|
PR RESUP NPTERF WND BODY 2.6-7.5 CM
|
Professional
|
Both
|
$210.68
|
|
|
Service Code
|
CPT 12002
|
| Hospital Charge Code |
z12002
|
| Min. Negotiated Rate |
$39.09 |
| Max. Negotiated Rate |
$6,500.00 |
| Rate for Payer: Aetna Commercial |
$54.83
|
| Rate for Payer: Aetna Commercial |
$54.83
|
| Rate for Payer: Aetna Medicare |
$54.83
|
| Rate for Payer: Aetna Medicare |
$54.83
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$205.66
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$205.66
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$205.66
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$205.66
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$205.66
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$205.66
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$205.66
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$205.66
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$39.09
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$39.09
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$103.62
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$103.62
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$63.05
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$63.05
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$60.31
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$60.31
|
| Rate for Payer: Cash Price |
$123.83
|
| Rate for Payer: Cash Price |
$126.41
|
| Rate for Payer: Centivo All Commercial |
$84.99
|
| Rate for Payer: Centivo All Commercial |
$84.99
|
| Rate for Payer: Cigna All Commercial |
$54.83
|
| Rate for Payer: Cigna All Commercial |
$54.83
|
| Rate for Payer: CORVEL All Commercial |
$54.83
|
| Rate for Payer: CORVEL All Commercial |
$54.83
|
| Rate for Payer: Coventry All Commercial |
$65.80
|
| Rate for Payer: Coventry All Commercial |
$65.80
|
| Rate for Payer: Encore All Commercial |
$54.83
|
| Rate for Payer: Encore All Commercial |
$54.83
|
| Rate for Payer: Frontpath All Commercial |
$77.73
|
| Rate for Payer: Frontpath All Commercial |
$77.73
|
| Rate for Payer: Humana ChoiceCare |
$104.20
|
| Rate for Payer: Humana ChoiceCare |
$104.20
|
| Rate for Payer: Humana Medicare |
$54.83
|
| Rate for Payer: Humana Medicare |
$54.83
|
| Rate for Payer: Lucent All Commercial |
$76.76
|
| Rate for Payer: Lucent All Commercial |
$76.76
|
| Rate for Payer: Lutheran Preferred All Commercial |
$70.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$70.00
|
| Rate for Payer: Managed Health Services Medicaid |
$103.62
|
| Rate for Payer: Managed Health Services Medicaid |
$103.62
|
| Rate for Payer: MDWise Medicaid |
$103.62
|
| Rate for Payer: MDWise Medicaid |
$103.62
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$39.09
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$39.09
|
| Rate for Payer: PHCS All Commercial |
$54.83
|
| Rate for Payer: PHCS All Commercial |
$54.83
|
| Rate for Payer: PHP All Commercial |
$74.05
|
| Rate for Payer: PHP All Commercial |
$74.05
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$54.83
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$54.83
|
| Rate for Payer: Sagamore Health Network All Products |
$54.83
|
| Rate for Payer: Sagamore Health Network All Products |
$54.83
|
| Rate for Payer: Signature Care EPO |
$160.65
|
| Rate for Payer: Signature Care EPO |
$160.65
|
| Rate for Payer: Signature Care PPO |
$160.65
|
| Rate for Payer: Signature Care PPO |
$160.65
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$6,500.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$6,500.00
|
| Rate for Payer: United Healthcare Commercial |
$124.53
|
| Rate for Payer: United Healthcare Commercial |
$124.53
|
| Rate for Payer: United Healthcare Medicare |
$103.19
|
| Rate for Payer: United Healthcare Medicare |
$103.19
|
|
|
PR REVAGINAL PROLAPSE,SACROSP LIG
|
Professional
|
Both
|
$1,291.26
|
|
|
Service Code
|
CPT 57282
|
| Hospital Charge Code |
z57282
|
| Min. Negotiated Rate |
$505.07 |
| Max. Negotiated Rate |
$84,700.00 |
| Rate for Payer: Aetna Commercial |
$656.92
|
| Rate for Payer: Aetna Commercial |
$656.92
|
| Rate for Payer: Aetna Medicare |
$656.92
|
