|
| Rate for Payer: Aetna Medicare |
$348.38
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$490.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$490.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$490.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$490.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$490.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$490.10
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$490.10
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$490.10
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$336.61
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$336.61
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$400.64
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$400.64
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$383.22
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$383.22
|
| Rate for Payer: Cash Price |
$424.32
|
| Rate for Payer: Cash Price |
$417.02
|
| Rate for Payer: Centivo All Commercial |
$539.99
|
| Rate for Payer: Centivo All Commercial |
$539.99
|
| Rate for Payer: Cigna All Commercial |
$348.38
|
| Rate for Payer: Cigna All Commercial |
$348.38
|
| Rate for Payer: CORVEL All Commercial |
$348.38
|
| Rate for Payer: CORVEL All Commercial |
$348.38
|
| Rate for Payer: Coventry All Commercial |
$418.06
|
| Rate for Payer: Coventry All Commercial |
$418.06
|
| Rate for Payer: Encore All Commercial |
$348.38
|
| Rate for Payer: Encore All Commercial |
$348.38
|
| Rate for Payer: Frontpath All Commercial |
$493.88
|
| Rate for Payer: Frontpath All Commercial |
$493.88
|
| Rate for Payer: Humana ChoiceCare |
$395.45
|
| Rate for Payer: Humana ChoiceCare |
$395.45
|
| Rate for Payer: Humana Medicare |
$348.38
|
| Rate for Payer: Humana Medicare |
$348.38
|
| Rate for Payer: Lucent All Commercial |
$487.73
|
| Rate for Payer: Lucent All Commercial |
$487.73
|
| Rate for Payer: Lutheran Preferred All Commercial |
$517.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$517.00
|
| Rate for Payer: Managed Health Services Medicaid |
$336.61
|
| Rate for Payer: Managed Health Services Medicaid |
$336.61
|
| Rate for Payer: MDWise Medicaid |
$336.61
|
| Rate for Payer: MDWise Medicaid |
$336.61
|
| Rate for Payer: PHCS All Commercial |
$348.38
|
| Rate for Payer: PHCS All Commercial |
$348.38
|
| Rate for Payer: PHP All Commercial |
$588.54
|
| Rate for Payer: PHP All Commercial |
$588.54
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$348.38
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$348.38
|
| Rate for Payer: Sagamore Health Network All Products |
$348.38
|
| Rate for Payer: Sagamore Health Network All Products |
$348.38
|
| Rate for Payer: Signature Care EPO |
$500.65
|
| Rate for Payer: Signature Care EPO |
$500.65
|
| Rate for Payer: Signature Care PPO |
$500.65
|
| Rate for Payer: Signature Care PPO |
$500.65
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$48,300.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$48,300.00
|
| Rate for Payer: United Healthcare Commercial |
$403.75
|
| Rate for Payer: United Healthcare Commercial |
$403.75
|
| Rate for Payer: United Healthcare Medicare |
$336.31
|
| Rate for Payer: United Healthcare Medicare |
$336.31
|
|
|
PR LAP,ABD/PERIT/OMENTUM,UNLIST
|
Professional
|
Both
|
$735.00
|
|
|
Service Code
|
CPT 49329
|
| Hospital Charge Code |
z49329
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$624.75 |
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$0.01
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$0.01
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$0.01
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$0.01
|
| Rate for Payer: Cash Price |
$455.70
|
| Rate for Payer: Cash Price |
$455.70
|
| Rate for Payer: Lutheran Preferred All Commercial |
$624.75
|
| Rate for Payer: Signature Care EPO |
$468.56
|
| Rate for Payer: Signature Care PPO |
$468.56
|
|
|
PR LAP,APPENDECTOMY
|
Professional
|
Both
|
$1,096.92
|
|
|
Service Code
|
CPT 44970
|
| Hospital Charge Code |
z44970
|
| Min. Negotiated Rate |
$538.73 |
| Max. Negotiated Rate |
$77,300.00 |
| Rate for Payer: Aetna Commercial |
$558.86
|
| Rate for Payer: Aetna Commercial |
$558.86
|
| Rate for Payer: Aetna Medicare |
$558.86
|
| Rate for Payer: Aetna Medicare |
$558.86
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$673.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$673.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$673.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$673.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$673.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$673.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$673.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$673.00
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$539.51
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$539.51
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$642.69
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$642.69
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$614.75
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$614.75
|
| Rate for Payer: Cash Price |
$680.09
|
| Rate for Payer: Cash Price |
$668.03
|
| Rate for Payer: Centivo All Commercial |
$866.23
|
| Rate for Payer: Centivo All Commercial |
$866.23
|
| Rate for Payer: Cigna All Commercial |
$558.86
|
| Rate for Payer: Cigna All Commercial |
$558.86
|
| Rate for Payer: CORVEL All Commercial |
$558.86
|
| Rate for Payer: CORVEL All Commercial |
$558.86
|
| Rate for Payer: Coventry All Commercial |
$670.63
|
| Rate for Payer: Coventry All Commercial |
$670.63
|
| Rate for Payer: Encore All Commercial |
$558.86
|
| Rate for Payer: Encore All Commercial |
$558.86
|
| Rate for Payer: Frontpath All Commercial |
$795.54
|
| Rate for Payer: Frontpath All Commercial |
$795.54
|
| Rate for Payer: Humana ChoiceCare |
$584.85
|
| Rate for Payer: Humana ChoiceCare |
$584.85
|
| Rate for Payer: Humana Medicare |
$558.86
|
| Rate for Payer: Humana Medicare |
$558.86
|
| Rate for Payer: Lucent All Commercial |
$782.40
|
| Rate for Payer: Lucent All Commercial |
$782.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$828.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$828.00
|
| Rate for Payer: Managed Health Services Medicaid |
$539.51
|
| Rate for Payer: Managed Health Services Medicaid |
$539.51
|
| Rate for Payer: MDWise Medicaid |
$539.51
|
| Rate for Payer: MDWise Medicaid |
$539.51
|
| Rate for Payer: PHCS All Commercial |
$558.86
|
| Rate for Payer: PHCS All Commercial |
$558.86
|
| Rate for Payer: PHP All Commercial |
$942.78
|
| Rate for Payer: PHP All Commercial |
$942.78
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$558.86
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$558.86
|
| Rate for Payer: Sagamore Health Network All Products |
$558.86
|
| Rate for Payer: Sagamore Health Network All Products |
$558.86
|
| Rate for Payer: Signature Care EPO |
$747.15
|
| Rate for Payer: Signature Care EPO |
$747.15
|
| Rate for Payer: Signature Care PPO |
$747.15
|
| Rate for Payer: Signature Care PPO |
$747.15
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$77,300.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$77,300.00
|
| Rate for Payer: United Healthcare Commercial |
$629.04
|
| Rate for Payer: United Healthcare Commercial |
$629.04
|
| Rate for Payer: United Healthcare Medicare |
$538.73
|
| Rate for Payer: United Healthcare Medicare |
$538.73
|
|
|
PR LAP,APPENDIX UNLISTED PROCED
|
Professional
|
Both
|
$1,588.00
|
|
|
Service Code
|
CPT 44979
|
| Hospital Charge Code |
z44979
|
| Rate for Payer: Cash Price |
$984.56
|
|
|
PR LAPAROSCOPY TOTAL HYSTERECTOMY UTERUS > 250 GRAM
|
Professional
|
Both
|
$1,892.82
|
|
|
Service Code
|
CPT 58572
|
| Hospital Charge Code |
z58572
|
| Min. Negotiated Rate |
$925.20 |
| Max. Negotiated Rate |
$126,100.00 |
| Rate for Payer: Aetna Commercial |
$977.67
|
| Rate for Payer: Aetna Commercial |
$977.67
|
| Rate for Payer: Aetna Medicare |
$977.67
|
| Rate for Payer: Aetna Medicare |
$977.67
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$925.20
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$925.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,124.32
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,124.32
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,075.44
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,075.44
|
| Rate for Payer: Cash Price |
$1,173.55
|
| Rate for Payer: Cash Price |
$1,166.28
|
| Rate for Payer: Centivo All Commercial |
$1,515.39
|
| Rate for Payer: Centivo All Commercial |
$1,515.39
|
| Rate for Payer: Cigna All Commercial |
$977.67
|
| Rate for Payer: Cigna All Commercial |
$977.67
|
| Rate for Payer: CORVEL All Commercial |
$977.67
|
| Rate for Payer: CORVEL All Commercial |
$977.67
|
| Rate for Payer: Coventry All Commercial |
$1,173.20
|
| Rate for Payer: Coventry All Commercial |
$1,173.20
|
| Rate for Payer: Encore All Commercial |
$977.67
|
| Rate for Payer: Encore All Commercial |
$977.67
|
| Rate for Payer: Frontpath All Commercial |
$1,357.60
|
| Rate for Payer: Frontpath All Commercial |
$1,357.60
|
| Rate for Payer: Humana ChoiceCare |
$1,145.17
|
| Rate for Payer: Humana ChoiceCare |
$1,145.17
|
| Rate for Payer: Humana Medicare |
$977.67
|
| Rate for Payer: Humana Medicare |
$977.67
|
| Rate for Payer: Lucent All Commercial |
$1,368.74
|
| Rate for Payer: Lucent All Commercial |
$1,368.74
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,358.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,358.00
|
| Rate for Payer: Managed Health Services Medicaid |
$925.20
|
| Rate for Payer: Managed Health Services Medicaid |
$925.20
|
| Rate for Payer: MDWise Medicaid |
$925.20
|
| Rate for Payer: MDWise Medicaid |
$925.20
|
