|
PR LAP,SPERMATIC CORD PROC,UNLIST
|
Professional
|
Both
|
$735.00
|
|
|
Service Code
|
CPT 55559
|
| Hospital Charge Code |
z55559
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$624.75 |
| Rate for Payer: Anthem Blue Cross of IN 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,STOMACH,OTHER,W/O TUBE
|
Professional
|
Both
|
$1,081.86
|
|
|
Service Code
|
CPT 43659
|
| Hospital Charge Code |
z43659
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$919.58 |
| Rate for Payer: Anthem Blue Cross of IN 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 |
$670.75
|
| Rate for Payer: Cash Price |
$670.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$919.58
|
| Rate for Payer: Signature Care EPO |
$689.69
|
| Rate for Payer: Signature Care PPO |
$689.69
|
|
|
PR LAP, SUPRACERVIAL HYSTERECTOMY, <250G
|
Professional
|
Both
|
$1,359.66
|
|
|
Service Code
|
CPT 58541
|
| Hospital Charge Code |
z58541
|
| Min. Negotiated Rate |
$668.73 |
| Max. Negotiated Rate |
$89,100.00 |
| Rate for Payer: Aetna Commercial |
$691.16
|
| Rate for Payer: Aetna Commercial |
$691.16
|
| Rate for Payer: Aetna Medicare |
$691.16
|
| Rate for Payer: Aetna Medicare |
$691.16
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$1,014.37
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$1,014.37
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,014.37
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,014.37
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,014.37
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,014.37
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,014.37
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,014.37
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$668.73
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$668.73
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$794.83
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$794.83
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$760.28
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$760.28
|
| Rate for Payer: Cash Price |
$842.99
|
| Rate for Payer: Cash Price |
$829.50
|
| Rate for Payer: Centivo All Commercial |
$1,071.30
|
| Rate for Payer: Centivo All Commercial |
$1,071.30
|
| Rate for Payer: Cigna All Commercial |
$691.16
|
| Rate for Payer: Cigna All Commercial |
$691.16
|
| Rate for Payer: CORVEL All Commercial |
$691.16
|
| Rate for Payer: CORVEL All Commercial |
$691.16
|
| Rate for Payer: Coventry All Commercial |
$829.39
|
| Rate for Payer: Coventry All Commercial |
$829.39
|
| Rate for Payer: Encore All Commercial |
$691.16
|
| Rate for Payer: Encore All Commercial |
$691.16
|
| Rate for Payer: Frontpath All Commercial |
$955.29
|
| Rate for Payer: Frontpath All Commercial |
$955.29
|
| Rate for Payer: Humana ChoiceCare |
$860.01
|
| Rate for Payer: Humana ChoiceCare |
$860.01
|
| Rate for Payer: Humana Medicare |
$691.16
|
| Rate for Payer: Humana Medicare |
$691.16
|
| Rate for Payer: Lucent All Commercial |
$967.62
|
| Rate for Payer: Lucent All Commercial |
$967.62
|
| Rate for Payer: Lutheran Preferred All Commercial |
$960.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$960.00
|
| Rate for Payer: Managed Health Services Medicaid |
$668.73
|
| Rate for Payer: Managed Health Services Medicaid |
$668.73
|
| Rate for Payer: MDWise Medicaid |
$668.73
|
| Rate for Payer: MDWise Medicaid |
$668.73
|
| Rate for Payer: PHCS All Commercial |
$691.16
|
| Rate for Payer: PHCS All Commercial |
$691.16
|
| Rate for Payer: PHP All Commercial |
$883.02
|
| Rate for Payer: PHP All Commercial |
$883.02
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$691.16
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$691.16
|
| Rate for Payer: Sagamore Health Network All Products |
$691.16
|
| Rate for Payer: Sagamore Health Network All Products |
$691.16
|
| Rate for Payer: Signature Care EPO |
$950.30
|
| Rate for Payer: Signature Care EPO |
$950.30
|
| Rate for Payer: Signature Care PPO |
$950.30
|
| Rate for Payer: Signature Care PPO |
$950.30
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$89,100.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$89,100.00
|
| Rate for Payer: United Healthcare Commercial |
$965.86
|
| Rate for Payer: United Healthcare Commercial |
$965.86
|
| Rate for Payer: United Healthcare Medicare |
$668.95
|
| Rate for Payer: United Healthcare Medicare |
$668.95
|
|
|
PR LAP, SUPRACERVIAL HYSTERECTOMY W/ TUBE&OV, <250G
|
Professional
|
Both
|
$1,542.10
|
|
|
Service Code
|
CPT 58542
|
| Hospital Charge Code |
z58542
|
| Min. Negotiated Rate |
$758.47 |
| Max. Negotiated Rate |
$101,200.00 |
| Rate for Payer: Aetna Commercial |
$785.98
|
| Rate for Payer: Aetna Commercial |
$785.98
|
| Rate for Payer: Aetna Medicare |
$785.98
|
| Rate for Payer: Aetna Medicare |
$785.98
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$1,127.15
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$1,127.15
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,127.15
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,127.15
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,127.15
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,127.15
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,127.15
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,127.15
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$758.47
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$758.47
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$903.88
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$903.88
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$864.58
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$864.58
|
| Rate for Payer: Cash Price |
$956.10
|
| Rate for Payer: Cash Price |
$941.97
|
| Rate for Payer: Centivo All Commercial |
$1,218.27
|
| Rate for Payer: Centivo All Commercial |
$1,218.27
|
| Rate for Payer: Cigna All Commercial |
$785.98
|
| Rate for Payer: Cigna All Commercial |
$785.98
|
| Rate for Payer: CORVEL All Commercial |
$785.98
|
| Rate for Payer: CORVEL All Commercial |
$785.98
|
| Rate for Payer: Coventry All Commercial |
$943.18
|
| Rate for Payer: Coventry All Commercial |
$943.18
|
| Rate for Payer: Encore All Commercial |
$785.98
|
| Rate for Payer: Encore All Commercial |
$785.98
|
| Rate for Payer: Frontpath All Commercial |
$1,090.32
|
| Rate for Payer: Frontpath All Commercial |
$1,090.32
|
| Rate for Payer: Humana ChoiceCare |
$955.63
|
| Rate for Payer: Humana ChoiceCare |
$955.63
|
| Rate for Payer: Humana Medicare |
$785.98
|
| Rate for Payer: Humana Medicare |
$785.98
|
| Rate for Payer: Lucent All Commercial |
$1,100.37
|
| Rate for Payer: Lucent All Commercial |
$1,100.37
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,090.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,090.00
|
| Rate for Payer: Managed Health Services Medicaid |
$758.47
|
| Rate for Payer: Managed Health Services Medicaid |
$758.47
|
| Rate for Payer: MDWise Medicaid |
$758.47
|
| Rate for Payer: MDWise Medicaid |
$758.47
|
| Rate for Payer: PHCS All Commercial |
$785.98
|
| Rate for Payer: PHCS All Commercial |
$785.98
|
| Rate for Payer: PHP All Commercial |
$1,002.74
|
| Rate for Payer: PHP All Commercial |
$1,002.74
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$785.98
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$785.98
|
| Rate for Payer: Sagamore Health Network All Products |
$785.98
|
| Rate for Payer: Sagamore Health Network All Products |
$785.98
|
| Rate for Payer: Signature Care EPO |
$1,054.85
|
| Rate for Payer: Signature Care EPO |
$1,054.85
|
| Rate for Payer: Signature Care PPO |
$1,054.85
|
| Rate for Payer: Signature Care PPO |
$1,054.85
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$101,200.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$101,200.00
|
| Rate for Payer: United Healthcare Commercial |
$1,073.58
|
| Rate for Payer: United Healthcare Commercial |
$1,073.58
|
| Rate for Payer: United Healthcare Medicare |
$759.65
|
| Rate for Payer: United Healthcare Medicare |
$759.65
|
|
|
PR LAP, SUPRACERVIAL HYSTERECTOMY W/ TUBE&OV, >250G
|
Professional
|
Both
|
$1,679.94
|
|
|
Service Code
|
CPT 58544
|
| Hospital Charge Code |
z58544
|
| Min. Negotiated Rate |
$826.26 |
| Max. Negotiated Rate |
$110,500.00 |
| Rate for Payer: Aetna Commercial |
$855.75
|
| Rate for Payer: Aetna Commercial |
$855.75
|
| Rate for Payer: Aetna Medicare |
$855.75
|
| Rate for Payer: Aetna Medicare |
$855.75
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$1,240.63
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$1,240.63
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,240.63
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,240.63
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,240.63
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,240.63
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,240.63
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,240.63
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$826.26
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$826.26
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$984.11
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$984.11
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$941.33
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$941.33
|
| Rate for Payer: Cash Price |
$1,041.56
|
| Rate for Payer: Cash Price |
$1,028.67
|
| Rate for Payer: Centivo All Commercial |
$1,326.41
|
| Rate for Payer: Centivo All Commercial |
$1,326.41
|
| Rate for Payer: Cigna All Commercial |
$855.75
|
| Rate for Payer: Cigna All Commercial |
$855.75
|
| Rate for Payer: CORVEL All Commercial |
$855.75
|
| Rate for Payer: CORVEL All Commercial |
$855.75
|
| Rate for Payer: Coventry All Commercial |
$1,026.90
|
| Rate for Payer: Coventry All Commercial |
$1,026.90
|
| Rate for Payer: Encore All Commercial |
$855.75
|
| Rate for Payer: Encore All Commercial |
$855.75
|
| Rate for Payer: Frontpath All Commercial |