| Rate for Payer: Aetna Medicare |
$656.92
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$606.48
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$606.48
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$606.48
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$606.48
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$606.48
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$606.48
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$606.48
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$606.48
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$635.10
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$635.10
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$755.46
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$755.46
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$722.61
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$722.61
|
| Rate for Payer: Cash Price |
$774.76
|
| Rate for Payer: Cash Price |
$762.58
|
| Rate for Payer: Centivo All Commercial |
$1,018.23
|
| Rate for Payer: Centivo All Commercial |
$1,018.23
|
| Rate for Payer: Cigna All Commercial |
$656.92
|
| Rate for Payer: Cigna All Commercial |
$656.92
|
| Rate for Payer: CORVEL All Commercial |
$656.92
|
| Rate for Payer: CORVEL All Commercial |
$656.92
|
| Rate for Payer: Coventry All Commercial |
$788.30
|
| Rate for Payer: Coventry All Commercial |
$788.30
|
| Rate for Payer: Encore All Commercial |
$656.92
|
| Rate for Payer: Encore All Commercial |
$656.92
|
| Rate for Payer: Frontpath All Commercial |
$908.61
|
| Rate for Payer: Frontpath All Commercial |
$908.61
|
| Rate for Payer: Humana ChoiceCare |
$505.07
|
| Rate for Payer: Humana ChoiceCare |
$505.07
|
| Rate for Payer: Humana Medicare |
$656.92
|
| Rate for Payer: Humana Medicare |
$656.92
|
| Rate for Payer: Lucent All Commercial |
$919.69
|
| Rate for Payer: Lucent All Commercial |
$919.69
|
| Rate for Payer: Lutheran Preferred All Commercial |
$912.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$912.00
|
| Rate for Payer: Managed Health Services Medicaid |
$635.10
|
| Rate for Payer: Managed Health Services Medicaid |
$635.10
|
| Rate for Payer: MDWise Medicaid |
$635.10
|
| Rate for Payer: MDWise Medicaid |
$635.10
|
| Rate for Payer: PHCS All Commercial |
$656.92
|
| Rate for Payer: PHCS All Commercial |
$656.92
|
| Rate for Payer: PHP All Commercial |
$838.84
|
| Rate for Payer: PHP All Commercial |
$838.84
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$656.92
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$656.92
|
| Rate for Payer: Sagamore Health Network All Products |
$656.92
|
| Rate for Payer: Sagamore Health Network All Products |
$656.92
|
| Rate for Payer: Signature Care EPO |
$704.65
|
| Rate for Payer: Signature Care EPO |
$704.65
|
| Rate for Payer: Signature Care PPO |
$704.65
|
| Rate for Payer: Signature Care PPO |
$704.65
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$84,700.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$84,700.00
|
| Rate for Payer: United Healthcare Commercial |
$572.20
|
| Rate for Payer: United Healthcare Commercial |
$572.20
|
| Rate for Payer: United Healthcare Medicare |
$635.48
|
| Rate for Payer: United Healthcare Medicare |
$635.48
|
|
|
PR REVAGINAL PROLAPSE,UTEROSACRAL
|
Professional
|
Both
|
$1,298.60
|
|
|
Service Code
|
CPT 57283
|
| Hospital Charge Code |
z57283
|
| Min. Negotiated Rate |
$638.70 |
| Max. Negotiated Rate |
$85,200.00 |
| Rate for Payer: Aetna Commercial |
$660.79
|
| Rate for Payer: Aetna Commercial |
$660.79
|
| Rate for Payer: Aetna Medicare |
$660.79
|
| Rate for Payer: Aetna Medicare |
$660.79
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$870.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$870.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$870.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$870.80
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$870.80
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$870.80
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$870.80
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$870.80
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$638.70
