|
PR REMV BONE FOR GRAFT MAJOR
|
Professional
|
Both
|
$504.00
|
|
|
Service Code
|
CPT 20902
|
| Hospital Charge Code |
z20902
|
| Min. Negotiated Rate |
$247.70 |
| Max. Negotiated Rate |
$626.85 |
| Rate for Payer: Aetna Commercial |
$257.21
|
| Rate for Payer: Aetna Medicare |
$257.21
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$247.70
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$295.79
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$282.93
|
| Rate for Payer: Cash Price |
$312.48
|
| Rate for Payer: Centivo All Commercial |
$398.68
|
| Rate for Payer: Cigna All Commercial |
$257.21
|
| Rate for Payer: CORVEL All Commercial |
$257.21
|
| Rate for Payer: Coventry All Commercial |
$308.65
|
| Rate for Payer: Encore All Commercial |
$257.21
|
| Rate for Payer: Frontpath All Commercial |
$360.58
|
| Rate for Payer: Humana ChoiceCare |
$626.85
|
| Rate for Payer: Humana Medicare |
$257.21
|
| Rate for Payer: Lucent All Commercial |
$360.09
|
| Rate for Payer: Managed Health Services Medicaid |
$247.70
|
| Rate for Payer: MDWise Medicaid |
$247.70
|
| Rate for Payer: PHCS All Commercial |
$257.21
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$257.21
|
| Rate for Payer: Sagamore Health Network All Products |
$257.21
|
| Rate for Payer: United Healthcare Commercial |
$396.79
|
| Rate for Payer: United Healthcare Medicare |
$248.48
|
|
|
PR REMV BONE FOR GRAFT MINOR
|
Professional
|
Both
|
$710.74
|
|
|
Service Code
|
CPT 20900
|
| Hospital Charge Code |
z20900
|
| Min. Negotiated Rate |
$133.04 |
| Max. Negotiated Rate |
$628.59 |
| Rate for Payer: Aetna Commercial |
$169.18
|
| Rate for Payer: Aetna Commercial |
$169.18
|
| Rate for Payer: Aetna Medicare |
$169.18
|
| Rate for Payer: Aetna Medicare |
$169.18
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$133.04
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$133.04
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$349.51
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$349.51
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$194.56
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$194.56
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$186.10
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$186.10
|
| Rate for Payer: Cash Price |
$440.57
|
| Rate for Payer: Cash Price |
$440.66
|
| Rate for Payer: Centivo All Commercial |
$262.23
|
| Rate for Payer: Centivo All Commercial |
$262.23
|
| Rate for Payer: Cigna All Commercial |
$169.18
|
| Rate for Payer: Cigna All Commercial |
$169.18
|
| Rate for Payer: CORVEL All Commercial |
$169.18
|
| Rate for Payer: CORVEL All Commercial |
$169.18
|
| Rate for Payer: Coventry All Commercial |
$203.02
|
| Rate for Payer: Coventry All Commercial |
$203.02
|
| Rate for Payer: Encore All Commercial |
$169.18
|
| Rate for Payer: Encore All Commercial |
$169.18
|
| Rate for Payer: Frontpath All Commercial |
$235.73
|
| Rate for Payer: Frontpath All Commercial |
$235.73
|
| Rate for Payer: Humana ChoiceCare |
$486.13
|
| Rate for Payer: Humana ChoiceCare |
$486.13
|
| Rate for Payer: Humana Medicare |
$169.18
|
| Rate for Payer: Humana Medicare |
$169.18
|
| Rate for Payer: Lucent All Commercial |
$236.85
|
| Rate for Payer: Lucent All Commercial |
$236.85
|
| Rate for Payer: Managed Health Services Medicaid |
$349.51
|
| Rate for Payer: Managed Health Services Medicaid |
$349.51
|
| Rate for Payer: MDWise Medicaid |
$349.51
|
| Rate for Payer: MDWise Medicaid |
$349.51
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$133.04
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$133.04
|
| Rate for Payer: PHCS All Commercial |
$169.18
|
| Rate for Payer: PHCS All Commercial |
$169.18
|
| Rate for Payer: PHP All Commercial |
$285.56
|
| Rate for Payer: PHP All Commercial |
$285.56
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$169.18
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$169.18
|
| Rate for Payer: Sagamore Health Network All Products |
$169.18
|
| Rate for Payer: Sagamore Health Network All Products |
$169.18
|
| Rate for Payer: Signature Care EPO |
$628.59
|
| Rate for Payer: Signature Care EPO |
$628.59
|
| Rate for Payer: Signature Care PPO |
$628.59
|
| Rate for Payer: Signature Care PPO |
$628.59
|
| Rate for Payer: United Healthcare Commercial |
$286.45
|
| Rate for Payer: United Healthcare Commercial |
$286.45
|
| Rate for Payer: United Healthcare Medicare |
$355.37
|
| Rate for Payer: United Healthcare Medicare |
$355.37
|
|
|
PR REMV EXT CANAL F.B.,GEN ANESTH
|
Professional
|
Both
|
$175.42
|
|
|
Service Code
|
CPT 69205
|
| Hospital Charge Code |
z69205
|
| Min. Negotiated Rate |
$87.61 |
| Max. Negotiated Rate |
$13,500.00 |
| Rate for Payer: Aetna Commercial |
$88.84
|
| Rate for Payer: Aetna Commercial |
$88.84
|
| Rate for Payer: Aetna Commercial |
$88.84
|
| Rate for Payer: Aetna Commercial |
$88.84
|
| Rate for Payer: Aetna Medicare |
$88.84
|
| Rate for Payer: Aetna Medicare |
$88.84
|
| Rate for Payer: Aetna Medicare |
$88.84
|
| Rate for Payer: Aetna Medicare |
$88.84
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$117.30
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$117.30
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$117.30
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$117.30
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$117.30
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$117.30
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$117.30
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$117.30
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$117.30
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$117.30
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$117.30
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$117.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$117.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$117.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$117.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$117.30
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$87.61
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$87.61
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$87.61
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$87.61
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$102.17
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$102.17
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$102.17
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$102.17
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$97.72
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$97.72
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$97.72
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$97.72
|
| Rate for Payer: Cash Price |
$108.76
|
| Rate for Payer: Cash Price |
$220.87
|
| Rate for Payer: Cash Price |
$217.52
|
| Rate for Payer: Cash Price |
$110.43
|
| Rate for Payer: Centivo All Commercial |
$137.70
|
| Rate for Payer: Centivo All Commercial |
$137.70
|
| Rate for Payer: Centivo All Commercial |
$137.70
|
| Rate for Payer: Centivo All Commercial |
$137.70
|
| Rate for Payer: Cigna All Commercial |
$88.84
|
| Rate for Payer: Cigna All Commercial |
$88.84
|
| Rate for Payer: Cigna All Commercial |
$88.84
|
| Rate for Payer: Cigna All Commercial |
$88.84
|
| Rate for Payer: CORVEL All Commercial |
$88.84
|
| Rate for Payer: CORVEL All Commercial |
$88.84
|
| Rate for Payer: CORVEL All Commercial |
$88.84
|
| Rate for Payer: CORVEL All Commercial |
$88.84
|
| Rate for Payer: Coventry All Commercial |
$106.61
|
| Rate for Payer: Coventry All Commercial |
$106.61
|
| Rate for Payer: Coventry All Commercial |
$106.61
|
| Rate for Payer: Coventry All Commercial |
$106.61
|
| Rate for Payer: Encore All Commercial |
$88.84
|
| Rate for Payer: Encore All Commercial |
$88.84
|
| Rate for Payer: Encore All Commercial |
$88.84
|
| Rate for Payer: Encore All Commercial |
$88.84
|
| Rate for Payer: Frontpath All Commercial |
$121.13
|
| Rate for Payer: Frontpath All Commercial |
$121.13
|
| Rate for Payer: Frontpath All Commercial |
$121.13
|
| Rate for Payer: Frontpath All Commercial |
$121.13
|
| Rate for Payer: Humana ChoiceCare |
$103.87
|
| Rate for Payer: Humana ChoiceCare |
$103.87
|
| Rate for Payer: Humana ChoiceCare |
$103.87
|
| Rate for Payer: Humana ChoiceCare |
$103.87
|
| Rate for Payer: Humana Medicare |
$88.84
|
| Rate for Payer: Humana Medicare |
$88.84
|
| Rate for Payer: Humana Medicare |
$88.84
|
| Rate for Payer: Humana Medicare |
$88.84
|
| Rate for Payer: Lucent All Commercial |
$124.38
|
| Rate for Payer: Lucent All Commercial |
$124.38
|
| Rate for Payer: Lucent All Commercial |
$124.38
|
| Rate for Payer: Lucent All Commercial |
$124.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$144.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$144.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$144.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$144.00
|
| Rate for Payer: Managed Health Services Medicaid |
$87.61
|
| Rate for Payer: Managed Health Services Medicaid |
$87.61
|
| Rate for Payer: Managed Health Services Medicaid |
$87.61
|
| Rate for Payer: Managed Health Services Medicaid |
$87.61
|
| Rate for Payer: MDWise Medicaid |
$87.61
|
| Rate for Payer: MDWise Medicaid |
$87.61
|
| Rate for Payer: MDWise Medicaid |
$87.61
|
| Rate for Payer: MDWise Medicaid |
$87.61
|
| Rate for Payer: PHCS All Commercial |
$88.84
|
| Rate for Payer: PHCS All Commercial |
$88.84
|
| Rate for Payer: PHCS All Commercial |
$88.84
|
| Rate for Payer: PHCS All Commercial |
$88.84
|
| Rate for Payer: PHP All Commercial |
$114.02
|
| Rate for Payer: PHP All Commercial |
$114.02
|
| Rate for Payer: PHP All Commercial |
$114.02
|
| Rate for Payer: PHP All Commercial |
$114.02
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$88.84
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$88.84
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$88.84
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$88.84
|
| Rate for Payer: Sagamore Health Network All Products |
$88.84
|
| Rate for Payer: Sagamore Health Network All Products |
$88.84
|
| Rate for Payer: Sagamore Health Network All Products |
$88.84
|
| Rate for Payer: Sagamore Health Network All Products |
$88.84
|
| Rate for Payer: Signature Care EPO |
$122.40
|
| Rate for Payer: Signature Care EPO |
$122.40
|
| Rate for Payer: Signature Care EPO |
$122.40
|
| Rate for Payer: Signature Care EPO |
$122.40
|
| Rate for Payer: Signature Care PPO |
$122.40
|
| Rate for Payer: Signature Care PPO |
$122.40
|
| Rate for Payer: Signature Care PPO |
$122.40
|
| Rate for Payer: Signature Care PPO |
$122.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$13,500.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$13,500.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$13,500.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$13,500.00
|