$1,189.51
|
| Rate for Payer: Frontpath All Commercial |
$1,189.51
|
| Rate for Payer: Humana ChoiceCare |
$1,051.84
|
| Rate for Payer: Humana ChoiceCare |
$1,051.84
|
| Rate for Payer: Humana Medicare |
$855.75
|
| Rate for Payer: Humana Medicare |
$855.75
|
| Rate for Payer: Lucent All Commercial |
$1,198.05
|
| Rate for Payer: Lucent All Commercial |
$1,198.05
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,190.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,190.00
|
| Rate for Payer: Managed Health Services Medicaid |
$826.26
|
| Rate for Payer: Managed Health Services Medicaid |
$826.26
|
| Rate for Payer: MDWise Medicaid |
$826.26
|
| Rate for Payer: MDWise Medicaid |
$826.26
|
| Rate for Payer: PHCS All Commercial |
$855.75
|
| Rate for Payer: PHCS All Commercial |
$855.75
|
| Rate for Payer: PHP All Commercial |
$1,095.03
|
| Rate for Payer: PHP All Commercial |
$1,095.03
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$855.75
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$855.75
|
| Rate for Payer: Sagamore Health Network All Products |
$855.75
|
| Rate for Payer: Sagamore Health Network All Products |
$855.75
|
| Rate for Payer: Signature Care EPO |
$1,161.10
|
| Rate for Payer: Signature Care EPO |
$1,161.10
|
| Rate for Payer: Signature Care PPO |
$1,161.10
|
| Rate for Payer: Signature Care PPO |
$1,161.10
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$110,500.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$110,500.00
|
| Rate for Payer: United Healthcare Commercial |
$1,180.03
|
| Rate for Payer: United Healthcare Commercial |
$1,180.03
|
| Rate for Payer: United Healthcare Medicare |
$829.57
|
| Rate for Payer: United Healthcare Medicare |
$829.57
|
|
|
PR LAP, SURG CLOSE ENTEROSTOMY RESECT ANAST
|
Professional
|
Both
|
$2,997.22
|
|
|
Service Code
|
CPT 44227
|
| Hospital Charge Code |
z44227
|
| Min. Negotiated Rate |
$1,474.15 |
| Max. Negotiated Rate |
$212,100.00 |
| Rate for Payer: Aetna Commercial |
$1,538.10
|
| Rate for Payer: Aetna Commercial |
$1,538.10
|
| Rate for Payer: Aetna Medicare |
$1,538.10
|
| Rate for Payer: Aetna Medicare |
$1,538.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$1,701.14
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$1,701.14
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,701.14
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,701.14
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,701.14
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,701.14
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,701.14
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,701.14
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$1,474.15
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$1,474.15
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,768.82
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,768.82
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,691.91
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,691.91
|
| Rate for Payer: Cash Price |
$1,858.28
|
| Rate for Payer: Cash Price |
$1,832.88
|
| Rate for Payer: Centivo All Commercial |
$2,384.05
|
| Rate for Payer: Centivo All Commercial |
$2,384.05
|
| Rate for Payer: Cigna All Commercial |
$1,538.10
|
| Rate for Payer: Cigna All Commercial |
$1,538.10
|
| Rate for Payer: CORVEL All Commercial |
$1,538.10
|
| Rate for Payer: CORVEL All Commercial |
$1,538.10
|
| Rate for Payer: Coventry All Commercial |
$1,845.72
|
| Rate for Payer: Coventry All Commercial |
$1,845.72
|
| Rate for Payer: Encore All Commercial |
$1,538.10
|
| Rate for Payer: Encore All Commercial |
$1,538.10
|
| Rate for Payer: Frontpath All Commercial |
$2,185.07
|
| Rate for Payer: Frontpath All Commercial |
$2,185.07
|
| Rate for Payer: Humana ChoiceCare |
$1,706.49
|
| Rate for Payer: Humana ChoiceCare |
$1,706.49
|
| Rate for Payer: Humana Medicare |
$1,538.10
|
| Rate for Payer: Humana Medicare |
$1,538.10
|
| Rate for Payer: Lucent All Commercial |
$2,153.34
|
| Rate for Payer: Lucent All Commercial |
$2,153.34
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,273.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,273.00
|
| Rate for Payer: Managed Health Services Medicaid |
$1,474.15
|
| Rate for Payer: Managed Health Services Medicaid |
$1,474.15
|
| Rate for Payer: MDWise Medicaid |
$1,474.15
|
| Rate for Payer: MDWise Medicaid |
$1,474.15
|
| Rate for Payer: PHCS All Commercial |
$1,538.10
|
| Rate for Payer: PHCS All Commercial |
$1,538.10
|
| Rate for Payer: PHP All Commercial |
$2,586.73
|
| Rate for Payer: PHP All Commercial |
$2,586.73
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,538.10
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,538.10
|
| Rate for Payer: Sagamore Health Network All Products |
$1,538.10
|
| Rate for Payer: Sagamore Health Network All Products |
$1,538.10
|
| Rate for Payer: Signature Care EPO |
$2,144.55
|
| Rate for Payer: Signature Care EPO |
$2,144.55
|
| Rate for Payer: Signature Care PPO |
$2,144.55
|
| Rate for Payer: Signature Care PPO |
$2,144.55
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$212,100.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$212,100.00
|
| Rate for Payer: United Healthcare Commercial |
$1,799.50
|
| Rate for Payer: United Healthcare Commercial |
$1,799.50
|
| Rate for Payer: United Healthcare Medicare |
$1,478.13
|
| Rate for Payer: United Healthcare Medicare |
$1,478.13
|
|
|
PR LAP,SURG,COLECTOMY, PARTIAL, W/ANAST
|
Professional
|
Both
|
$2,781.80
|
|
|
Service Code
|
CPT 44204
|
| Hospital Charge Code |
z44204
|
| Min. Negotiated Rate |
$1,368.20 |
| Max. Negotiated Rate |
$196,700.00 |
| Rate for Payer: Aetna Commercial |
$1,424.46
|
| Rate for Payer: Aetna Commercial |
$1,424.46
|
| Rate for Payer: Aetna Medicare |
$1,424.46
|
| Rate for Payer: Aetna Medicare |
$1,424.46
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$1,752.70
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$1,752.70
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,752.70
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,752.70
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,752.70
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,752.70
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,752.70
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,752.70
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$1,368.20
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$1,368.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,638.13
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,638.13
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,566.91
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,566.91
|
| Rate for Payer: Cash Price |
$1,724.72
|
| Rate for Payer: Cash Price |
$1,699.68
|
| Rate for Payer: Centivo All Commercial |
$2,207.91
|
| Rate for Payer: Centivo All Commercial |
$2,207.91
|
| Rate for Payer: Cigna All Commercial |
$1,424.46
|
| Rate for Payer: Cigna All Commercial |
$1,424.46
|
| Rate for Payer: CORVEL All Commercial |
$1,424.46
|
| Rate for Payer: CORVEL All Commercial |
$1,424.46
|
| Rate for Payer: Coventry All Commercial |
$1,709.35
|
| Rate for Payer: Coventry All Commercial |
$1,709.35
|
| Rate for Payer: Encore All Commercial |
$1,424.46
|
| Rate for Payer: Encore All Commercial |
$1,424.46
|
| Rate for Payer: Frontpath All Commercial |
$2,020.67
|
| Rate for Payer: Frontpath All Commercial |
$2,020.67
|
| Rate for Payer: Humana ChoiceCare |
$1,607.38
|
| Rate for Payer: Humana ChoiceCare |
$1,607.38
|
| Rate for Payer: Humana Medicare |
$1,424.46
|
| Rate for Payer: Humana Medicare |
$1,424.46
|
| Rate for Payer: Lucent All Commercial |
$1,994.24
|
| Rate for Payer: Lucent All Commercial |
$1,994.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,108.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,108.00
|
| Rate for Payer: Managed Health Services Medicaid |
$1,368.20
|
| Rate for Payer: Managed Health Services Medicaid |
$1,368.20
|
| Rate for Payer: MDWise Medicaid |
$1,368.20
|
| Rate for Payer: MDWise Medicaid |
$1,368.20
|
| Rate for Payer: PHCS All Commercial |
$1,424.46
|
| Rate for Payer: PHCS All Commercial |
$1,424.46
|
| Rate for Payer: PHP All Commercial |
$2,398.75
|
| Rate for Payer: PHP All Commercial |
$2,398.75
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,424.46
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,424.46
|
| Rate for Payer: Sagamore Health Network All Products |
$1,424.46
|
| Rate for Payer: Sagamore Health Network All Products |
$1,424.46
|
| Rate for Payer: Signature Care EPO |
$2,038.30
|
| Rate for Payer: Signature Care EPO |
$2,038.30
|
| Rate for Payer: Signature Care PPO |
$2,038.30
|
| Rate for Payer: Signature Care PPO |
$2,038.30
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$196,700.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$196,700.00
|
| Rate for Payer: United Healthcare Commercial |
$1,661.98
|
| Rate for Payer: United Healthcare Commercial |
$1,661.98
|
| Rate for Payer: United Healthcare Medicare |
$1,370.71
|
| Rate for Payer: United Healthcare Medicare |
$1,370.71
|
|
|
PR LAP,SURG,COLECTOMY,W/ANAST
|
Professional
|
Both
|
$3,285.24
|
|
|
Service Code
|
CPT 44207
|
| Hospital Charge Code |
z44207
|
| Min. Negotiated Rate |
$1,615.81 |
| Max. Negotiated Rate |
$232,500.00 |
| Rate for Payer: Aetna Commercial |
$1,682.87
|
| Rate for Payer: Aetna Commercial |
$1,682.87
|
| Rate for Payer: Aetna Medicare |
$1,682.87
|
| Rate for Payer: Aetna Medicare |
$1,682.87
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$1,915.30
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$1,915.30
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,915.30
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,915.30
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,915.30
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,915.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,915.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,915.30