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$638.70
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$759.91
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$759.91
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$726.87
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$726.87
|
| Rate for Payer: Cash Price |
$779.16
|
| Rate for Payer: Cash Price |
$767.63
|
| Rate for Payer: Centivo All Commercial |
$1,024.22
|
| Rate for Payer: Centivo All Commercial |
$1,024.22
|
| Rate for Payer: Cigna All Commercial |
$660.79
|
| Rate for Payer: Cigna All Commercial |
$660.79
|
| Rate for Payer: CORVEL All Commercial |
$660.79
|
| Rate for Payer: CORVEL All Commercial |
$660.79
|
| Rate for Payer: Coventry All Commercial |
$792.95
|
| Rate for Payer: Coventry All Commercial |
$792.95
|
| Rate for Payer: Encore All Commercial |
$660.79
|
| Rate for Payer: Encore All Commercial |
$660.79
|
| Rate for Payer: Frontpath All Commercial |
$915.37
|
| Rate for Payer: Frontpath All Commercial |
$915.37
|
| Rate for Payer: Humana ChoiceCare |
$738.59
|
| Rate for Payer: Humana ChoiceCare |
$738.59
|
| Rate for Payer: Humana Medicare |
$660.79
|
| Rate for Payer: Humana Medicare |
$660.79
|
| Rate for Payer: Lucent All Commercial |
$925.11
|
| Rate for Payer: Lucent All Commercial |
$925.11
|
| Rate for Payer: Lutheran Preferred All Commercial |
$918.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$918.00
|
| Rate for Payer: Managed Health Services Medicaid |
$638.70
|
| Rate for Payer: Managed Health Services Medicaid |
$638.70
|
| Rate for Payer: MDWise Medicaid |
$638.70
|
| Rate for Payer: MDWise Medicaid |
$638.70
|
| Rate for Payer: PHCS All Commercial |
$660.79
|
| Rate for Payer: PHCS All Commercial |
$660.79
|
| Rate for Payer: PHP All Commercial |
$844.40
|
| Rate for Payer: PHP All Commercial |
$844.40
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$660.79
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$660.79
|
| Rate for Payer: Sagamore Health Network All Products |
$660.79
|
| Rate for Payer: Sagamore Health Network All Products |
$660.79
|
| Rate for Payer: Signature Care EPO |
$838.95
|
| Rate for Payer: Signature Care EPO |
$838.95
|
| Rate for Payer: Signature Care PPO |
$838.95
|
| Rate for Payer: Signature Care PPO |
$838.95
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$85,200.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$85,200.00
|
| Rate for Payer: United Healthcare Commercial |
$775.99
|
| Rate for Payer: United Healthcare Commercial |
$775.99
|
| Rate for Payer: United Healthcare Medicare |
$639.69
|
| Rate for Payer: United Healthcare Medicare |
$639.69
|
|
|
PR REVISE ACETABULAR PART OF TOTAL HIP
|
Professional
|
Both
|
$2,682.22
|
|
|
Service Code
|
CPT 27137
|
| Hospital Charge Code |
z27137
|
| Min. Negotiated Rate |
$1,318.14 |
| Max. Negotiated Rate |
$202,600.00 |
| Rate for Payer: Aetna Commercial |
$1,358.73
|
| Rate for Payer: Aetna Commercial |
$1,358.73
|
| Rate for Payer: Aetna Medicare |
$1,358.73
|
| Rate for Payer: Aetna Medicare |
$1,358.73
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$2,073.90
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$2,073.90
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,073.90
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,073.90
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$2,073.90
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$2,073.90
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,073.90
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,073.90
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$1,319.22
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$1,319.22
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,562.54
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,562.54
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,494.60
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,494.60
|
| Rate for Payer: Cash Price |
$1,609.33
|
| Rate for Payer: Cash Price |
$1,581.77
|
| Rate for Payer: Centivo All Commercial |
$2,106.03
|
| Rate for Payer: Centivo All Commercial |
$2,106.03
|
| Rate for Payer: Cigna All Commercial |
