|
PR REMOVAL OF OVARY/TUBE(S)
|
Professional
|
Both
|
$1,409.92
|
|
|
Service Code
|
CPT 58720
|
| Hospital Charge Code |
z58720
|
| Min. Negotiated Rate |
$690.99 |
| Max. Negotiated Rate |
$92,100.00 |
| Rate for Payer: Aetna Commercial |
$713.57
|
| Rate for Payer: Aetna Commercial |
$713.57
|
| Rate for Payer: Aetna Medicare |
$713.57
|
| Rate for Payer: Aetna Medicare |
$713.57
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$906.53
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$906.53
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$906.53
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$906.53
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$906.53
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$906.53
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$906.53
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$906.53
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$693.46
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$693.46
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$820.61
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$820.61
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$784.93
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$784.93
|
| Rate for Payer: Cash Price |
$845.95
|
| Rate for Payer: Cash Price |
$829.19
|
| Rate for Payer: Centivo All Commercial |
$1,106.03
|
| Rate for Payer: Centivo All Commercial |
$1,106.03
|
| Rate for Payer: Cigna All Commercial |
$713.57
|
| Rate for Payer: Cigna All Commercial |
$713.57
|
| Rate for Payer: CORVEL All Commercial |
$713.57
|
| Rate for Payer: CORVEL All Commercial |
$713.57
|
| Rate for Payer: Coventry All Commercial |
$856.28
|
| Rate for Payer: Coventry All Commercial |
$856.28
|
| Rate for Payer: Encore All Commercial |
$713.57
|
| Rate for Payer: Encore All Commercial |
$713.57
|
| Rate for Payer: Frontpath All Commercial |
$991.65
|
| Rate for Payer: Frontpath All Commercial |
$991.65
|
| Rate for Payer: Humana ChoiceCare |
$762.29
|
| Rate for Payer: Humana ChoiceCare |
$762.29
|
| Rate for Payer: Humana Medicare |
$713.57
|
| Rate for Payer: Humana Medicare |
$713.57
|
| Rate for Payer: Lucent All Commercial |
$999.00
|
| Rate for Payer: Lucent All Commercial |
$999.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$992.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$992.00
|
| Rate for Payer: Managed Health Services Medicaid |
$693.46
|
| Rate for Payer: Managed Health Services Medicaid |
$693.46
|
| Rate for Payer: MDWise Medicaid |
$693.46
|
| Rate for Payer: MDWise Medicaid |
$693.46
|
| Rate for Payer: PHCS All Commercial |
$713.57
|
| Rate for Payer: PHCS All Commercial |
$713.57
|
| Rate for Payer: PHP All Commercial |
$912.11
|
| Rate for Payer: PHP All Commercial |
$912.11
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$713.57
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$713.57
|
| Rate for Payer: Sagamore Health Network All Products |
$713.57
|
| Rate for Payer: Sagamore Health Network All Products |
$713.57
|
| Rate for Payer: Signature Care EPO |
$914.60
|
| Rate for Payer: Signature Care EPO |
$914.60
|
| Rate for Payer: Signature Care PPO |
$914.60
|
| Rate for Payer: Signature Care PPO |
$914.60
|
| 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 |
$806.46
|
| Rate for Payer: United Healthcare Commercial |
$806.46
|
| Rate for Payer: United Healthcare Medicare |
$690.99
|
| Rate for Payer: United Healthcare Medicare |
$690.99
|
|
|
PR REMOVAL OF RECTAL MARKER
|
Professional
|
Both
|
$467.82
|
|
|
Service Code
|
CPT 46030
|
| Hospital Charge Code |
z46030
|
| Min. Negotiated Rate |
$52.12 |
| Max. Negotiated Rate |
$11,300.00 |
| Rate for Payer: Aetna Commercial |
$81.40
|
| Rate for Payer: Aetna Commercial |
$81.40
|
| Rate for Payer: Aetna Medicare |
$81.40
|
| Rate for Payer: Aetna Medicare |
$81.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$137.90
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$137.90
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$137.90
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$137.90
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$137.90
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$137.90
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$137.90
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$137.90
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$52.12
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$52.12
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$230.09
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$230.09
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$93.61
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$93.61
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$89.54
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$89.54
|
| Rate for Payer: Cash Price |
$280.28
|
| Rate for Payer: Cash Price |
$280.69
|
| Rate for Payer: Centivo All Commercial |
$126.17
|
| Rate for Payer: Centivo All Commercial |
$126.17
|
| Rate for Payer: Cigna All Commercial |
$81.40
|
| Rate for Payer: Cigna All Commercial |
$81.40
|
| Rate for Payer: CORVEL All Commercial |
$81.40
|
| Rate for Payer: CORVEL All Commercial |
$81.40
|
| Rate for Payer: Coventry All Commercial |
$97.68
|
| Rate for Payer: Coventry All Commercial |
$97.68
|
| Rate for Payer: Encore All Commercial |
$81.40
|
| Rate for Payer: Encore All Commercial |
$81.40
|
| Rate for Payer: Frontpath All Commercial |
$113.39
|
| Rate for Payer: Frontpath All Commercial |
$113.39
|
| Rate for Payer: Humana ChoiceCare |
$87.75
|
| Rate for Payer: Humana ChoiceCare |
$87.75
|
| Rate for Payer: Humana Medicare |
$81.40
|
| Rate for Payer: Humana Medicare |
$81.40
|
| Rate for Payer: Lucent All Commercial |
$113.96
|
| Rate for Payer: Lucent All Commercial |
$113.96
|
| Rate for Payer: Lutheran Preferred All Commercial |
$121.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$121.00
|
| Rate for Payer: Managed Health Services Medicaid |
$230.09
|
| Rate for Payer: Managed Health Services Medicaid |
$230.09
|
| Rate for Payer: MDWise Medicaid |
$230.09
|
| Rate for Payer: MDWise Medicaid |
$230.09
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$52.12
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$52.12
|
| Rate for Payer: PHCS All Commercial |
$81.40
|
| Rate for Payer: PHCS All Commercial |
$81.40
|
| Rate for Payer: PHP All Commercial |
$137.83
|
| Rate for Payer: PHP All Commercial |
$137.83
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$81.40
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$81.40
|
| Rate for Payer: Sagamore Health Network All Products |
$81.40
|
| Rate for Payer: Sagamore Health Network All Products |
$81.40
|
| Rate for Payer: Signature Care EPO |
$208.18
|
| Rate for Payer: Signature Care EPO |
$208.18
|
| Rate for Payer: Signature Care PPO |
$208.18
|
| Rate for Payer: Signature Care PPO |
$208.18
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$11,300.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$11,300.00
|
| Rate for Payer: United Healthcare Commercial |
$92.38
|
| Rate for Payer: United Healthcare Commercial |
$92.38
|
| Rate for Payer: United Healthcare Medicare |
$233.57
|
| Rate for Payer: United Healthcare Medicare |
$233.57
|
|
|
PR REMOVAL OF SPERM DUCT(S)
|
Professional
|
Both
|
$611.26
|
|
|
Service Code
|
CPT 55250
|
| Hospital Charge Code |
z55250
|
| Min. Negotiated Rate |
$162.42 |
| Max. Negotiated Rate |
$27,800.00 |
| Rate for Payer: Aetna Commercial |
$214.32
|
| Rate for Payer: Aetna Commercial |
$214.32
|
| Rate for Payer: Aetna Medicare |
$214.32
|
| Rate for Payer: Aetna Medicare |
$214.32
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$736.19
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$736.19
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$736.19
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$736.19
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$736.19
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$736.19
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$736.19
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$736.19
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$162.42
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$162.42
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$307.50
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$307.50
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$246.47
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$246.47
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$235.75
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$235.75
|
| Rate for Payer: Cash Price |
$361.66
|
| Rate for Payer: Cash Price |
$366.76
|
| Rate for Payer: Centivo All Commercial |
$332.20
|
| Rate for Payer: Centivo All Commercial |
$332.20
|
| Rate for Payer: Cigna All Commercial |
$214.32
|
| Rate for Payer: Cigna All Commercial |
$214.32
|
| Rate for Payer: CORVEL All Commercial |
$214.32
|
| Rate for Payer: CORVEL All Commercial |
$214.32
|
| Rate for Payer: Coventry All Commercial |
$257.18
|
| Rate for Payer: Coventry All Commercial |
$257.18
|
| Rate for Payer: Encore All Commercial |
$214.32
|
| Rate for Payer: Encore All Commercial |
$214.32
|
| Rate for Payer: Frontpath All Commercial |
$291.64
|
| Rate for Payer: Frontpath All Commercial |
$291.64
|
| Rate for Payer: Humana ChoiceCare |
$260.20
|
| Rate for Payer: Humana ChoiceCare |
$260.20
|
| Rate for Payer: Humana Medicare |
$214.32
|
| Rate for Payer: Humana Medicare |
$214.32
|
| Rate for Payer: Lucent All Commercial |
$300.05
|
| Rate for Payer: Lucent All Commercial |
$300.05
|
| Rate for Payer: Lutheran Preferred All Commercial |
$300.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$300.00
|
| Rate for Payer: Managed Health Services Medicaid |
$307.50
|
| Rate for Payer: Managed Health Services Medicaid |
$307.50
|
| Rate for Payer: MDWise Medicaid |
$307.50
|
| Rate for Payer: MDWise Medicaid |
$307.50
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$162.42