| Rate for Payer: United Healthcare Commercial |
$109.36
|
| Rate for Payer: United Healthcare Commercial |
$109.36
|
| Rate for Payer: United Healthcare Commercial |
$109.36
|
| Rate for Payer: United Healthcare Commercial |
$109.36
|
| Rate for Payer: United Healthcare Medicare |
$87.71
|
| Rate for Payer: United Healthcare Medicare |
$87.71
|
| Rate for Payer: United Healthcare Medicare |
$87.71
|
| Rate for Payer: United Healthcare Medicare |
$87.71
|
|
|
PR REMV EXT CANAL FOREIGN BODY
|
Professional
|
Both
|
$149.34
|
|
|
Service Code
|
CPT 69200
|
| Hospital Charge Code |
z69200
|
| Min. Negotiated Rate |
$26.26 |
| Max. Negotiated Rate |
$6,600.00 |
| Rate for Payer: Aetna Commercial |
$44.30
|
| Rate for Payer: Aetna Commercial |
$44.30
|
| Rate for Payer: Aetna Commercial |
$44.30
|
| Rate for Payer: Aetna Commercial |
$44.30
|
| Rate for Payer: Aetna Medicare |
$44.30
|
| Rate for Payer: Aetna Medicare |
$44.30
|
| Rate for Payer: Aetna Medicare |
$44.30
|
| Rate for Payer: Aetna Medicare |
$44.30
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$142.59
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$142.59
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$142.59
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$142.59
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$142.59
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$142.59
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$142.59
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$142.59
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$142.59
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$142.59
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$142.59
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$142.59
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$142.59
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$142.59
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$142.59
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$142.59
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$26.26
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$26.26
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$26.26
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$26.26
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$73.45
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$73.45
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$73.45
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$73.45
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$50.95
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$50.95
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$50.95
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$50.95
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$48.73
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$48.73
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$48.73
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$48.73
|
| Rate for Payer: Cash Price |
$181.71
|
| Rate for Payer: Cash Price |
$92.59
|
| Rate for Payer: Cash Price |
$185.18
|
| Rate for Payer: Cash Price |
$90.85
|
| Rate for Payer: Centivo All Commercial |
$68.67
|
| Rate for Payer: Centivo All Commercial |
$68.67
|
| Rate for Payer: Centivo All Commercial |
$68.67
|
| Rate for Payer: Centivo All Commercial |
$68.67
|
| Rate for Payer: Cigna All Commercial |
$44.30
|
| Rate for Payer: Cigna All Commercial |
$44.30
|
| Rate for Payer: Cigna All Commercial |
$44.30
|
| Rate for Payer: Cigna All Commercial |
$44.30
|
| Rate for Payer: CORVEL All Commercial |
$44.30
|
| Rate for Payer: CORVEL All Commercial |
$44.30
|
| Rate for Payer: CORVEL All Commercial |
$44.30
|
| Rate for Payer: CORVEL All Commercial |
$44.30
|
| Rate for Payer: Coventry All Commercial |
$53.16
|
| Rate for Payer: Coventry All Commercial |
$53.16
|
| Rate for Payer: Coventry All Commercial |
$53.16
|
| Rate for Payer: Coventry All Commercial |
$53.16
|
| Rate for Payer: Encore All Commercial |
$44.30
|
| Rate for Payer: Encore All Commercial |
$44.30
|
| Rate for Payer: Encore All Commercial |
$44.30
|
| Rate for Payer: Encore All Commercial |
$44.30
|
| Rate for Payer: Frontpath All Commercial |
$61.00
|
| Rate for Payer: Frontpath All Commercial |
$61.00
|
| Rate for Payer: Frontpath All Commercial |
$61.00
|
| Rate for Payer: Frontpath All Commercial |
$61.00
|
| Rate for Payer: Humana ChoiceCare |
$54.31
|
| Rate for Payer: Humana ChoiceCare |
$54.31
|
| Rate for Payer: Humana ChoiceCare |
$54.31
|
| Rate for Payer: Humana ChoiceCare |
$54.31
|
| Rate for Payer: Humana Medicare |
$44.30
|
| Rate for Payer: Humana Medicare |
$44.30
|
| Rate for Payer: Humana Medicare |
$44.30
|
| Rate for Payer: Humana Medicare |
$44.30
|
| Rate for Payer: Lucent All Commercial |
$62.02
|
| Rate for Payer: Lucent All Commercial |
$62.02
|
| Rate for Payer: Lucent All Commercial |
$62.02
|
| Rate for Payer: Lucent All Commercial |
$62.02
|
| Rate for Payer: Lutheran Preferred All Commercial |
$71.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$71.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$71.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$71.00
|
| Rate for Payer: Managed Health Services Medicaid |
$73.45
|
| Rate for Payer: Managed Health Services Medicaid |
$73.45
|
| Rate for Payer: Managed Health Services Medicaid |
$73.45
|
| Rate for Payer: Managed Health Services Medicaid |
$73.45
|
| Rate for Payer: MDWise Medicaid |
$73.45
|
| Rate for Payer: MDWise Medicaid |
$73.45
|
| Rate for Payer: MDWise Medicaid |
$73.45
|
| Rate for Payer: MDWise Medicaid |
$73.45
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$26.26
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$26.26
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$26.26
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$26.26
|
| Rate for Payer: PHCS All Commercial |
$44.30
|
| Rate for Payer: PHCS All Commercial |
$44.30
|
| Rate for Payer: PHCS All Commercial |
$44.30
|
| Rate for Payer: PHCS All Commercial |
$44.30
|
| Rate for Payer: PHP All Commercial |
$56.09
|
| Rate for Payer: PHP All Commercial |
$56.09
|
| Rate for Payer: PHP All Commercial |
$56.09
|
| Rate for Payer: PHP All Commercial |
$56.09
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$44.30
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$44.30
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$44.30
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$44.30
|
| Rate for Payer: Sagamore Health Network All Products |
$44.30
|
| Rate for Payer: Sagamore Health Network All Products |
$44.30
|
| Rate for Payer: Sagamore Health Network All Products |
$44.30
|
| Rate for Payer: Sagamore Health Network All Products |
$44.30
|
| Rate for Payer: Signature Care EPO |
$127.74
|
| Rate for Payer: Signature Care EPO |
$127.74
|
| Rate for Payer: Signature Care EPO |
$127.74
|
| Rate for Payer: Signature Care EPO |
$127.74
|
| Rate for Payer: Signature Care PPO |
$127.74
|
| Rate for Payer: Signature Care PPO |
$127.74
|
| Rate for Payer: Signature Care PPO |
$127.74
|
| Rate for Payer: Signature Care PPO |
$127.74
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$6,600.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$6,600.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$6,600.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$6,600.00
|
| Rate for Payer: United Healthcare Commercial |
$61.16
|
| Rate for Payer: United Healthcare Commercial |
$61.16
|
| Rate for Payer: United Healthcare Commercial |
$61.16
|
| Rate for Payer: United Healthcare Commercial |
$61.16
|
| Rate for Payer: United Healthcare Medicare |
$73.27
|
| Rate for Payer: United Healthcare Medicare |
$73.27
|
| Rate for Payer: United Healthcare Medicare |
$73.27
|
| Rate for Payer: United Healthcare Medicare |
$73.27
|
|
|
PR REMV EXT CANAL SOFT TISSUE LESN
|
Professional
|
Both
|
$764.14
|
|
|
Service Code
|
CPT 69145
|
| Hospital Charge Code |
z69145
|
| Min. Negotiated Rate |
$132.72 |
| Max. Negotiated Rate |
$36,400.00 |
| Rate for Payer: Aetna Commercial |
$242.36
|
| Rate for Payer: Aetna Commercial |
$242.36
|
| Rate for Payer: Aetna Medicare |
$242.36
|
| Rate for Payer: Aetna Medicare |
$242.36
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$320.29
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$320.29
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$320.29
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$320.29
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$320.29
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$320.29
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$320.29
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$320.29
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$132.72
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$132.72
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$375.83
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$375.83
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$278.71
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$278.71
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$266.60
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$266.60
|
| Rate for Payer: Cash Price |
$468.77
|
| Rate for Payer: Cash Price |
$473.77
|
| Rate for Payer: Centivo All Commercial |
$375.66
|
| Rate for Payer: Centivo All Commercial |
$375.66
|
| Rate for Payer: Cigna All Commercial |
$242.36
|
| Rate for Payer: Cigna All Commercial |
$242.36
|
| Rate for Payer: CORVEL All Commercial |
$242.36
|
| Rate for Payer: CORVEL All Commercial |
$242.36
|
| Rate for Payer: Coventry All Commercial |
$290.83
|
| Rate for Payer: Coventry All Commercial |
$290.83
|
| Rate for Payer: Encore All Commercial |
$242.36
|
| Rate for Payer: Encore All Commercial |
$242.36
|
| Rate for Payer: Frontpath All Commercial |
$328.78
|
| Rate for Payer: Frontpath All Commercial |
$328.78
|
| Rate for Payer: Humana ChoiceCare |
$239.57
|
| Rate for Payer: Humana ChoiceCare |
$239.57
|
| Rate for Payer: Humana Medicare |
$242.36
|
| Rate for Payer: Humana Medicare |
$242.36
|
| Rate for Payer: Lucent All Commercial |
$339.30
|
| Rate for Payer: Lucent All Commercial |
$339.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$388.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$388.00
|
| Rate for Payer: Managed Health Services Medicaid |
$375.83
|
| Rate for Payer: Managed Health Services Medicaid |
$375.83
|
| Rate for Payer: MDWise Medicaid |
$375.83
|
| Rate for Payer: MDWise Medicaid |
$375.83
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$132.72
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$132.72
|
| Rate for Payer: PHCS All Commercial |
$242.36
|
| Rate for Payer: PHCS All Commercial |
$242.36
|
| Rate for Payer: PHP All Commercial |
$307.82
|
| Rate for Payer: PHP All Commercial |
$307.82
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$242.36
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$242.36