$1,358.73
|
| Rate for Payer: Cigna All Commercial |
$1,358.73
|
| Rate for Payer: CORVEL All Commercial |
$1,358.73
|
| Rate for Payer: CORVEL All Commercial |
$1,358.73
|
| Rate for Payer: Coventry All Commercial |
$1,630.48
|
| Rate for Payer: Coventry All Commercial |
$1,630.48
|
| Rate for Payer: Encore All Commercial |
$1,358.73
|
| Rate for Payer: Encore All Commercial |
$1,358.73
|
| Rate for Payer: Frontpath All Commercial |
$1,907.84
|
| Rate for Payer: Frontpath All Commercial |
$1,907.84
|
| Rate for Payer: Humana ChoiceCare |
$1,545.36
|
| Rate for Payer: Humana ChoiceCare |
$1,545.36
|
| Rate for Payer: Humana Medicare |
$1,358.73
|
| Rate for Payer: Humana Medicare |
$1,358.73
|
| Rate for Payer: Lucent All Commercial |
$1,902.22
|
| Rate for Payer: Lucent All Commercial |
$1,902.22
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,161.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,161.00
|
| Rate for Payer: Managed Health Services Medicaid |
$1,319.22
|
| Rate for Payer: Managed Health Services Medicaid |
$1,319.22
|
| Rate for Payer: MDWise Medicaid |
$1,319.22
|
| Rate for Payer: MDWise Medicaid |
$1,319.22
|
| Rate for Payer: PHCS All Commercial |
$1,358.73
|
| Rate for Payer: PHCS All Commercial |
$1,358.73
|
| Rate for Payer: PHP All Commercial |
$2,293.56
|
| Rate for Payer: PHP All Commercial |
$2,293.56
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,358.73
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,358.73
|
| Rate for Payer: Sagamore Health Network All Products |
$1,358.73
|
| Rate for Payer: Sagamore Health Network All Products |
$1,358.73
|
| Rate for Payer: Signature Care EPO |
$2,062.95
|
| Rate for Payer: Signature Care EPO |
$2,062.95
|
| Rate for Payer: Signature Care PPO |
$2,062.95
|
| Rate for Payer: Signature Care PPO |
$2,062.95
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$202,600.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$202,600.00
|
| Rate for Payer: United Healthcare Commercial |
$1,643.26
|
| Rate for Payer: United Healthcare Commercial |
$1,643.26
|
| Rate for Payer: United Healthcare Medicare |
$1,318.14
|
| Rate for Payer: United Healthcare Medicare |
$1,318.14
|
|
|
PR REVISE FEM PART OFTOTAL HIP
|
Professional
|
Both
|
$2,785.32
|
|
|
Service Code
|
CPT 27138
|
| Hospital Charge Code |
z27138
|
| Min. Negotiated Rate |
$1,369.08 |
| Max. Negotiated Rate |
$210,500.00 |
| Rate for Payer: Aetna Commercial |
$1,412.29
|
| Rate for Payer: Aetna Commercial |
$1,412.29
|
| Rate for Payer: Aetna Medicare |
$1,412.29
|
| Rate for Payer: Aetna Medicare |
$1,412.29
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$2,158.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$2,158.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,158.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,158.80
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$2,158.80
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$2,158.80
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,158.80
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,158.80
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$1,369.93
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$1,369.93
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,624.13
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,624.13
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,553.52
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,553.52
|
| Rate for Payer: Cash Price |
$1,671.19
|
| Rate for Payer: Cash Price |
$1,642.90
|
| Rate for Payer: Centivo All Commercial |
$2,189.05
|
| Rate for Payer: Centivo All Commercial |
$2,189.05
|
| Rate for Payer: Cigna All Commercial |
$1,412.29
|
| Rate for Payer: Cigna All Commercial |
$1,412.29
|
| Rate for Payer: CORVEL All Commercial |
$1,412.29
|
| Rate for Payer: CORVEL All Commercial |
$1,412.29
|
| Rate for Payer: Coventry All Commercial |
$1,694.75
|
| Rate for Payer: Coventry All Commercial |
$1,694.75
|
| Rate for Payer: Encore All Commercial |
$1,412.29
|
| Rate for Payer: Encore All Commercial |
$1,412.29
|
| Rate for Payer: Frontpath All Commercial |
$1,983.71
|