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$162.42
|
| Rate for Payer: PHCS All Commercial |
$214.32
|
| Rate for Payer: PHCS All Commercial |
$214.32
|
| Rate for Payer: PHP All Commercial |
$275.82
|
| Rate for Payer: PHP All Commercial |
$275.82
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$214.32
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$214.32
|
| Rate for Payer: Sagamore Health Network All Products |
$214.32
|
| Rate for Payer: Sagamore Health Network All Products |
$214.32
|
| Rate for Payer: Signature Care EPO |
$538.05
|
| Rate for Payer: Signature Care EPO |
$538.05
|
| Rate for Payer: Signature Care PPO |
$538.05
|
| Rate for Payer: Signature Care PPO |
$538.05
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$27,800.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$27,800.00
|
| Rate for Payer: United Healthcare Commercial |
$276.04
|
| Rate for Payer: United Healthcare Commercial |
$276.04
|
| Rate for Payer: United Healthcare Medicare |
$305.63
|
| Rate for Payer: United Healthcare Medicare |
$305.63
|
|
|
PR REMOVAL OF TONSILS,<12 Y/O
|
Professional
|
Both
|
$505.18
|
|
|
Service Code
|
CPT 42825
|
| Hospital Charge Code |
z42825
|
| Min. Negotiated Rate |
$247.08 |
| Max. Negotiated Rate |
$35,500.00 |
| Rate for Payer: Aetna Commercial |
$251.92
|
| Rate for Payer: Aetna Commercial |
$251.92
|
| Rate for Payer: Aetna Medicare |
$251.92
|
| Rate for Payer: Aetna Medicare |
$251.92
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$317.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$317.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$317.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$317.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$317.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$317.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$317.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$317.00
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$248.46
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$248.46
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$289.71
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$289.71
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$277.11
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$277.11
|
| Rate for Payer: Cash Price |
$303.11
|
| Rate for Payer: Cash Price |
$296.50
|
| Rate for Payer: Centivo All Commercial |
$390.48
|
| Rate for Payer: Centivo All Commercial |
$390.48
|
| Rate for Payer: Cigna All Commercial |
$251.92
|
| Rate for Payer: Cigna All Commercial |
$251.92
|
| Rate for Payer: CORVEL All Commercial |
$251.92
|
| Rate for Payer: CORVEL All Commercial |
$251.92
|
| Rate for Payer: Coventry All Commercial |
$302.30
|
| Rate for Payer: Coventry All Commercial |
$302.30
|
| Rate for Payer: Encore All Commercial |
$251.92
|
| Rate for Payer: Encore All Commercial |
$251.92
|
| Rate for Payer: Frontpath All Commercial |
$343.94
|
| Rate for Payer: Frontpath All Commercial |
$343.94
|
| Rate for Payer: Humana ChoiceCare |
$290.33
|
| Rate for Payer: Humana ChoiceCare |
$290.33
|
| Rate for Payer: Humana Medicare |
$251.92
|
| Rate for Payer: Humana Medicare |
$251.92
|
| Rate for Payer: Lucent All Commercial |
$352.69
|
| Rate for Payer: Lucent All Commercial |
$352.69
|
| Rate for Payer: Lutheran Preferred All Commercial |
$380.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$380.00
|
| Rate for Payer: Managed Health Services Medicaid |
$248.46
|
| Rate for Payer: Managed Health Services Medicaid |
$248.46
|
| Rate for Payer: MDWise Medicaid |
$248.46
|
| Rate for Payer: MDWise Medicaid |
$248.46
|
| Rate for Payer: PHCS All Commercial |
$251.92
|
| Rate for Payer: PHCS All Commercial |
$251.92
|
| Rate for Payer: PHP All Commercial |
$432.39
|
| Rate for Payer: PHP All Commercial |
$432.39
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$251.92
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$251.92
|
| Rate for Payer: Sagamore Health Network All Products |
$251.92
|
| Rate for Payer: Sagamore Health Network All Products |
$251.92
|
| Rate for Payer: Signature Care EPO |
$377.40
|
| Rate for Payer: Signature Care EPO |
$377.40
|
| Rate for Payer: Signature Care PPO |
$377.40
|
| Rate for Payer: Signature Care PPO |
$377.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$35,500.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$35,500.00
|
| Rate for Payer: United Healthcare Commercial |
$286.45
|
| Rate for Payer: United Healthcare Commercial |
$286.45
|
| Rate for Payer: United Healthcare Medicare |
$247.08
|
| Rate for Payer: United Healthcare Medicare |
$247.08
|
|
|
PR REMOVAL OF TONSILS,12+ Y/O
|
Professional
|
Both
|
$480.92
|
|
|
Service Code
|
CPT 42826
|
| Hospital Charge Code |
z42826
|
| Min. Negotiated Rate |
$235.16 |
| Max. Negotiated Rate |
$33,700.00 |
| Rate for Payer: Aetna Commercial |
$239.87
|
| Rate for Payer: Aetna Commercial |
$239.87
|
| Rate for Payer: Aetna Medicare |
$239.87
|
| Rate for Payer: Aetna Medicare |
$239.87
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$341.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$341.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$341.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$341.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$341.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$341.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$341.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$341.00
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$236.54
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$236.54
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$275.85
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$275.85
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$263.86
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$263.86
|
| Rate for Payer: Cash Price |
$288.55
|
| Rate for Payer: Cash Price |
$282.19
|
| Rate for Payer: Centivo All Commercial |
$371.80
|
| Rate for Payer: Centivo All Commercial |
$371.80
|
| Rate for Payer: Cigna All Commercial |
$239.87
|
| Rate for Payer: Cigna All Commercial |
$239.87
|
| Rate for Payer: CORVEL All Commercial |
$239.87
|
| Rate for Payer: CORVEL All Commercial |
$239.87
|
| Rate for Payer: Coventry All Commercial |
$287.84
|
| Rate for Payer: Coventry All Commercial |
$287.84
|
| Rate for Payer: Encore All Commercial |
$239.87
|
| Rate for Payer: Encore All Commercial |
$239.87
|
| Rate for Payer: Frontpath All Commercial |
$328.09
|
| Rate for Payer: Frontpath All Commercial |
$328.09
|
| Rate for Payer: Humana ChoiceCare |
$283.15
|
| Rate for Payer: Humana ChoiceCare |
$283.15
|
| Rate for Payer: Humana Medicare |
$239.87
|
| Rate for Payer: Humana Medicare |
$239.87
|
| Rate for Payer: Lucent All Commercial |
$335.82
|
| Rate for Payer: Lucent All Commercial |
$335.82
|
| Rate for Payer: Lutheran Preferred All Commercial |
$362.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$362.00
|
| Rate for Payer: Managed Health Services Medicaid |
$236.54
|
| Rate for Payer: Managed Health Services Medicaid |
$236.54
|
| Rate for Payer: MDWise Medicaid |
$236.54
|
| Rate for Payer: MDWise Medicaid |
$236.54
|
| Rate for Payer: PHCS All Commercial |
$239.87
|
| Rate for Payer: PHCS All Commercial |
$239.87
|
| Rate for Payer: PHP All Commercial |
$411.52
|
| Rate for Payer: PHP All Commercial |
$411.52
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$239.87
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$239.87
|
| Rate for Payer: Sagamore Health Network All Products |
$239.87
|
| Rate for Payer: Sagamore Health Network All Products |
$239.87
|
| Rate for Payer: Signature Care EPO |
$368.90
|
| Rate for Payer: Signature Care EPO |
$368.90
|
| Rate for Payer: Signature Care PPO |
$368.90
|
| Rate for Payer: Signature Care PPO |
$368.90
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$33,700.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$33,700.00
|
| Rate for Payer: United Healthcare Commercial |
$276.88
|
| Rate for Payer: United Healthcare Commercial |
$276.88
|
| Rate for Payer: United Healthcare Medicare |
$235.16
|
| Rate for Payer: United Healthcare Medicare |
$235.16
|
|
|
PR REMOVAL PERMANENT PACEMAKER PULSE GENERATOR ONLY
|
Professional
|
Both
|
$420.12
|
|
|
Service Code
|
CPT 33233
|
| Hospital Charge Code |
z33233
|
| Min. Negotiated Rate |
$206.63 |
| Max. Negotiated Rate |
$365.50 |
| Rate for Payer: Aetna Commercial |
$215.72
|
| Rate for Payer: Aetna Commercial |
$215.72
|
| Rate for Payer: Aetna Medicare |
$215.72
|
| Rate for Payer: Aetna Medicare |
$215.72
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$206.63
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$206.63
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$248.08
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$248.08
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$237.29
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$237.29
|
| Rate for Payer: Cash Price |
$252.07
|
| Rate for Payer: Cash Price |
$249.64
|
| Rate for Payer: Centivo All Commercial |
$334.37
|
| Rate for Payer: Centivo All Commercial |
$334.37
|
| Rate for Payer: Cigna All Commercial |
$215.72
|
| Rate for Payer: Cigna All Commercial |
$215.72
|
| Rate for Payer: CORVEL All Commercial |
$215.72
|
| Rate for Payer: CORVEL All Commercial |
$215.72
|
| Rate for Payer: Coventry All Commercial |
$258.86
|
| Rate for Payer: Coventry All Commercial |
$258.86
|
| Rate for Payer: Encore All Commercial |
$215.72
|
| Rate for Payer: Encore All Commercial |
$215.72
|
| Rate for Payer: Frontpath All Commercial |
$302.87
|
| Rate for Payer: Frontpath All Commercial |
$302.87
|
| Rate for Payer: Humana ChoiceCare |
$314.43
|
| Rate for Payer: Humana ChoiceCare |
$314.43
|
| Rate for Payer: Humana Medicare |
$215.72
|
| Rate for Payer: Humana Medicare |
$215.72
|
| Rate for Payer: Lucent All Commercial |
$302.01
|
| Rate for Payer: Lucent All Commercial |
$302.01
|
| Rate for Payer: Managed Health Services Medicaid |
$206.63
|
| Rate for Payer: Managed Health Services Medicaid |