| Rate for Payer: PHCS All Commercial |
$977.67
|
| Rate for Payer: PHCS All Commercial |
$977.67
|
| Rate for Payer: PHP All Commercial |
$1,249.26
|
| Rate for Payer: PHP All Commercial |
$1,249.26
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$977.67
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$977.67
|
| Rate for Payer: Sagamore Health Network All Products |
$977.67
|
| Rate for Payer: Sagamore Health Network All Products |
$977.67
|
| Rate for Payer: Signature Care EPO |
$1,264.59
|
| Rate for Payer: Signature Care EPO |
$1,264.59
|
| Rate for Payer: Signature Care PPO |
$1,264.59
|
| Rate for Payer: Signature Care PPO |
$1,264.59
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$126,100.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$126,100.00
|
| Rate for Payer: United Healthcare Commercial |
$1,290.85
|
| Rate for Payer: United Healthcare Commercial |
$1,290.85
|
| Rate for Payer: United Healthcare Medicare |
$946.41
|
| Rate for Payer: United Healthcare Medicare |
$946.41
|
|
|
PR LAPAROSCOPY TOT HYSTERECTOMY UTERUS >250 GRAM W TUBE/OVARY
|
Professional
|
Both
|
$2,259.22
|
|
|
Service Code
|
CPT 58573
|
| Hospital Charge Code |
z58573
|
| Min. Negotiated Rate |
$1,108.63 |
| Max. Negotiated Rate |
$147,700.00 |
| Rate for Payer: Aetna Commercial |
$1,146.83
|
| Rate for Payer: Aetna Commercial |
$1,146.83
|
| Rate for Payer: Aetna Medicare |
$1,146.83
|
| Rate for Payer: Aetna Medicare |
$1,146.83
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$1,111.17
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$1,111.17
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,318.85
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,318.85
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,261.51
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,261.51
|
| Rate for Payer: Cash Price |
$1,400.72
|
| Rate for Payer: Cash Price |
$1,374.70
|
| Rate for Payer: Centivo All Commercial |
$1,777.59
|
| Rate for Payer: Centivo All Commercial |
$1,777.59
|
| Rate for Payer: Cigna All Commercial |
$1,146.83
|
| Rate for Payer: Cigna All Commercial |
$1,146.83
|
| Rate for Payer: CORVEL All Commercial |
$1,146.83
|
| Rate for Payer: CORVEL All Commercial |
$1,146.83
|
| Rate for Payer: Coventry All Commercial |
$1,376.20
|
| Rate for Payer: Coventry All Commercial |
$1,376.20
|
| Rate for Payer: Encore All Commercial |
$1,146.83
|
| Rate for Payer: Encore All Commercial |
$1,146.83
|
| Rate for Payer: Frontpath All Commercial |
$1,593.80
|
| Rate for Payer: Frontpath All Commercial |
$1,593.80
|
| Rate for Payer: Humana ChoiceCare |
$1,296.35
|
| Rate for Payer: Humana ChoiceCare |
$1,296.35
|
| Rate for Payer: Humana Medicare |
$1,146.83
|
| Rate for Payer: Humana Medicare |
$1,146.83
|
| Rate for Payer: Lucent All Commercial |
$1,605.56
|
| Rate for Payer: Lucent All Commercial |
$1,605.56
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,591.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,591.00
|
| Rate for Payer: Managed Health Services Medicaid |
$1,111.17
|
| Rate for Payer: Managed Health Services Medicaid |
$1,111.17
|
| Rate for Payer: MDWise Medicaid |
$1,111.17
|
| Rate for Payer: MDWise Medicaid |
$1,111.17
|
| Rate for Payer: PHCS All Commercial |
$1,146.83
|
| Rate for Payer: PHCS All Commercial |
$1,146.83
|
| Rate for Payer: PHP All Commercial |
$1,463.39
|
| Rate for Payer: PHP All Commercial |
$1,463.39
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,146.83
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,146.83
|
| Rate for Payer: Sagamore Health Network All Products |
$1,146.83
|
| Rate for Payer: Sagamore Health Network All Products |
$1,146.83
|
| Rate for Payer: Signature Care EPO |
$1,431.52
|
| Rate for Payer: Signature Care EPO |
$1,431.52
|
| Rate for Payer: Signature Care PPO |
$1,431.52
|
| Rate for Payer: Signature Care PPO |
$1,431.52
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$147,700.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$147,700.00
|
| Rate for Payer: United Healthcare Commercial |
$1,462.61
|
| Rate for Payer: United Healthcare Commercial |
$1,462.61
|
| Rate for Payer: United Healthcare Medicare |
$1,108.63
|
| Rate for Payer: United Healthcare Medicare |
$1,108.63
|
|
|
PR LAPAROSCOPY W TOT HYSTERECT UTERUS 250 GRAM OR LESS
|
Professional
|
Both
|
$1,499.48
|
|
|
Service Code
|
CPT 58570
|
| Hospital Charge Code |
z58570
|
| Min. Negotiated Rate |
$736.78 |
| Max. Negotiated Rate |
$98,200.00 |
| Rate for Payer: Aetna Commercial |
$759.82
|
| Rate for Payer: Aetna Commercial |
$759.82
|
| Rate for Payer: Aetna Medicare |
$759.82
|
| Rate for Payer: Aetna Medicare |
$759.82
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$737.50
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$737.50
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$873.79
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$873.79
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$835.80
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$835.80
|
| Rate for Payer: Cash Price |
$929.68
|
| Rate for Payer: Cash Price |
$913.61
|
| Rate for Payer: Centivo All Commercial |
$1,177.72
|
| Rate for Payer: Centivo All Commercial |
$1,177.72
|
| Rate for Payer: Cigna All Commercial |
$759.82
|
| Rate for Payer: Cigna All Commercial |
$759.82
|
| Rate for Payer: CORVEL All Commercial |
$759.82
|
| Rate for Payer: CORVEL All Commercial |
$759.82
|
| Rate for Payer: Coventry All Commercial |
$911.78
|
| Rate for Payer: Coventry All Commercial |
$911.78
|
| Rate for Payer: Encore All Commercial |
$759.82
|
| Rate for Payer: Encore All Commercial |
$759.82
|
| Rate for Payer: Frontpath All Commercial |
$1,054.09
|
| Rate for Payer: Frontpath All Commercial |
$1,054.09
|
| Rate for Payer: Humana ChoiceCare |
$922.30
|
| Rate for Payer: Humana ChoiceCare |
$922.30
|
| Rate for Payer: Humana Medicare |
$759.82
|
| Rate for Payer: Humana Medicare |
$759.82
|
| Rate for Payer: Lucent All Commercial |
$1,063.75
|
| Rate for Payer: Lucent All Commercial |
$1,063.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,057.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,057.00
|
| Rate for Payer: Managed Health Services Medicaid |
$737.50
|
| Rate for Payer: Managed Health Services Medicaid |
$737.50
|
| Rate for Payer: MDWise Medicaid |
$737.50
|
| Rate for Payer: MDWise Medicaid |
$737.50
|
| Rate for Payer: PHCS All Commercial |
$759.82
|
| Rate for Payer: PHCS All Commercial |
$759.82
|
| Rate for Payer: PHP All Commercial |
$972.54
|
| Rate for Payer: PHP All Commercial |
$972.54
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$759.82
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$759.82
|
| Rate for Payer: Sagamore Health Network All Products |
$759.82
|
| Rate for Payer: Sagamore Health Network All Products |
$759.82
|
| Rate for Payer: Signature Care EPO |
$1,018.47
|
| Rate for Payer: Signature Care EPO |
$1,018.47
|
| Rate for Payer: Signature Care PPO |
$1,018.47
|
| Rate for Payer: Signature Care PPO |
$1,018.47
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$98,200.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$98,200.00
|
| Rate for Payer: United Healthcare Commercial |
$1,037.33
|
| Rate for Payer: United Healthcare Commercial |
$1,037.33
|
| Rate for Payer: United Healthcare Medicare |
$736.78
|
| Rate for Payer: United Healthcare Medicare |
$736.78
|
|
|
PR LAPAROSCOPY W TOT HYSTERECTUTERUS <=250 GRAM W TUBE/OVARY
|
Professional
|
Both
|
$1,687.70
|
|
|
Service Code
|
CPT 58571
|
| Hospital Charge Code |
z58571
|
| Min. Negotiated Rate |
$827.75 |
| Max. Negotiated Rate |
$110,300.00 |
| Rate for Payer: Aetna Commercial |
$855.50
|
| Rate for Payer: Aetna Commercial |
$855.50
|
| Rate for Payer: Aetna Medicare |
$855.50
|
| Rate for Payer: Aetna Medicare |
$855.50
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$830.08
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$830.08
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$983.83
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$983.83
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$941.05
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$941.05
|
| Rate for Payer: Cash Price |
$1,046.37
|
| Rate for Payer: Cash Price |
$1,026.41
|
| Rate for Payer: Centivo All Commercial |
$1,326.03
|
| Rate for Payer: Centivo All Commercial |
$1,326.03
|
| Rate for Payer: Cigna All Commercial |
$855.50
|
| Rate for Payer: Cigna All Commercial |
$855.50
|
| Rate for Payer: CORVEL All Commercial |
$855.50
|
| Rate for Payer: CORVEL All Commercial |
$855.50
|
| Rate for Payer: Coventry All Commercial |
$1,026.60
|
| Rate for Payer: Coventry All Commercial |
$1,026.60
|
| Rate for Payer: Encore All Commercial |
$855.50
|
| Rate for Payer: Encore All Commercial |
$855.50
|
| Rate for Payer: Frontpath All Commercial |
$1,187.33
|
| Rate for Payer: Frontpath All Commercial |
$1,187.33
|
| Rate for Payer: Humana ChoiceCare |
$1,012.83
|
| Rate for Payer: Humana ChoiceCare |
$1,012.83
|
| Rate for Payer: Humana Medicare |
$855.50
|
| Rate for Payer: Humana Medicare |
$855.50
|
| Rate for Payer: Lucent All Commercial |
$1,197.70
|
| Rate for Payer: Lucent All Commercial |
$1,197.70
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,188.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,188.00
|
| Rate for Payer: Managed Health Services Medicaid |
$830.08
|
| Rate for Payer: Managed Health Services Medicaid |
$830.08
|
| Rate for Payer: MDWise Medicaid |
$830.08
|
| Rate for Payer: MDWise Medicaid |
$830.08
|
| Rate for Payer: PHCS All Commercial |
$855.50
|
| Rate for Payer: PHCS All Commercial |
$855.50
|
| Rate for Payer: PHP All Commercial |
$1,092.63
|
| Rate for Payer: PHP All Commercial |
$1,092.63
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$855.50