|
| Rate for Payer: Sagamore Health Network All Products |
$242.36
|
| Rate for Payer: Sagamore Health Network All Products |
$242.36
|
| Rate for Payer: Signature Care EPO |
$332.02
|
| Rate for Payer: Signature Care EPO |
$332.02
|
| Rate for Payer: Signature Care PPO |
$332.02
|
| Rate for Payer: Signature Care PPO |
$332.02
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$36,400.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$36,400.00
|
| Rate for Payer: United Healthcare Commercial |
$264.20
|
| Rate for Payer: United Healthcare Commercial |
$264.20
|
| Rate for Payer: United Healthcare Medicare |
$378.04
|
| Rate for Payer: United Healthcare Medicare |
$378.04
|
|
|
PR REMV F.B.,EYE,CORNEA,NO SLIT
|
Professional
|
Both
|
$112.78
|
|
|
Service Code
|
CPT 65220
|
| Hospital Charge Code |
z65220
|
| Min. Negotiated Rate |
$21.67 |
| Max. Negotiated Rate |
$5,800.00 |
| Rate for Payer: Aetna Commercial |
$38.48
|
| Rate for Payer: Aetna Commercial |
$38.48
|
| Rate for Payer: Aetna Medicare |
$38.48
|
| Rate for Payer: Aetna Medicare |
$38.48
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$140.64
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$140.64
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$140.64
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$140.64
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$140.64
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$140.64
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$140.64
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$140.64
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$21.67
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$21.67
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$55.47
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$55.47
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$44.25
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$44.25
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$42.33
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$42.33
|
| Rate for Payer: Cash Price |
$68.03
|
| Rate for Payer: Cash Price |
$69.92
|
| Rate for Payer: Centivo All Commercial |
$59.64
|
| Rate for Payer: Centivo All Commercial |
$59.64
|
| Rate for Payer: Cigna All Commercial |
$38.48
|
| Rate for Payer: Cigna All Commercial |
$38.48
|
| Rate for Payer: CORVEL All Commercial |
$38.48
|
| Rate for Payer: CORVEL All Commercial |
$38.48
|
| Rate for Payer: Coventry All Commercial |
$46.18
|
| Rate for Payer: Coventry All Commercial |
$46.18
|
| Rate for Payer: Encore All Commercial |
$38.48
|
| Rate for Payer: Encore All Commercial |
$38.48
|
| Rate for Payer: Frontpath All Commercial |
$52.81
|
| Rate for Payer: Frontpath All Commercial |
$52.81
|
| Rate for Payer: Humana ChoiceCare |
$38.66
|
| Rate for Payer: Humana ChoiceCare |
$38.66
|
| Rate for Payer: Humana Medicare |
$38.48
|
| Rate for Payer: Humana Medicare |
$38.48
|
| Rate for Payer: Lucent All Commercial |
$53.87
|
| Rate for Payer: Lucent All Commercial |
$53.87
|
| Rate for Payer: Lutheran Preferred All Commercial |
$62.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$62.00
|
| Rate for Payer: Managed Health Services Medicaid |
$55.47
|
| Rate for Payer: Managed Health Services Medicaid |
$55.47
|
| Rate for Payer: MDWise Medicaid |
$55.47
|
| Rate for Payer: MDWise Medicaid |
$55.47
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$21.67
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$21.67
|
| Rate for Payer: PHCS All Commercial |
$38.48
|
| Rate for Payer: PHCS All Commercial |
$38.48
|
| Rate for Payer: PHP All Commercial |
$69.73
|
| Rate for Payer: PHP All Commercial |
$69.73
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$38.48
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$38.48
|
| Rate for Payer: Sagamore Health Network All Products |
$38.48
|
| Rate for Payer: Sagamore Health Network All Products |
$38.48
|
| Rate for Payer: Signature Care EPO |
$68.85
|
| Rate for Payer: Signature Care EPO |
$68.85
|
| Rate for Payer: Signature Care PPO |
$68.85
|
| Rate for Payer: Signature Care PPO |
$68.85
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5,800.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5,800.00
|
| Rate for Payer: United Healthcare Commercial |
$45.36
|
| Rate for Payer: United Healthcare Commercial |
$45.36
|
| Rate for Payer: United Healthcare Medicare |
$54.86
|
| Rate for Payer: United Healthcare Medicare |
$54.86
|
|
|
PR REMV F.B.,EYE,CORNEA,SLIT LAMP
|
Professional
|
Both
|
$127.52
|
|
|
Service Code
|
CPT 65222
|
| Hospital Charge Code |
z65222
|
| Min. Negotiated Rate |
$33.04 |
| Max. Negotiated Rate |
$7,100.00 |
| Rate for Payer: Aetna Commercial |
$47.63
|
| Rate for Payer: Aetna Commercial |
$47.63
|
| Rate for Payer: Aetna Medicare |
$47.63
|
| Rate for Payer: Aetna Medicare |
$47.63
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$89.35
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$89.35
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$89.35
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$89.35
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$89.35
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$89.35
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$89.35
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$89.35
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$33.04
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$33.04
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$62.72
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$62.72
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$54.77
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$54.77
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$52.39
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$52.39
|
| Rate for Payer: Cash Price |
$77.04
|
| Rate for Payer: Cash Price |
$79.06
|
| Rate for Payer: Centivo All Commercial |
$73.83
|
| Rate for Payer: Centivo All Commercial |
$73.83
|
| Rate for Payer: Cigna All Commercial |
$47.63
|
| Rate for Payer: Cigna All Commercial |
$47.63
|
| Rate for Payer: CORVEL All Commercial |
$47.63
|
| Rate for Payer: CORVEL All Commercial |
$47.63
|
| Rate for Payer: Coventry All Commercial |
$57.16
|
| Rate for Payer: Coventry All Commercial |
$57.16
|
| Rate for Payer: Encore All Commercial |
$47.63
|
| Rate for Payer: Encore All Commercial |
$47.63
|
| Rate for Payer: Frontpath All Commercial |
$63.66
|
| Rate for Payer: Frontpath All Commercial |
$63.66
|
| Rate for Payer: Humana ChoiceCare |
$50.66
|
| Rate for Payer: Humana ChoiceCare |
$50.66
|
| Rate for Payer: Humana Medicare |
$47.63
|
| Rate for Payer: Humana Medicare |
$47.63
|
| Rate for Payer: Lucent All Commercial |
$66.68
|
| Rate for Payer: Lucent All Commercial |
$66.68
|
| Rate for Payer: Lutheran Preferred All Commercial |
$76.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$76.00
|
| Rate for Payer: Managed Health Services Medicaid |
$62.72
|
| Rate for Payer: Managed Health Services Medicaid |
$62.72
|
| Rate for Payer: MDWise Medicaid |
$62.72
|
| Rate for Payer: MDWise Medicaid |
$62.72
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$33.04
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$33.04
|
| Rate for Payer: PHCS All Commercial |
$47.63
|
| Rate for Payer: PHCS All Commercial |
$47.63
|
| Rate for Payer: PHP All Commercial |
$85.41
|
| Rate for Payer: PHP All Commercial |
$85.41
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$47.63
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$47.63
|
| Rate for Payer: Sagamore Health Network All Products |
$47.63
|
| Rate for Payer: Sagamore Health Network All Products |
$47.63
|
| Rate for Payer: Signature Care EPO |
$88.40
|
| Rate for Payer: Signature Care EPO |
$88.40
|
| Rate for Payer: Signature Care PPO |
$88.40
|
| Rate for Payer: Signature Care PPO |
$88.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$7,100.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$7,100.00
|
| Rate for Payer: United Healthcare Commercial |
$60.80
|
| Rate for Payer: United Healthcare Commercial |
$60.80
|
| Rate for Payer: United Healthcare Medicare |
$62.13
|
| Rate for Payer: United Healthcare Medicare |
$62.13
|
|
|
PR REMV F.B.,EYE,SUPERF CONJUNC
|
Professional
|
Both
|
$53.84
|
|
|
Service Code
|
CPT 65205
|
| Hospital Charge Code |
z65205
|
| Min. Negotiated Rate |
$26.15 |
| Max. Negotiated Rate |
$4,100.00 |
| Rate for Payer: Aetna Commercial |
$27.57
|
| Rate for Payer: Aetna Commercial |
$27.57
|
| Rate for Payer: Aetna Medicare |
$27.57
|
| Rate for Payer: Aetna Medicare |
$27.57
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$102.42
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$102.42
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$102.42
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$102.42
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$102.42
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$102.42
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$102.42
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$102.42
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$26.15
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$26.15
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$26.48
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$26.48
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$31.71
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$31.71
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$30.33
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$30.33
|
| Rate for Payer: Cash Price |
$33.38
|
| Rate for Payer: Cash Price |
$33.19
|
| Rate for Payer: Centivo All Commercial |
$42.73
|
| Rate for Payer: Centivo All Commercial |
$42.73
|
| Rate for Payer: Cigna All Commercial |
$27.57
|
| Rate for Payer: Cigna All Commercial |
$27.57
|
| Rate for Payer: CORVEL All Commercial |
$27.57
|
| Rate for Payer: CORVEL All Commercial |
$27.57
|
| Rate for Payer: Coventry All Commercial |
$33.08
|
| Rate for Payer: Coventry All Commercial |
$33.08
|
| Rate for Payer: Encore All Commercial |
$27.57
|
| Rate for Payer: Encore All Commercial |
$27.57
|
| Rate for Payer: Frontpath All Commercial |
$37.15
|
| Rate for Payer: Frontpath All Commercial |
$37.15
|
| Rate for Payer: Humana ChoiceCare |
$38.67
|
| Rate for Payer: Humana ChoiceCare |
$38.67
|
| Rate for Payer: Humana Medicare |
$27.57
|
| Rate for Payer: Humana Medicare |
$27.57
|
| Rate for Payer: Lucent All Commercial |
$38.60
|
| Rate for Payer: Lucent All Commercial |
$38.60
|
| Rate for Payer: Lutheran Preferred All Commercial |
$44.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$44.00
|
| Rate for Payer: Managed Health Services Medicaid |
$26.48
|
| Rate for Payer: Managed Health Services Medicaid |
$26.48
|
| Rate for Payer: MDWise Medicaid |
$26.48
|
| Rate for Payer: MDWise Medicaid |
$26.48
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$26.15