$206.63
|
| Rate for Payer: MDWise Medicaid |
$206.63
|
| Rate for Payer: MDWise Medicaid |
$206.63
|
| Rate for Payer: PHCS All Commercial |
$215.72
|
| Rate for Payer: PHCS All Commercial |
$215.72
|
| Rate for Payer: PHP All Commercial |
$291.24
|
| Rate for Payer: PHP All Commercial |
$291.24
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$215.72
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$215.72
|
| Rate for Payer: Sagamore Health Network All Products |
$215.72
|
| Rate for Payer: Sagamore Health Network All Products |
$215.72
|
| Rate for Payer: Signature Care EPO |
$365.50
|
| Rate for Payer: Signature Care EPO |
$365.50
|
| Rate for Payer: Signature Care PPO |
$365.50
|
| Rate for Payer: Signature Care PPO |
$365.50
|
| Rate for Payer: United Healthcare Commercial |
$289.75
|
| Rate for Payer: United Healthcare Commercial |
$289.75
|
| Rate for Payer: United Healthcare Medicare |
$208.03
|
| Rate for Payer: United Healthcare Medicare |
$208.03
|
|
|
PR REMOVAL PREPATELLA BURSA
|
Professional
|
Both
|
$705.80
|
|
|
Service Code
|
CPT 27340
|
| Hospital Charge Code |
z27340
|
| Min. Negotiated Rate |
$343.21 |
| Max. Negotiated Rate |
$52,800.00 |
| Rate for Payer: Aetna Commercial |
$350.69
|
| Rate for Payer: Aetna Commercial |
$350.69
|
| Rate for Payer: Aetna Medicare |
$350.69
|
| Rate for Payer: Aetna Medicare |
$350.69
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$431.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$431.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$431.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$431.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$431.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$431.50
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$431.50
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$431.50
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$347.14
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$347.14
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$403.29
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$403.29
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$385.76
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$385.76
|
| Rate for Payer: Cash Price |
$423.48
|
| Rate for Payer: Cash Price |
$411.85
|
| Rate for Payer: Centivo All Commercial |
$543.57
|
| Rate for Payer: Centivo All Commercial |
$543.57
|
| Rate for Payer: Cigna All Commercial |
$350.69
|
| Rate for Payer: Cigna All Commercial |
$350.69
|
| Rate for Payer: CORVEL All Commercial |
$350.69
|
| Rate for Payer: CORVEL All Commercial |
$350.69
|
| Rate for Payer: Coventry All Commercial |
$420.83
|
| Rate for Payer: Coventry All Commercial |
$420.83
|
| Rate for Payer: Encore All Commercial |
$350.69
|
| Rate for Payer: Encore All Commercial |
$350.69
|
| Rate for Payer: Frontpath All Commercial |
$484.60
|
| Rate for Payer: Frontpath All Commercial |
$484.60
|
| Rate for Payer: Humana ChoiceCare |
$376.52
|
| Rate for Payer: Humana ChoiceCare |
$376.52
|
| Rate for Payer: Humana Medicare |
$350.69
|
| Rate for Payer: Humana Medicare |
$350.69
|
| Rate for Payer: Lucent All Commercial |
$490.97
|
| Rate for Payer: Lucent All Commercial |
$490.97
|
| Rate for Payer: Lutheran Preferred All Commercial |
$563.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$563.00
|
| Rate for Payer: Managed Health Services Medicaid |
$347.14
|
| Rate for Payer: Managed Health Services Medicaid |
$347.14
|
| Rate for Payer: MDWise Medicaid |
$347.14
|
| Rate for Payer: MDWise Medicaid |
$347.14
|
| Rate for Payer: PHCS All Commercial |
$350.69
|
| Rate for Payer: PHCS All Commercial |
$350.69
|
| Rate for Payer: PHP All Commercial |
$597.18
|
| Rate for Payer: PHP All Commercial |
$597.18
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$350.69
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$350.69
|
| Rate for Payer: Sagamore Health Network All Products |
$350.69
|
| Rate for Payer: Sagamore Health Network All Products |
$350.69
|
| Rate for Payer: Signature Care EPO |
$503.20
|
| Rate for Payer: Signature Care EPO |
$503.20
|
| Rate for Payer: Signature Care PPO |
$503.20
|
| Rate for Payer: Signature Care PPO |
$503.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$52,800.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$52,800.00
|
| Rate for Payer: United Healthcare Commercial |
$384.80
|
| Rate for Payer: United Healthcare Commercial |
$384.80
|
| Rate for Payer: United Healthcare Medicare |
$343.21
|
| Rate for Payer: United Healthcare Medicare |
$343.21
|
|
|
PR REMOVAL SUBCUTANEOUS CARDIAC RHYTHM MONITOR
|
Professional
|
Both
|
$236.36
|
|
|
Service Code
|
CPT 33286
|
| Hospital Charge Code |
z33286
|
| Min. Negotiated Rate |
$71.63 |
| Max. Negotiated Rate |
$11,700.00 |
| Rate for Payer: Aetna Commercial |
$79.49
|
| Rate for Payer: Aetna Commercial |
$79.49
|
| Rate for Payer: Aetna Medicare |
$79.49
|
| Rate for Payer: Aetna Medicare |
$79.49
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$123.42
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$123.42
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$123.42
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$123.42
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$123.42
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$123.42
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$123.42
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$123.42
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$71.63
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$71.63
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$115.80
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$115.80
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$91.41
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$91.41
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$87.44
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$87.44
|
| Rate for Payer: Cash Price |
$141.26
|
| Rate for Payer: Cash Price |
$141.82
|
| Rate for Payer: Centivo All Commercial |
$123.21
|
| Rate for Payer: Centivo All Commercial |
$123.21
|
| Rate for Payer: Cigna All Commercial |
$79.49
|
| Rate for Payer: Cigna All Commercial |
$79.49
|
| Rate for Payer: CORVEL All Commercial |
$79.49
|
| Rate for Payer: CORVEL All Commercial |
$79.49
|
| Rate for Payer: Coventry All Commercial |
$95.39
|
| Rate for Payer: Coventry All Commercial |
$95.39
|
| Rate for Payer: Encore All Commercial |
$79.49
|
| Rate for Payer: Encore All Commercial |
$79.49
|
| Rate for Payer: Frontpath All Commercial |
$113.37
|
| Rate for Payer: Frontpath All Commercial |
$113.37
|
| Rate for Payer: Humana ChoiceCare |
$106.61
|
| Rate for Payer: Humana ChoiceCare |
$106.61
|
| Rate for Payer: Humana Medicare |
$79.49
|
| Rate for Payer: Humana Medicare |
$79.49
|
| Rate for Payer: Lucent All Commercial |
$111.29
|
| Rate for Payer: Lucent All Commercial |
$111.29
|
| Rate for Payer: Lutheran Preferred All Commercial |
$125.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$125.00
|
| Rate for Payer: Managed Health Services Medicaid |
$115.80
|
| Rate for Payer: Managed Health Services Medicaid |
$115.80
|
| Rate for Payer: MDWise Medicaid |
$115.80
|
| Rate for Payer: MDWise Medicaid |
$115.80
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$71.63
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$71.63
|
| Rate for Payer: PHCS All Commercial |
$79.49
|
| Rate for Payer: PHCS All Commercial |
$79.49
|
| Rate for Payer: PHP All Commercial |
$106.84
|
| Rate for Payer: PHP All Commercial |
$106.84
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$79.49
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$79.49
|
| Rate for Payer: Sagamore Health Network All Products |
$79.49
|
| Rate for Payer: Sagamore Health Network All Products |
$79.49
|
| Rate for Payer: Signature Care EPO |
$174.15
|
| Rate for Payer: Signature Care EPO |
$174.15
|
| Rate for Payer: Signature Care PPO |
$174.15
|
| Rate for Payer: Signature Care PPO |
$174.15
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$11,700.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$11,700.00
|
| Rate for Payer: United Healthcare Commercial |
$105.64
|
| Rate for Payer: United Healthcare Commercial |
$105.64
|
| Rate for Payer: United Healthcare Medicare |
$118.18
|
| Rate for Payer: United Healthcare Medicare |
$118.18
|
|
|
PR REMOVAL SUTURES/STAPLES NOT REQUIRING ANESTHESIA
|
Professional
|
Both
|
$21.20
|
|
|
Service Code
|
CPT 15853
|
| Hospital Charge Code |
z15853
|
| Min. Negotiated Rate |
$10.10 |
| Max. Negotiated Rate |
$13.93 |
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$10.42
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$10.42
|
| Rate for Payer: Cash Price |
$12.72
|
| Rate for Payer: Cash Price |
$12.12
|
| Rate for Payer: Humana ChoiceCare |
$10.35
|
| Rate for Payer: Humana ChoiceCare |
$10.35
|
| Rate for Payer: Managed Health Services Medicaid |
$10.42
|
| Rate for Payer: Managed Health Services Medicaid |
$10.42
|
| Rate for Payer: MDWise Medicaid |
$10.42
|
| Rate for Payer: MDWise Medicaid |
$10.42
|
| Rate for Payer: United Healthcare Commercial |
$13.93
|
| Rate for Payer: United Healthcare Commercial |
$13.93
|
| Rate for Payer: United Healthcare Medicare |
$10.10
|
| Rate for Payer: United Healthcare Medicare |
$10.10
|
|
|
PR REMOVAL TESTIS,RADICAL
|
Professional
|
Both
|
$931.60
|
|
|
Service Code
|
CPT 54530
|
| Hospital Charge Code |
z54530
|
| Min. Negotiated Rate |
$463.48 |
| Max. Negotiated Rate |
$740.90 |
| Rate for Payer: Aetna Commercial |
$478.00
|
| Rate for Payer: Aetna Medicare |
$478.00
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$468.06
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$549.70
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$525.80
|
| Rate for Payer: Cash Price |
$558.96
|
| Rate for Payer: Centivo All Commercial |
$740.90
|
| Rate for Payer: Cigna All Commercial |
$478.00
|
| Rate for Payer: CORVEL All Commercial |
$478.00
|
| Rate for Payer: Coventry All Commercial |