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$1,615.81
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$1,615.81
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,935.30
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,935.30
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,851.16
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,851.16
|
| Rate for Payer: Cash Price |
$2,036.85
|
| Rate for Payer: Cash Price |
$2,008.76
|
| Rate for Payer: Centivo All Commercial |
$2,608.45
|
| Rate for Payer: Centivo All Commercial |
$2,608.45
|
| Rate for Payer: Cigna All Commercial |
$1,682.87
|
| Rate for Payer: Cigna All Commercial |
$1,682.87
|
| Rate for Payer: CORVEL All Commercial |
$1,682.87
|
| Rate for Payer: CORVEL All Commercial |
$1,682.87
|
| Rate for Payer: Coventry All Commercial |
$2,019.44
|
| Rate for Payer: Coventry All Commercial |
$2,019.44
|
| Rate for Payer: Encore All Commercial |
$1,682.87
|
| Rate for Payer: Encore All Commercial |
$1,682.87
|
| Rate for Payer: Frontpath All Commercial |
$2,376.08
|
| Rate for Payer: Frontpath All Commercial |
$2,376.08
|
| Rate for Payer: Humana ChoiceCare |
$1,904.52
|
| Rate for Payer: Humana ChoiceCare |
$1,904.52
|
| Rate for Payer: Humana Medicare |
$1,682.87
|
| Rate for Payer: Humana Medicare |
$1,682.87
|
| Rate for Payer: Lucent All Commercial |
$2,356.02
|
| Rate for Payer: Lucent All Commercial |
$2,356.02
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,491.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,491.00
|
| Rate for Payer: Managed Health Services Medicaid |
$1,615.81
|
| Rate for Payer: Managed Health Services Medicaid |
$1,615.81
|
| Rate for Payer: MDWise Medicaid |
$1,615.81
|
| Rate for Payer: MDWise Medicaid |
$1,615.81
|
| Rate for Payer: PHCS All Commercial |
$1,682.87
|
| Rate for Payer: PHCS All Commercial |
$1,682.87
|
| Rate for Payer: PHP All Commercial |
$2,834.94
|
| Rate for Payer: PHP All Commercial |
$2,834.94
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,682.87
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,682.87
|
| Rate for Payer: Sagamore Health Network All Products |
$1,682.87
|
| Rate for Payer: Sagamore Health Network All Products |
$1,682.87
|
| Rate for Payer: Signature Care EPO |
$2,391.90
|
| Rate for Payer: Signature Care EPO |
$2,391.90
|
| Rate for Payer: Signature Care PPO |
$2,391.90
|
| Rate for Payer: Signature Care PPO |
$2,391.90
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$232,500.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$232,500.00
|
| Rate for Payer: United Healthcare Commercial |
$1,982.18
|
| Rate for Payer: United Healthcare Commercial |
$1,982.18
|
| Rate for Payer: United Healthcare Medicare |
$1,619.97
|
| Rate for Payer: United Healthcare Medicare |
$1,619.97
|
|
|
PR LAP,SURG,COLECTOMY,W/REMVL TERM ILEUM
|
Professional
|
Both
|
$2,420.38
|
|
|
Service Code
|
CPT 44205
|
| Hospital Charge Code |
z44205
|
| Min. Negotiated Rate |
$1,190.43 |
| Max. Negotiated Rate |
$171,200.00 |
| Rate for Payer: Aetna Commercial |
$1,239.12
|
| Rate for Payer: Aetna Commercial |
$1,239.12
|
| Rate for Payer: Aetna Medicare |
$1,239.12
|
| Rate for Payer: Aetna Medicare |
$1,239.12
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$1,551.90
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$1,551.90
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,551.90
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,551.90
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,551.90
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,551.90
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,551.90
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,551.90
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$1,190.43
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$1,190.43
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,424.99
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,424.99
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,363.03
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,363.03
|
| Rate for Payer: Cash Price |
$1,500.64
|
| Rate for Payer: Cash Price |
$1,479.22
|
| Rate for Payer: Centivo All Commercial |
$1,920.64
|
| Rate for Payer: Centivo All Commercial |
$1,920.64
|
| Rate for Payer: Cigna All Commercial |
$1,239.12
|
| Rate for Payer: Cigna All Commercial |
$1,239.12
|
| Rate for Payer: CORVEL All Commercial |
$1,239.12
|
| Rate for Payer: CORVEL All Commercial |
$1,239.12
|
| Rate for Payer: Coventry All Commercial |
$1,486.94
|
| Rate for Payer: Coventry All Commercial |
$1,486.94
|
| Rate for Payer: Encore All Commercial |
$1,239.12
|
| Rate for Payer: Encore All Commercial |
$1,239.12
|
| Rate for Payer: Frontpath All Commercial |
$1,753.31
|
| Rate for Payer: Frontpath All Commercial |
$1,753.31
|
| Rate for Payer: Humana ChoiceCare |
$1,425.81
|
| Rate for Payer: Humana ChoiceCare |
$1,425.81
|
| Rate for Payer: Humana Medicare |
$1,239.12
|
| Rate for Payer: Humana Medicare |
$1,239.12
|
| Rate for Payer: Lucent All Commercial |
$1,734.77
|
| Rate for Payer: Lucent All Commercial |
$1,734.77
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,834.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,834.00
|
| Rate for Payer: Managed Health Services Medicaid |
$1,190.43
|
| Rate for Payer: Managed Health Services Medicaid |
$1,190.43
|
| Rate for Payer: MDWise Medicaid |
$1,190.43
|
| Rate for Payer: MDWise Medicaid |
$1,190.43
|
| Rate for Payer: PHCS All Commercial |
$1,239.12
|
| Rate for Payer: PHCS All Commercial |
$1,239.12
|
| Rate for Payer: PHP All Commercial |
$2,087.62
|
| Rate for Payer: PHP All Commercial |
$2,087.62
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,239.12
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,239.12
|
| Rate for Payer: Sagamore Health Network All Products |
$1,239.12
|
| Rate for Payer: Sagamore Health Network All Products |
$1,239.12
|
| Rate for Payer: Signature Care EPO |
$1,806.25
|
| Rate for Payer: Signature Care EPO |
$1,806.25
|
| Rate for Payer: Signature Care PPO |
$1,806.25
|
| Rate for Payer: Signature Care PPO |
$1,806.25
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$171,200.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$171,200.00
|
| Rate for Payer: United Healthcare Commercial |
$1,450.86
|
| Rate for Payer: United Healthcare Commercial |
$1,450.86
|
| Rate for Payer: United Healthcare Medicare |
$1,192.92
|
| Rate for Payer: United Healthcare Medicare |
$1,192.92
|
|
|
PR LAP,SURG,ENTERECTOMY,RESECT & ANAST
|
Professional
|
Both
|
$2,507.64
|
|
|
Service Code
|
CPT 44202
|
| Hospital Charge Code |
z44202
|
| Min. Negotiated Rate |
$1,233.36 |
| Max. Negotiated Rate |
$177,300.00 |
| Rate for Payer: Aetna Commercial |
$1,282.90
|
| Rate for Payer: Aetna Commercial |
$1,282.90
|
| Rate for Payer: Aetna Medicare |
$1,282.90
|
| Rate for Payer: Aetna Medicare |
$1,282.90
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$1,709.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$1,709.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,709.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,709.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,709.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,709.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,709.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,709.00
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$1,233.36
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$1,233.36
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,475.34
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,475.34
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,411.19
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,411.19
|
| Rate for Payer: Cash Price |
$1,554.74
|
| Rate for Payer: Cash Price |
$1,531.82
|
| Rate for Payer: Centivo All Commercial |
$1,988.49
|
| Rate for Payer: Centivo All Commercial |
$1,988.49
|
| Rate for Payer: Cigna All Commercial |
$1,282.90
|
| Rate for Payer: Cigna All Commercial |
$1,282.90
|
| Rate for Payer: CORVEL All Commercial |
$1,282.90
|
| Rate for Payer: CORVEL All Commercial |
$1,282.90
|
| Rate for Payer: Coventry All Commercial |
$1,539.48
|
| Rate for Payer: Coventry All Commercial |
$1,539.48
|
| Rate for Payer: Encore All Commercial |
$1,282.90
|
| Rate for Payer: Encore All Commercial |
$1,282.90
|
| Rate for Payer: Frontpath All Commercial |
$1,830.63
|
| Rate for Payer: Frontpath All Commercial |
$1,830.63
|
| Rate for Payer: Humana ChoiceCare |
$1,422.45
|
| Rate for Payer: Humana ChoiceCare |
$1,422.45
|
| Rate for Payer: Humana Medicare |
$1,282.90
|
| Rate for Payer: Humana Medicare |
$1,282.90
|
| Rate for Payer: Lucent All Commercial |
$1,796.06
|
| Rate for Payer: Lucent All Commercial |
$1,796.06
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,899.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,899.00
|
| Rate for Payer: Managed Health Services Medicaid |
$1,233.36
|
| Rate for Payer: Managed Health Services Medicaid |
$1,233.36
|
| Rate for Payer: MDWise Medicaid |
$1,233.36
|
| Rate for Payer: MDWise Medicaid |
$1,233.36
|
| Rate for Payer: PHCS All Commercial |
$1,282.90
|
| Rate for Payer: PHCS All Commercial |
$1,282.90
|
| Rate for Payer: PHP All Commercial |
$2,161.85
|
| Rate for Payer: PHP All Commercial |
$2,161.85
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,282.90
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,282.90
|
| Rate for Payer: Sagamore Health Network All Products |
$1,282.90
|
| Rate for Payer: Sagamore Health Network All Products |
$1,282.90
|
| Rate for Payer: Signature Care EPO |
$1,798.60
|
| Rate for Payer: Signature Care EPO |
$1,798.60
|
| Rate for Payer: Signature Care PPO |
$1,798.60
|
| Rate for Payer: Signature Care PPO |
$1,798.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$177,300.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$177,300.00
|