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$855.50
|
| Rate for Payer: Sagamore Health Network All Products |
$855.50
|
| Rate for Payer: Sagamore Health Network All Products |
$855.50
|
| Rate for Payer: Signature Care EPO |
$1,118.45
|
| Rate for Payer: Signature Care EPO |
$1,118.45
|
| Rate for Payer: Signature Care PPO |
$1,118.45
|
| Rate for Payer: Signature Care PPO |
$1,118.45
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$110,300.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$110,300.00
|
| Rate for Payer: United Healthcare Commercial |
$1,140.59
|
| Rate for Payer: United Healthcare Commercial |
$1,140.59
|
| Rate for Payer: United Healthcare Medicare |
$827.75
|
| Rate for Payer: United Healthcare Medicare |
$827.75
|
|
|
PR LAP,CHOLECYSTECTOMY
|
Professional
|
Both
|
$1,178.08
|
|
|
Service Code
|
CPT 47562
|
| Hospital Charge Code |
z47562
|
| Min. Negotiated Rate |
$589.04 |
| Max. Negotiated Rate |
$84,500.00 |
| Rate for Payer: Aetna Commercial |
$612.38
|
| Rate for Payer: Aetna Commercial |
$612.38
|
| Rate for Payer: Aetna Medicare |
$612.38
|
| Rate for Payer: Aetna Medicare |
$612.38
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$892.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$892.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$892.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$892.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$892.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$892.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$892.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$892.00
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$590.35
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$590.35
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$704.24
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$704.24
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$673.62
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$673.62
|
| Rate for Payer: Cash Price |
$730.41
|
| Rate for Payer: Cash Price |
$744.19
|
| Rate for Payer: Centivo All Commercial |
$949.19
|
| Rate for Payer: Centivo All Commercial |
$949.19
|
| Rate for Payer: Cigna All Commercial |
$612.38
|
| Rate for Payer: Cigna All Commercial |
$612.38
|
| Rate for Payer: CORVEL All Commercial |
$612.38
|
| Rate for Payer: CORVEL All Commercial |
$612.38
|
| Rate for Payer: Coventry All Commercial |
$734.86
|
| Rate for Payer: Coventry All Commercial |
$734.86
|
| Rate for Payer: Encore All Commercial |
$612.38
|
| Rate for Payer: Encore All Commercial |
$612.38
|
| Rate for Payer: Frontpath All Commercial |
$873.86
|
| Rate for Payer: Frontpath All Commercial |
$873.86
|
| Rate for Payer: Humana ChoiceCare |
$736.13
|
| Rate for Payer: Humana ChoiceCare |
$736.13
|
| Rate for Payer: Humana Medicare |
$612.38
|
| Rate for Payer: Humana Medicare |
$612.38
|
| Rate for Payer: Lucent All Commercial |
$857.33
|
| Rate for Payer: Lucent All Commercial |
$857.33
|
| Rate for Payer: Lutheran Preferred All Commercial |
$906.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$906.00
|
| Rate for Payer: Managed Health Services Medicaid |
$590.35
|
| Rate for Payer: Managed Health Services Medicaid |
$590.35
|
| Rate for Payer: MDWise Medicaid |
$590.35
|
| Rate for Payer: MDWise Medicaid |
$590.35
|
| Rate for Payer: PHCS All Commercial |
$612.38
|
| Rate for Payer: PHCS All Commercial |
$612.38
|
| Rate for Payer: PHP All Commercial |
$1,030.83
|
| Rate for Payer: PHP All Commercial |
$1,030.83
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$612.38
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$612.38
|
| Rate for Payer: Sagamore Health Network All Products |
$612.38
|
| Rate for Payer: Sagamore Health Network All Products |
$612.38
|
| Rate for Payer: Signature Care EPO |
$931.60
|
| Rate for Payer: Signature Care EPO |
$931.60
|
| Rate for Payer: Signature Care PPO |
$931.60
|
| Rate for Payer: Signature Care PPO |
$931.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$84,500.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$84,500.00
|
| Rate for Payer: United Healthcare Commercial |
$783.93
|
| Rate for Payer: United Healthcare Commercial |
$783.93
|
| Rate for Payer: United Healthcare Medicare |
$589.04
|
| Rate for Payer: United Healthcare Medicare |
$589.04
|
|
|
PR LAP,CHOLECYSTECTOMY/EXPLORE
|
Professional
|
Both
|
$2,026.32
|
|
|
Service Code
|
CPT 47564
|
| Hospital Charge Code |
z47564
|
| Min. Negotiated Rate |
$926.74 |
| Max. Negotiated Rate |
$142,900.00 |
| Rate for Payer: Aetna Commercial |
$1,034.32
|
| Rate for Payer: Aetna Commercial |
$1,034.32
|
| Rate for Payer: Aetna Medicare |
$1,034.32
|
| Rate for Payer: Aetna Medicare |
$1,034.32
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$1,139.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$1,139.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,139.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,139.20
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,139.20
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,139.20
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,139.20
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,139.20
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$996.62
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$996.62
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,189.47
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,189.47
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,137.75
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,137.75
|
| Rate for Payer: Cash Price |
$1,256.32
|
| Rate for Payer: Cash Price |
$1,234.79
|
| Rate for Payer: Centivo All Commercial |
$1,603.20
|
| Rate for Payer: Centivo All Commercial |
$1,603.20
|
| Rate for Payer: Cigna All Commercial |
$1,034.32
|
| Rate for Payer: Cigna All Commercial |
$1,034.32
|
| Rate for Payer: CORVEL All Commercial |
$1,034.32
|
| Rate for Payer: CORVEL All Commercial |
$1,034.32
|
| Rate for Payer: Coventry All Commercial |
$1,241.18
|
| Rate for Payer: Coventry All Commercial |
$1,241.18
|
| Rate for Payer: Encore All Commercial |
$1,034.32
|
| Rate for Payer: Encore All Commercial |
$1,034.32
|
| Rate for Payer: Frontpath All Commercial |
$1,476.92
|
| Rate for Payer: Frontpath All Commercial |
$1,476.92
|
| Rate for Payer: Humana ChoiceCare |
$926.74
|
| Rate for Payer: Humana ChoiceCare |
$926.74
|
| Rate for Payer: Humana Medicare |
$1,034.32
|
| Rate for Payer: Humana Medicare |
$1,034.32
|
| Rate for Payer: Lucent All Commercial |
$1,448.05
|
| Rate for Payer: Lucent All Commercial |
$1,448.05
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,531.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,531.00
|
| Rate for Payer: Managed Health Services Medicaid |
$996.62
|
| Rate for Payer: Managed Health Services Medicaid |
$996.62
|
| Rate for Payer: MDWise Medicaid |
$996.62
|
| Rate for Payer: MDWise Medicaid |
$996.62
|
| Rate for Payer: PHCS All Commercial |
$1,034.32
|
| Rate for Payer: PHCS All Commercial |
$1,034.32
|
| Rate for Payer: PHP All Commercial |
$1,742.66
|
| Rate for Payer: PHP All Commercial |
$1,742.66
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,034.32
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,034.32
|
| Rate for Payer: Sagamore Health Network All Products |
$1,034.32
|
| Rate for Payer: Sagamore Health Network All Products |
$1,034.32
|
| Rate for Payer: Signature Care EPO |
$1,172.15
|
| Rate for Payer: Signature Care EPO |
$1,172.15
|
| Rate for Payer: Signature Care PPO |
$1,172.15
|
| Rate for Payer: Signature Care PPO |
$1,172.15
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$142,900.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$142,900.00
|
| Rate for Payer: United Healthcare Commercial |
$928.40
|
| Rate for Payer: United Healthcare Commercial |
$928.40
|
| Rate for Payer: United Healthcare Medicare |
$995.80
|
| Rate for Payer: United Healthcare Medicare |
$995.80
|
|
|
PR LAP,CHOLECYSTECTOMY/GRAPH
|
Professional
|
Both
|
$1,304.40
|
|
|
Service Code
|
CPT 47563
|
| Hospital Charge Code |
z47563
|
| Min. Negotiated Rate |
$641.56 |
| Max. Negotiated Rate |
$92,100.00 |
| Rate for Payer: Aetna Commercial |
$666.42
|
| Rate for Payer: Aetna Commercial |
$666.42
|
| Rate for Payer: Aetna Medicare |
$666.42
|
| Rate for Payer: Aetna Medicare |
$666.42
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$965.28
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$965.28
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$965.28
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$965.28
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$965.28
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$965.28
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$965.28
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$965.28
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$641.56
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$641.56
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$766.38
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$766.38
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$733.06
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$733.06
|
| Rate for Payer: Cash Price |
$808.73
|
| Rate for Payer: Cash Price |
$795.71
|
| Rate for Payer: Centivo All Commercial |
$1,032.95
|
| Rate for Payer: Centivo All Commercial |
$1,032.95
|
| Rate for Payer: Cigna All Commercial |
$666.42
|
| Rate for Payer: Cigna All Commercial |
$666.42
|
| Rate for Payer: CORVEL All Commercial |
$666.42
|
| Rate for Payer: CORVEL All Commercial |
$666.42
|
| Rate for Payer: Coventry All Commercial |
$799.70
|
| Rate for Payer: Coventry All Commercial |
$799.70
|
| Rate for Payer: Encore All Commercial |
$666.42
|
| Rate for Payer: Encore All Commercial |