$573.60
|
| Rate for Payer: Encore All Commercial |
$478.00
|
| Rate for Payer: Frontpath All Commercial |
$653.99
|
| Rate for Payer: Humana ChoiceCare |
$610.73
|
| Rate for Payer: Humana Medicare |
$478.00
|
| Rate for Payer: Lucent All Commercial |
$669.20
|
| Rate for Payer: Managed Health Services Medicaid |
$468.06
|
| Rate for Payer: MDWise Medicaid |
$468.06
|
| Rate for Payer: PHCS All Commercial |
$478.00
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$478.00
|
| Rate for Payer: Sagamore Health Network All Products |
$478.00
|
| Rate for Payer: United Healthcare Commercial |
$622.73
|
| Rate for Payer: United Healthcare Medicare |
$463.48
|
|
|
PR REMOVAL VAGINAL FOR.BODY W ANESTH
|
Professional
|
Both
|
$327.84
|
|
|
Service Code
|
CPT 57415
|
| Hospital Charge Code |
z57415
|
| Min. Negotiated Rate |
$157.90 |
| Max. Negotiated Rate |
$257.22 |
| Rate for Payer: Aetna Commercial |
$165.95
|
| Rate for Payer: Aetna Commercial |
$165.95
|
| Rate for Payer: Aetna Medicare |
$165.95
|
| Rate for Payer: Aetna Medicare |
$165.95
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$161.25
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$161.25
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$190.84
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$190.84
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$182.54
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$182.54
|
| Rate for Payer: Cash Price |
$196.70
|
| Rate for Payer: Cash Price |
$192.68
|
| Rate for Payer: Centivo All Commercial |
$257.22
|
| Rate for Payer: Centivo All Commercial |
$257.22
|
| Rate for Payer: Cigna All Commercial |
$165.95
|
| Rate for Payer: Cigna All Commercial |
$165.95
|
| Rate for Payer: CORVEL All Commercial |
$165.95
|
| Rate for Payer: CORVEL All Commercial |
$165.95
|
| Rate for Payer: Coventry All Commercial |
$199.14
|
| Rate for Payer: Coventry All Commercial |
$199.14
|
| Rate for Payer: Encore All Commercial |
$165.95
|
| Rate for Payer: Encore All Commercial |
$165.95
|
| Rate for Payer: Frontpath All Commercial |
$228.15
|
| Rate for Payer: Frontpath All Commercial |
$228.15
|
| Rate for Payer: Humana ChoiceCare |
$157.90
|
| Rate for Payer: Humana ChoiceCare |
$157.90
|
| Rate for Payer: Humana Medicare |
$165.95
|
| Rate for Payer: Humana Medicare |
$165.95
|
| Rate for Payer: Lucent All Commercial |
$232.33
|
| Rate for Payer: Lucent All Commercial |
$232.33
|
| Rate for Payer: Managed Health Services Medicaid |
$161.25
|
| Rate for Payer: Managed Health Services Medicaid |
$161.25
|
| Rate for Payer: MDWise Medicaid |
$161.25
|
| Rate for Payer: MDWise Medicaid |
$161.25
|
| Rate for Payer: PHCS All Commercial |
$165.95
|
| Rate for Payer: PHCS All Commercial |
$165.95
|
| Rate for Payer: PHP All Commercial |
$211.96
|
| Rate for Payer: PHP All Commercial |
$211.96
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$165.95
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$165.95
|
| Rate for Payer: Sagamore Health Network All Products |
$165.95
|
| Rate for Payer: Sagamore Health Network All Products |
$165.95
|
| Rate for Payer: Signature Care EPO |
$177.65
|
| Rate for Payer: Signature Care EPO |
$177.65
|
| Rate for Payer: Signature Care PPO |
$177.65
|
| Rate for Payer: Signature Care PPO |
$177.65
|
| Rate for Payer: United Healthcare Commercial |
$179.39
|
| Rate for Payer: United Healthcare Commercial |
$179.39
|
| Rate for Payer: United Healthcare Medicare |
$160.57
|
| Rate for Payer: United Healthcare Medicare |
$160.57
|
|
|
PR REMOVAL W/ REINSERT DRUG IMPLANT DEVICE
|
Professional
|
Both
|
$262.12
|
|
|
Service Code
|
CPT 11983
|
| Hospital Charge Code |
z11983
|
| Min. Negotiated Rate |
$96.64 |
| Max. Negotiated Rate |
$11,500.00 |
| Rate for Payer: Aetna Commercial |
$96.64
|
| Rate for Payer: Aetna Commercial |
$96.64
|
| Rate for Payer: Aetna Medicare |
$96.64
|
| Rate for Payer: Aetna Medicare |
$96.64
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$277.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$277.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$277.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$277.60
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$277.60
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$277.60
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$277.60
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$277.60
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$104.67
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$104.67
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$128.93
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$128.93
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$111.14
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$111.14
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$106.30
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$106.30
|
| Rate for Payer: Cash Price |
$154.82
|
| Rate for Payer: Cash Price |
$157.27
|
| Rate for Payer: Centivo All Commercial |
$149.79
|
| Rate for Payer: Centivo All Commercial |
$149.79
|
| Rate for Payer: Cigna All Commercial |
$96.64
|
| Rate for Payer: Cigna All Commercial |
$96.64
|
| Rate for Payer: CORVEL All Commercial |
$96.64
|
| Rate for Payer: CORVEL All Commercial |
$96.64
|
| Rate for Payer: Coventry All Commercial |
$115.97
|
| Rate for Payer: Coventry All Commercial |
$115.97
|
| Rate for Payer: Encore All Commercial |
$96.64
|
| Rate for Payer: Encore All Commercial |
$96.64
|
| Rate for Payer: Frontpath All Commercial |
$135.43
|
| Rate for Payer: Frontpath All Commercial |
$135.43
|
| Rate for Payer: Humana ChoiceCare |
$179.33
|
| Rate for Payer: Humana ChoiceCare |
$179.33
|
| Rate for Payer: Humana Medicare |
$96.64
|
| Rate for Payer: Humana Medicare |
$96.64
|
| Rate for Payer: Lucent All Commercial |
$135.30
|
| Rate for Payer: Lucent All Commercial |
$135.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$125.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$125.00
|
| Rate for Payer: Managed Health Services Medicaid |
$128.93
|
| Rate for Payer: Managed Health Services Medicaid |
$128.93
|
| Rate for Payer: MDWise Medicaid |
$128.93
|
| Rate for Payer: MDWise Medicaid |
$128.93
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$104.67
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$104.67
|
| Rate for Payer: PHCS All Commercial |
$96.64
|
| Rate for Payer: PHCS All Commercial |
$96.64
|
| Rate for Payer: PHP All Commercial |
$130.88
|
| Rate for Payer: PHP All Commercial |
$130.88
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$96.64
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$96.64
|
| Rate for Payer: Sagamore Health Network All Products |
$96.64
|
| Rate for Payer: Sagamore Health Network All Products |
$96.64
|
| Rate for Payer: Signature Care EPO |
$226.76
|
| Rate for Payer: Signature Care EPO |
$226.76
|
| Rate for Payer: Signature Care PPO |
$226.76
|
| Rate for Payer: Signature Care PPO |
$226.76
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$11,500.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$11,500.00
|
| Rate for Payer: United Healthcare Commercial |
$214.59
|
| Rate for Payer: United Healthcare Commercial |
$214.59
|
| Rate for Payer: United Healthcare Medicare |
$129.02
|
| Rate for Payer: United Healthcare Medicare |
$129.02
|
|
|
PR REMOVE ABD LYMPH NODES RAD REGNL
|
Professional
|
Both
|
$476.86
|
|
|
Service Code
|
CPT 38747
|
| Hospital Charge Code |
z38747
|
| Min. Negotiated Rate |
$234.54 |
| Max. Negotiated Rate |
$36,100.00 |
| Rate for Payer: Aetna Commercial |
$245.01
|
| Rate for Payer: Aetna Commercial |
$245.01
|
| Rate for Payer: Aetna Medicare |
$245.01
|
| Rate for Payer: Aetna Medicare |
$245.01
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$358.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$358.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$358.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$358.80
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$358.80
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$358.80
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$358.80
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$358.80
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$234.54
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$234.54
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$281.76
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$281.76
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$269.51
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$269.51
|
| Rate for Payer: Cash Price |
$286.12
|
| Rate for Payer: Cash Price |
$281.95
|
| Rate for Payer: Centivo All Commercial |
$379.77
|
| Rate for Payer: Centivo All Commercial |
$379.77
|
| Rate for Payer: Cigna All Commercial |
$245.01
|
| Rate for Payer: Cigna All Commercial |
$245.01
|
| Rate for Payer: CORVEL All Commercial |
$245.01
|
| Rate for Payer: CORVEL All Commercial |
$245.01
|
| Rate for Payer: Coventry All Commercial |
$294.01
|
| Rate for Payer: Coventry All Commercial |
$294.01
|
| Rate for Payer: Encore All Commercial |
$245.01
|
| Rate for Payer: Encore All Commercial |
$245.01
|
| Rate for Payer: Frontpath All Commercial |
$352.70
|
| Rate for Payer: Frontpath All Commercial |
$352.70
|
| Rate for Payer: Humana ChoiceCare |
$329.97
|
| Rate for Payer: Humana ChoiceCare |
$329.97
|
| Rate for Payer: Humana Medicare |
$245.01
|
| Rate for Payer: Humana Medicare |
$245.01
|
| Rate for Payer: Lucent All Commercial |
$343.01
|
| Rate for Payer: Lucent All Commercial |
$343.01
|
| Rate for Payer: Lutheran Preferred All Commercial |
$385.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$385.00
|
| Rate for Payer: Managed Health Services Medicaid |
$234.54
|
| Rate for Payer: Managed Health Services Medicaid |
$234.54
|
| Rate for Payer: MDWise Medicaid |
$234.54
|
| Rate for Payer: MDWise Medicaid |
$234.54
|
| Rate for Payer: PHCS All Commercial |
$245.01
|
| Rate for Payer: PHCS All Commercial |
$245.01
|
| Rate for Payer: PHP All Commercial |