| Rate for Payer: United Healthcare Commercial |
$1,487.74
|
| Rate for Payer: United Healthcare Commercial |
$1,487.74
|
| Rate for Payer: United Healthcare Medicare |
$1,235.34
|
| Rate for Payer: United Healthcare Medicare |
$1,235.34
|
|
|
PR LAP, SURG ENTEROLYSIS
|
Professional
|
Both
|
$1,665.86
|
|
|
Service Code
|
CPT 44180
|
| Hospital Charge Code |
z44180
|
| Min. Negotiated Rate |
$819.34 |
| Max. Negotiated Rate |
$117,600.00 |
| Rate for Payer: Aetna Commercial |
$851.77
|
| Rate for Payer: Aetna Commercial |
$851.77
|
| Rate for Payer: Aetna Medicare |
$851.77
|
| Rate for Payer: Aetna Medicare |
$851.77
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$944.63
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$944.63
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$944.63
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$944.63
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$944.63
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$944.63
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$944.63
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$944.63
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$819.34
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$819.34
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$979.54
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$979.54
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$936.95
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$936.95
|
| Rate for Payer: Cash Price |
$1,032.83
|
| Rate for Payer: Cash Price |
$1,016.02
|
| Rate for Payer: Centivo All Commercial |
$1,320.24
|
| Rate for Payer: Centivo All Commercial |
$1,320.24
|
| Rate for Payer: Cigna All Commercial |
$851.77
|
| Rate for Payer: Cigna All Commercial |
$851.77
|
| Rate for Payer: CORVEL All Commercial |
$851.77
|
| Rate for Payer: CORVEL All Commercial |
$851.77
|
| Rate for Payer: Coventry All Commercial |
$1,022.12
|
| Rate for Payer: Coventry All Commercial |
$1,022.12
|
| Rate for Payer: Encore All Commercial |
$851.77
|
| Rate for Payer: Encore All Commercial |
$851.77
|
| Rate for Payer: Frontpath All Commercial |
$1,216.40
|
| Rate for Payer: Frontpath All Commercial |
$1,216.40
|
| Rate for Payer: Humana ChoiceCare |
$947.59
|
| Rate for Payer: Humana ChoiceCare |
$947.59
|
| Rate for Payer: Humana Medicare |
$851.77
|
| Rate for Payer: Humana Medicare |
$851.77
|
| Rate for Payer: Lucent All Commercial |
$1,192.48
|
| Rate for Payer: Lucent All Commercial |
$1,192.48
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,260.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,260.00
|
| Rate for Payer: Managed Health Services Medicaid |
$819.34
|
| Rate for Payer: Managed Health Services Medicaid |
$819.34
|
| Rate for Payer: MDWise Medicaid |
$819.34
|
| Rate for Payer: MDWise Medicaid |
$819.34
|
| Rate for Payer: PHCS All Commercial |
$851.77
|
| Rate for Payer: PHCS All Commercial |
$851.77
|
| Rate for Payer: PHP All Commercial |
$1,433.89
|
| Rate for Payer: PHP All Commercial |
$1,433.89
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$851.77
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$851.77
|
| Rate for Payer: Sagamore Health Network All Products |
$851.77
|
| Rate for Payer: Sagamore Health Network All Products |
$851.77
|
| Rate for Payer: Signature Care EPO |
$1,190.85
|
| Rate for Payer: Signature Care EPO |
$1,190.85
|
| Rate for Payer: Signature Care PPO |
$1,190.85
|
| Rate for Payer: Signature Care PPO |
$1,190.85
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$117,600.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$117,600.00
|
| Rate for Payer: United Healthcare Commercial |
$987.09
|
| Rate for Payer: United Healthcare Commercial |
$987.09
|
| Rate for Payer: United Healthcare Medicare |
$819.37
|
| Rate for Payer: United Healthcare Medicare |
$819.37
|
|
|
PR LAP, SURG MOBIL SPLENIC FL DUR PTL COLECTOMY
|
Professional
|
Both
|
$335.74
|
|
|
Service Code
|
CPT 44213
|
| Hospital Charge Code |
z44213
|
| Min. Negotiated Rate |
$165.13 |
| Max. Negotiated Rate |
$23,800.00 |
| Rate for Payer: Aetna Commercial |
$173.20
|
| Rate for Payer: Aetna Commercial |
$173.20
|
| Rate for Payer: Aetna Medicare |
$173.20
|
| Rate for Payer: Aetna Medicare |
$173.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$216.93
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$216.93
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$216.93
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$216.93
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$216.93
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$216.93
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$216.93
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$216.93
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$165.13
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$165.13
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$199.18
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$199.18
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$190.52
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$190.52
|
| Rate for Payer: Cash Price |
$208.16
|
| Rate for Payer: Cash Price |
$205.47
|
| Rate for Payer: Centivo All Commercial |
$268.46
|
| Rate for Payer: Centivo All Commercial |
$268.46
|
| Rate for Payer: Cigna All Commercial |
$173.20
|
| Rate for Payer: Cigna All Commercial |
$173.20
|
| Rate for Payer: CORVEL All Commercial |
$173.20
|
| Rate for Payer: CORVEL All Commercial |
$173.20
|
| Rate for Payer: Coventry All Commercial |
$207.84
|
| Rate for Payer: Coventry All Commercial |
$207.84
|
| Rate for Payer: Encore All Commercial |
$173.20
|
| Rate for Payer: Encore All Commercial |
$173.20
|
| Rate for Payer: Frontpath All Commercial |
$246.28
|
| Rate for Payer: Frontpath All Commercial |
$246.28
|
| Rate for Payer: Humana ChoiceCare |
$217.61
|
| Rate for Payer: Humana ChoiceCare |
$217.61
|
| Rate for Payer: Humana Medicare |
$173.20
|
| Rate for Payer: Humana Medicare |
$173.20
|
| Rate for Payer: Lucent All Commercial |
$242.48
|
| Rate for Payer: Lucent All Commercial |
$242.48
|
| Rate for Payer: Lutheran Preferred All Commercial |
$255.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$255.00
|
| Rate for Payer: Managed Health Services Medicaid |
$165.13
|
| Rate for Payer: Managed Health Services Medicaid |
$165.13
|
| Rate for Payer: MDWise Medicaid |
$165.13
|
| Rate for Payer: MDWise Medicaid |
$165.13
|
| Rate for Payer: PHCS All Commercial |
$173.20
|
| Rate for Payer: PHCS All Commercial |
$173.20
|
| Rate for Payer: PHP All Commercial |
$289.98
|
| Rate for Payer: PHP All Commercial |
$289.98
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$173.20
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$173.20
|
| Rate for Payer: Sagamore Health Network All Products |
$173.20
|
| Rate for Payer: Sagamore Health Network All Products |
$173.20
|
| Rate for Payer: Signature Care EPO |
$273.70
|
| Rate for Payer: Signature Care EPO |
$273.70
|
| Rate for Payer: Signature Care PPO |
$273.70
|
| Rate for Payer: Signature Care PPO |
$273.70
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$23,800.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$23,800.00
|
| Rate for Payer: United Healthcare Commercial |
$211.06
|
| Rate for Payer: United Healthcare Commercial |
$211.06
|
| Rate for Payer: United Healthcare Medicare |
$165.70
|
| Rate for Payer: United Healthcare Medicare |
$165.70
|
|
|
PR LAP,TUBAL CAUTERY
|
Professional
|
Both
|
$691.86
|
|
|
Service Code
|
CPT 58670
|
| Hospital Charge Code |
z58670
|
| Min. Negotiated Rate |
$340.13 |
| Max. Negotiated Rate |
$45,300.00 |
| Rate for Payer: Aetna Commercial |
$351.41
|
| Rate for Payer: Aetna Commercial |
$351.41
|
| Rate for Payer: Aetna Medicare |
$351.41
|
| Rate for Payer: Aetna Medicare |
$351.41
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$466.97
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$466.97
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$466.97
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$466.97
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$466.97
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$466.97
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$466.97
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$466.97
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$340.28
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$340.28
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$404.12
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$404.12
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$386.55
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$386.55
|
| Rate for Payer: Cash Price |
$428.95
|
| Rate for Payer: Cash Price |
$421.76
|
| Rate for Payer: Centivo All Commercial |
$544.69
|
| Rate for Payer: Centivo All Commercial |
$544.69
|
| Rate for Payer: Cigna All Commercial |
$351.41
|
| Rate for Payer: Cigna All Commercial |
$351.41
|
| Rate for Payer: CORVEL All Commercial |
$351.41
|
| Rate for Payer: CORVEL All Commercial |
$351.41
|
| Rate for Payer: Coventry All Commercial |
$421.69
|
| Rate for Payer: Coventry All Commercial |
$421.69
|
| Rate for Payer: Encore All Commercial |
$351.41
|
| Rate for Payer: Encore All Commercial |
$351.41
|
| Rate for Payer: Frontpath All Commercial |
$486.46
|
| Rate for Payer: Frontpath All Commercial |
$486.46
|
| Rate for Payer: Humana ChoiceCare |
$392.58
|
| Rate for Payer: Humana ChoiceCare |
$392.58
|
| Rate for Payer: Humana Medicare |
$351.41
|
| Rate for Payer: Humana Medicare |
$351.41
|
| Rate for Payer: Lucent All Commercial |
$491.97
|
| Rate for Payer: Lucent All Commercial |
$491.97
|
| Rate for Payer: Lutheran Preferred All Commercial |
$488.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$488.00
|
| Rate for Payer: Managed Health Services Medicaid |
$340.28
|
| Rate for Payer: Managed Health Services Medicaid |
$340.28
|
| Rate for Payer: MDWise Medicaid |
$340.28
|