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$26.15
|
| Rate for Payer: PHCS All Commercial |
$27.57
|
| Rate for Payer: PHCS All Commercial |
$27.57
|
| Rate for Payer: PHP All Commercial |
$49.52
|
| Rate for Payer: PHP All Commercial |
$49.52
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$27.57
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$27.57
|
| Rate for Payer: Sagamore Health Network All Products |
$27.57
|
| Rate for Payer: Sagamore Health Network All Products |
$27.57
|
| Rate for Payer: Signature Care EPO |
$46.87
|
| Rate for Payer: Signature Care EPO |
$46.87
|
| Rate for Payer: Signature Care PPO |
$46.87
|
| Rate for Payer: Signature Care PPO |
$46.87
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,100.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,100.00
|
| Rate for Payer: United Healthcare Commercial |
$46.06
|
| Rate for Payer: United Healthcare Commercial |
$46.06
|
| Rate for Payer: United Healthcare Medicare |
$26.77
|
| Rate for Payer: United Healthcare Medicare |
$26.77
|
|
|
PR REMV FOOT FOREIGN BODY,DEEP
|
Professional
|
Both
|
$856.34
|
|
|
Service Code
|
CPT 28192
|
| Hospital Charge Code |
z28192
|
| Min. Negotiated Rate |
$157.81 |
| Max. Negotiated Rate |
$43,900.00 |
| Rate for Payer: Aetna Commercial |
$293.97
|
| Rate for Payer: Aetna Commercial |
$293.97
|
| Rate for Payer: Aetna Medicare |
$293.97
|
| Rate for Payer: Aetna Medicare |
$293.97
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$438.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$438.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$438.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$438.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$438.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$438.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$438.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$438.00
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$157.81
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$157.81
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$421.19
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$421.19
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$338.07
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$338.07
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$323.37
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$323.37
|
| Rate for Payer: Cash Price |
$518.61
|
| Rate for Payer: Cash Price |
$530.93
|
| Rate for Payer: Centivo All Commercial |
$455.65
|
| Rate for Payer: Centivo All Commercial |
$455.65
|
| Rate for Payer: Cigna All Commercial |
$293.97
|
| Rate for Payer: Cigna All Commercial |
$293.97
|
| Rate for Payer: CORVEL All Commercial |
$293.97
|
| Rate for Payer: CORVEL All Commercial |
$293.97
|
| Rate for Payer: Coventry All Commercial |
$352.76
|
| Rate for Payer: Coventry All Commercial |
$352.76
|
| Rate for Payer: Encore All Commercial |
$293.97
|
| Rate for Payer: Encore All Commercial |
$293.97
|
| Rate for Payer: Frontpath All Commercial |
$396.89
|
| Rate for Payer: Frontpath All Commercial |
$396.89
|
| Rate for Payer: Humana ChoiceCare |
$358.12
|
| Rate for Payer: Humana ChoiceCare |
$358.12
|
| Rate for Payer: Humana Medicare |
$293.97
|
| Rate for Payer: Humana Medicare |
$293.97
|
| Rate for Payer: Lucent All Commercial |
$411.56
|
| Rate for Payer: Lucent All Commercial |
$411.56
|
| Rate for Payer: Lutheran Preferred All Commercial |
$469.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$469.00
|
| Rate for Payer: Managed Health Services Medicaid |
$421.19
|
| Rate for Payer: Managed Health Services Medicaid |
$421.19
|
| Rate for Payer: MDWise Medicaid |
$421.19
|
| Rate for Payer: MDWise Medicaid |
$421.19
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$157.81
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$157.81
|
| Rate for Payer: PHCS All Commercial |
$293.97
|
| Rate for Payer: PHCS All Commercial |
$293.97
|
| Rate for Payer: PHP All Commercial |
$497.14
|
| Rate for Payer: PHP All Commercial |
$497.14
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$293.97
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$293.97
|
| Rate for Payer: Sagamore Health Network All Products |
$293.97
|
| Rate for Payer: Sagamore Health Network All Products |
$293.97
|
| Rate for Payer: Signature Care EPO |
$629.85
|
| Rate for Payer: Signature Care EPO |
$629.85
|
| Rate for Payer: Signature Care PPO |
$629.85
|
| Rate for Payer: Signature Care PPO |
$629.85
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$43,900.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$43,900.00
|
| Rate for Payer: United Healthcare Commercial |
$362.84
|
| Rate for Payer: United Healthcare Commercial |
$362.84
|
| Rate for Payer: United Healthcare Medicare |
$418.23
|
| Rate for Payer: United Healthcare Medicare |
$418.23
|
|
|
PR REMV FOOT FOREIGN BODY,SUBCUTANEOUS
|
Professional
|
Both
|
$447.80
|
|
|
Service Code
|
CPT 28190
|
| Hospital Charge Code |
z28190
|
| Min. Negotiated Rate |
$74.17 |
| Max. Negotiated Rate |
$18,700.00 |
| Rate for Payer: Aetna Commercial |
$125.10
|
| Rate for Payer: Aetna Commercial |
$125.10
|
| Rate for Payer: Aetna Medicare |
$125.10
|
| Rate for Payer: Aetna Medicare |
$125.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$229.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$229.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$229.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$229.80
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$229.80
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$229.80
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$229.80
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$229.80
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$74.17
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$74.17
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$220.24
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$220.24
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$143.87
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$143.87
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$137.61
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$137.61
|
| Rate for Payer: Cash Price |
$272.47
|
| Rate for Payer: Cash Price |
$277.64
|
| Rate for Payer: Centivo All Commercial |
$193.91
|
| Rate for Payer: Centivo All Commercial |
$193.91
|
| Rate for Payer: Cigna All Commercial |
$125.10
|
| Rate for Payer: Cigna All Commercial |
$125.10
|
| Rate for Payer: CORVEL All Commercial |
$125.10
|
| Rate for Payer: CORVEL All Commercial |
$125.10
|
| Rate for Payer: Coventry All Commercial |
$150.12
|
| Rate for Payer: Coventry All Commercial |
$150.12
|
| Rate for Payer: Encore All Commercial |
$125.10
|
| Rate for Payer: Encore All Commercial |
$125.10
|
| Rate for Payer: Frontpath All Commercial |
$169.27
|
| Rate for Payer: Frontpath All Commercial |
$169.27
|
| Rate for Payer: Humana ChoiceCare |
$148.30
|
| Rate for Payer: Humana ChoiceCare |
$148.30
|
| Rate for Payer: Humana Medicare |
$125.10
|
| Rate for Payer: Humana Medicare |
$125.10
|
| Rate for Payer: Lucent All Commercial |
$175.14
|
| Rate for Payer: Lucent All Commercial |
$175.14
|
| Rate for Payer: Lutheran Preferred All Commercial |
$199.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$199.00
|
| Rate for Payer: Managed Health Services Medicaid |
$220.24
|
| Rate for Payer: Managed Health Services Medicaid |
$220.24
|
| Rate for Payer: MDWise Medicaid |
$220.24
|
| Rate for Payer: MDWise Medicaid |
$220.24
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$74.17
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$74.17
|
| Rate for Payer: PHCS All Commercial |
$125.10
|
| Rate for Payer: PHCS All Commercial |
$125.10
|
| Rate for Payer: PHP All Commercial |
$211.48
|
| Rate for Payer: PHP All Commercial |
$211.48
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$125.10
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$125.10
|
| Rate for Payer: Sagamore Health Network All Products |
$125.10
|
| Rate for Payer: Sagamore Health Network All Products |
$125.10
|
| Rate for Payer: Signature Care EPO |
$389.52
|
| Rate for Payer: Signature Care EPO |
$389.52
|
| Rate for Payer: Signature Care PPO |
$389.52
|
| Rate for Payer: Signature Care PPO |
$389.52
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$18,700.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$18,700.00
|
| Rate for Payer: United Healthcare Commercial |
$151.49
|
| Rate for Payer: United Healthcare Commercial |
$151.49
|
| Rate for Payer: United Healthcare Medicare |
$219.73
|
| Rate for Payer: United Healthcare Medicare |
$219.73
|
|
|
PR REMV FOREIGN BODY,KNEE/THIGH,DEEP
|
Professional
|
Both
|
$1,083.06
|
|
|
Service Code
|
CPT 27372
|
| Hospital Charge Code |
z27372
|
| Min. Negotiated Rate |
$207.29 |
| Max. Negotiated Rate |
$56,000.00 |
| Rate for Payer: Aetna Commercial |
$375.05
|
| Rate for Payer: Aetna Commercial |
$375.05
|
| Rate for Payer: Aetna Medicare |
$375.05
|
| Rate for Payer: Aetna Medicare |
$375.05
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$616.48
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$616.48
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$616.48
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$616.48
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$616.48
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$616.48
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$616.48
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$616.48
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$207.29
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$207.29
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$532.69
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$532.69
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$431.31
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$431.31
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$412.56
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$412.56
|
| Rate for Payer: Cash Price |
$664.47
|
| Rate for Payer: Cash Price |
$671.50
|
| Rate for Payer: Centivo All Commercial |
$581.33
|
| Rate for Payer: Centivo All Commercial |
$581.33
|
| Rate for Payer: Cigna All Commercial |
$375.05
|
| Rate for Payer: Cigna All Commercial |
$375.05
|
| Rate for Payer: CORVEL All Commercial |
$375.05
|
| Rate for Payer: CORVEL All Commercial |
$375.05
|
| Rate for Payer: Coventry All Commercial |
$450.06
|
| Rate for Payer: Coventry All Commercial |
$450.06
|
| Rate for Payer: Encore All Commercial |
$375.05
|
| Rate for Payer: Encore All Commercial |
$375.05
|
| Rate for Payer: Frontpath All Commercial |
$521.17
|
| Rate for Payer: Frontpath All Commercial |
$521.17
|
| Rate for Payer: Humana ChoiceCare |
$422.81
|
| Rate for Payer: Humana ChoiceCare |
$422.81
|
| Rate for Payer: Humana Medicare |