$328.94
|
| Rate for Payer: PHP All Commercial |
$328.94
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$245.01
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$245.01
|
| Rate for Payer: Sagamore Health Network All Products |
$245.01
|
| Rate for Payer: Sagamore Health Network All Products |
$245.01
|
| Rate for Payer: Signature Care EPO |
$355.30
|
| Rate for Payer: Signature Care EPO |
$355.30
|
| Rate for Payer: Signature Care PPO |
$355.30
|
| Rate for Payer: Signature Care PPO |
$355.30
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$36,100.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$36,100.00
|
| Rate for Payer: United Healthcare Commercial |
$296.89
|
| Rate for Payer: United Healthcare Commercial |
$296.89
|
| Rate for Payer: United Healthcare Medicare |
$234.96
|
| Rate for Payer: United Healthcare Medicare |
$234.96
|
|
|
PR REMOVE ADDITIONAL NAIL PLATE
|
Professional
|
Both
|
$61.86
|
|
|
Service Code
|
CPT 11732
|
| Hospital Charge Code |
z11732
|
| Min. Negotiated Rate |
$16.02 |
| Max. Negotiated Rate |
$2,000.00 |
| Rate for Payer: Aetna Commercial |
$16.60
|
| Rate for Payer: Aetna Commercial |
$16.60
|
| Rate for Payer: Aetna Medicare |
$16.60
|
| Rate for Payer: Aetna Medicare |
$16.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$48.34
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$48.34
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$48.34
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$48.34
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$48.34
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$48.34
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$48.34
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$48.34
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$16.02
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$16.02
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$30.43
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$30.43
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$19.09
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$19.09
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$18.26
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$18.26
|
| Rate for Payer: Cash Price |
$36.79
|
| Rate for Payer: Cash Price |
$37.12
|
| Rate for Payer: Centivo All Commercial |
$25.73
|
| Rate for Payer: Centivo All Commercial |
$25.73
|
| Rate for Payer: Cigna All Commercial |
$16.60
|
| Rate for Payer: Cigna All Commercial |
$16.60
|
| Rate for Payer: CORVEL All Commercial |
$16.60
|
| Rate for Payer: CORVEL All Commercial |
$16.60
|
| Rate for Payer: Coventry All Commercial |
$19.92
|
| Rate for Payer: Coventry All Commercial |
$19.92
|
| Rate for Payer: Encore All Commercial |
$16.60
|
| Rate for Payer: Encore All Commercial |
$16.60
|
| Rate for Payer: Frontpath All Commercial |
$22.76
|
| Rate for Payer: Frontpath All Commercial |
$22.76
|
| Rate for Payer: Humana ChoiceCare |
$30.31
|
| Rate for Payer: Humana ChoiceCare |
$30.31
|
| Rate for Payer: Humana Medicare |
$16.60
|
| Rate for Payer: Humana Medicare |
$16.60
|
| Rate for Payer: Lucent All Commercial |
$23.24
|
| Rate for Payer: Lucent All Commercial |
$23.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$21.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$21.00
|
| Rate for Payer: Managed Health Services Medicaid |
$30.43
|
| Rate for Payer: Managed Health Services Medicaid |
$30.43
|
| Rate for Payer: MDWise Medicaid |
$30.43
|
| Rate for Payer: MDWise Medicaid |
$30.43
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$16.02
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$16.02
|
| Rate for Payer: PHCS All Commercial |
$16.60
|
| Rate for Payer: PHCS All Commercial |
$16.60
|
| Rate for Payer: PHP All Commercial |
$22.26
|
| Rate for Payer: PHP All Commercial |
$22.26
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$16.60
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$16.60
|
| Rate for Payer: Sagamore Health Network All Products |
$16.60
|
| Rate for Payer: Sagamore Health Network All Products |
$16.60
|
| Rate for Payer: Signature Care EPO |
$41.65
|
| Rate for Payer: Signature Care EPO |
$41.65
|
| Rate for Payer: Signature Care PPO |
$41.65
|
| Rate for Payer: Signature Care PPO |
$41.65
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,000.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,000.00
|
| Rate for Payer: United Healthcare Commercial |
$34.63
|
| Rate for Payer: United Healthcare Commercial |
$34.63
|
| Rate for Payer: United Healthcare Medicare |
$30.66
|
| Rate for Payer: United Healthcare Medicare |
$30.66
|
|
|
PR REMOVE ARMPIT LYMPH NODES SUPERFIC
|
Professional
|
Both
|
$1,278.90
|
|
|
Service Code
|
CPT 38740
|
| Hospital Charge Code |
z38740
|
| Min. Negotiated Rate |
$575.00 |
| Max. Negotiated Rate |
$96,400.00 |
| Rate for Payer: Aetna Commercial |
$648.84
|
| Rate for Payer: Aetna Commercial |
$648.84
|
| Rate for Payer: Aetna Medicare |
$648.84
|
| Rate for Payer: Aetna Medicare |
$648.84
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$575.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$575.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$575.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$575.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$575.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$575.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$575.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$575.00
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$629.01
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$629.01
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$746.17
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$746.17
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$713.72
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$713.72
|
| Rate for Payer: Cash Price |
$767.34
|
| Rate for Payer: Cash Price |
$752.34
|
| Rate for Payer: Centivo All Commercial |
$1,005.70
|
| Rate for Payer: Centivo All Commercial |
$1,005.70
|
| Rate for Payer: Cigna All Commercial |
$648.84
|
| Rate for Payer: Cigna All Commercial |
$648.84
|
| Rate for Payer: CORVEL All Commercial |
$648.84
|
| Rate for Payer: CORVEL All Commercial |
$648.84
|
| Rate for Payer: Coventry All Commercial |
$778.61
|
| Rate for Payer: Coventry All Commercial |
$778.61
|
| Rate for Payer: Encore All Commercial |
$648.84
|
| Rate for Payer: Encore All Commercial |
$648.84
|
| Rate for Payer: Frontpath All Commercial |
$922.08
|
| Rate for Payer: Frontpath All Commercial |
$922.08
|
| Rate for Payer: Humana ChoiceCare |
$745.31
|
| Rate for Payer: Humana ChoiceCare |
$745.31
|
| Rate for Payer: Humana Medicare |
$648.84
|
| Rate for Payer: Humana Medicare |
$648.84
|
| Rate for Payer: Lucent All Commercial |
$908.38
|
| Rate for Payer: Lucent All Commercial |
$908.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,028.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,028.00
|
| Rate for Payer: Managed Health Services Medicaid |
$629.01
|
| Rate for Payer: Managed Health Services Medicaid |
$629.01
|
| Rate for Payer: MDWise Medicaid |
$629.01
|
| Rate for Payer: MDWise Medicaid |
$629.01
|
| Rate for Payer: PHCS All Commercial |
$648.84
|
| Rate for Payer: PHCS All Commercial |
$648.84
|
| Rate for Payer: PHP All Commercial |
$877.73
|
| Rate for Payer: PHP All Commercial |
$877.73
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$648.84
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$648.84
|
| Rate for Payer: Sagamore Health Network All Products |
$648.84
|
| Rate for Payer: Sagamore Health Network All Products |
$648.84
|
| Rate for Payer: Signature Care EPO |
$795.60
|
| Rate for Payer: Signature Care EPO |
$795.60
|
| Rate for Payer: Signature Care PPO |
$795.60
|
| Rate for Payer: Signature Care PPO |
$795.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$96,400.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$96,400.00
|
| Rate for Payer: United Healthcare Commercial |
$724.08
|
| Rate for Payer: United Healthcare Commercial |
$724.08
|
| Rate for Payer: United Healthcare Medicare |
$626.95
|
| Rate for Payer: United Healthcare Medicare |
$626.95
|
|
|
PR REMOVE ARMPITS LYMPH NODES COMPLT
|
Professional
|
Both
|
$1,604.78
|
|
|
Service Code
|
CPT 38745
|
| Hospital Charge Code |
z38745
|
| Min. Negotiated Rate |
$787.06 |
| Max. Negotiated Rate |
$121,000.00 |
| Rate for Payer: Aetna Commercial |
$815.17
|
| Rate for Payer: Aetna Commercial |
$815.17
|
| Rate for Payer: Aetna Medicare |
$815.17
|
| Rate for Payer: Aetna Medicare |
$815.17
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$820.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$820.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$820.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$820.80
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$820.80
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$820.80
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$820.80
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$820.80
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$789.29
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$789.29
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$937.45
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$937.45
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$896.69
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$896.69
|
| Rate for Payer: Cash Price |
$962.87
|
| Rate for Payer: Cash Price |
$944.47
|
| Rate for Payer: Centivo All Commercial |
$1,263.51
|
| Rate for Payer: Centivo All Commercial |
$1,263.51
|
| Rate for Payer: Cigna All Commercial |
$815.17
|
| Rate for Payer: Cigna All Commercial |
$815.17
|
| Rate for Payer: CORVEL All Commercial |
$815.17
|
| Rate for Payer: CORVEL All Commercial |
$815.17
|
| Rate for Payer: Coventry All Commercial |
$978.20
|
| Rate for Payer: Coventry All Commercial |
$978.20
|
| Rate for Payer: Encore All Commercial |
$815.17
|
| Rate for Payer: Encore All Commercial |
$815.17
|