| Rate for Payer: MDWise Medicaid |
$340.28
|
| Rate for Payer: PHCS All Commercial |
$351.41
|
| Rate for Payer: PHCS All Commercial |
$351.41
|
| Rate for Payer: PHP All Commercial |
$448.97
|
| Rate for Payer: PHP All Commercial |
$448.97
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$351.41
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$351.41
|
| Rate for Payer: Sagamore Health Network All Products |
$351.41
|
| Rate for Payer: Sagamore Health Network All Products |
$351.41
|
| Rate for Payer: Signature Care EPO |
$471.75
|
| Rate for Payer: Signature Care EPO |
$471.75
|
| Rate for Payer: Signature Care PPO |
$471.75
|
| Rate for Payer: Signature Care PPO |
$471.75
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$45,300.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$45,300.00
|
| Rate for Payer: United Healthcare Commercial |
$410.58
|
| Rate for Payer: United Healthcare Commercial |
$410.58
|
| Rate for Payer: United Healthcare Medicare |
$340.13
|
| Rate for Payer: United Healthcare Medicare |
$340.13
|
|
|
PR LAP,UTERUS,UNLISTED PROCEDURE
|
Professional
|
Both
|
$2,157.53
|
|
|
Service Code
|
CPT 58578
|
| Hospital Charge Code |
z58578
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$1,833.90 |
| Rate for Payer: Anthem Blue Cross of IN 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 |
$1,337.67
|
| Rate for Payer: Cash Price |
$1,337.67
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,833.90
|
| Rate for Payer: Signature Care EPO |
$1,375.43
|
| Rate for Payer: Signature Care PPO |
$1,375.43
|
|
|
PR LAP,VAG HYST,UTERUS >250GMS
|
Professional
|
Both
|
$2,073.22
|
|
|
Service Code
|
CPT 58553
|
| Hospital Charge Code |
z58553
|
| Min. Negotiated Rate |
$1,019.69 |
| Max. Negotiated Rate |
$136,200.00 |
| Rate for Payer: Aetna Commercial |
$1,057.04
|
| Rate for Payer: Aetna Commercial |
$1,057.04
|
| Rate for Payer: Aetna Medicare |
$1,057.04
|
| Rate for Payer: Aetna Medicare |
$1,057.04
|
| 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 |
$1,019.69
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$1,019.69
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,215.60
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,215.60
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,162.74
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,162.74
|
| Rate for Payer: Cash Price |
$1,285.40
|
| Rate for Payer: Cash Price |
$1,267.38
|
| Rate for Payer: Centivo All Commercial |
$1,638.41
|
| Rate for Payer: Centivo All Commercial |
$1,638.41
|
| Rate for Payer: Cigna All Commercial |
$1,057.04
|
| Rate for Payer: Cigna All Commercial |
$1,057.04
|
| Rate for Payer: CORVEL All Commercial |
$1,057.04
|
| Rate for Payer: CORVEL All Commercial |
$1,057.04
|
| Rate for Payer: Coventry All Commercial |
$1,268.45
|
| Rate for Payer: Coventry All Commercial |
$1,268.45
|
| Rate for Payer: Encore All Commercial |
$1,057.04
|
| Rate for Payer: Encore All Commercial |
$1,057.04
|
| Rate for Payer: Frontpath All Commercial |
$1,473.07
|
| Rate for Payer: Frontpath All Commercial |
$1,473.07
|
| Rate for Payer: Humana ChoiceCare |
$1,244.74
|
| Rate for Payer: Humana ChoiceCare |
$1,244.74
|
| Rate for Payer: Humana Medicare |
$1,057.04
|
| Rate for Payer: Humana Medicare |
$1,057.04
|
| Rate for Payer: Lucent All Commercial |
$1,479.86
|
| Rate for Payer: Lucent All Commercial |
$1,479.86
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,467.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,467.00
|
| Rate for Payer: Managed Health Services Medicaid |
$1,019.69
|
| Rate for Payer: Managed Health Services Medicaid |
$1,019.69
|
| Rate for Payer: MDWise Medicaid |
$1,019.69
|
| Rate for Payer: MDWise Medicaid |
$1,019.69
|
| Rate for Payer: PHCS All Commercial |
$1,057.04
|
| Rate for Payer: PHCS All Commercial |
$1,057.04
|
| Rate for Payer: PHP All Commercial |
$1,349.15
|
| Rate for Payer: PHP All Commercial |
$1,349.15
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,057.04
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,057.04
|
| Rate for Payer: Sagamore Health Network All Products |
$1,057.04
|
| Rate for Payer: Sagamore Health Network All Products |
$1,057.04
|
| Rate for Payer: Signature Care EPO |
$1,382.10
|
| Rate for Payer: Signature Care EPO |
$1,382.10
|
| Rate for Payer: Signature Care PPO |
$1,382.10
|
| Rate for Payer: Signature Care PPO |
$1,382.10
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$136,200.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$136,200.00
|
| Rate for Payer: United Healthcare Commercial |
$1,286.30
|
| Rate for Payer: United Healthcare Commercial |
$1,286.30
|
| Rate for Payer: United Healthcare Medicare |
$1,022.08
|
| Rate for Payer: United Healthcare Medicare |
$1,022.08
|
|
|
PR LAP,VAG HYST,UTERUS 250GMS/<
|
Professional
|
Both
|
$1,637.28
|
|
|
Service Code
|
CPT 58550
|
| Hospital Charge Code |
z58550
|
| Min. Negotiated Rate |
$805.15 |
| Max. Negotiated Rate |
$107,300.00 |
| Rate for Payer: Aetna Commercial |
$831.71
|
| Rate for Payer: Aetna Commercial |
$831.71
|
| Rate for Payer: Aetna Medicare |
$831.71
|
| Rate for Payer: Aetna Medicare |
$831.71
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$1,213.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$1,213.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,213.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,213.60
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,213.60
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,213.60
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,213.60
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,213.60
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$805.28
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$805.28
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$956.47
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$956.47
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$914.88
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$914.88
|
| Rate for Payer: Cash Price |
$1,015.11
|
| Rate for Payer: Cash Price |
$998.39
|
| Rate for Payer: Centivo All Commercial |
$1,289.15
|
| Rate for Payer: Centivo All Commercial |
$1,289.15
|
| Rate for Payer: Cigna All Commercial |
$831.71
|
| Rate for Payer: Cigna All Commercial |
$831.71
|
| Rate for Payer: CORVEL All Commercial |
$831.71
|
| Rate for Payer: CORVEL All Commercial |
$831.71
|
| Rate for Payer: Coventry All Commercial |
$998.05
|
| Rate for Payer: Coventry All Commercial |
$998.05
|
| Rate for Payer: Encore All Commercial |
$831.71
|
| Rate for Payer: Encore All Commercial |
$831.71
|
| Rate for Payer: Frontpath All Commercial |
$1,156.18
|
| Rate for Payer: Frontpath All Commercial |
$1,156.18
|
| Rate for Payer: Humana ChoiceCare |
$955.21
|
| Rate for Payer: Humana ChoiceCare |
$955.21
|
| Rate for Payer: Humana Medicare |
$831.71
|
| Rate for Payer: Humana Medicare |
$831.71
|
| Rate for Payer: Lucent All Commercial |
$1,164.39
|
| Rate for Payer: Lucent All Commercial |
$1,164.39
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,156.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,156.00
|
| Rate for Payer: Managed Health Services Medicaid |
$805.28
|
| Rate for Payer: Managed Health Services Medicaid |
$805.28
|
| Rate for Payer: MDWise Medicaid |
$805.28
|
| Rate for Payer: MDWise Medicaid |
$805.28
|
| Rate for Payer: PHCS All Commercial |
$831.71
|
| Rate for Payer: PHCS All Commercial |
$831.71
|
| Rate for Payer: PHP All Commercial |
$1,062.80
|
| Rate for Payer: PHP All Commercial |
$1,062.80
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$831.71
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$831.71
|
| Rate for Payer: Sagamore Health Network All Products |
$831.71
|
| Rate for Payer: Sagamore Health Network All Products |
$831.71
|
| Rate for Payer: Signature Care EPO |
$1,074.40
|
| Rate for Payer: Signature Care EPO |
$1,074.40
|
| Rate for Payer: Signature Care PPO |
$1,074.40
|
| Rate for Payer: Signature Care PPO |
$1,074.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$107,300.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$107,300.00
|
| Rate for Payer: United Healthcare Commercial |
$995.59
|
| Rate for Payer: United Healthcare Commercial |
$995.59
|
| Rate for Payer: United Healthcare Medicare |
$805.15
|
| Rate for Payer: United Healthcare Medicare |
$805.15
|
|
|
PR LAP,VAG HYST,UTERUS >250GMS,SALP-OOPH
|
Professional
|
Both
|
$2,416.70
|
|
|
Service Code
|
CPT 58554
|
| Hospital Charge Code |
z58554
|
| Min. Negotiated Rate |
$1,188.63 |
| Max. Negotiated Rate |
$158,400.00 |
| Rate for Payer: Aetna Commercial |
$1,229.96
|
| Rate for Payer: Aetna Commercial |
$1,229.96
|
| Rate for Payer: Aetna Medicare |
$1,229.96
|
| Rate for Payer: Aetna Medicare |
$1,229.96
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$1,696.57
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$1,696.57
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,696.57
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,696.57
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,696.57
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,696.57
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,696.57
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,696.57
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$1,188.63
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$1,188.63
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,414.45
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,414.45
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,352.96
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,352.96
|
| Rate for Payer: Cash Price |
$1,498.35
|
| Rate for Payer: Cash Price |
$1,474.03
|
| Rate for Payer: Centivo All Commercial |
$1,906.44
|
| Rate for Payer: Centivo All Commercial |
$1,906.44
|
| Rate for Payer: Cigna All Commercial |
$1,229.96
|
| Rate for Payer: Cigna All Commercial |
$1,229.96
|