$375.05
|
| Rate for Payer: Humana Medicare |
$375.05
|
| Rate for Payer: Lucent All Commercial |
$525.07
|
| Rate for Payer: Lucent All Commercial |
$525.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$597.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$597.00
|
| Rate for Payer: Managed Health Services Medicaid |
$532.69
|
| Rate for Payer: Managed Health Services Medicaid |
$532.69
|
| Rate for Payer: MDWise Medicaid |
$532.69
|
| Rate for Payer: MDWise Medicaid |
$532.69
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$207.29
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$207.29
|
| Rate for Payer: PHCS All Commercial |
$375.05
|
| Rate for Payer: PHCS All Commercial |
$375.05
|
| Rate for Payer: PHP All Commercial |
$633.67
|
| Rate for Payer: PHP All Commercial |
$633.67
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$375.05
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$375.05
|
| Rate for Payer: Sagamore Health Network All Products |
$375.05
|
| Rate for Payer: Sagamore Health Network All Products |
$375.05
|
| Rate for Payer: Signature Care EPO |
$634.95
|
| Rate for Payer: Signature Care EPO |
$634.95
|
| Rate for Payer: Signature Care PPO |
$634.95
|
| Rate for Payer: Signature Care PPO |
$634.95
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$56,000.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$56,000.00
|
| Rate for Payer: United Healthcare Commercial |
$430.65
|
| Rate for Payer: United Healthcare Commercial |
$430.65
|
| Rate for Payer: United Healthcare Medicare |
$535.86
|
| Rate for Payer: United Healthcare Medicare |
$535.86
|
|
|
PR REMV GALLBLADDER W CHOLANGIOGRAM
|
Professional
|
Both
|
$2,039.98
|
|
|
Service Code
|
CPT 47605
|
| Hospital Charge Code |
z47605
|
| Min. Negotiated Rate |
$971.40 |
| Max. Negotiated Rate |
$1,619.38 |
| Rate for Payer: Aetna Commercial |
$1,044.76
|
| Rate for Payer: Aetna Medicare |
$1,044.76
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$1,003.34
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,201.47
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,149.24
|
| Rate for Payer: Cash Price |
$1,264.79
|
| Rate for Payer: Centivo All Commercial |
$1,619.38
|
| Rate for Payer: Cigna All Commercial |
$1,044.76
|
| Rate for Payer: CORVEL All Commercial |
$1,044.76
|
| Rate for Payer: Coventry All Commercial |
$1,253.71
|
| Rate for Payer: Encore All Commercial |
$1,044.76
|
| Rate for Payer: Frontpath All Commercial |
$1,493.74
|
| Rate for Payer: Humana ChoiceCare |
$971.40
|
| Rate for Payer: Humana Medicare |
$1,044.76
|
| Rate for Payer: Lucent All Commercial |
$1,462.66
|
| Rate for Payer: Managed Health Services Medicaid |
$1,003.34
|
| Rate for Payer: MDWise Medicaid |
$1,003.34
|
| Rate for Payer: PHCS All Commercial |
$1,044.76
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,044.76
|
| Rate for Payer: Sagamore Health Network All Products |
$1,044.76
|
| Rate for Payer: United Healthcare Commercial |
$1,041.80
|
| Rate for Payer: United Healthcare Medicare |
$1,004.82
|
|
|
PR REMVL COLON & TERM ILEUM W/ILEOCOLOSTOMY
|
Professional
|
Both
|
$2,248.96
|
|
|
Service Code
|
CPT 44160
|
| Hospital Charge Code |
z44160
|
| Min. Negotiated Rate |
$1,106.12 |
| Max. Negotiated Rate |
$158,900.00 |
| Rate for Payer: Aetna Commercial |
$1,150.07
|
| Rate for Payer: Aetna Commercial |
$1,150.07
|
| Rate for Payer: Aetna Medicare |
$1,150.07
|
| Rate for Payer: Aetna Medicare |
$1,150.07
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$1,317.90
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$1,317.90
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,317.90
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,317.90
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,317.90
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,317.90
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,317.90
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,317.90
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$1,106.12
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$1,106.12
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,322.58
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,322.58
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,265.08
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,265.08
|
| Rate for Payer: Cash Price |
$1,394.36
|
| Rate for Payer: Cash Price |
$1,372.75
|
| Rate for Payer: Centivo All Commercial |
$1,782.61
|
| Rate for Payer: Centivo All Commercial |
$1,782.61
|
| Rate for Payer: Cigna All Commercial |
$1,150.07
|
| Rate for Payer: Cigna All Commercial |
$1,150.07
|
| Rate for Payer: CORVEL All Commercial |
$1,150.07
|
| Rate for Payer: CORVEL All Commercial |
$1,150.07
|
| Rate for Payer: Coventry All Commercial |
$1,380.08
|
| Rate for Payer: Coventry All Commercial |
$1,380.08
|
| Rate for Payer: Encore All Commercial |
$1,150.07
|
| Rate for Payer: Encore All Commercial |
$1,150.07
|
| Rate for Payer: Frontpath All Commercial |
$1,636.65
|
| Rate for Payer: Frontpath All Commercial |
$1,636.65
|
| Rate for Payer: Humana ChoiceCare |
$1,208.91
|
| Rate for Payer: Humana ChoiceCare |
$1,208.91
|
| Rate for Payer: Humana Medicare |
$1,150.07
|
| Rate for Payer: Humana Medicare |
$1,150.07
|
| Rate for Payer: Lucent All Commercial |
$1,610.10
|
| Rate for Payer: Lucent All Commercial |
$1,610.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,702.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,702.00
|
| Rate for Payer: Managed Health Services Medicaid |
$1,106.12
|
| Rate for Payer: Managed Health Services Medicaid |
$1,106.12
|
| Rate for Payer: MDWise Medicaid |
$1,106.12
|
| Rate for Payer: MDWise Medicaid |
$1,106.12
|
| Rate for Payer: PHCS All Commercial |
$1,150.07
|
| Rate for Payer: PHCS All Commercial |
$1,150.07
|
| Rate for Payer: PHP All Commercial |
$1,937.36
|
| Rate for Payer: PHP All Commercial |
$1,937.36
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,150.07
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,150.07
|
| Rate for Payer: Sagamore Health Network All Products |
$1,150.07
|
| Rate for Payer: Sagamore Health Network All Products |
$1,150.07
|
| Rate for Payer: Signature Care EPO |
$1,531.70
|
| Rate for Payer: Signature Care EPO |
$1,531.70
|
| Rate for Payer: Signature Care PPO |
$1,531.70
|
| Rate for Payer: Signature Care PPO |
$1,531.70
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$158,900.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$158,900.00
|
| Rate for Payer: United Healthcare Commercial |
$1,324.89
|
| Rate for Payer: United Healthcare Commercial |
$1,324.89
|
| Rate for Payer: United Healthcare Medicare |
$1,107.06
|
| Rate for Payer: United Healthcare Medicare |
$1,107.06
|
|
|
PR REMVL PERM PM PLSE GEN W/REPL PLSE GEN SNGL LEAD
|
Professional
|
Both
|
$607.72
|
|
|
Service Code
|
CPT 33227
|
| Hospital Charge Code |
z33227
|
| Min. Negotiated Rate |
$298.90 |
| Max. Negotiated Rate |
$46,300.00 |
| Rate for Payer: Aetna Commercial |
$313.43
|
| Rate for Payer: Aetna Commercial |
$313.43
|
| Rate for Payer: Aetna Medicare |
$313.43
|
| Rate for Payer: Aetna Medicare |
$313.43
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$475.16
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$475.16
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$475.16
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$475.16
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$475.16
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$475.16
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$475.16
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$475.16
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$298.90
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$298.90
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$360.44
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$360.44
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$344.77
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$344.77
|
| Rate for Payer: Cash Price |
$376.79
|
| Rate for Payer: Cash Price |
$373.20
|
| Rate for Payer: Centivo All Commercial |
$485.82
|
| Rate for Payer: Centivo All Commercial |
$485.82
|
| Rate for Payer: Cigna All Commercial |
$313.43
|
| Rate for Payer: Cigna All Commercial |
$313.43
|
| Rate for Payer: CORVEL All Commercial |
$313.43
|
| Rate for Payer: CORVEL All Commercial |
$313.43
|
| Rate for Payer: Coventry All Commercial |
$376.12
|
| Rate for Payer: Coventry All Commercial |
$376.12
|
| Rate for Payer: Encore All Commercial |
$313.43
|
| Rate for Payer: Encore All Commercial |
$313.43
|
| Rate for Payer: Frontpath All Commercial |
$443.52
|
| Rate for Payer: Frontpath All Commercial |
$443.52
|
| Rate for Payer: Humana ChoiceCare |
$413.50
|
| Rate for Payer: Humana ChoiceCare |
$413.50
|
| Rate for Payer: Humana Medicare |
$313.43
|
| Rate for Payer: Humana Medicare |
$313.43
|
| Rate for Payer: Lucent All Commercial |
$438.80
|
| Rate for Payer: Lucent All Commercial |
$438.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$494.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$494.00
|
| Rate for Payer: Managed Health Services Medicaid |
$298.90
|
| Rate for Payer: Managed Health Services Medicaid |
$298.90
|
| Rate for Payer: MDWise Medicaid |
$298.90
|
| Rate for Payer: MDWise Medicaid |
$298.90
|
| Rate for Payer: PHCS All Commercial |
$313.43
|
| Rate for Payer: PHCS All Commercial |
$313.43
|
| Rate for Payer: PHP All Commercial |
$421.36
|
| Rate for Payer: PHP All Commercial |
$421.36
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$313.43
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$313.43
|
| Rate for Payer: Sagamore Health Network All Products |
$313.43
|
| Rate for Payer: Sagamore Health Network All Products |
$313.43
|
| Rate for Payer: Signature Care EPO |
$404.00
|
| Rate for Payer: Signature Care EPO |
$404.00
|
| Rate for Payer: Signature Care PPO |
$404.00
|
| Rate for Payer: Signature Care PPO |
$404.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$46,300.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$46,300.00
|
| Rate for Payer: United Healthcare Commercial |
$418.16
|
| Rate for Payer: United Healthcare Commercial |
$418.16
|
| Rate for Payer: United Healthcare Medicare |
$300.97
|
| Rate for Payer: United Healthcare Medicare |
$300.97
|
|
|
PR REMVL PERM PM PLS GEN W/REPL PLSE GEN 2 LEAD SYS
|
Professional
|
Both
|
$634.68
|
|
|
Service Code
|
CPT 33228
|
| Hospital Charge Code |
z33228
|
| Min. Negotiated Rate |
$312.16 |
| Max. Negotiated Rate |
$48,300.00 |
| Rate for Payer: Aetna Commercial |
$327.80
|
| Rate for Payer: Aetna Commercial |
$327.80
|
| Rate for Payer: Aetna Medicare |
$327.80
|
| Rate for Payer: Aetna Medicare |
$327.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$495.53
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$495.53
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$495.53