$666.42
|
| Rate for Payer: Frontpath All Commercial |
$951.20
|
| Rate for Payer: Frontpath All Commercial |
$951.20
|
| Rate for Payer: Humana ChoiceCare |
$790.21
|
| Rate for Payer: Humana ChoiceCare |
$790.21
|
| Rate for Payer: Humana Medicare |
$666.42
|
| Rate for Payer: Humana Medicare |
$666.42
|
| Rate for Payer: Lucent All Commercial |
$932.99
|
| Rate for Payer: Lucent All Commercial |
$932.99
|
| Rate for Payer: Lutheran Preferred All Commercial |
$987.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$987.00
|
| Rate for Payer: Managed Health Services Medicaid |
$641.56
|
| Rate for Payer: Managed Health Services Medicaid |
$641.56
|
| Rate for Payer: MDWise Medicaid |
$641.56
|
| Rate for Payer: MDWise Medicaid |
$641.56
|
| Rate for Payer: PHCS All Commercial |
$666.42
|
| Rate for Payer: PHCS All Commercial |
$666.42
|
| Rate for Payer: PHP All Commercial |
$1,122.98
|
| Rate for Payer: PHP All Commercial |
$1,122.98
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$666.42
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$666.42
|
| Rate for Payer: Sagamore Health Network All Products |
$666.42
|
| Rate for Payer: Sagamore Health Network All Products |
$666.42
|
| Rate for Payer: Signature Care EPO |
$999.60
|
| Rate for Payer: Signature Care EPO |
$999.60
|
| Rate for Payer: Signature Care PPO |
$999.60
|
| Rate for Payer: Signature Care PPO |
$999.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$92,100.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$92,100.00
|
| Rate for Payer: United Healthcare Commercial |
$802.71
|
| Rate for Payer: United Healthcare Commercial |
$802.71
|
| Rate for Payer: United Healthcare Medicare |
$641.70
|
| Rate for Payer: United Healthcare Medicare |
$641.70
|
|
|
PR LAP,DIAGNOSTIC ABDOMEN
|
Professional
|
Both
|
$601.34
|
|
|
Service Code
|
CPT 49320
|
| Hospital Charge Code |
z49320
|
| Min. Negotiated Rate |
$294.48 |
| Max. Negotiated Rate |
$42,300.00 |
| Rate for Payer: Aetna Commercial |
$304.94
|
| Rate for Payer: Aetna Commercial |
$304.94
|
| Rate for Payer: Aetna Medicare |
$304.94
|
| Rate for Payer: Aetna Medicare |
$304.94
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$442.70
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$442.70
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$442.70
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$442.70
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$442.70
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$442.70
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$442.70
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$442.70
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$295.76
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$295.76
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$350.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$350.68
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$335.43
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$335.43
|
| Rate for Payer: Cash Price |
$372.83
|
| Rate for Payer: Cash Price |
$365.16
|
| Rate for Payer: Centivo All Commercial |
$472.66
|
| Rate for Payer: Centivo All Commercial |
$472.66
|
| Rate for Payer: Cigna All Commercial |
$304.94
|
| Rate for Payer: Cigna All Commercial |
$304.94
|
| Rate for Payer: CORVEL All Commercial |
$304.94
|
| Rate for Payer: CORVEL All Commercial |
$304.94
|
| Rate for Payer: Coventry All Commercial |
$365.93
|
| Rate for Payer: Coventry All Commercial |
$365.93
|
| Rate for Payer: Encore All Commercial |
$304.94
|
| Rate for Payer: Encore All Commercial |
$304.94
|
| Rate for Payer: Frontpath All Commercial |
$431.85
|
| Rate for Payer: Frontpath All Commercial |
$431.85
|
| Rate for Payer: Humana ChoiceCare |
$352.25
|
| Rate for Payer: Humana ChoiceCare |
$352.25
|
| Rate for Payer: Humana Medicare |
$304.94
|
| Rate for Payer: Humana Medicare |
$304.94
|
| Rate for Payer: Lucent All Commercial |
$426.92
|
| Rate for Payer: Lucent All Commercial |
$426.92
|
| Rate for Payer: Lutheran Preferred All Commercial |
$453.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$453.00
|
| Rate for Payer: Managed Health Services Medicaid |
$295.76
|
| Rate for Payer: Managed Health Services Medicaid |
$295.76
|
| Rate for Payer: MDWise Medicaid |
$295.76
|
| Rate for Payer: MDWise Medicaid |
$295.76
|
| Rate for Payer: PHCS All Commercial |
$304.94
|
| Rate for Payer: PHCS All Commercial |
$304.94
|
| Rate for Payer: PHP All Commercial |
$515.34
|
| Rate for Payer: PHP All Commercial |
$515.34
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$304.94
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$304.94
|
| Rate for Payer: Sagamore Health Network All Products |
$304.94
|
| Rate for Payer: Sagamore Health Network All Products |
$304.94
|
| Rate for Payer: Signature Care EPO |
$445.40
|
| Rate for Payer: Signature Care EPO |
$445.40
|
| Rate for Payer: Signature Care PPO |
$445.40
|
| Rate for Payer: Signature Care PPO |
$445.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$42,300.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$42,300.00
|
| Rate for Payer: United Healthcare Commercial |
$352.56
|
| Rate for Payer: United Healthcare Commercial |
$352.56
|
| Rate for Payer: United Healthcare Medicare |
$294.48
|
| Rate for Payer: United Healthcare Medicare |
$294.48
|
|
|
PR LAP,DX SURGICAL ABD W/BIOPSY
|
Professional
|
Both
|
$630.52
|
|
|
Service Code
|
CPT 49321
|
| Hospital Charge Code |
z49321
|
| Min. Negotiated Rate |
$309.23 |
| Max. Negotiated Rate |
$44,400.00 |
| Rate for Payer: Aetna Commercial |
$320.31
|
| Rate for Payer: Aetna Commercial |
$320.31
|
| Rate for Payer: Aetna Medicare |
$320.31
|
| Rate for Payer: Aetna Medicare |
$320.31
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$471.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$471.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$471.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$471.80
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$471.80
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$471.80
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$471.80
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$471.80
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$310.11
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$310.11
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$368.36
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$368.36
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$352.34
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$352.34
|
| Rate for Payer: Cash Price |
$390.92
|
| Rate for Payer: Cash Price |
$383.45
|
| Rate for Payer: Centivo All Commercial |
$496.48
|
| Rate for Payer: Centivo All Commercial |
$496.48
|
| Rate for Payer: Cigna All Commercial |
$320.31
|
| Rate for Payer: Cigna All Commercial |
$320.31
|
| Rate for Payer: CORVEL All Commercial |
$320.31
|
| Rate for Payer: CORVEL All Commercial |
$320.31
|
| Rate for Payer: Coventry All Commercial |
$384.37
|
| Rate for Payer: Coventry All Commercial |
$384.37
|
| Rate for Payer: Encore All Commercial |
$320.31
|
| Rate for Payer: Encore All Commercial |
$320.31
|
| Rate for Payer: Frontpath All Commercial |
$452.48
|
| Rate for Payer: Frontpath All Commercial |
$452.48
|
| Rate for Payer: Humana ChoiceCare |
$367.26
|
| Rate for Payer: Humana ChoiceCare |
$367.26
|
| Rate for Payer: Humana Medicare |
$320.31
|
| Rate for Payer: Humana Medicare |
$320.31
|
| Rate for Payer: Lucent All Commercial |
$448.43
|
| Rate for Payer: Lucent All Commercial |
$448.43
|
| Rate for Payer: Lutheran Preferred All Commercial |
$475.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$475.00
|
| Rate for Payer: Managed Health Services Medicaid |
$310.11
|
| Rate for Payer: Managed Health Services Medicaid |
$310.11
|
| Rate for Payer: MDWise Medicaid |
$310.11
|
| Rate for Payer: MDWise Medicaid |
$310.11
|
| Rate for Payer: PHCS All Commercial |
$320.31
|
| Rate for Payer: PHCS All Commercial |
$320.31
|
| Rate for Payer: PHP All Commercial |
$541.15
|
| Rate for Payer: PHP All Commercial |
$541.15
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$320.31
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$320.31
|
| Rate for Payer: Sagamore Health Network All Products |
$320.31
|
| Rate for Payer: Sagamore Health Network All Products |
$320.31
|
| Rate for Payer: Signature Care EPO |
$464.10
|
| Rate for Payer: Signature Care EPO |
$464.10
|
| Rate for Payer: Signature Care PPO |
$464.10
|
| Rate for Payer: Signature Care PPO |
$464.10
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$44,400.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$44,400.00
|
| Rate for Payer: United Healthcare Commercial |
$371.16
|
| Rate for Payer: United Healthcare Commercial |
$371.16
|
| Rate for Payer: United Healthcare Medicare |
$309.23
|
| Rate for Payer: United Healthcare Medicare |
$309.23
|
|
|
PR LAP,FULGURATE/EXCISE LESIONS
|
Professional
|
Both
|
$1,322.62
|
|
|
Service Code
|
CPT 58662
|
| Hospital Charge Code |
z58662
|
| Min. Negotiated Rate |
$649.51 |
| Max. Negotiated Rate |
$86,500.00 |
| Rate for Payer: Aetna Commercial |
$670.52
|
| Rate for Payer: Aetna Commercial |
$670.52
|
| Rate for Payer: Aetna Medicare |
$670.52
|
| Rate for Payer: Aetna Medicare |
$670.52
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$930.03
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$930.03
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$930.03
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$930.03
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$930.03
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$930.03
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$930.03
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$930.03