| Rate for Payer: CORVEL All Commercial |
$1,229.96
|
| Rate for Payer: CORVEL All Commercial |
$1,229.96
|
| Rate for Payer: Coventry All Commercial |
$1,475.95
|
| Rate for Payer: Coventry All Commercial |
$1,475.95
|
| Rate for Payer: Encore All Commercial |
$1,229.96
|
| Rate for Payer: Encore All Commercial |
$1,229.96
|
| Rate for Payer: Frontpath All Commercial |
$1,712.85
|
| Rate for Payer: Frontpath All Commercial |
$1,712.85
|
| Rate for Payer: Humana ChoiceCare |
$1,436.63
|
| Rate for Payer: Humana ChoiceCare |
$1,436.63
|
| Rate for Payer: Humana Medicare |
$1,229.96
|
| Rate for Payer: Humana Medicare |
$1,229.96
|
| Rate for Payer: Lucent All Commercial |
$1,721.94
|
| Rate for Payer: Lucent All Commercial |
$1,721.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,706.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,706.00
|
| Rate for Payer: Managed Health Services Medicaid |
$1,188.63
|
| Rate for Payer: Managed Health Services Medicaid |
$1,188.63
|
| Rate for Payer: MDWise Medicaid |
$1,188.63
|
| Rate for Payer: MDWise Medicaid |
$1,188.63
|
| Rate for Payer: PHCS All Commercial |
$1,229.96
|
| Rate for Payer: PHCS All Commercial |
$1,229.96
|
| Rate for Payer: PHP All Commercial |
$1,569.12
|
| Rate for Payer: PHP All Commercial |
$1,569.12
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,229.96
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,229.96
|
| Rate for Payer: Sagamore Health Network All Products |
$1,229.96
|
| Rate for Payer: Sagamore Health Network All Products |
$1,229.96
|
| Rate for Payer: Signature Care EPO |
$1,598.85
|
| Rate for Payer: Signature Care EPO |
$1,598.85
|
| Rate for Payer: Signature Care PPO |
$1,598.85
|
| Rate for Payer: Signature Care PPO |
$1,598.85
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$158,400.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$158,400.00
|
| Rate for Payer: United Healthcare Commercial |
$1,474.61
|
| Rate for Payer: United Healthcare Commercial |
$1,474.61
|
| Rate for Payer: United Healthcare Medicare |
$1,188.73
|
| Rate for Payer: United Healthcare Medicare |
$1,188.73
|
|
|
PR LAP,VAG HYST,UTERUS 250GMS/<,SALP-OOPH
|
Professional
|
Both
|
$1,818.70
|
|
|
Service Code
|
CPT 58552
|
| Hospital Charge Code |
z58552
|
| Min. Negotiated Rate |
$894.51 |
| Max. Negotiated Rate |
$119,300.00 |
| Rate for Payer: Aetna Commercial |
$924.24
|
| Rate for Payer: Aetna Commercial |
$924.24
|
| Rate for Payer: Aetna Medicare |
$924.24
|
| Rate for Payer: Aetna Medicare |
$924.24
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$1,327.01
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$1,327.01
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,327.01
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,327.01
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,327.01
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,327.01
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,327.01
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,327.01
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$894.51
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$894.51
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,062.88
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,062.88
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,016.66
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,016.66
|
| Rate for Payer: Cash Price |
$1,127.59
|
| Rate for Payer: Cash Price |
$1,110.57
|
| Rate for Payer: Centivo All Commercial |
$1,432.57
|
| Rate for Payer: Centivo All Commercial |
$1,432.57
|
| Rate for Payer: Cigna All Commercial |
$924.24
|
| Rate for Payer: Cigna All Commercial |
$924.24
|
| Rate for Payer: CORVEL All Commercial |
$924.24
|
| Rate for Payer: CORVEL All Commercial |
$924.24
|
| Rate for Payer: Coventry All Commercial |
$1,109.09
|
| Rate for Payer: Coventry All Commercial |
$1,109.09
|
| Rate for Payer: Encore All Commercial |
$924.24
|
| Rate for Payer: Encore All Commercial |
$924.24
|
| Rate for Payer: Frontpath All Commercial |
$1,285.15
|
| Rate for Payer: Frontpath All Commercial |
$1,285.15
|
| Rate for Payer: Humana ChoiceCare |
$1,064.38
|
| Rate for Payer: Humana ChoiceCare |
$1,064.38
|
| Rate for Payer: Humana Medicare |
$924.24
|
| Rate for Payer: Humana Medicare |
$924.24
|
| Rate for Payer: Lucent All Commercial |
$1,293.94
|
| Rate for Payer: Lucent All Commercial |
$1,293.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,285.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,285.00
|
| Rate for Payer: Managed Health Services Medicaid |
$894.51
|
| Rate for Payer: Managed Health Services Medicaid |
$894.51
|
| Rate for Payer: MDWise Medicaid |
$894.51
|
| Rate for Payer: MDWise Medicaid |
$894.51
|
| Rate for Payer: PHCS All Commercial |
$924.24
|
| Rate for Payer: PHCS All Commercial |
$924.24
|
| Rate for Payer: PHP All Commercial |
$1,182.22
|
| Rate for Payer: PHP All Commercial |
$1,182.22
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$924.24
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$924.24
|
| Rate for Payer: Sagamore Health Network All Products |
$924.24
|
| Rate for Payer: Sagamore Health Network All Products |
$924.24
|
| Rate for Payer: Signature Care EPO |
$1,277.55
|
| Rate for Payer: Signature Care EPO |
$1,277.55
|
| Rate for Payer: Signature Care PPO |
$1,277.55
|
| Rate for Payer: Signature Care PPO |
$1,277.55
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$119,300.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$119,300.00
|
| Rate for Payer: United Healthcare Commercial |
$1,099.54
|
| Rate for Payer: United Healthcare Commercial |
$1,099.54
|
| Rate for Payer: United Healthcare Medicare |
$895.62
|
| Rate for Payer: United Healthcare Medicare |
$895.62
|
|
|
PR LARYNGOSCOPY FLEXIBLE DIAGNOSTIC
|
Professional
|
Both
|
$238.98
|
|
|
Service Code
|
CPT 31575
|
| Hospital Charge Code |
z31575
|
| Min. Negotiated Rate |
$43.85 |
| Max. Negotiated Rate |
$9,500.00 |
| Rate for Payer: Aetna Commercial |
$62.80
|
| Rate for Payer: Aetna Commercial |
$62.80
|
| Rate for Payer: Aetna Medicare |
$62.80
|
| Rate for Payer: Aetna Medicare |
$62.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$145.26
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$145.26
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$145.26
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$145.26
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$145.26
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$145.26
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$145.26
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$145.26
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$43.85
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$43.85
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$117.54
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$117.54
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$72.22
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$72.22
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$69.08
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$69.08
|
| Rate for Payer: Cash Price |
$146.58
|
| Rate for Payer: Cash Price |
$148.17
|
| Rate for Payer: Centivo All Commercial |
$97.34
|
| Rate for Payer: Centivo All Commercial |
$97.34
|
| Rate for Payer: Cigna All Commercial |
$62.80
|
| Rate for Payer: Cigna All Commercial |
$62.80
|
| Rate for Payer: CORVEL All Commercial |
$62.80
|
| Rate for Payer: CORVEL All Commercial |
$62.80
|
| Rate for Payer: Coventry All Commercial |
$75.36
|
| Rate for Payer: Coventry All Commercial |
$75.36
|
| Rate for Payer: Encore All Commercial |
$62.80
|
| Rate for Payer: Encore All Commercial |
$62.80
|
| Rate for Payer: Frontpath All Commercial |
$85.57
|
| Rate for Payer: Frontpath All Commercial |
$85.57
|
| Rate for Payer: Humana ChoiceCare |
$89.58
|
| Rate for Payer: Humana ChoiceCare |
$89.58
|
| Rate for Payer: Humana Medicare |
$62.80
|
| Rate for Payer: Humana Medicare |
$62.80
|
| Rate for Payer: Lucent All Commercial |
$87.92
|
| Rate for Payer: Lucent All Commercial |
$87.92
|
| Rate for Payer: Lutheran Preferred All Commercial |
$101.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$101.00
|
| Rate for Payer: Managed Health Services Medicaid |
$117.54
|
| Rate for Payer: Managed Health Services Medicaid |
$117.54
|
| Rate for Payer: MDWise Medicaid |
$117.54
|
| Rate for Payer: MDWise Medicaid |
$117.54
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$43.85
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$43.85
|
| Rate for Payer: PHCS All Commercial |
$62.80
|
| Rate for Payer: PHCS All Commercial |
$62.80
|
| Rate for Payer: PHP All Commercial |
$86.64
|
| Rate for Payer: PHP All Commercial |
$86.64
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$62.80
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$62.80
|
| Rate for Payer: Sagamore Health Network All Products |
$62.80
|
| Rate for Payer: Sagamore Health Network All Products |
$62.80
|
| Rate for Payer: Signature Care EPO |
$154.70
|
| Rate for Payer: Signature Care EPO |
$154.70
|
| Rate for Payer: Signature Care PPO |
$154.70
|
| Rate for Payer: Signature Care PPO |
$154.70
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$9,500.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$9,500.00
|
| Rate for Payer: United Healthcare Commercial |
$85.55
|
| Rate for Payer: United Healthcare Commercial |
$85.55
|
| Rate for Payer: United Healthcare Medicare |
$118.21
|
| Rate for Payer: United Healthcare Medicare |
$118.21
|
|
|
PR LARYNGOSCOPY,INDIRECT+INJECT CORD
|
Professional
|
Both
|
$243.12
|
|
|
Service Code
|
CPT 31513
|
| Hospital Charge Code |
z31513
|
| Min. Negotiated Rate |
$119.16 |
| Max. Negotiated Rate |
$18,300.00 |
| Rate for Payer: Aetna Commercial |
$121.88
|
| Rate for Payer: Aetna Commercial |
$121.88
|
| Rate for Payer: Aetna Medicare |
$121.88
|
| Rate for Payer: Aetna Medicare |
$121.88
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$193.70