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$495.53
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$495.53
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$495.53
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$495.53
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$495.53
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$312.16
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$312.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$376.97
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$376.97
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$360.58
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$360.58
|
| Rate for Payer: Cash Price |
$393.50
|
| Rate for Payer: Cash Price |
$389.91
|
| Rate for Payer: Centivo All Commercial |
$508.09
|
| Rate for Payer: Centivo All Commercial |
$508.09
|
| Rate for Payer: Cigna All Commercial |
$327.80
|
| Rate for Payer: Cigna All Commercial |
$327.80
|
| Rate for Payer: CORVEL All Commercial |
$327.80
|
| Rate for Payer: CORVEL All Commercial |
$327.80
|
| Rate for Payer: Coventry All Commercial |
$393.36
|
| Rate for Payer: Coventry All Commercial |
$393.36
|
| Rate for Payer: Encore All Commercial |
$327.80
|
| Rate for Payer: Encore All Commercial |
$327.80
|
| Rate for Payer: Frontpath All Commercial |
$464.54
|
| Rate for Payer: Frontpath All Commercial |
$464.54
|
| Rate for Payer: Humana ChoiceCare |
$431.22
|
| Rate for Payer: Humana ChoiceCare |
$431.22
|
| Rate for Payer: Humana Medicare |
$327.80
|
| Rate for Payer: Humana Medicare |
$327.80
|
| Rate for Payer: Lucent All Commercial |
$458.92
|
| Rate for Payer: Lucent All Commercial |
$458.92
|
| Rate for Payer: Lutheran Preferred All Commercial |
$516.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$516.00
|
| Rate for Payer: Managed Health Services Medicaid |
$312.16
|
| Rate for Payer: Managed Health Services Medicaid |
$312.16
|
| Rate for Payer: MDWise Medicaid |
$312.16
|
| Rate for Payer: MDWise Medicaid |
$312.16
|
| Rate for Payer: PHCS All Commercial |
$327.80
|
| Rate for Payer: PHCS All Commercial |
$327.80
|
| Rate for Payer: PHP All Commercial |
$440.22
|
| Rate for Payer: PHP All Commercial |
$440.22
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$327.80
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$327.80
|
| Rate for Payer: Sagamore Health Network All Products |
$327.80
|
| Rate for Payer: Sagamore Health Network All Products |
$327.80
|
| Rate for Payer: Signature Care EPO |
$421.32
|
| Rate for Payer: Signature Care EPO |
$421.32
|
| Rate for Payer: Signature Care PPO |
$421.32
|
| Rate for Payer: Signature Care PPO |
$421.32
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$48,300.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$48,300.00
|
| Rate for Payer: United Healthcare Commercial |
$436.10
|
| Rate for Payer: United Healthcare Commercial |
$436.10
|
| Rate for Payer: United Healthcare Medicare |
$314.44
|
| Rate for Payer: United Healthcare Medicare |
$314.44
|
|
|
PR REMVL PERM PM PLS GEN W/REPL PLSE GEN MULT LEAD
|
Professional
|
Both
|
$667.48
|
|
|
Service Code
|
CPT 33229
|
| Hospital Charge Code |
z33229
|
| Min. Negotiated Rate |
$328.29 |
| Max. Negotiated Rate |
$51,100.00 |
| Rate for Payer: Aetna Commercial |
$346.35
|
| Rate for Payer: Aetna Commercial |
$346.35
|
| Rate for Payer: Aetna Medicare |
$346.35
|
| Rate for Payer: Aetna Medicare |
$346.35
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$515.90
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$515.90
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$515.90
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$515.90
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$515.90
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$515.90
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$515.90
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$515.90
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$328.29
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$328.29
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$398.30
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$398.30
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$380.99
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$380.99
|
| Rate for Payer: Cash Price |
$413.84
|
| Rate for Payer: Cash Price |
$412.05
|
| Rate for Payer: Centivo All Commercial |
$536.84
|
| Rate for Payer: Centivo All Commercial |
$536.84
|
| Rate for Payer: Cigna All Commercial |
$346.35
|
| Rate for Payer: Cigna All Commercial |
$346.35
|
| Rate for Payer: CORVEL All Commercial |
$346.35
|
| Rate for Payer: CORVEL All Commercial |
$346.35
|
| Rate for Payer: Coventry All Commercial |
$415.62
|
| Rate for Payer: Coventry All Commercial |
$415.62
|
| Rate for Payer: Encore All Commercial |
$346.35
|
| Rate for Payer: Encore All Commercial |
$346.35
|
| Rate for Payer: Frontpath All Commercial |
$490.23
|
| Rate for Payer: Frontpath All Commercial |
$490.23
|
| Rate for Payer: Humana ChoiceCare |
$448.96
|
| Rate for Payer: Humana ChoiceCare |
$448.96
|
| Rate for Payer: Humana Medicare |
$346.35
|
| Rate for Payer: Humana Medicare |
$346.35
|
| Rate for Payer: Lucent All Commercial |
$484.89
|
| Rate for Payer: Lucent All Commercial |
$484.89
|
| Rate for Payer: Lutheran Preferred All Commercial |
$545.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$545.00
|
| Rate for Payer: Managed Health Services Medicaid |
$328.29
|
| Rate for Payer: Managed Health Services Medicaid |
$328.29
|
| Rate for Payer: MDWise Medicaid |
$328.29
|
| Rate for Payer: MDWise Medicaid |
$328.29
|
| Rate for Payer: PHCS All Commercial |
$346.35
|
| Rate for Payer: PHCS All Commercial |
$346.35
|
| Rate for Payer: PHP All Commercial |
$465.22
|
| Rate for Payer: PHP All Commercial |
$465.22
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$346.35
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$346.35
|
| Rate for Payer: Sagamore Health Network All Products |
$346.35
|
| Rate for Payer: Sagamore Health Network All Products |
$346.35
|
| Rate for Payer: Signature Care EPO |
$438.63
|
| Rate for Payer: Signature Care EPO |
$438.63
|
| Rate for Payer: Signature Care PPO |
$438.63
|
| Rate for Payer: Signature Care PPO |
$438.63
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$51,100.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$51,100.00
|
| Rate for Payer: United Healthcare Commercial |
$454.03
|
| Rate for Payer: United Healthcare Commercial |
$454.03
|
| Rate for Payer: United Healthcare Medicare |
$332.30
|
| Rate for Payer: United Healthcare Medicare |
$332.30
|
|
|
PR REMV NASAL FOR BODY,GEN ANESTH
|
Professional
|
Both
|
$388.70
|
|
|
Service Code
|
CPT 30310
|
| Hospital Charge Code |
z30310
|
| Min. Negotiated Rate |
$181.00 |
| Max. Negotiated Rate |
$29,500.00 |
| Rate for Payer: Aetna Commercial |
$198.02
|
| Rate for Payer: Aetna Commercial |
$198.02
|
| Rate for Payer: Aetna Medicare |
$198.02
|
| Rate for Payer: Aetna Medicare |
$198.02
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$181.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$181.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$181.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$181.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$181.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$181.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$181.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$181.00
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$191.18
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$191.18
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$227.72
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$227.72
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$217.82
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$217.82
|
| Rate for Payer: Cash Price |
$240.99
|
| Rate for Payer: Cash Price |
$237.79
|
| Rate for Payer: Centivo All Commercial |
$306.93
|
| Rate for Payer: Centivo All Commercial |
$306.93
|
| Rate for Payer: Cigna All Commercial |
$198.02
|
| Rate for Payer: Cigna All Commercial |
$198.02
|
| Rate for Payer: CORVEL All Commercial |
$198.02
|
| Rate for Payer: CORVEL All Commercial |
$198.02
|
| Rate for Payer: Coventry All Commercial |
$237.62
|
| Rate for Payer: Coventry All Commercial |
$237.62
|
| Rate for Payer: Encore All Commercial |
$198.02
|
| Rate for Payer: Encore All Commercial |
$198.02
|
| Rate for Payer: Frontpath All Commercial |
$267.68
|
| Rate for Payer: Frontpath All Commercial |
$267.68
|
| Rate for Payer: Humana ChoiceCare |
$223.21
|
| Rate for Payer: Humana ChoiceCare |
$223.21
|
| Rate for Payer: Humana Medicare |
$198.02
|
| Rate for Payer: Humana Medicare |
$198.02
|
| Rate for Payer: Lucent All Commercial |
$277.23
|
| Rate for Payer: Lucent All Commercial |
$277.23
|
| Rate for Payer: Lutheran Preferred All Commercial |
$314.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$314.00
|
| Rate for Payer: Managed Health Services Medicaid |
$191.18
|
| Rate for Payer: Managed Health Services Medicaid |
$191.18
|
| Rate for Payer: MDWise Medicaid |
$191.18
|
| Rate for Payer: MDWise Medicaid |
$191.18
|
| Rate for Payer: PHCS All Commercial |
$198.02
|
| Rate for Payer: PHCS All Commercial |
$198.02
|
| Rate for Payer: PHP All Commercial |
$268.47
|
| Rate for Payer: PHP All Commercial |
$268.47
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$198.02
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$198.02
|
| Rate for Payer: Sagamore Health Network All Products |
$198.02
|
| Rate for Payer: Sagamore Health Network All Products |
$198.02
|
| Rate for Payer: Signature Care EPO |
$267.75
|
| Rate for Payer: Signature Care EPO |
$267.75
|
| Rate for Payer: Signature Care PPO |
$267.75
|
| Rate for Payer: Signature Care PPO |
$267.75
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$29,500.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$29,500.00
|
| Rate for Payer: United Healthcare Commercial |
$215.68
|
| Rate for Payer: United Healthcare Commercial |
$215.68
|
| Rate for Payer: United Healthcare Medicare |
$191.77
|
| Rate for Payer: United Healthcare Medicare |
$191.77
|
|
|
PR REMV PILONIDAL LESION COMPLIC
|
Professional
|
Both
|
$1,418.24
|
|
|
Service Code
|
CPT 11772
|
| Hospital Charge Code |
z11772
|
| Min. Negotiated Rate |
$300.04 |
| Max. Negotiated Rate |
$64,200.00 |
| Rate for Payer: Aetna Commercial |
$540.66
|
| Rate for Payer: Aetna Commercial |
$540.66
|
| Rate for Payer: Aetna Medicare |
$540.66
|
| Rate for Payer: Aetna Medicare |
$540.66
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$647.88
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$647.88
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$647.88
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$647.88
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$647.88