| Rate for Payer: Frontpath All Commercial |
$1,983.71
|
| Rate for Payer: Humana ChoiceCare |
$1,610.45
|
| Rate for Payer: Humana ChoiceCare |
$1,610.45
|
| Rate for Payer: Humana Medicare |
$1,412.29
|
| Rate for Payer: Humana Medicare |
$1,412.29
|
| Rate for Payer: Lucent All Commercial |
$1,977.21
|
| Rate for Payer: Lucent All Commercial |
$1,977.21
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,245.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,245.00
|
| Rate for Payer: Managed Health Services Medicaid |
$1,369.93
|
| Rate for Payer: Managed Health Services Medicaid |
$1,369.93
|
| Rate for Payer: MDWise Medicaid |
$1,369.93
|
| Rate for Payer: MDWise Medicaid |
$1,369.93
|
| Rate for Payer: PHCS All Commercial |
$1,412.29
|
| Rate for Payer: PHCS All Commercial |
$1,412.29
|
| Rate for Payer: PHP All Commercial |
$2,382.20
|
| Rate for Payer: PHP All Commercial |
$2,382.20
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,412.29
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,412.29
|
| Rate for Payer: Sagamore Health Network All Products |
$1,412.29
|
| Rate for Payer: Sagamore Health Network All Products |
$1,412.29
|
| Rate for Payer: Signature Care EPO |
$2,150.50
|
| Rate for Payer: Signature Care EPO |
$2,150.50
|
| Rate for Payer: Signature Care PPO |
$2,150.50
|
| Rate for Payer: Signature Care PPO |
$2,150.50
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$210,500.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$210,500.00
|
| Rate for Payer: United Healthcare Commercial |
$1,710.74
|
| Rate for Payer: United Healthcare Commercial |
$1,710.74
|
| Rate for Payer: United Healthcare Medicare |
$1,369.08
|
| Rate for Payer: United Healthcare Medicare |
$1,369.08
|
|
|
PR REVISE KNEE JOINT REPLACE,1 PART
|
Professional
|
Both
|
$2,576.48
|
|
|
Service Code
|
CPT 27486
|
| Hospital Charge Code |
z27486
|
| Min. Negotiated Rate |
$1,265.08 |
| Max. Negotiated Rate |
$194,500.00 |
| Rate for Payer: Aetna Commercial |
$1,302.47
|
| Rate for Payer: Aetna Commercial |
$1,302.47
|
| Rate for Payer: Aetna Medicare |
$1,302.47
|
| Rate for Payer: Aetna Medicare |
$1,302.47
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$1,887.30
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$1,887.30
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,887.30
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,887.30
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,887.30
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,887.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,887.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,887.30
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$1,267.21
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$1,267.21
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,497.84
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,497.84
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,432.72
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,432.72
|
| Rate for Payer: Cash Price |
$1,545.89
|
| Rate for Payer: Cash Price |
$1,518.10
|
| Rate for Payer: Centivo All Commercial |
$2,018.83
|
| Rate for Payer: Centivo All Commercial |
$2,018.83
|
| Rate for Payer: Cigna All Commercial |
$1,302.47
|
| Rate for Payer: Cigna All Commercial |
$1,302.47
|
| Rate for Payer: CORVEL All Commercial |
$1,302.47
|
| Rate for Payer: CORVEL All Commercial |
$1,302.47
|
| Rate for Payer: Coventry All Commercial |
$1,562.96
|
| Rate for Payer: Coventry All Commercial |
$1,562.96
|
| Rate for Payer: Encore All Commercial |
$1,302.47
|
| Rate for Payer: Encore All Commercial |
$1,302.47
|
| Rate for Payer: Frontpath All Commercial |
$1,824.88
|
| Rate for Payer: Frontpath All Commercial |
$1,824.88
|
| Rate for Payer: Humana ChoiceCare |
$1,439.10
|
| Rate for Payer: Humana ChoiceCare |
$1,439.10
|
| Rate for Payer: Humana Medicare |
$1,302.47
|
| Rate for Payer: Humana Medicare |
$1,302.47
|
| Rate for Payer: Lucent All Commercial |
$1,823.46
|
| Rate for Payer: Lucent All Commercial |
$1,823.46
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,075.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,075.00
|