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$193.70
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$193.70
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$193.70
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$193.70
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$193.70
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$193.70
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$193.70
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$119.57
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$119.57
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$140.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$140.16
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$134.07
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$134.07
|
| Rate for Payer: Cash Price |
$150.73
|
| Rate for Payer: Cash Price |
$147.76
|
| Rate for Payer: Centivo All Commercial |
$188.91
|
| Rate for Payer: Centivo All Commercial |
$188.91
|
| Rate for Payer: Cigna All Commercial |
$121.88
|
| Rate for Payer: Cigna All Commercial |
$121.88
|
| Rate for Payer: CORVEL All Commercial |
$121.88
|
| Rate for Payer: CORVEL All Commercial |
$121.88
|
| Rate for Payer: Coventry All Commercial |
$146.26
|
| Rate for Payer: Coventry All Commercial |
$146.26
|
| Rate for Payer: Encore All Commercial |
$121.88
|
| Rate for Payer: Encore All Commercial |
$121.88
|
| Rate for Payer: Frontpath All Commercial |
$167.48
|
| Rate for Payer: Frontpath All Commercial |
$167.48
|
| Rate for Payer: Humana ChoiceCare |
$161.01
|
| Rate for Payer: Humana ChoiceCare |
$161.01
|
| Rate for Payer: Humana Medicare |
$121.88
|
| Rate for Payer: Humana Medicare |
$121.88
|
| Rate for Payer: Lucent All Commercial |
$170.63
|
| Rate for Payer: Lucent All Commercial |
$170.63
|
| Rate for Payer: Lutheran Preferred All Commercial |
$195.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$195.00
|
| Rate for Payer: Managed Health Services Medicaid |
$119.57
|
| Rate for Payer: Managed Health Services Medicaid |
$119.57
|
| Rate for Payer: MDWise Medicaid |
$119.57
|
| Rate for Payer: MDWise Medicaid |
$119.57
|
| Rate for Payer: PHCS All Commercial |
$121.88
|
| Rate for Payer: PHCS All Commercial |
$121.88
|
| Rate for Payer: PHP All Commercial |
$166.82
|
| Rate for Payer: PHP All Commercial |
$166.82
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$121.88
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$121.88
|
| Rate for Payer: Sagamore Health Network All Products |
$121.88
|
| Rate for Payer: Sagamore Health Network All Products |
$121.88
|
| Rate for Payer: Signature Care EPO |
$190.40
|
| Rate for Payer: Signature Care EPO |
$190.40
|
| Rate for Payer: Signature Care PPO |
$190.40
|
| Rate for Payer: Signature Care PPO |
$190.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$18,300.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$18,300.00
|
| Rate for Payer: United Healthcare Commercial |
$149.76
|
| Rate for Payer: United Healthcare Commercial |
$149.76
|
| Rate for Payer: United Healthcare Medicare |
$119.16
|
| Rate for Payer: United Healthcare Medicare |
$119.16
|
|
|
PR LATERAL RETINACULAR RELEASE OPEN
|
Professional
|
Both
|
$852.60
|
|
|
Service Code
|
CPT 27425
|
| Hospital Charge Code |
z27425
|
| Min. Negotiated Rate |
$415.61 |
| Max. Negotiated Rate |
$657.62 |
| Rate for Payer: Aetna Commercial |
$424.27
|
| Rate for Payer: Aetna Commercial |
$424.27
|
| Rate for Payer: Aetna Medicare |
$424.27
|
| Rate for Payer: Aetna Medicare |
$424.27
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$419.34
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$419.34
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$487.91
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$487.91
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$466.70
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$466.70
|
| Rate for Payer: Cash Price |
$515.36
|
| Rate for Payer: Cash Price |
$528.61
|
| Rate for Payer: Centivo All Commercial |
$657.62
|
| Rate for Payer: Centivo All Commercial |
$657.62
|
| Rate for Payer: Cigna All Commercial |
$424.27
|
| Rate for Payer: Cigna All Commercial |
$424.27
|
| Rate for Payer: CORVEL All Commercial |
$424.27
|
| Rate for Payer: CORVEL All Commercial |
$424.27
|
| Rate for Payer: Coventry All Commercial |
$509.12
|
| Rate for Payer: Coventry All Commercial |
$509.12
|
| Rate for Payer: Encore All Commercial |
$424.27
|
| Rate for Payer: Encore All Commercial |
$424.27
|
| Rate for Payer: Frontpath All Commercial |
$586.52
|
| Rate for Payer: Frontpath All Commercial |
$586.52
|
| Rate for Payer: Humana ChoiceCare |
$463.71
|
| Rate for Payer: Humana ChoiceCare |
$463.71
|
| Rate for Payer: Humana Medicare |
$424.27
|
| Rate for Payer: Humana Medicare |
$424.27
|
| Rate for Payer: Lucent All Commercial |
$593.98
|
| Rate for Payer: Lucent All Commercial |
$593.98
|
| Rate for Payer: Managed Health Services Medicaid |
$419.34
|
| Rate for Payer: Managed Health Services Medicaid |
$419.34
|
| Rate for Payer: MDWise Medicaid |
$419.34
|
| Rate for Payer: MDWise Medicaid |
$419.34
|
| Rate for Payer: PHCS All Commercial |
$424.27
|
| Rate for Payer: PHCS All Commercial |
$424.27
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$424.27
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$424.27
|
| Rate for Payer: Sagamore Health Network All Products |
$424.27
|
| Rate for Payer: Sagamore Health Network All Products |
$424.27
|
| Rate for Payer: United Healthcare Commercial |
$468.04
|
| Rate for Payer: United Healthcare Commercial |
$468.04
|
| Rate for Payer: United Healthcare Medicare |
$415.61
|
| Rate for Payer: United Healthcare Medicare |
$415.61
|
|
|
PR LAYR CLOS WND FACE,FACIAL 2.5-5 CM
|
Professional
|
Both
|
$587.24
|
|
|
Service Code
|
CPT 12052
|
| Hospital Charge Code |
z12052
|
| Min. Negotiated Rate |
$100.53 |
| Max. Negotiated Rate |
$22,400.00 |
| Rate for Payer: Aetna Commercial |
$185.77
|
| Rate for Payer: Aetna Commercial |
$185.77
|
| Rate for Payer: Aetna Medicare |
$185.77
|
| Rate for Payer: Aetna Medicare |
$185.77
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$302.83
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$302.83
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$302.83
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$302.83
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$302.83
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$302.83
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$302.83
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$302.83
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$100.53
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$100.53
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$288.83
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$288.83
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$213.64
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$213.64
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$204.35
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$204.35
|
| Rate for Payer: Cash Price |
$359.00
|
| Rate for Payer: Cash Price |
$364.09
|
| Rate for Payer: Centivo All Commercial |
$287.94
|
| Rate for Payer: Centivo All Commercial |
$287.94
|
| Rate for Payer: Cigna All Commercial |
$185.77
|
| Rate for Payer: Cigna All Commercial |
$185.77
|
| Rate for Payer: CORVEL All Commercial |
$185.77
|
| Rate for Payer: CORVEL All Commercial |
$185.77
|
| Rate for Payer: Coventry All Commercial |
$222.92
|
| Rate for Payer: Coventry All Commercial |
$222.92
|
| Rate for Payer: Encore All Commercial |
$185.77
|
| Rate for Payer: Encore All Commercial |
$185.77
|
| Rate for Payer: Frontpath All Commercial |
$252.64
|
| Rate for Payer: Frontpath All Commercial |
$252.64
|
| Rate for Payer: Humana ChoiceCare |
$156.88
|
| Rate for Payer: Humana ChoiceCare |
$156.88
|
| Rate for Payer: Humana Medicare |
$185.77
|
| Rate for Payer: Humana Medicare |
$185.77
|
| Rate for Payer: Lucent All Commercial |
$260.08
|
| Rate for Payer: Lucent All Commercial |
$260.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$243.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$243.00
|
| Rate for Payer: Managed Health Services Medicaid |
$288.83
|
| Rate for Payer: Managed Health Services Medicaid |
$288.83
|
| Rate for Payer: MDWise Medicaid |
$288.83
|
| Rate for Payer: MDWise Medicaid |
$288.83
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$100.53
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$100.53
|
| Rate for Payer: PHCS All Commercial |
$185.77
|
| Rate for Payer: PHCS All Commercial |
$185.77
|
| Rate for Payer: PHP All Commercial |
$254.80
|
| Rate for Payer: PHP All Commercial |
$254.80
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$185.77
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$185.77
|
| Rate for Payer: Sagamore Health Network All Products |
$185.77
|
| Rate for Payer: Sagamore Health Network All Products |
$185.77
|
| Rate for Payer: Signature Care EPO |
$253.74
|
| Rate for Payer: Signature Care EPO |
$253.74
|
| Rate for Payer: Signature Care PPO |
$253.74
|
| Rate for Payer: Signature Care PPO |
$253.74
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$22,400.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$22,400.00
|
| Rate for Payer: United Healthcare Commercial |
$227.29
|
| Rate for Payer: United Healthcare Commercial |
$227.29
|
| Rate for Payer: United Healthcare Medicare |
$289.52
|
| Rate for Payer: United Healthcare Medicare |
$289.52
|
|
|
PR LAYR CLOS WND FACE,FACIAL <2.5 CM
|
Professional
|
Both
|
$526.68
|
|
|
Service Code
|
CPT 12051
|
| Hospital Charge Code |
z12051
|
| Min. Negotiated Rate |
$85.48 |
| Max. Negotiated Rate |
$19,000.00 |
| Rate for Payer: Aetna Commercial |
$157.56
|
| Rate for Payer: Aetna Commercial |
$157.56
|
| Rate for Payer: Aetna Medicare |
$157.56
|
| Rate for Payer: Aetna Medicare |
$157.56