| Rate for Payer: Frontpath All Commercial |
$1,161.49
|
| Rate for Payer: Frontpath All Commercial |
$1,161.49
|
| Rate for Payer: Humana ChoiceCare |
$957.07
|
| Rate for Payer: Humana ChoiceCare |
$957.07
|
| Rate for Payer: Humana Medicare |
$815.17
|
| Rate for Payer: Humana Medicare |
$815.17
|
| Rate for Payer: Lucent All Commercial |
$1,141.24
|
| Rate for Payer: Lucent All Commercial |
$1,141.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,291.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,291.00
|
| Rate for Payer: Managed Health Services Medicaid |
$789.29
|
| Rate for Payer: Managed Health Services Medicaid |
$789.29
|
| Rate for Payer: MDWise Medicaid |
$789.29
|
| Rate for Payer: MDWise Medicaid |
$789.29
|
| Rate for Payer: PHCS All Commercial |
$815.17
|
| Rate for Payer: PHCS All Commercial |
$815.17
|
| Rate for Payer: PHP All Commercial |
$1,101.88
|
| Rate for Payer: PHP All Commercial |
$1,101.88
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$815.17
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$815.17
|
| Rate for Payer: Sagamore Health Network All Products |
$815.17
|
| Rate for Payer: Sagamore Health Network All Products |
$815.17
|
| Rate for Payer: Signature Care EPO |
$1,022.55
|
| Rate for Payer: Signature Care EPO |
$1,022.55
|
| Rate for Payer: Signature Care PPO |
$1,022.55
|
| Rate for Payer: Signature Care PPO |
$1,022.55
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$121,000.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$121,000.00
|
| Rate for Payer: United Healthcare Commercial |
$922.09
|
| Rate for Payer: United Healthcare Commercial |
$922.09
|
| Rate for Payer: United Healthcare Medicare |
$787.06
|
| Rate for Payer: United Healthcare Medicare |
$787.06
|
|
|
PR REMOVE BLADDER STONE,<2.5 CM
|
Professional
|
Both
|
$1,525.12
|
|
|
Service Code
|
CPT 52317
|
| Hospital Charge Code |
z52317
|
| Min. Negotiated Rate |
$173.90 |
| Max. Negotiated Rate |
$808.60 |
| Rate for Payer: Aetna Commercial |
$324.34
|
| Rate for Payer: Aetna Medicare |
$324.34
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$173.90
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$803.47
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$372.99
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$356.77
|
| Rate for Payer: Cash Price |
$915.07
|
| Rate for Payer: Centivo All Commercial |
$502.73
|
| Rate for Payer: Cigna All Commercial |
$324.34
|
| Rate for Payer: CORVEL All Commercial |
$324.34
|
| Rate for Payer: Coventry All Commercial |
$389.21
|
| Rate for Payer: Encore All Commercial |
$324.34
|
| Rate for Payer: Frontpath All Commercial |
$445.48
|
| Rate for Payer: Humana ChoiceCare |
$343.58
|
| Rate for Payer: Humana Medicare |
$324.34
|
| Rate for Payer: Lucent All Commercial |
$454.08
|
| Rate for Payer: Managed Health Services Medicaid |
$803.47
|
| Rate for Payer: MDWise Medicaid |
$803.47
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$173.90
|
| Rate for Payer: PHCS All Commercial |
$324.34
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$324.34
|
| Rate for Payer: Sagamore Health Network All Products |
$324.34
|
| Rate for Payer: United Healthcare Commercial |
$439.21
|
| Rate for Payer: United Healthcare Medicare |
$808.60
|
|
|
PR REMOVE BLADDER STONE,>2.5 CM
|
Professional
|
Both
|
$850.90
|
|
|
Service Code
|
CPT 52318
|
| Hospital Charge Code |
z52318
|
| Min. Negotiated Rate |
$426.79 |
| Max. Negotiated Rate |
$685.67 |
| Rate for Payer: Aetna Commercial |
$442.37
|
| Rate for Payer: Aetna Medicare |
$442.37
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$427.98
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$508.73
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$486.61
|
| Rate for Payer: Cash Price |
$510.54
|
| Rate for Payer: Centivo All Commercial |
$685.67
|
| Rate for Payer: Cigna All Commercial |
$442.37
|
| Rate for Payer: CORVEL All Commercial |
$442.37
|
| Rate for Payer: Coventry All Commercial |
$530.84
|
| Rate for Payer: Encore All Commercial |
$442.37
|
| Rate for Payer: Frontpath All Commercial |
$607.93
|
| Rate for Payer: Humana ChoiceCare |
$468.80
|
| Rate for Payer: Humana Medicare |
$442.37
|
| Rate for Payer: Lucent All Commercial |
$619.32
|
| Rate for Payer: Managed Health Services Medicaid |
$427.98
|
| Rate for Payer: MDWise Medicaid |
$427.98
|
| Rate for Payer: PHCS All Commercial |
$442.37
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$442.37
|
| Rate for Payer: Sagamore Health Network All Products |
$442.37
|
| Rate for Payer: United Healthcare Commercial |
$598.61
|
| Rate for Payer: United Healthcare Medicare |
$426.79
|
|
|
PR REMOVE CERCLAGE SUTURE
|
Professional
|
Both
|
$238.62
|
|
|
Service Code
|
CPT 59871
|
| Hospital Charge Code |
z59871
|
| Min. Negotiated Rate |
$116.77 |
| Max. Negotiated Rate |
$15,600.00 |
| Rate for Payer: Aetna Commercial |
$119.81
|
| Rate for Payer: Aetna Commercial |
$119.81
|
| Rate for Payer: Aetna Medicare |
$119.81
|
| Rate for Payer: Aetna Medicare |
$119.81
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$214.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$214.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$214.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$214.40
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$214.40
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$214.40
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$214.40
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$214.40
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$117.36
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$117.36
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$137.78
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$137.78
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$131.79
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$131.79
|
| Rate for Payer: Cash Price |
$143.17
|
| Rate for Payer: Cash Price |
$140.12
|
| Rate for Payer: Centivo All Commercial |
$185.71
|
| Rate for Payer: Centivo All Commercial |
$185.71
|
| Rate for Payer: Cigna All Commercial |
$119.81
|
| Rate for Payer: Cigna All Commercial |
$119.81
|
| Rate for Payer: CORVEL All Commercial |
$119.81
|
| Rate for Payer: CORVEL All Commercial |
$119.81
|
| Rate for Payer: Coventry All Commercial |
$143.77
|
| Rate for Payer: Coventry All Commercial |
$143.77
|
| Rate for Payer: Encore All Commercial |
$119.81
|
| Rate for Payer: Encore All Commercial |
$119.81
|
| Rate for Payer: Frontpath All Commercial |
$170.74
|
| Rate for Payer: Frontpath All Commercial |
$170.74
|
| Rate for Payer: Humana ChoiceCare |
$127.78
|
| Rate for Payer: Humana ChoiceCare |
$127.78
|
| Rate for Payer: Humana Medicare |
$119.81
|
| Rate for Payer: Humana Medicare |
$119.81
|
| Rate for Payer: Lucent All Commercial |
$167.73
|
| Rate for Payer: Lucent All Commercial |
$167.73
|
| Rate for Payer: Lutheran Preferred All Commercial |
$168.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$168.00
|
| Rate for Payer: Managed Health Services Medicaid |
$117.36
|
| Rate for Payer: Managed Health Services Medicaid |
$117.36
|
| Rate for Payer: MDWise Medicaid |
$117.36
|
| Rate for Payer: MDWise Medicaid |
$117.36
|
| Rate for Payer: PHCS All Commercial |
$119.81
|
| Rate for Payer: PHCS All Commercial |
$119.81
|
| Rate for Payer: PHP All Commercial |
$154.13
|
| Rate for Payer: PHP All Commercial |
$154.13
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$119.81
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$119.81
|
| Rate for Payer: Sagamore Health Network All Products |
$119.81
|
| Rate for Payer: Sagamore Health Network All Products |
$119.81
|
| Rate for Payer: Signature Care EPO |
$192.10
|
| Rate for Payer: Signature Care EPO |
$192.10
|
| Rate for Payer: Signature Care PPO |
$192.10
|
| Rate for Payer: Signature Care PPO |
$192.10
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$15,600.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$15,600.00
|
| Rate for Payer: United Healthcare Commercial |
$150.91
|
| Rate for Payer: United Healthcare Commercial |
$150.91
|
| Rate for Payer: United Healthcare Medicare |
$116.77
|
| Rate for Payer: United Healthcare Medicare |
$116.77
|
|
|
PR REMOVE EYELID FOREIGN BODY,EMBEDDED
|
Professional
|
Both
|
$500.52
|
|
|
Service Code
|
CPT 67938
|
| Hospital Charge Code |
z67938
|
| Min. Negotiated Rate |
$58.83 |
| Max. Negotiated Rate |
$16,600.00 |
| Rate for Payer: Aetna Commercial |
$109.32
|
| Rate for Payer: Aetna Commercial |
$109.32
|
| Rate for Payer: Aetna Medicare |
$109.32
|
| Rate for Payer: Aetna Medicare |
$109.32
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$370.23
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$370.23
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$370.23
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$370.23
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$370.23
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$370.23
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$370.23
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$370.23
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$58.83
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$58.83
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$246.17
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$246.17
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$125.72
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$125.72
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$120.25
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$120.25
|
| Rate for Payer: Cash Price |
$298.79
|
| Rate for Payer: Cash Price |
$300.31
|
| Rate for Payer: Centivo All Commercial |
$169.45
|
| Rate for Payer: Centivo All Commercial |
$169.45
|
| Rate for Payer: Cigna All Commercial |
$109.32
|
| Rate for Payer: Cigna All Commercial |
$109.32
|
| Rate for Payer: CORVEL All Commercial |
$109.32
|
| Rate for Payer: CORVEL All Commercial |
$109.32
|
| Rate for Payer: Coventry All Commercial |
$131.18
|
| Rate for Payer: Coventry All Commercial |