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$647.88
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$647.88
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$647.88
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$300.04
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$300.04
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$697.54
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$697.54
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$621.76
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$621.76
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$594.73
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$594.73
|
| Rate for Payer: Cash Price |
$867.09
|
| Rate for Payer: Cash Price |
$879.31
|
| Rate for Payer: Centivo All Commercial |
$838.02
|
| Rate for Payer: Centivo All Commercial |
$838.02
|
| Rate for Payer: Cigna All Commercial |
$540.66
|
| Rate for Payer: Cigna All Commercial |
$540.66
|
| Rate for Payer: CORVEL All Commercial |
$540.66
|
| Rate for Payer: CORVEL All Commercial |
$540.66
|
| Rate for Payer: Coventry All Commercial |
$648.79
|
| Rate for Payer: Coventry All Commercial |
$648.79
|
| Rate for Payer: Encore All Commercial |
$540.66
|
| Rate for Payer: Encore All Commercial |
$540.66
|
| Rate for Payer: Frontpath All Commercial |
$754.43
|
| Rate for Payer: Frontpath All Commercial |
$754.43
|
| Rate for Payer: Humana ChoiceCare |
$453.27
|
| Rate for Payer: Humana ChoiceCare |
$453.27
|
| Rate for Payer: Humana Medicare |
$540.66
|
| Rate for Payer: Humana Medicare |
$540.66
|
| Rate for Payer: Lucent All Commercial |
$756.92
|
| Rate for Payer: Lucent All Commercial |
$756.92
|
| Rate for Payer: Lutheran Preferred All Commercial |
$695.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$695.00
|
| Rate for Payer: Managed Health Services Medicaid |
$697.54
|
| Rate for Payer: Managed Health Services Medicaid |
$697.54
|
| Rate for Payer: MDWise Medicaid |
$697.54
|
| Rate for Payer: MDWise Medicaid |
$697.54
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$300.04
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$300.04
|
| Rate for Payer: PHCS All Commercial |
$540.66
|
| Rate for Payer: PHCS All Commercial |
$540.66
|
| Rate for Payer: PHP All Commercial |
$730.63
|
| Rate for Payer: PHP All Commercial |
$730.63
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$540.66
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$540.66
|
| Rate for Payer: Sagamore Health Network All Products |
$540.66
|
| Rate for Payer: Sagamore Health Network All Products |
$540.66
|
| Rate for Payer: Signature Care EPO |
$619.99
|
| Rate for Payer: Signature Care EPO |
$619.99
|
| Rate for Payer: Signature Care PPO |
$619.99
|
| Rate for Payer: Signature Care PPO |
$619.99
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$64,200.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$64,200.00
|
| Rate for Payer: United Healthcare Commercial |
$575.54
|
| Rate for Payer: United Healthcare Commercial |
$575.54
|
| Rate for Payer: United Healthcare Medicare |
$699.27
|
| Rate for Payer: United Healthcare Medicare |
$699.27
|
|
|
PR REMV PILONIDAL LESION EXTENS
|
Professional
|
Both
|
$1,157.16
|
|
|
Service Code
|
CPT 11771
|
| Hospital Charge Code |
z11771
|
| Min. Negotiated Rate |
$232.53 |
| Max. Negotiated Rate |
$49,700.00 |
| Rate for Payer: Aetna Commercial |
$417.35
|
| Rate for Payer: Aetna Commercial |
$417.35
|
| Rate for Payer: Aetna Medicare |
$417.35
|
| Rate for Payer: Aetna Medicare |
$417.35
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$533.87
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$533.87
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$533.87
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$533.87
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$533.87
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$533.87
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$533.87
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$533.87
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$232.53
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$232.53
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$569.13
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$569.13
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$479.95
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$479.95
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$459.08
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$459.08
|
| Rate for Payer: Cash Price |
$704.90
|
| Rate for Payer: Cash Price |
$717.44
|
| Rate for Payer: Centivo All Commercial |
$646.89
|
| Rate for Payer: Centivo All Commercial |
$646.89
|
| Rate for Payer: Cigna All Commercial |
$417.35
|
| Rate for Payer: Cigna All Commercial |
$417.35
|
| Rate for Payer: CORVEL All Commercial |
$417.35
|
| Rate for Payer: CORVEL All Commercial |
$417.35
|
| Rate for Payer: Coventry All Commercial |
$500.82
|
| Rate for Payer: Coventry All Commercial |
$500.82
|
| Rate for Payer: Encore All Commercial |
$417.35
|
| Rate for Payer: Encore All Commercial |
$417.35
|
| Rate for Payer: Frontpath All Commercial |
$585.62
|
| Rate for Payer: Frontpath All Commercial |
$585.62
|
| Rate for Payer: Humana ChoiceCare |
$343.37
|
| Rate for Payer: Humana ChoiceCare |
$343.37
|
| Rate for Payer: Humana Medicare |
$417.35
|
| Rate for Payer: Humana Medicare |
$417.35
|
| Rate for Payer: Lucent All Commercial |
$584.29
|
| Rate for Payer: Lucent All Commercial |
$584.29
|
| Rate for Payer: Lutheran Preferred All Commercial |
$538.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$538.00
|
| Rate for Payer: Managed Health Services Medicaid |
$569.13
|
| Rate for Payer: Managed Health Services Medicaid |
$569.13
|
| Rate for Payer: MDWise Medicaid |
$569.13
|
| Rate for Payer: MDWise Medicaid |
$569.13
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$232.53
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$232.53
|
| Rate for Payer: PHCS All Commercial |
$417.35
|
| Rate for Payer: PHCS All Commercial |
$417.35
|
| Rate for Payer: PHP All Commercial |
$565.63
|
| Rate for Payer: PHP All Commercial |
$565.63
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$417.35
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$417.35
|
| Rate for Payer: Sagamore Health Network All Products |
$417.35
|
| Rate for Payer: Sagamore Health Network All Products |
$417.35
|
| Rate for Payer: Signature Care EPO |
$503.53
|
| Rate for Payer: Signature Care EPO |
$503.53
|
| Rate for Payer: Signature Care PPO |
$503.53
|
| Rate for Payer: Signature Care PPO |
$503.53
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$49,700.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$49,700.00
|
| Rate for Payer: United Healthcare Commercial |
$441.89
|
| Rate for Payer: United Healthcare Commercial |
$441.89
|
| Rate for Payer: United Healthcare Medicare |
$568.47
|
| Rate for Payer: United Healthcare Medicare |
$568.47
|
|
|
PR REMV PILONIDAL LESION SIMPLE
|
Professional
|
Both
|
$651.30
|
|
|
Service Code
|
CPT 11770
|
| Hospital Charge Code |
z11770
|
| Min. Negotiated Rate |
$112.84 |
| Max. Negotiated Rate |
$20,500.00 |
| Rate for Payer: Aetna Commercial |
$172.41
|
| Rate for Payer: Aetna Commercial |
$172.41
|
| Rate for Payer: Aetna Medicare |
$172.41
|
| Rate for Payer: Aetna Medicare |
$172.41
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$269.70
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$269.70
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$269.70
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$269.70
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$269.70
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$269.70
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$269.70
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$269.70
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$112.84
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$112.84
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$320.34
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$320.34
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$198.27
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$198.27
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$189.65
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$189.65
|
| Rate for Payer: Cash Price |
$399.52
|
| Rate for Payer: Cash Price |
$403.81
|
| Rate for Payer: Centivo All Commercial |
$267.24
|
| Rate for Payer: Centivo All Commercial |
$267.24
|
| Rate for Payer: Cigna All Commercial |
$172.41
|
| Rate for Payer: Cigna All Commercial |
$172.41
|
| Rate for Payer: CORVEL All Commercial |
$172.41
|
| Rate for Payer: CORVEL All Commercial |
$172.41
|
| Rate for Payer: Coventry All Commercial |
$206.89
|
| Rate for Payer: Coventry All Commercial |
$206.89
|
| Rate for Payer: Encore All Commercial |
$172.41
|
| Rate for Payer: Encore All Commercial |
$172.41
|
| Rate for Payer: Frontpath All Commercial |
$242.44
|
| Rate for Payer: Frontpath All Commercial |
$242.44
|
| Rate for Payer: Humana ChoiceCare |
$155.87
|
| Rate for Payer: Humana ChoiceCare |
$155.87
|
| Rate for Payer: Humana Medicare |
$172.41
|
| Rate for Payer: Humana Medicare |
$172.41
|
| Rate for Payer: Lucent All Commercial |
$241.37
|
| Rate for Payer: Lucent All Commercial |
$241.37
|
| Rate for Payer: Lutheran Preferred All Commercial |
$222.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$222.00
|
| Rate for Payer: Managed Health Services Medicaid |
$320.34
|
| Rate for Payer: Managed Health Services Medicaid |
$320.34
|
| Rate for Payer: MDWise Medicaid |
$320.34
|
| Rate for Payer: MDWise Medicaid |
$320.34
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$112.84
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$112.84
|
| Rate for Payer: PHCS All Commercial |
$172.41
|
| Rate for Payer: PHCS All Commercial |
$172.41
|
| Rate for Payer: PHP All Commercial |
$233.07
|
| Rate for Payer: PHP All Commercial |
$233.07
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$172.41
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$172.41
|
| Rate for Payer: Sagamore Health Network All Products |
$172.41
|
| Rate for Payer: Sagamore Health Network All Products |
$172.41
|
| Rate for Payer: Signature Care EPO |
$289.24
|
| Rate for Payer: Signature Care EPO |
$289.24
|
| Rate for Payer: Signature Care PPO |
$289.24
|
| Rate for Payer: Signature Care PPO |
$289.24
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$20,500.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$20,500.00
|
| Rate for Payer: United Healthcare Commercial |
$190.80
|
| Rate for Payer: United Healthcare Commercial |
$190.80
|
| Rate for Payer: United Healthcare Medicare |
$322.19
|
| Rate for Payer: United Healthcare Medicare |
$322.19
|
|
|
PR REMV RESID OBSTRUC PROSTATE,>1 YR
|
Professional
|
Both
|
$744.68
|
|
|
Service Code
|
CPT 52630
|
| Hospital Charge Code |