| Rate for Payer: Managed Health Services Medicaid |
$1,267.21
|
| Rate for Payer: Managed Health Services Medicaid |
$1,267.21
|
| Rate for Payer: MDWise Medicaid |
$1,267.21
|
| Rate for Payer: MDWise Medicaid |
$1,267.21
|
| Rate for Payer: PHCS All Commercial |
$1,302.47
|
| Rate for Payer: PHCS All Commercial |
$1,302.47
|
| Rate for Payer: PHP All Commercial |
$2,201.24
|
| Rate for Payer: PHP All Commercial |
$2,201.24
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,302.47
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,302.47
|
| Rate for Payer: Sagamore Health Network All Products |
$1,302.47
|
| Rate for Payer: Sagamore Health Network All Products |
$1,302.47
|
| Rate for Payer: Signature Care EPO |
$1,918.45
|
| Rate for Payer: Signature Care EPO |
$1,918.45
|
| Rate for Payer: Signature Care PPO |
$1,918.45
|
| Rate for Payer: Signature Care PPO |
$1,918.45
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$194,500.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$194,500.00
|
| Rate for Payer: United Healthcare Commercial |
$1,551.89
|
| Rate for Payer: United Healthcare Commercial |
$1,551.89
|
| Rate for Payer: United Healthcare Medicare |
$1,265.08
|
| Rate for Payer: United Healthcare Medicare |
$1,265.08
|
|
|
PR REVISE KNEE JOINT REPLACE,ALL PARTS
|
Professional
|
Both
|
$3,207.76
|
|
|
Service Code
|
CPT 27487
|
| Hospital Charge Code |
z27487
|
| Min. Negotiated Rate |
$1,576.54 |
| Max. Negotiated Rate |
$242,400.00 |
| Rate for Payer: Aetna Commercial |
$1,625.02
|
| Rate for Payer: Aetna Commercial |
$1,625.02
|
| Rate for Payer: Aetna Medicare |
$1,625.02
|
| Rate for Payer: Aetna Medicare |
$1,625.02
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$2,439.30
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$2,439.30
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,439.30
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,439.30
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$2,439.30
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$2,439.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,439.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,439.30
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$1,577.70
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$1,577.70
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,868.77
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,868.77
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,787.52
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,787.52
|
| Rate for Payer: Cash Price |
$1,924.66
|
| Rate for Payer: Cash Price |
$1,891.85
|
| Rate for Payer: Centivo All Commercial |
$2,518.78
|
| Rate for Payer: Centivo All Commercial |
$2,518.78
|
| Rate for Payer: Cigna All Commercial |
$1,625.02
|
| Rate for Payer: Cigna All Commercial |
$1,625.02
|
| Rate for Payer: CORVEL All Commercial |
$1,625.02
|
| Rate for Payer: CORVEL All Commercial |
$1,625.02
|
| Rate for Payer: Coventry All Commercial |
$1,950.02
|
| Rate for Payer: Coventry All Commercial |
$1,950.02
|
| Rate for Payer: Encore All Commercial |
$1,625.02
|
| Rate for Payer: Encore All Commercial |
$1,625.02
|
| Rate for Payer: Frontpath All Commercial |
$2,281.07
|
| Rate for Payer: Frontpath All Commercial |
$2,281.07
|
| Rate for Payer: Humana ChoiceCare |
$1,841.64
|
| Rate for Payer: Humana ChoiceCare |
$1,841.64
|
| Rate for Payer: Humana Medicare |
$1,625.02
|
| Rate for Payer: Humana Medicare |
$1,625.02
|
| Rate for Payer: Lucent All Commercial |
$2,275.03
|
| Rate for Payer: Lucent All Commercial |
$2,275.03
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,585.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,585.00
|
| Rate for Payer: Managed Health Services Medicaid |
$1,577.70
|
| Rate for Payer: Managed Health Services Medicaid |
$1,577.70
|
| Rate for Payer: MDWise Medicaid |
$1,577.70
|
| Rate for Payer: MDWise Medicaid |
$1,577.70
|
| Rate for Payer: PHCS All Commercial |
$1,625.02
|
| Rate for Payer: PHCS All Commercial |
$1,625.02
|
| Rate for Payer: PHP All Commercial |
$2,743.18
|
| Rate for Payer: PHP All Commercial |
$2,743.18
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,625.02