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$650.52
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$650.52
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$771.10
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$771.10
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$737.57
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$737.57
|
| Rate for Payer: Cash Price |
$820.02
|
| Rate for Payer: Cash Price |
$805.39
|
| Rate for Payer: Centivo All Commercial |
$1,039.31
|
| Rate for Payer: Centivo All Commercial |
$1,039.31
|
| Rate for Payer: Cigna All Commercial |
$670.52
|
| Rate for Payer: Cigna All Commercial |
$670.52
|
| Rate for Payer: CORVEL All Commercial |
$670.52
|
| Rate for Payer: CORVEL All Commercial |
$670.52
|
| Rate for Payer: Coventry All Commercial |
$804.62
|
| Rate for Payer: Coventry All Commercial |
$804.62
|
| Rate for Payer: Encore All Commercial |
$670.52
|
| Rate for Payer: Encore All Commercial |
$670.52
|
| Rate for Payer: Frontpath All Commercial |
$932.63
|
| Rate for Payer: Frontpath All Commercial |
$932.63
|
| Rate for Payer: Humana ChoiceCare |
$782.53
|
| Rate for Payer: Humana ChoiceCare |
$782.53
|
| Rate for Payer: Humana Medicare |
$670.52
|
| Rate for Payer: Humana Medicare |
$670.52
|
| Rate for Payer: Lucent All Commercial |
$938.73
|
| Rate for Payer: Lucent All Commercial |
$938.73
|
| Rate for Payer: Lutheran Preferred All Commercial |
$932.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$932.00
|
| Rate for Payer: Managed Health Services Medicaid |
$650.52
|
| Rate for Payer: Managed Health Services Medicaid |
$650.52
|
| Rate for Payer: MDWise Medicaid |
$650.52
|
| Rate for Payer: MDWise Medicaid |
$650.52
|
| Rate for Payer: PHCS All Commercial |
$670.52
|
| Rate for Payer: PHCS All Commercial |
$670.52
|
| Rate for Payer: PHP All Commercial |
$857.36
|
| Rate for Payer: PHP All Commercial |
$857.36
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$670.52
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$670.52
|
| Rate for Payer: Sagamore Health Network All Products |
$670.52
|
| Rate for Payer: Sagamore Health Network All Products |
$670.52
|
| Rate for Payer: Signature Care EPO |
$879.75
|
| Rate for Payer: Signature Care EPO |
$879.75
|
| Rate for Payer: Signature Care PPO |
$879.75
|
| Rate for Payer: Signature Care PPO |
$879.75
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$86,500.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$86,500.00
|
| Rate for Payer: United Healthcare Commercial |
$797.19
|
| Rate for Payer: United Healthcare Commercial |
$797.19
|
| Rate for Payer: United Healthcare Medicare |
$649.51
|
| Rate for Payer: United Healthcare Medicare |
$649.51
|
|
|
PR LAP,HERNIA REPAIR PROC,UNLIST
|
Professional
|
Both
|
$735.00
|
|
|
Service Code
|
CPT 49659
|
| Hospital Charge Code |
z49659
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$624.75 |
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$0.01
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$0.01
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$0.01
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$0.01
|
| Rate for Payer: Cash Price |
$455.70
|
| Rate for Payer: Cash Price |
$455.70
|
| Rate for Payer: Lutheran Preferred All Commercial |
$624.75
|
| Rate for Payer: Signature Care EPO |
$468.56
|
| Rate for Payer: Signature Care PPO |
$468.56
|
|
|
PR LAP,INGUINAL HERNIA REPR,INITIAL
|
Professional
|
Both
|
$1,551.04
|
|
|
Service Code
|
CPT 49650
|
| Hospital Charge Code |
z49650
|
| Min. Negotiated Rate |
$387.76 |
| Max. Negotiated Rate |
$55,600.00 |
| Rate for Payer: Aetna Commercial |
$401.71
|
| Rate for Payer: Aetna Commercial |
$401.71
|
| Rate for Payer: Aetna Commercial |
$401.71
|
| Rate for Payer: Aetna Commercial |
$401.71
|
| Rate for Payer: Aetna Medicare |
$401.71
|
| Rate for Payer: Aetna Medicare |
$401.71
|
| Rate for Payer: Aetna Medicare |
$401.71
|
| Rate for Payer: Aetna Medicare |
$401.71
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$516.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$516.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$516.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$516.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$516.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$516.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$516.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$516.40
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$516.40
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$516.40
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$516.40
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$516.40
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$516.40
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$516.40
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$516.40
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$516.40
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$389.30
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$389.30
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$389.30
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$389.30
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$461.97
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$461.97
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$461.97
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$461.97
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$441.88
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$441.88
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$441.88
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$441.88
|
| Rate for Payer: Cash Price |
$490.74
|
| Rate for Payer: Cash Price |
$981.48
|
| Rate for Payer: Cash Price |
$961.64
|
| Rate for Payer: Cash Price |
$480.82
|
| Rate for Payer: Centivo All Commercial |
$622.65
|
| Rate for Payer: Centivo All Commercial |
$622.65
|
| Rate for Payer: Centivo All Commercial |
$622.65
|
| Rate for Payer: Centivo All Commercial |
$622.65
|
| Rate for Payer: Cigna All Commercial |
$401.71
|
| Rate for Payer: Cigna All Commercial |
$401.71
|
| Rate for Payer: Cigna All Commercial |
$401.71
|
| Rate for Payer: Cigna All Commercial |
$401.71
|
| Rate for Payer: CORVEL All Commercial |
$401.71
|
| Rate for Payer: CORVEL All Commercial |
$401.71
|
| Rate for Payer: CORVEL All Commercial |
$401.71
|
| Rate for Payer: CORVEL All Commercial |
$401.71
|
| Rate for Payer: Coventry All Commercial |
$482.05
|
| Rate for Payer: Coventry All Commercial |
$482.05
|
| Rate for Payer: Coventry All Commercial |
$482.05
|
| Rate for Payer: Coventry All Commercial |
$482.05
|
| Rate for Payer: Encore All Commercial |
$401.71
|
| Rate for Payer: Encore All Commercial |
$401.71
|
| Rate for Payer: Encore All Commercial |
$401.71
|
| Rate for Payer: Encore All Commercial |
$401.71
|
| Rate for Payer: Frontpath All Commercial |
$569.58
|
| Rate for Payer: Frontpath All Commercial |
$569.58
|
| Rate for Payer: Frontpath All Commercial |
$569.58
|
| Rate for Payer: Frontpath All Commercial |
$569.58
|
| Rate for Payer: Humana ChoiceCare |
$433.89
|
| Rate for Payer: Humana ChoiceCare |
$433.89
|
| Rate for Payer: Humana ChoiceCare |
$433.89
|
| Rate for Payer: Humana ChoiceCare |
$433.89
|
| Rate for Payer: Humana Medicare |
$401.71
|
| Rate for Payer: Humana Medicare |
$401.71
|
| Rate for Payer: Humana Medicare |
$401.71
|
| Rate for Payer: Humana Medicare |
$401.71
|
| Rate for Payer: Lucent All Commercial |
$562.39
|
| Rate for Payer: Lucent All Commercial |
$562.39
|
| Rate for Payer: Lucent All Commercial |
$562.39
|
| Rate for Payer: Lucent All Commercial |
$562.39
|
| Rate for Payer: Lutheran Preferred All Commercial |
$596.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$596.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$596.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$596.00
|
| Rate for Payer: Managed Health Services Medicaid |
$389.30
|
| Rate for Payer: Managed Health Services Medicaid |
$389.30
|
| Rate for Payer: Managed Health Services Medicaid |
$389.30
|
| Rate for Payer: Managed Health Services Medicaid |
$389.30
|
| Rate for Payer: MDWise Medicaid |
$389.30
|
| Rate for Payer: MDWise Medicaid |
$389.30
|
| Rate for Payer: MDWise Medicaid |
$389.30
|
| Rate for Payer: MDWise Medicaid |
$389.30
|
| Rate for Payer: PHCS All Commercial |
$401.71
|
| Rate for Payer: PHCS All Commercial |
$401.71
|
| Rate for Payer: PHCS All Commercial |
$401.71
|
| Rate for Payer: PHCS All Commercial |
$401.71
|
| Rate for Payer: PHP All Commercial |
$678.59
|
| Rate for Payer: PHP All Commercial |
$678.59
|
| Rate for Payer: PHP All Commercial |
$678.59
|
| Rate for Payer: PHP All Commercial |
$678.59
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$401.71
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$401.71
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$401.71
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$401.71
|
| Rate for Payer: Sagamore Health Network All Products |
$401.71
|
| Rate for Payer: Sagamore Health Network All Products |
$401.71
|
| Rate for Payer: Sagamore Health Network All Products |
$401.71
|
| Rate for Payer: Sagamore Health Network All Products |
$401.71
|
| Rate for Payer: Signature Care EPO |
$548.25
|
| Rate for Payer: Signature Care EPO |
$548.25
|
| Rate for Payer: Signature Care EPO |
$548.25
|
| Rate for Payer: Signature Care EPO |
$548.25
|
| Rate for Payer: Signature Care PPO |
$548.25
|
| Rate for Payer: Signature Care PPO |
$548.25
|
| Rate for Payer: Signature Care PPO |
$548.25
|
| Rate for Payer: Signature Care PPO |
$548.25
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$55,600.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$55,600.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$55,600.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$55,600.00