$131.18
|
| Rate for Payer: Encore All Commercial |
$109.32
|
| Rate for Payer: Encore All Commercial |
$109.32
|
| Rate for Payer: Frontpath All Commercial |
$145.78
|
| Rate for Payer: Frontpath All Commercial |
$145.78
|
| Rate for Payer: Humana ChoiceCare |
$97.97
|
| Rate for Payer: Humana ChoiceCare |
$97.97
|
| Rate for Payer: Humana Medicare |
$109.32
|
| Rate for Payer: Humana Medicare |
$109.32
|
| Rate for Payer: Lucent All Commercial |
$153.05
|
| Rate for Payer: Lucent All Commercial |
$153.05
|
| Rate for Payer: Lutheran Preferred All Commercial |
$177.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$177.00
|
| Rate for Payer: Managed Health Services Medicaid |
$246.17
|
| Rate for Payer: Managed Health Services Medicaid |
$246.17
|
| Rate for Payer: MDWise Medicaid |
$246.17
|
| Rate for Payer: MDWise Medicaid |
$246.17
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$58.83
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$58.83
|
| Rate for Payer: PHCS All Commercial |
$109.32
|
| Rate for Payer: PHCS All Commercial |
$109.32
|
| Rate for Payer: PHP All Commercial |
$199.30
|
| Rate for Payer: PHP All Commercial |
$199.30
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$109.32
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$109.32
|
| Rate for Payer: Sagamore Health Network All Products |
$109.32
|
| Rate for Payer: Sagamore Health Network All Products |
$109.32
|
| Rate for Payer: Signature Care EPO |
$360.40
|
| Rate for Payer: Signature Care EPO |
$360.40
|
| Rate for Payer: Signature Care PPO |
$360.40
|
| Rate for Payer: Signature Care PPO |
$360.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$16,600.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$16,600.00
|
| Rate for Payer: United Healthcare Commercial |
$114.63
|
| Rate for Payer: United Healthcare Commercial |
$114.63
|
| Rate for Payer: United Healthcare Medicare |
$248.99
|
| Rate for Payer: United Healthcare Medicare |
$248.99
|
|
|
PR REMOVE FOREARM/WRIST FOREIGN BODY
|
Professional
|
Both
|
$793.60
|
|
|
Service Code
|
CPT 25248
|
| Hospital Charge Code |
z25248
|
| Min. Negotiated Rate |
$379.84 |
| Max. Negotiated Rate |
$58,400.00 |
| Rate for Payer: Aetna Commercial |
$392.84
|
| Rate for Payer: Aetna Commercial |
$392.84
|
| Rate for Payer: Aetna Medicare |
$392.84
|
| Rate for Payer: Aetna Medicare |
$392.84
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$530.90
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$530.90
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$530.90
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$530.90
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$530.90
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$530.90
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$530.90
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$530.90
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$390.33
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$390.33
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$451.77
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$451.77
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$432.12
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$432.12
|
| Rate for Payer: Cash Price |
$476.16
|
| Rate for Payer: Cash Price |
$455.81
|
| Rate for Payer: Centivo All Commercial |
$608.90
|
| Rate for Payer: Centivo All Commercial |
$608.90
|
| Rate for Payer: Cigna All Commercial |
$392.84
|
| Rate for Payer: Cigna All Commercial |
$392.84
|
| Rate for Payer: CORVEL All Commercial |
$392.84
|
| Rate for Payer: CORVEL All Commercial |
$392.84
|
| Rate for Payer: Coventry All Commercial |
$471.41
|
| Rate for Payer: Coventry All Commercial |
$471.41
|
| Rate for Payer: Encore All Commercial |
$392.84
|
| Rate for Payer: Encore All Commercial |
$392.84
|
| Rate for Payer: Frontpath All Commercial |
$545.14
|
| Rate for Payer: Frontpath All Commercial |
$545.14
|
| Rate for Payer: Humana ChoiceCare |
$575.46
|
| Rate for Payer: Humana ChoiceCare |
$575.46
|
| Rate for Payer: Humana Medicare |
$392.84
|
| Rate for Payer: Humana Medicare |
$392.84
|
| Rate for Payer: Lucent All Commercial |
$549.98
|
| Rate for Payer: Lucent All Commercial |
$549.98
|
| Rate for Payer: Lutheran Preferred All Commercial |
$623.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$623.00
|
| Rate for Payer: Managed Health Services Medicaid |
$390.33
|
| Rate for Payer: Managed Health Services Medicaid |
$390.33
|
| Rate for Payer: MDWise Medicaid |
$390.33
|
| Rate for Payer: MDWise Medicaid |
$390.33
|
| Rate for Payer: PHCS All Commercial |
$392.84
|
| Rate for Payer: PHCS All Commercial |
$392.84
|
| Rate for Payer: PHP All Commercial |
$660.91
|
| Rate for Payer: PHP All Commercial |
$660.91
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$392.84
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$392.84
|
| Rate for Payer: Sagamore Health Network All Products |
$392.84
|
| Rate for Payer: Sagamore Health Network All Products |
$392.84
|
| Rate for Payer: Signature Care EPO |
$667.83
|
| Rate for Payer: Signature Care EPO |
$667.83
|
| Rate for Payer: Signature Care PPO |
$667.83
|
| Rate for Payer: Signature Care PPO |
$667.83
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$58,400.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$58,400.00
|
| Rate for Payer: United Healthcare Commercial |
$468.68
|
| Rate for Payer: United Healthcare Commercial |
$468.68
|
| Rate for Payer: United Healthcare Medicare |
$379.84
|
| Rate for Payer: United Healthcare Medicare |
$379.84
|
|
|
PR REMOVE INTRAUTERINE DEVICE
|
Professional
|
Both
|
$204.88
|
|
|
Service Code
|
CPT 58301
|
| Hospital Charge Code |
z58301
|
| Min. Negotiated Rate |
$35.04 |
| Max. Negotiated Rate |
$8,000.00 |
| Rate for Payer: Aetna Commercial |
$62.43
|
| Rate for Payer: Aetna Commercial |
$62.43
|
| Rate for Payer: Aetna Medicare |
$62.43
|
| Rate for Payer: Aetna Medicare |
$62.43
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.12
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.12
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$134.12
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$134.12
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$134.12
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$134.12
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$134.12
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$134.12
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$35.04
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$35.04
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$100.77
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$100.77
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$71.79
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$71.79
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$68.67
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$68.67
|
| Rate for Payer: Cash Price |
$121.02
|
| Rate for Payer: Cash Price |
$122.93
|
| Rate for Payer: Centivo All Commercial |
$96.77
|
| Rate for Payer: Centivo All Commercial |
$96.77
|
| Rate for Payer: Cigna All Commercial |
$62.43
|
| Rate for Payer: Cigna All Commercial |
$62.43
|
| Rate for Payer: CORVEL All Commercial |
$62.43
|
| Rate for Payer: CORVEL All Commercial |
$62.43
|
| Rate for Payer: Coventry All Commercial |
$74.92
|
| Rate for Payer: Coventry All Commercial |
$74.92
|
| Rate for Payer: Encore All Commercial |
$62.43
|
| Rate for Payer: Encore All Commercial |
$62.43
|
| Rate for Payer: Frontpath All Commercial |
$87.10
|
| Rate for Payer: Frontpath All Commercial |
$87.10
|
| Rate for Payer: Humana ChoiceCare |
$78.50
|
| Rate for Payer: Humana ChoiceCare |
$78.50
|
| Rate for Payer: Humana Medicare |
$62.43
|
| Rate for Payer: Humana Medicare |
$62.43
|
| Rate for Payer: Lucent All Commercial |
$87.40
|
| Rate for Payer: Lucent All Commercial |
$87.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$86.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$86.00
|
| Rate for Payer: Managed Health Services Medicaid |
$100.77
|
| Rate for Payer: Managed Health Services Medicaid |
$100.77
|
| Rate for Payer: MDWise Medicaid |
$100.77
|
| Rate for Payer: MDWise Medicaid |
$100.77
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$35.04
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$35.04
|
| Rate for Payer: PHCS All Commercial |
$62.43
|
| Rate for Payer: PHCS All Commercial |
$62.43
|
| Rate for Payer: PHP All Commercial |
$79.45
|
| Rate for Payer: PHP All Commercial |
$79.45
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$62.43
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$62.43
|
| Rate for Payer: Sagamore Health Network All Products |
$62.43
|
| Rate for Payer: Sagamore Health Network All Products |
$62.43
|
| Rate for Payer: Signature Care EPO |
$127.50
|
| Rate for Payer: Signature Care EPO |
$127.50
|
| Rate for Payer: Signature Care PPO |
$127.50
|
| Rate for Payer: Signature Care PPO |
$127.50
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$8,000.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$8,000.00
|
| Rate for Payer: United Healthcare Commercial |
$77.86
|
| Rate for Payer: United Healthcare Commercial |
$77.86
|
| Rate for Payer: United Healthcare Medicare |
$100.85
|
| Rate for Payer: United Healthcare Medicare |
$100.85
|
|
|
PR REMOVE KNEE CYST/GANGLION
|
Professional
|
Both
|
$986.68
|
|
|
Service Code
|
CPT 27347
|
| Hospital Charge Code |
z27347
|
| Min. Negotiated Rate |
$419.80 |
| Max. Negotiated Rate |
$74,100.00 |
| Rate for Payer: Aetna Commercial |
$491.65
|
| Rate for Payer: Aetna Commercial |
$491.65
|
| Rate for Payer: Aetna Medicare |
$491.65
|
| Rate for Payer: Aetna Medicare |
$491.65
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$419.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$419.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$419.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$419.80
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$419.80