z52630
|
| Min. Negotiated Rate |
$369.75 |
| Max. Negotiated Rate |
$589.71 |
| Rate for Payer: Aetna Commercial |
$380.46
|
| Rate for Payer: Aetna Medicare |
$380.46
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$373.74
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$437.53
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$418.51
|
| Rate for Payer: Cash Price |
$461.70
|
| Rate for Payer: Centivo All Commercial |
$589.71
|
| Rate for Payer: Cigna All Commercial |
$380.46
|
| Rate for Payer: CORVEL All Commercial |
$380.46
|
| Rate for Payer: Coventry All Commercial |
$456.55
|
| Rate for Payer: Encore All Commercial |
$380.46
|
| Rate for Payer: Frontpath All Commercial |
$519.05
|
| Rate for Payer: Humana ChoiceCare |
$396.20
|
| Rate for Payer: Humana Medicare |
$380.46
|
| Rate for Payer: Lucent All Commercial |
$532.64
|
| Rate for Payer: Managed Health Services Medicaid |
$373.74
|
| Rate for Payer: MDWise Medicaid |
$373.74
|
| Rate for Payer: PHCS All Commercial |
$380.46
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$380.46
|
| Rate for Payer: Sagamore Health Network All Products |
$380.46
|
| Rate for Payer: United Healthcare Commercial |
$545.73
|
| Rate for Payer: United Healthcare Medicare |
$369.75
|
|
|
PR REMV TALUS/HEEL BENIGN BONE LESN
|
Professional
|
Both
|
$1,135.84
|
|
|
Service Code
|
CPT 28100
|
| Hospital Charge Code |
z28100
|
| Min. Negotiated Rate |
$214.73 |
| Max. Negotiated Rate |
$610.54 |
| Rate for Payer: Aetna Commercial |
$393.90
|
| Rate for Payer: Aetna Commercial |
$393.90
|
| Rate for Payer: Aetna Medicare |
$393.90
|
| Rate for Payer: Aetna Medicare |
$393.90
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$214.73
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$214.73
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$558.66
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$558.66
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$452.99
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$452.99
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$433.29
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$433.29
|
| Rate for Payer: Cash Price |
$690.64
|
| Rate for Payer: Cash Price |
$704.22
|
| Rate for Payer: Centivo All Commercial |
$610.54
|
| Rate for Payer: Centivo All Commercial |
$610.54
|
| Rate for Payer: Cigna All Commercial |
$393.90
|
| Rate for Payer: Cigna All Commercial |
$393.90
|
| Rate for Payer: CORVEL All Commercial |
$393.90
|
| Rate for Payer: CORVEL All Commercial |
$393.90
|
| Rate for Payer: Coventry All Commercial |
$472.68
|
| Rate for Payer: Coventry All Commercial |
$472.68
|
| Rate for Payer: Encore All Commercial |
$393.90
|
| Rate for Payer: Encore All Commercial |
$393.90
|
| Rate for Payer: Frontpath All Commercial |
$539.47
|
| Rate for Payer: Frontpath All Commercial |
$539.47
|
| Rate for Payer: Humana ChoiceCare |
$448.19
|
| Rate for Payer: Humana ChoiceCare |
$448.19
|
| Rate for Payer: Humana Medicare |
$393.90
|
| Rate for Payer: Humana Medicare |
$393.90
|
| Rate for Payer: Lucent All Commercial |
$551.46
|
| Rate for Payer: Lucent All Commercial |
$551.46
|
| Rate for Payer: Managed Health Services Medicaid |
$558.66
|
| Rate for Payer: Managed Health Services Medicaid |
$558.66
|
| Rate for Payer: MDWise Medicaid |
$558.66
|
| Rate for Payer: MDWise Medicaid |
$558.66
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$214.73
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$214.73
|
| Rate for Payer: PHCS All Commercial |
$393.90
|
| Rate for Payer: PHCS All Commercial |
$393.90
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$393.90
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$393.90
|
| Rate for Payer: Sagamore Health Network All Products |
$393.90
|
| Rate for Payer: Sagamore Health Network All Products |
$393.90
|
| Rate for Payer: United Healthcare Commercial |
$454.68
|
| Rate for Payer: United Healthcare Commercial |
$454.68
|
| Rate for Payer: United Healthcare Medicare |
$556.97
|
| Rate for Payer: United Healthcare Medicare |
$556.97
|
|
|
PR REMV TARSAL/METATARSAL BENIGN BONE LESN
|
Professional
|
Both
|
$977.88
|
|
|
Service Code
|
CPT 28104
|
| Hospital Charge Code |
z28104
|
| Min. Negotiated Rate |
$179.61 |
| Max. Negotiated Rate |
$49,900.00 |
| Rate for Payer: Aetna Commercial |
$332.46
|
| Rate for Payer: Aetna Commercial |
$332.46
|
| Rate for Payer: Aetna Medicare |
$332.46
|
| Rate for Payer: Aetna Medicare |
$332.46
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$490.01
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$490.01
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$490.01
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$490.01
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$490.01
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$490.01
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$490.01
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$490.01
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$179.61
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$179.61
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$480.96
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$480.96
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$382.33
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$382.33
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$365.71
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$365.71
|
| Rate for Payer: Cash Price |
$590.88
|
| Rate for Payer: Cash Price |
$606.29
|
| Rate for Payer: Centivo All Commercial |
$515.31
|
| Rate for Payer: Centivo All Commercial |
$515.31
|
| Rate for Payer: Cigna All Commercial |
$332.46
|
| Rate for Payer: Cigna All Commercial |
$332.46
|
| Rate for Payer: CORVEL All Commercial |
$332.46
|
| Rate for Payer: CORVEL All Commercial |
$332.46
|
| Rate for Payer: Coventry All Commercial |
$398.95
|
| Rate for Payer: Coventry All Commercial |
$398.95
|
| Rate for Payer: Encore All Commercial |
$332.46
|
| Rate for Payer: Encore All Commercial |
$332.46
|
| Rate for Payer: Frontpath All Commercial |
$451.83
|
| Rate for Payer: Frontpath All Commercial |
$451.83
|
| Rate for Payer: Humana ChoiceCare |
$391.86
|
| Rate for Payer: Humana ChoiceCare |
$391.86
|
| Rate for Payer: Humana Medicare |
$332.46
|
| Rate for Payer: Humana Medicare |
$332.46
|
| Rate for Payer: Lucent All Commercial |
$465.44
|
| Rate for Payer: Lucent All Commercial |
$465.44
|
| Rate for Payer: Lutheran Preferred All Commercial |
$532.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$532.00
|
| Rate for Payer: Managed Health Services Medicaid |
$480.96
|
| Rate for Payer: Managed Health Services Medicaid |
$480.96
|
| Rate for Payer: MDWise Medicaid |
$480.96
|
| Rate for Payer: MDWise Medicaid |
$480.96
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$179.61
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$179.61
|
| Rate for Payer: PHCS All Commercial |
$332.46
|
| Rate for Payer: PHCS All Commercial |
$332.46
|
| Rate for Payer: PHP All Commercial |
$564.49
|
| Rate for Payer: PHP All Commercial |
$564.49
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$332.46
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$332.46
|
| Rate for Payer: Sagamore Health Network All Products |
$332.46
|
| Rate for Payer: Sagamore Health Network All Products |
$332.46
|
| Rate for Payer: Signature Care EPO |
$658.75
|
| Rate for Payer: Signature Care EPO |
$658.75
|
| Rate for Payer: Signature Care PPO |
$658.75
|
| Rate for Payer: Signature Care PPO |
$658.75
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$49,900.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$49,900.00
|
| Rate for Payer: United Healthcare Commercial |
$398.49
|
| Rate for Payer: United Healthcare Commercial |
$398.49
|
| Rate for Payer: United Healthcare Medicare |
$476.52
|
| Rate for Payer: United Healthcare Medicare |
$476.52
|
|
|
PR REMV TOE BENIGN BONE LESN
|
Professional
|
Both
|
$810.50
|
|
|
Service Code
|
CPT 28108
|
| Hospital Charge Code |
z28108
|
| Min. Negotiated Rate |
$146.21 |
| Max. Negotiated Rate |
$421.66 |
| Rate for Payer: Aetna Commercial |
$272.04
|
| Rate for Payer: Aetna Medicare |
$272.04
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$146.21
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$398.64
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$312.85
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$299.24
|
| Rate for Payer: Cash Price |
$502.51
|
| Rate for Payer: Centivo All Commercial |
$421.66
|
| Rate for Payer: Cigna All Commercial |
$272.04
|
| Rate for Payer: CORVEL All Commercial |
$272.04
|
| Rate for Payer: Coventry All Commercial |
$326.45
|
| Rate for Payer: Encore All Commercial |
$272.04
|
| Rate for Payer: Frontpath All Commercial |
$367.16
|
| Rate for Payer: Humana ChoiceCare |
$320.21
|
| Rate for Payer: Humana Medicare |
$272.04
|
| Rate for Payer: Lucent All Commercial |
$380.86
|
| Rate for Payer: Managed Health Services Medicaid |
$398.64
|
| Rate for Payer: MDWise Medicaid |
$398.64
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$146.21
|
| Rate for Payer: PHCS All Commercial |
$272.04
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$272.04
|
| Rate for Payer: Sagamore Health Network All Products |
$272.04
|
| Rate for Payer: United Healthcare Commercial |
$328.69
|
| Rate for Payer: United Healthcare Medicare |
$395.70
|
|
|
PR RENAL BIOPSY PRQ TROCAR/NEEDLE
|
Professional
|
Both
|
$890.66
|
|
|
Service Code
|
CPT 50200
|
| Hospital Charge Code |
z50200
|
| Min. Negotiated Rate |
$101.48 |
| Max. Negotiated Rate |
$472.33 |
| Rate for Payer: Aetna Commercial |
$120.16
|
| Rate for Payer: Aetna Medicare |
$120.16
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$101.48
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$461.53
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$138.18
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$132.18
|
| Rate for Payer: Cash Price |
$552.21
|
| Rate for Payer: Centivo All Commercial |
$186.25
|
| Rate for Payer: Cigna All Commercial |
$120.16
|
| Rate for Payer: CORVEL All Commercial |
$120.16
|
| Rate for Payer: Coventry All Commercial |
$144.19
|
| Rate for Payer: Encore All Commercial |
$120.16
|
| Rate for Payer: Frontpath All Commercial |
$163.08
|
| Rate for Payer: Humana ChoiceCare |
$147.78
|
| Rate for Payer: Humana Medicare |
$120.16
|
| Rate for Payer: Lucent All Commercial |
$168.22
|
| Rate for Payer: Managed Health Services Medicaid |
$461.53
|
| Rate for Payer: MDWise Medicaid |
$461.53
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$101.48
|
| Rate for Payer: PHCS All Commercial |
$120.16
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$120.16
|
| Rate for Payer: Sagamore Health Network All Products |
$120.16
|
| Rate for Payer: United Healthcare Commercial |
$175.45
|
| Rate for Payer: United Healthcare Medicare |
$472.33
|
|