|
| Rate for Payer: United Healthcare Commercial |
$448.61
|
| Rate for Payer: United Healthcare Commercial |
$448.61
|
| Rate for Payer: United Healthcare Commercial |
$448.61
|
| Rate for Payer: United Healthcare Commercial |
$448.61
|
| Rate for Payer: United Healthcare Medicare |
$387.76
|
| Rate for Payer: United Healthcare Medicare |
$387.76
|
| Rate for Payer: United Healthcare Medicare |
$387.76
|
| Rate for Payer: United Healthcare Medicare |
$387.76
|
|
|
PR LAP,INGUINAL HERNIA REPR,RECUR
|
Professional
|
Both
|
$1,032.40
|
|
|
Service Code
|
CPT 49651
|
| Hospital Charge Code |
z49651
|
| Min. Negotiated Rate |
$506.08 |
| Max. Negotiated Rate |
$72,600.00 |
| Rate for Payer: Aetna Commercial |
$524.36
|
| Rate for Payer: Aetna Commercial |
$524.36
|
| Rate for Payer: Aetna Medicare |
$524.36
|
| Rate for Payer: Aetna Medicare |
$524.36
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$662.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$662.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$662.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$662.20
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$662.20
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$662.20
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$662.20
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$662.20
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$507.78
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$507.78
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$603.01
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$603.01
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$576.80
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$576.80
|
| Rate for Payer: Cash Price |
$640.09
|
| Rate for Payer: Cash Price |
$627.54
|
| Rate for Payer: Centivo All Commercial |
$812.76
|
| Rate for Payer: Centivo All Commercial |
$812.76
|
| Rate for Payer: Cigna All Commercial |
$524.36
|
| Rate for Payer: Cigna All Commercial |
$524.36
|
| Rate for Payer: CORVEL All Commercial |
$524.36
|
| Rate for Payer: CORVEL All Commercial |
$524.36
|
| Rate for Payer: Coventry All Commercial |
$629.23
|
| Rate for Payer: Coventry All Commercial |
$629.23
|
| Rate for Payer: Encore All Commercial |
$524.36
|
| Rate for Payer: Encore All Commercial |
$524.36
|
| Rate for Payer: Frontpath All Commercial |
$744.30
|
| Rate for Payer: Frontpath All Commercial |
$744.30
|
| Rate for Payer: Humana ChoiceCare |
$562.34
|
| Rate for Payer: Humana ChoiceCare |
$562.34
|
| Rate for Payer: Humana Medicare |
$524.36
|
| Rate for Payer: Humana Medicare |
$524.36
|
| Rate for Payer: Lucent All Commercial |
$734.10
|
| Rate for Payer: Lucent All Commercial |
$734.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$778.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$778.00
|
| Rate for Payer: Managed Health Services Medicaid |
$507.78
|
| Rate for Payer: Managed Health Services Medicaid |
$507.78
|
| Rate for Payer: MDWise Medicaid |
$507.78
|
| Rate for Payer: MDWise Medicaid |
$507.78
|
| Rate for Payer: PHCS All Commercial |
$524.36
|
| Rate for Payer: PHCS All Commercial |
$524.36
|
| Rate for Payer: PHP All Commercial |
$885.65
|
| Rate for Payer: PHP All Commercial |
$885.65
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$524.36
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$524.36
|
| Rate for Payer: Sagamore Health Network All Products |
$524.36
|
| Rate for Payer: Sagamore Health Network All Products |
$524.36
|
| Rate for Payer: Signature Care EPO |
$712.30
|
| Rate for Payer: Signature Care EPO |
$712.30
|
| Rate for Payer: Signature Care PPO |
$712.30
|
| Rate for Payer: Signature Care PPO |
$712.30
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$72,600.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$72,600.00
|
| Rate for Payer: United Healthcare Commercial |
$580.41
|
| Rate for Payer: United Healthcare Commercial |
$580.41
|
| Rate for Payer: United Healthcare Medicare |
$506.08
|
| Rate for Payer: United Healthcare Medicare |
$506.08
|
|
|
PR LAP INSERTION TUNNELED INTRAPERITONEAL CATHETER
|
Professional
|
Both
|
$700.44
|
|
|
Service Code
|
CPT 49324
|
| Hospital Charge Code |
z49324
|
| Min. Negotiated Rate |
$344.50 |
| Max. Negotiated Rate |
$49,500.00 |
| Rate for Payer: Aetna Commercial |
$358.89
|
| Rate for Payer: Aetna Commercial |
$358.89
|
| Rate for Payer: Aetna Medicare |
$358.89
|
| Rate for Payer: Aetna Medicare |
$358.89
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$528.02
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$528.02
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$528.02
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$528.02
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$528.02
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$528.02
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$528.02
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$528.02
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$344.50
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$344.50
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$412.72
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$412.72
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$394.78
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$394.78
|
| Rate for Payer: Cash Price |
$434.27
|
| Rate for Payer: Cash Price |
$427.65
|
| Rate for Payer: Centivo All Commercial |
$556.28
|
| Rate for Payer: Centivo All Commercial |
$556.28
|
| Rate for Payer: Cigna All Commercial |
$358.89
|
| Rate for Payer: Cigna All Commercial |
$358.89
|
| Rate for Payer: CORVEL All Commercial |
$358.89
|
| Rate for Payer: CORVEL All Commercial |
$358.89
|
| Rate for Payer: Coventry All Commercial |
$430.67
|
| Rate for Payer: Coventry All Commercial |
$430.67
|
| Rate for Payer: Encore All Commercial |
$358.89
|
| Rate for Payer: Encore All Commercial |
$358.89
|
| Rate for Payer: Frontpath All Commercial |
$512.59
|
| Rate for Payer: Frontpath All Commercial |
$512.59
|
| Rate for Payer: Humana ChoiceCare |
$385.39
|
| Rate for Payer: Humana ChoiceCare |
$385.39
|
| Rate for Payer: Humana Medicare |
$358.89
|
| Rate for Payer: Humana Medicare |
$358.89
|
| Rate for Payer: Lucent All Commercial |
$502.45
|
| Rate for Payer: Lucent All Commercial |
$502.45
|
| Rate for Payer: Lutheran Preferred All Commercial |
$530.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$530.00
|
| Rate for Payer: Managed Health Services Medicaid |
$344.50
|
| Rate for Payer: Managed Health Services Medicaid |
$344.50
|
| Rate for Payer: MDWise Medicaid |
$344.50
|
| Rate for Payer: MDWise Medicaid |
$344.50
|
| Rate for Payer: PHCS All Commercial |
$358.89
|
| Rate for Payer: PHCS All Commercial |
$358.89
|
| Rate for Payer: PHP All Commercial |
$603.54
|
| Rate for Payer: PHP All Commercial |
$603.54
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$358.89
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$358.89
|
| Rate for Payer: Sagamore Health Network All Products |
$358.89
|
| Rate for Payer: Sagamore Health Network All Products |
$358.89
|
| Rate for Payer: Signature Care EPO |
$484.50
|
| Rate for Payer: Signature Care EPO |
$484.50
|
| Rate for Payer: Signature Care PPO |
$484.50
|
| Rate for Payer: Signature Care PPO |
$484.50
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$49,500.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$49,500.00
|
| Rate for Payer: United Healthcare Commercial |
$420.34
|
| Rate for Payer: United Healthcare Commercial |
$420.34
|
| Rate for Payer: United Healthcare Medicare |
$344.88
|
| Rate for Payer: United Healthcare Medicare |
$344.88
|
|
|
PR LAP,LYMPH NODE BX
|
Professional
|
Both
|
$954.00
|
|
|
Service Code
|
CPT 38570
|
| Hospital Charge Code |
z38570
|
| Min. Negotiated Rate |
$466.40 |
| Max. Negotiated Rate |
$71,700.00 |
| Rate for Payer: Aetna Commercial |
$481.91
|
| Rate for Payer: Aetna Commercial |
$481.91
|
| Rate for Payer: Aetna Medicare |
$481.91
|
| Rate for Payer: Aetna Medicare |
$481.91
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$741.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$741.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$741.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$741.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$741.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$741.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$741.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$741.00
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$469.22
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$469.22
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$554.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$554.20
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$530.10
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$530.10
|
| Rate for Payer: Cash Price |
$591.48
|
| Rate for Payer: Cash Price |
$578.34
|
| Rate for Payer: Centivo All Commercial |
$746.96
|
| Rate for Payer: Centivo All Commercial |
$746.96
|
| Rate for Payer: Cigna All Commercial |
$481.91
|
| Rate for Payer: Cigna All Commercial |
$481.91
|
| Rate for Payer: CORVEL All Commercial |
$481.91
|
| Rate for Payer: CORVEL All Commercial |
$481.91
|
| Rate for Payer: Coventry All Commercial |
$578.29
|
| Rate for Payer: Coventry All Commercial |
$578.29
|
| Rate for Payer: Encore All Commercial |
$481.91
|
| Rate for Payer: Encore All Commercial |
$481.91
|
| Rate for Payer: Frontpath All Commercial |
$671.16
|
| Rate for Payer: Frontpath All Commercial |
$671.16
|
| Rate for Payer: Humana ChoiceCare |
$659.68
|
| Rate for Payer: Humana ChoiceCare |
$659.68
|
| Rate for Payer: Humana Medicare |
$481.91
|