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$419.80
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$419.80
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$419.80
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$485.28
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$485.28
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$565.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$565.40
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$540.82
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$540.82
|
| Rate for Payer: Cash Price |
$592.01
|
| Rate for Payer: Cash Price |
$578.48
|
| Rate for Payer: Centivo All Commercial |
$762.06
|
| Rate for Payer: Centivo All Commercial |
$762.06
|
| Rate for Payer: Cigna All Commercial |
$491.65
|
| Rate for Payer: Cigna All Commercial |
$491.65
|
| Rate for Payer: CORVEL All Commercial |
$491.65
|
| Rate for Payer: CORVEL All Commercial |
$491.65
|
| Rate for Payer: Coventry All Commercial |
$589.98
|
| Rate for Payer: Coventry All Commercial |
$589.98
|
| Rate for Payer: Encore All Commercial |
$491.65
|
| Rate for Payer: Encore All Commercial |
$491.65
|
| Rate for Payer: Frontpath All Commercial |
$682.36
|
| Rate for Payer: Frontpath All Commercial |
$682.36
|
| Rate for Payer: Humana ChoiceCare |
$485.73
|
| Rate for Payer: Humana ChoiceCare |
$485.73
|
| Rate for Payer: Humana Medicare |
$491.65
|
| Rate for Payer: Humana Medicare |
$491.65
|
| Rate for Payer: Lucent All Commercial |
$688.31
|
| Rate for Payer: Lucent All Commercial |
$688.31
|
| Rate for Payer: Lutheran Preferred All Commercial |
$791.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$791.00
|
| Rate for Payer: Managed Health Services Medicaid |
$485.28
|
| Rate for Payer: Managed Health Services Medicaid |
$485.28
|
| Rate for Payer: MDWise Medicaid |
$485.28
|
| Rate for Payer: MDWise Medicaid |
$485.28
|
| Rate for Payer: PHCS All Commercial |
$491.65
|
| Rate for Payer: PHCS All Commercial |
$491.65
|
| Rate for Payer: PHP All Commercial |
$838.79
|
| Rate for Payer: PHP All Commercial |
$838.79
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$491.65
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$491.65
|
| Rate for Payer: Sagamore Health Network All Products |
$491.65
|
| Rate for Payer: Sagamore Health Network All Products |
$491.65
|
| Rate for Payer: Signature Care EPO |
$650.25
|
| Rate for Payer: Signature Care EPO |
$650.25
|
| Rate for Payer: Signature Care PPO |
$650.25
|
| Rate for Payer: Signature Care PPO |
$650.25
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$74,100.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$74,100.00
|
| Rate for Payer: United Healthcare Commercial |
$548.25
|
| Rate for Payer: United Healthcare Commercial |
$548.25
|
| Rate for Payer: United Healthcare Medicare |
$482.07
|
| Rate for Payer: United Healthcare Medicare |
$482.07
|
|
|
PR REMOVE NASAL FOREIGN BODY
|
Professional
|
Both
|
$390.16
|
|
|
Service Code
|
CPT 30300
|
| Hospital Charge Code |
z30300
|
| Min. Negotiated Rate |
$64.02 |
| Max. Negotiated Rate |
$17,500.00 |
| Rate for Payer: Aetna Commercial |
$116.90
|
| Rate for Payer: Aetna Commercial |
$116.90
|
| Rate for Payer: Aetna Medicare |
$116.90
|
| Rate for Payer: Aetna Medicare |
$116.90
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$114.90
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$114.90
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$114.90
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$114.90
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$114.90
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$114.90
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$114.90
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$114.90
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$64.02
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$64.02
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$191.90
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$191.90
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$134.44
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$134.44
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$128.59
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$128.59
|
| Rate for Payer: Cash Price |
$231.13
|
| Rate for Payer: Cash Price |
$234.10
|
| Rate for Payer: Centivo All Commercial |
$181.19
|
| Rate for Payer: Centivo All Commercial |
$181.19
|
| Rate for Payer: Cigna All Commercial |
$116.90
|
| Rate for Payer: Cigna All Commercial |
$116.90
|
| Rate for Payer: CORVEL All Commercial |
$116.90
|
| Rate for Payer: CORVEL All Commercial |
$116.90
|
| Rate for Payer: Coventry All Commercial |
$140.28
|
| Rate for Payer: Coventry All Commercial |
$140.28
|
| Rate for Payer: Encore All Commercial |
$116.90
|
| Rate for Payer: Encore All Commercial |
$116.90
|
| Rate for Payer: Frontpath All Commercial |
$157.38
|
| Rate for Payer: Frontpath All Commercial |
$157.38
|
| Rate for Payer: Humana ChoiceCare |
$129.59
|
| Rate for Payer: Humana ChoiceCare |
$129.59
|
| Rate for Payer: Humana Medicare |
$116.90
|
| Rate for Payer: Humana Medicare |
$116.90
|
| Rate for Payer: Lucent All Commercial |
$163.66
|
| Rate for Payer: Lucent All Commercial |
$163.66
|
| 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 |
$191.90
|
| Rate for Payer: Managed Health Services Medicaid |
$191.90
|
| Rate for Payer: MDWise Medicaid |
$191.90
|
| Rate for Payer: MDWise Medicaid |
$191.90
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$64.02
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$64.02
|
| Rate for Payer: PHCS All Commercial |
$116.90
|
| Rate for Payer: PHCS All Commercial |
$116.90
|
| Rate for Payer: PHP All Commercial |
$159.18
|
| Rate for Payer: PHP All Commercial |
$159.18
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$116.90
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$116.90
|
| Rate for Payer: Sagamore Health Network All Products |
$116.90
|
| Rate for Payer: Sagamore Health Network All Products |
$116.90
|
| Rate for Payer: Signature Care EPO |
$297.50
|
| Rate for Payer: Signature Care EPO |
$297.50
|
| Rate for Payer: Signature Care PPO |
$297.50
|
| Rate for Payer: Signature Care PPO |
$297.50
|
| 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 |
$127.34
|
| Rate for Payer: United Healthcare Commercial |
$127.34
|
| Rate for Payer: United Healthcare Medicare |
$192.61
|
| Rate for Payer: United Healthcare Medicare |
$192.61
|
|
|
PR REMOVE TONSILS/ADENOIDS,<12 Y/O
|
Professional
|
Both
|
$547.40
|
|
|
Service Code
|
CPT 42820
|
| Hospital Charge Code |
z42820
|
| Min. Negotiated Rate |
$267.75 |
| Max. Negotiated Rate |
$38,400.00 |
| Rate for Payer: Aetna Commercial |
$273.74
|
| Rate for Payer: Aetna Commercial |
$273.74
|
| Rate for Payer: Aetna Medicare |
$273.74
|
| Rate for Payer: Aetna Medicare |
$273.74
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$358.30
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$358.30
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$358.30
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$358.30
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$358.30
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$358.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$358.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$358.30
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$269.23
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$269.23
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$314.80
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$314.80
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$301.11
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$301.11
|
| Rate for Payer: Cash Price |
$328.44
|
| Rate for Payer: Cash Price |
$321.30
|
| Rate for Payer: Centivo All Commercial |
$424.30
|
| Rate for Payer: Centivo All Commercial |
$424.30
|
| Rate for Payer: Cigna All Commercial |
$273.74
|
| Rate for Payer: Cigna All Commercial |
$273.74
|
| Rate for Payer: CORVEL All Commercial |
$273.74
|
| Rate for Payer: CORVEL All Commercial |
$273.74
|
| Rate for Payer: Coventry All Commercial |
$328.49
|
| Rate for Payer: Coventry All Commercial |
$328.49
|
| Rate for Payer: Encore All Commercial |
$273.74
|
| Rate for Payer: Encore All Commercial |
$273.74
|
| Rate for Payer: Frontpath All Commercial |
$375.05
|
| Rate for Payer: Frontpath All Commercial |
$375.05
|
| Rate for Payer: Humana ChoiceCare |
$318.68
|
| Rate for Payer: Humana ChoiceCare |
$318.68
|
| Rate for Payer: Humana Medicare |
$273.74
|
| Rate for Payer: Humana Medicare |
$273.74
|
| Rate for Payer: Lucent All Commercial |
$383.24
|
| Rate for Payer: Lucent All Commercial |
$383.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$412.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$412.00
|
| Rate for Payer: Managed Health Services Medicaid |
$269.23
|
| Rate for Payer: Managed Health Services Medicaid |
$269.23
|
| Rate for Payer: MDWise Medicaid |
$269.23
|
| Rate for Payer: MDWise Medicaid |
$269.23
|
| Rate for Payer: PHCS All Commercial |
$273.74
|
| Rate for Payer: PHCS All Commercial |
$273.74
|
| Rate for Payer: PHP All Commercial |
$468.56
|
| Rate for Payer: PHP All Commercial |
$468.56
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$273.74
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$273.74
|
| Rate for Payer: Sagamore Health Network All Products |
$273.74
|
| Rate for Payer: Sagamore Health Network All Products |
$273.74
|
| Rate for Payer: Signature Care EPO |
$414.80
|
| Rate for Payer: Signature Care EPO |
$414.80
|
| Rate for Payer: Signature Care PPO |
$414.80
|
| Rate for Payer: Signature Care PPO |
$414.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$38,400.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$38,400.00
|
| Rate for Payer: United Healthcare Commercial |
$320.94
|
| Rate for Payer: United Healthcare Commercial |
$320.94
|
| Rate for Payer: United Healthcare Medicare |
$267.75
|
| Rate for Payer: United Healthcare Medicare |
$267.75
|
|