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$267.11
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$267.11
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$267.11
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$267.11
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$267.11
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$267.11
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$267.11
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$267.11
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$85.48
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$85.48
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$259.04
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$259.04
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$181.19
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$181.19
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$173.32
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$173.32
|
| Rate for Payer: Cash Price |
$322.08
|
| Rate for Payer: Cash Price |
$326.54
|
| Rate for Payer: Centivo All Commercial |
$244.22
|
| Rate for Payer: Centivo All Commercial |
$244.22
|
| Rate for Payer: Cigna All Commercial |
$157.56
|
| Rate for Payer: Cigna All Commercial |
$157.56
|
| Rate for Payer: CORVEL All Commercial |
$157.56
|
| Rate for Payer: CORVEL All Commercial |
$157.56
|
| Rate for Payer: Coventry All Commercial |
$189.07
|
| Rate for Payer: Coventry All Commercial |
$189.07
|
| Rate for Payer: Encore All Commercial |
$157.56
|
| Rate for Payer: Encore All Commercial |
$157.56
|
| Rate for Payer: Frontpath All Commercial |
$214.38
|
| Rate for Payer: Frontpath All Commercial |
$214.38
|
| Rate for Payer: Humana ChoiceCare |
$146.70
|
| Rate for Payer: Humana ChoiceCare |
$146.70
|
| Rate for Payer: Humana Medicare |
$157.56
|
| Rate for Payer: Humana Medicare |
$157.56
|
| Rate for Payer: Lucent All Commercial |
$220.58
|
| Rate for Payer: Lucent All Commercial |
$220.58
|
| 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 |
$259.04
|
| Rate for Payer: Managed Health Services Medicaid |
$259.04
|
| Rate for Payer: MDWise Medicaid |
$259.04
|
| Rate for Payer: MDWise Medicaid |
$259.04
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$85.48
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$85.48
|
| Rate for Payer: PHCS All Commercial |
$157.56
|
| Rate for Payer: PHCS All Commercial |
$157.56
|
| Rate for Payer: PHP All Commercial |
$216.06
|
| Rate for Payer: PHP All Commercial |
$216.06
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$157.56
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$157.56
|
| Rate for Payer: Sagamore Health Network All Products |
$157.56
|
| Rate for Payer: Sagamore Health Network All Products |
$157.56
|
| Rate for Payer: Signature Care EPO |
$232.05
|
| Rate for Payer: Signature Care EPO |
$232.05
|
| Rate for Payer: Signature Care PPO |
$232.05
|
| Rate for Payer: Signature Care PPO |
$232.05
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$19,000.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$19,000.00
|
| Rate for Payer: United Healthcare Commercial |
$193.81
|
| Rate for Payer: United Healthcare Commercial |
$193.81
|
| Rate for Payer: United Healthcare Medicare |
$259.74
|
| Rate for Payer: United Healthcare Medicare |
$259.74
|
|
|
PR LAYR CLOS WND FACE,FACIAL 5.1-7.5 CM
|
Professional
|
Both
|
$675.74
|
|
|
Service Code
|
CPT 12053
|
| Hospital Charge Code |
z12053
|
| Min. Negotiated Rate |
$108.32 |
| Max. Negotiated Rate |
$24,100.00 |
| Rate for Payer: Aetna Commercial |
$199.92
|
| Rate for Payer: Aetna Commercial |
$199.92
|
| Rate for Payer: Aetna Medicare |
$199.92
|
| Rate for Payer: Aetna Medicare |
$199.92
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$332.96
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$332.96
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$332.96
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$332.96
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$332.96
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$332.96
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$332.96
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$332.96
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$108.32
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$108.32
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$332.35
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$332.35
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$229.91
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$229.91
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$219.91
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$219.91
|
| Rate for Payer: Cash Price |
$413.55
|
| Rate for Payer: Cash Price |
$418.96
|
| Rate for Payer: Centivo All Commercial |
$309.88
|
| Rate for Payer: Centivo All Commercial |
$309.88
|
| Rate for Payer: Cigna All Commercial |
$199.92
|
| Rate for Payer: Cigna All Commercial |
$199.92
|
| Rate for Payer: CORVEL All Commercial |
$199.92
|
| Rate for Payer: CORVEL All Commercial |
$199.92
|
| Rate for Payer: Coventry All Commercial |
$239.90
|
| Rate for Payer: Coventry All Commercial |
$239.90
|
| Rate for Payer: Encore All Commercial |
$199.92
|
| Rate for Payer: Encore All Commercial |
$199.92
|
| Rate for Payer: Frontpath All Commercial |
$272.79
|
| Rate for Payer: Frontpath All Commercial |
$272.79
|
| Rate for Payer: Humana ChoiceCare |
$174.57
|
| Rate for Payer: Humana ChoiceCare |
$174.57
|
| Rate for Payer: Humana Medicare |
$199.92
|
| Rate for Payer: Humana Medicare |
$199.92
|
| Rate for Payer: Lucent All Commercial |
$279.89
|
| Rate for Payer: Lucent All Commercial |
$279.89
|
| Rate for Payer: Lutheran Preferred All Commercial |
$261.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$261.00
|
| Rate for Payer: Managed Health Services Medicaid |
$332.35
|
| Rate for Payer: Managed Health Services Medicaid |
$332.35
|
| Rate for Payer: MDWise Medicaid |
$332.35
|
| Rate for Payer: MDWise Medicaid |
$332.35
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$108.32
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$108.32
|
| Rate for Payer: PHCS All Commercial |
$199.92
|
| Rate for Payer: PHCS All Commercial |
$199.92
|
| Rate for Payer: PHP All Commercial |
$274.64
|
| Rate for Payer: PHP All Commercial |
$274.64
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$199.92
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$199.92
|
| Rate for Payer: Sagamore Health Network All Products |
$199.92
|
| Rate for Payer: Sagamore Health Network All Products |
$199.92
|
| Rate for Payer: Signature Care EPO |
$292.77
|
| Rate for Payer: Signature Care EPO |
$292.77
|
| Rate for Payer: Signature Care PPO |
$292.77
|
| Rate for Payer: Signature Care PPO |
$292.77
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$24,100.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$24,100.00
|
| Rate for Payer: United Healthcare Commercial |
$231.38
|
| Rate for Payer: United Healthcare Commercial |
$231.38
|
| Rate for Payer: United Healthcare Medicare |
$333.51
|
| Rate for Payer: United Healthcare Medicare |
$333.51
|
|
|
PR LAYR CLOS WND FACE,FACIAL 7.6-12.5 CM
|
Professional
|
Both
|
$709.56
|
|
|
Service Code
|
CPT 12054
|
| Hospital Charge Code |
z12054
|
| Min. Negotiated Rate |
$110.92 |
| Max. Negotiated Rate |
$351.59 |
| Rate for Payer: Aetna Commercial |
$203.33
|
| Rate for Payer: Aetna Commercial |
$203.33
|
| Rate for Payer: Aetna Medicare |
$203.33
|
| Rate for Payer: Aetna Medicare |
$203.33
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$110.92
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$110.92
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$348.99
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$348.99
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$233.83
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$233.83
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$223.66
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$223.66
|
| Rate for Payer: Cash Price |
$435.97
|
| Rate for Payer: Cash Price |
$439.93
|
| Rate for Payer: Centivo All Commercial |
$315.16
|
| Rate for Payer: Centivo All Commercial |
$315.16
|
| Rate for Payer: Cigna All Commercial |
$203.33
|
| Rate for Payer: Cigna All Commercial |
$203.33
|
| Rate for Payer: CORVEL All Commercial |
$203.33
|
| Rate for Payer: CORVEL All Commercial |
$203.33
|
| Rate for Payer: Coventry All Commercial |
$244.00
|
| Rate for Payer: Coventry All Commercial |
$244.00
|
| Rate for Payer: Encore All Commercial |
$203.33
|
| Rate for Payer: Encore All Commercial |
$203.33
|
| Rate for Payer: Frontpath All Commercial |
$281.54
|
| Rate for Payer: Frontpath All Commercial |
$281.54
|
| Rate for Payer: Humana ChoiceCare |
$191.67
|
| Rate for Payer: Humana ChoiceCare |
$191.67
|
| Rate for Payer: Humana Medicare |
$203.33
|
| Rate for Payer: Humana Medicare |
$203.33
|
| Rate for Payer: Lucent All Commercial |
$284.66
|
| Rate for Payer: Lucent All Commercial |
$284.66
|
| Rate for Payer: Managed Health Services Medicaid |
$348.99
|
| Rate for Payer: Managed Health Services Medicaid |
$348.99
|
| Rate for Payer: MDWise Medicaid |
$348.99
|
| Rate for Payer: MDWise Medicaid |
$348.99
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$110.92
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$110.92
|
| Rate for Payer: PHCS All Commercial |
$203.33
|
| Rate for Payer: PHCS All Commercial |
$203.33
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$203.33
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$203.33
|
| Rate for Payer: Sagamore Health Network All Products |
$203.33
|
| Rate for Payer: Sagamore Health Network All Products |
$203.33
|
| Rate for Payer: United Healthcare Commercial |
$246.08
|
| Rate for Payer: United Healthcare Commercial |
$246.08
|
| Rate for Payer: United Healthcare Medicare |
$351.59
|
| Rate for Payer: United Healthcare Medicare |
$351.59
|
|