| Rate for Payer: Humana Medicare |
$481.91
|
| Rate for Payer: Lucent All Commercial |
$674.67
|
| Rate for Payer: Lucent All Commercial |
$674.67
|
| Rate for Payer: Lutheran Preferred All Commercial |
$765.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$765.00
|
| Rate for Payer: Managed Health Services Medicaid |
$469.22
|
| Rate for Payer: Managed Health Services Medicaid |
$469.22
|
| Rate for Payer: MDWise Medicaid |
$469.22
|
| Rate for Payer: MDWise Medicaid |
$469.22
|
| Rate for Payer: PHCS All Commercial |
$481.91
|
| Rate for Payer: PHCS All Commercial |
$481.91
|
| Rate for Payer: PHP All Commercial |
$652.95
|
| Rate for Payer: PHP All Commercial |
$652.95
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$481.91
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$481.91
|
| Rate for Payer: Sagamore Health Network All Products |
$481.91
|
| Rate for Payer: Sagamore Health Network All Products |
$481.91
|
| Rate for Payer: Signature Care EPO |
$708.05
|
| Rate for Payer: Signature Care EPO |
$708.05
|
| Rate for Payer: Signature Care PPO |
$708.05
|
| Rate for Payer: Signature Care PPO |
$708.05
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$71,700.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$71,700.00
|
| Rate for Payer: United Healthcare Commercial |
$623.95
|
| Rate for Payer: United Healthcare Commercial |
$623.95
|
| Rate for Payer: United Healthcare Medicare |
$466.40
|
| Rate for Payer: United Healthcare Medicare |
$466.40
|
|
|
PR LAP,LYSIS OF ADHESIONS
|
Professional
|
Both
|
$1,262.26
|
|
|
Service Code
|
CPT 58660
|
| Hospital Charge Code |
z58660
|
| Min. Negotiated Rate |
$619.19 |
| Max. Negotiated Rate |
$82,500.00 |
| Rate for Payer: Aetna Commercial |
$640.15
|
| Rate for Payer: Aetna Commercial |
$640.15
|
| Rate for Payer: Aetna Medicare |
$640.15
|
| Rate for Payer: Aetna Medicare |
$640.15
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$878.14
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$878.14
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$878.14
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$878.14
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$878.14
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$878.14
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$878.14
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$878.14
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$620.83
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$620.83
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$736.17
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$736.17
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$704.16
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$704.16
|
| Rate for Payer: Cash Price |
$782.60
|
| Rate for Payer: Cash Price |
$767.80
|
| Rate for Payer: Centivo All Commercial |
$992.23
|
| Rate for Payer: Centivo All Commercial |
$992.23
|
| Rate for Payer: Cigna All Commercial |
$640.15
|
| Rate for Payer: Cigna All Commercial |
$640.15
|
| Rate for Payer: CORVEL All Commercial |
$640.15
|
| Rate for Payer: CORVEL All Commercial |
$640.15
|
| Rate for Payer: Coventry All Commercial |
$768.18
|
| Rate for Payer: Coventry All Commercial |
$768.18
|
| Rate for Payer: Encore All Commercial |
$640.15
|
| Rate for Payer: Encore All Commercial |
$640.15
|
| Rate for Payer: Frontpath All Commercial |
$896.60
|
| Rate for Payer: Frontpath All Commercial |
$896.60
|
| Rate for Payer: Humana ChoiceCare |
$738.48
|
| Rate for Payer: Humana ChoiceCare |
$738.48
|
| Rate for Payer: Humana Medicare |
$640.15
|
| Rate for Payer: Humana Medicare |
$640.15
|
| Rate for Payer: Lucent All Commercial |
$896.21
|
| Rate for Payer: Lucent All Commercial |
$896.21
|
| Rate for Payer: Lutheran Preferred All Commercial |
$888.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$888.00
|
| Rate for Payer: Managed Health Services Medicaid |
$620.83
|
| Rate for Payer: Managed Health Services Medicaid |
$620.83
|
| Rate for Payer: MDWise Medicaid |
$620.83
|
| Rate for Payer: MDWise Medicaid |
$620.83
|
| Rate for Payer: PHCS All Commercial |
$640.15
|
| Rate for Payer: PHCS All Commercial |
$640.15
|
| Rate for Payer: PHP All Commercial |
$817.33
|
| Rate for Payer: PHP All Commercial |
$817.33
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$640.15
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$640.15
|
| Rate for Payer: Sagamore Health Network All Products |
$640.15
|
| Rate for Payer: Sagamore Health Network All Products |
$640.15
|
| Rate for Payer: Signature Care EPO |
$885.70
|
| Rate for Payer: Signature Care EPO |
$885.70
|
| Rate for Payer: Signature Care PPO |
$885.70
|
| Rate for Payer: Signature Care PPO |
$885.70
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$82,500.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$82,500.00
|
| Rate for Payer: United Healthcare Commercial |
$758.38
|
| Rate for Payer: United Healthcare Commercial |
$758.38
|
| Rate for Payer: United Healthcare Medicare |
$619.19
|
| Rate for Payer: United Healthcare Medicare |
$619.19
|
|
|
PR LAP,MYOMECTOMY 1-4,TOT WT 250 GMS
|
Professional
|
Both
|
$1,671.18
|
|
|
Service Code
|
CPT 58545
|
| Hospital Charge Code |
z58545
|
| Min. Negotiated Rate |
$821.64 |
| Max. Negotiated Rate |
$109,500.00 |
| Rate for Payer: Aetna Commercial |
$849.07
|
| Rate for Payer: Aetna Commercial |
$849.07
|
| Rate for Payer: Aetna Medicare |
$849.07
|
| Rate for Payer: Aetna Medicare |
$849.07
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$1,152.75
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$1,152.75
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,152.75
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,152.75
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,152.75
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,152.75
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,152.75
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,152.75
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$821.95
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$821.95
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$976.43
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$976.43
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$933.98
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$933.98
|
| Rate for Payer: Cash Price |
$1,036.13
|
| Rate for Payer: Cash Price |
$1,018.83
|
| Rate for Payer: Centivo All Commercial |
$1,316.06
|
| Rate for Payer: Centivo All Commercial |
$1,316.06
|
| Rate for Payer: Cigna All Commercial |
$849.07
|
| Rate for Payer: Cigna All Commercial |
$849.07
|
| Rate for Payer: CORVEL All Commercial |
$849.07
|
| Rate for Payer: CORVEL All Commercial |
$849.07
|
| Rate for Payer: Coventry All Commercial |
$1,018.88
|
| Rate for Payer: Coventry All Commercial |
$1,018.88
|
| Rate for Payer: Encore All Commercial |
$849.07
|
| Rate for Payer: Encore All Commercial |
$849.07
|
| Rate for Payer: Frontpath All Commercial |
$1,182.99
|
| Rate for Payer: Frontpath All Commercial |
$1,182.99
|
| Rate for Payer: Humana ChoiceCare |
$969.93
|
| Rate for Payer: Humana ChoiceCare |
$969.93
|
| Rate for Payer: Humana Medicare |
$849.07
|
| Rate for Payer: Humana Medicare |
$849.07
|
| Rate for Payer: Lucent All Commercial |
$1,188.70
|
| Rate for Payer: Lucent All Commercial |
$1,188.70
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,179.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,179.00
|
| Rate for Payer: Managed Health Services Medicaid |
$821.95
|
| Rate for Payer: Managed Health Services Medicaid |
$821.95
|
| Rate for Payer: MDWise Medicaid |
$821.95
|
| Rate for Payer: MDWise Medicaid |
$821.95
|
| Rate for Payer: PHCS All Commercial |
$849.07
|
| Rate for Payer: PHCS All Commercial |
$849.07
|
| Rate for Payer: PHP All Commercial |
$1,084.57
|
| Rate for Payer: PHP All Commercial |
$1,084.57
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$849.07
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$849.07
|
| Rate for Payer: Sagamore Health Network All Products |
$849.07
|
| Rate for Payer: Sagamore Health Network All Products |
$849.07
|
| Rate for Payer: Signature Care EPO |
$1,089.70
|
| Rate for Payer: Signature Care EPO |
$1,089.70
|
| Rate for Payer: Signature Care PPO |
$1,089.70
|
| Rate for Payer: Signature Care PPO |
$1,089.70
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$109,500.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$109,500.00
|
| Rate for Payer: United Healthcare Commercial |
$1,009.06
|
| Rate for Payer: United Healthcare Commercial |
$1,009.06
|
| Rate for Payer: United Healthcare Medicare |
$821.64
|
| Rate for Payer: United Healthcare Medicare |
$821.64
|
|
|
PR LAP,MYOMECTOMY 5/>,TOTAL WT >250 GMS
|
Professional
|
Both
|
$2,061.52
|
|
|
Service Code
|
CPT 58546
|
| Hospital Charge Code |
z58546
|
| Min. Negotiated Rate |
$1,013.93 |
| Max. Negotiated Rate |
$135,500.00 |
| Rate for Payer: Aetna Commercial |
$1,051.32
|
| Rate for Payer: Aetna Commercial |
$1,051.32
|
| Rate for Payer: Aetna Medicare |
$1,051.32
|
| Rate for Payer: Aetna Medicare |
$1,051.32
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$1,478.75
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$1,478.75
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,478.75
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,478.75
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,478.75
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,478.75
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,478.75
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,478.75
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$1,013.93
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$1,013.93
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,209.02
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,209.02
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,156.45
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,156.45
|
| Rate for Payer: Cash Price |
$1,278.14
|
| Rate for Payer: Cash Price |
$1,260.58
|
| Rate for Payer: Centivo All Commercial |
$1,629.55
|
| Rate for Payer: Centivo All Commercial |
$1,629.55
|
| Rate for Payer: Cigna All Commercial |
$1,051.32
|
| Rate for Payer: Cigna All Commercial |
$1,051.32
|
| Rate for Payer: CORVEL All Commercial |
$1,051.32
|
| Rate for Payer: CORVEL All Commercial |
$1,051.32
|
| Rate for Payer: Coventry All Commercial |
$1,261.58
|
| Rate for Payer: Coventry All Commercial |
$1,261.58
|
| Rate for Payer: Encore All Commercial |
$1,051.32
|
| Rate for Payer: Encore All Commercial |
$1,051.32
|
| Rate for Payer: Frontpath All Commercial |
$1,465.05
|
| Rate for Payer: Frontpath All Commercial |
$1,465.05
|
| Rate for Payer: Humana ChoiceCare |
$1,244.74
|
| Rate for Payer: Humana ChoiceCare |
$1,244.74
|
| Rate for Payer: Humana Medicare |
$1,051.32
|
| Rate for Payer: Humana Medicare |
$1,051.32
|
| Rate for Payer: Lucent All Commercial |
$1,471.85
|
| Rate for Payer: Lucent All Commercial |
$1,471.85
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,459.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,459.00
|
| Rate for Payer: Managed Health Services Medicaid |
$1,013.93
|
| Rate for Payer: Managed Health Services Medicaid |
$1,013.93
|
| Rate for Payer: MDWise Medicaid |
$1,013.93
|
| Rate for Payer: MDWise Medicaid |
$1,013.93
|
| Rate for Payer: PHCS All Commercial |
$1,051.32
|
| Rate for Payer: PHCS All Commercial |
$1,051.32
|
| Rate for Payer: PHP All Commercial |
$1,341.91
|
| Rate for Payer: PHP All Commercial |
$1,341.91
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,051.32
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,051.32
|
| Rate for Payer: Sagamore Health Network All Products |
$1,051.32
|
| Rate for Payer: Sagamore Health Network All Products |
$1,051.32
|
| Rate for Payer: Signature Care EPO |
$1,388.90
|
| Rate for Payer: Signature Care EPO |
$1,388.90
|
| Rate for Payer: Signature Care PPO |
$1,388.90
|
| Rate for Payer: Signature Care PPO |
$1,388.90
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$135,500.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$135,500.00
|
| Rate for Payer: United Healthcare Commercial |
$1,279.65
|
| Rate for Payer: United Healthcare Commercial |
$1,279.65
|
| Rate for Payer: United Healthcare Medicare |
$1,016.60
|
| Rate for Payer: United Healthcare Medicare |
$1,016.60
|
|
|
PR LAP,RMV ADNEXAL STRUCTURE
|
Professional
|
Both
|
$1,209.24
|
|
|
Service Code
|
CPT 58661
|
| Hospital Charge Code |
z58661
|
| Min. Negotiated Rate |
$594.75 |
| Max. Negotiated Rate |
$79,300.00 |
| Rate for Payer: Aetna Commercial |
$614.88
|
| Rate for Payer: Aetna Commercial |
$614.88
|
| Rate for Payer: Aetna Medicare |
$614.88
|
| Rate for Payer: Aetna Medicare |
$614.88
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$856.61
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$856.61
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$856.61
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$856.61
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$856.61
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$856.61
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$856.61
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$856.61
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$594.75
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$594.75
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$707.11
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$707.11
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$676.37
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$676.37
|
| Rate for Payer: Cash Price |
$749.73
|
| Rate for Payer: Cash Price |
$737.95
|
| Rate for Payer: Centivo All Commercial |
$953.06
|
| Rate for Payer: Centivo All Commercial |
$953.06
|
| Rate for Payer: Cigna All Commercial |
$614.88
|
| Rate for Payer: Cigna All Commercial |
$614.88
|
| Rate for Payer: CORVEL All Commercial |
$614.88
|
| Rate for Payer: CORVEL All Commercial |
$614.88
|
| Rate for Payer: Coventry All Commercial |
$737.86
|
| Rate for Payer: Coventry All Commercial |
$737.86
|
| Rate for Payer: Encore All Commercial |
$614.88
|
| Rate for Payer: Encore All Commercial |
$614.88
|
| Rate for Payer: Frontpath All Commercial |
$855.58
|
| Rate for Payer: Frontpath All Commercial |
$855.58
|
| Rate for Payer: Humana ChoiceCare |
$721.06
|
| Rate for Payer: Humana ChoiceCare |
$721.06
|
| Rate for Payer: Humana Medicare |
$614.88
|
| Rate for Payer: Humana Medicare |
$614.88
|
| Rate for Payer: Lucent All Commercial |
$860.83
|
| Rate for Payer: Lucent All Commercial |
$860.83
|
| Rate for Payer: Lutheran Preferred All Commercial |
$854.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$854.00
|
| Rate for Payer: Managed Health Services Medicaid |
$594.75
|
| Rate for Payer: Managed Health Services Medicaid |
$594.75
|
| Rate for Payer: MDWise Medicaid |
$594.75
|
| Rate for Payer: MDWise Medicaid |
$594.75
|
| Rate for Payer: PHCS All Commercial |
$614.88
|
| Rate for Payer: PHCS All Commercial |
$614.88
|
| Rate for Payer: PHP All Commercial |
$785.56
|
| Rate for Payer: PHP All Commercial |
$785.56
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$614.88
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$614.88
|
| Rate for Payer: Sagamore Health Network All Products |
$614.88
|
| Rate for Payer: Sagamore Health Network All Products |
$614.88
|
| Rate for Payer: Signature Care EPO |
$866.15
|
| Rate for Payer: Signature Care EPO |
$866.15
|
| Rate for Payer: Signature Care PPO |
$866.15
|
| Rate for Payer: Signature Care PPO |
$866.15
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$79,300.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$79,300.00
|
| Rate for Payer: United Healthcare Commercial |
$729.39
|
| Rate for Payer: United Healthcare Commercial |
$729.39
|
| Rate for Payer: United Healthcare Medicare |
$595.12
|
| Rate for Payer: United Healthcare Medicare |
$595.12
|
|
|
PR LAP,SALPINGOSTOMY
|
Professional
|
Both
|
$1,469.14
|
|
|
Service Code
|
CPT 58673
|
| Hospital Charge Code |
z58673
|
| Min. Negotiated Rate |
$722.58 |
| Max. Negotiated Rate |
$96,500.00 |
| Rate for Payer: Aetna Commercial |
$749.15
|
| Rate for Payer: Aetna Commercial |
$749.15
|
| Rate for Payer: Aetna Medicare |
$749.15
|
| Rate for Payer: Aetna Medicare |
$749.15
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$1,076.88
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$1,076.88
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,076.88
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,076.88
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,076.88
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,076.88
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,076.88
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,076.88
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$722.58
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$722.58
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$861.52
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$861.52
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$824.07
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$824.07
|
| Rate for Payer: Cash Price |
$910.87
|
| Rate for Payer: Cash Price |
$898.23
|
| Rate for Payer: Centivo All Commercial |
$1,161.18
|
| Rate for Payer: Centivo All Commercial |
$1,161.18
|
| Rate for Payer: Cigna All Commercial |
$749.15
|
| Rate for Payer: Cigna All Commercial |
$749.15
|
| Rate for Payer: CORVEL All Commercial |
$749.15
|
| Rate for Payer: CORVEL All Commercial |
$749.15
|
| Rate for Payer: Coventry All Commercial |
$898.98
|
| Rate for Payer: Coventry All Commercial |
$898.98
|
| Rate for Payer: Encore All Commercial |
$749.15
|
| Rate for Payer: Encore All Commercial |
$749.15
|
| Rate for Payer: Frontpath All Commercial |
$1,042.95
|
| Rate for Payer: Frontpath All Commercial |
$1,042.95
|
| Rate for Payer: Humana ChoiceCare |
$905.76
|
| Rate for Payer: Humana ChoiceCare |
$905.76
|
| Rate for Payer: Humana Medicare |
$749.15
|
| Rate for Payer: Humana Medicare |
$749.15
|
| Rate for Payer: Lucent All Commercial |
$1,048.81
|
| Rate for Payer: Lucent All Commercial |
$1,048.81
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,039.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,039.00
|
| Rate for Payer: Managed Health Services Medicaid |
$722.58
|
| Rate for Payer: Managed Health Services Medicaid |
$722.58
|
| Rate for Payer: MDWise Medicaid |
$722.58
|
| Rate for Payer: MDWise Medicaid |
$722.58
|
| Rate for Payer: PHCS All Commercial |
$749.15
|
| Rate for Payer: PHCS All Commercial |
$749.15
|
| Rate for Payer: PHP All Commercial |
$956.19
|
| Rate for Payer: PHP All Commercial |
$956.19
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$749.15
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$749.15
|
| Rate for Payer: Sagamore Health Network All Products |
$749.15
|
| Rate for Payer: Sagamore Health Network All Products |
$749.15
|
| Rate for Payer: Signature Care EPO |
$1,020.00
|
| Rate for Payer: Signature Care EPO |
$1,020.00
|
| Rate for Payer: Signature Care PPO |
$1,020.00
|
| Rate for Payer: Signature Care PPO |
$1,020.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$96,500.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$96,500.00
|
| Rate for Payer: United Healthcare Commercial |
$912.94
|
| Rate for Payer: United Healthcare Commercial |
$912.94
|
| Rate for Payer: United Healthcare Medicare |
$724.38
|
| Rate for Payer: United Healthcare Medicare |
$724.38
|
|