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,625.02
|
| Rate for Payer: Sagamore Health Network All Products |
$1,625.02
|
| Rate for Payer: Sagamore Health Network All Products |
$1,625.02
|
| Rate for Payer: Signature Care EPO |
$2,458.20
|
| Rate for Payer: Signature Care EPO |
$2,458.20
|
| Rate for Payer: Signature Care PPO |
$2,458.20
|
| Rate for Payer: Signature Care PPO |
$2,458.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$242,400.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$242,400.00
|
| Rate for Payer: United Healthcare Commercial |
$1,960.26
|
| Rate for Payer: United Healthcare Commercial |
$1,960.26
|
| Rate for Payer: United Healthcare Medicare |
$1,576.54
|
| Rate for Payer: United Healthcare Medicare |
$1,576.54
|
|
|
PR REVISE MEDIAN N/CARPAL TUNNEL SURG
|
Professional
|
Both
|
$831.22
|
|
|
Service Code
|
CPT 64721
|
| Hospital Charge Code |
z64721
|
| Min. Negotiated Rate |
$263.04 |
| Max. Negotiated Rate |
$61,200.00 |
| Rate for Payer: Aetna Commercial |
$406.25
|
| Rate for Payer: Aetna Commercial |
$406.25
|
| Rate for Payer: Aetna Medicare |
$406.25
|
| Rate for Payer: Aetna Medicare |
$406.25
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$490.67
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$490.67
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$490.67
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$490.67
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$490.67
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$490.67
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$490.67
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$490.67
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$263.04
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$263.04
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$408.83
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$408.83
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$467.19
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$467.19
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$446.88
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$446.88
|
| Rate for Payer: Cash Price |
$486.52
|
| Rate for Payer: Cash Price |
$498.73
|
| Rate for Payer: Centivo All Commercial |
$629.69
|
| Rate for Payer: Centivo All Commercial |
$629.69
|
| Rate for Payer: Cigna All Commercial |
$406.25
|
| Rate for Payer: Cigna All Commercial |
$406.25
|
| Rate for Payer: CORVEL All Commercial |
$406.25
|
| Rate for Payer: CORVEL All Commercial |
$406.25
|
| Rate for Payer: Coventry All Commercial |
$487.50
|
| Rate for Payer: Coventry All Commercial |
$487.50
|
| Rate for Payer: Encore All Commercial |
$406.25
|
| Rate for Payer: Encore All Commercial |
$406.25
|
| Rate for Payer: Frontpath All Commercial |
$560.25
|
| Rate for Payer: Frontpath All Commercial |
$560.25
|
| Rate for Payer: Humana ChoiceCare |
$484.64
|
| Rate for Payer: Humana ChoiceCare |
$484.64
|
| Rate for Payer: Humana Medicare |
$406.25
|
| Rate for Payer: Humana Medicare |
$406.25
|
| Rate for Payer: Lucent All Commercial |
$568.75
|
| Rate for Payer: Lucent All Commercial |
$568.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$653.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$653.00
|
| Rate for Payer: Managed Health Services Medicaid |
$408.83
|
| Rate for Payer: Managed Health Services Medicaid |
$408.83
|
| Rate for Payer: MDWise Medicaid |
$408.83
|
| Rate for Payer: MDWise Medicaid |
$408.83
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$263.04
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$263.04
|
| Rate for Payer: PHCS All Commercial |
$406.25
|
| Rate for Payer: PHCS All Commercial |
$406.25
|
| Rate for Payer: PHP All Commercial |
$696.86
|
| Rate for Payer: PHP All Commercial |
$696.86
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$406.25
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$406.25
|
| Rate for Payer: Sagamore Health Network All Products |
$406.25
|
| Rate for Payer: Sagamore Health Network All Products |
$406.25
|
| Rate for Payer: Signature Care EPO |
$646.00
|
| Rate for Payer: Signature Care EPO |
$646.00
|
| Rate for Payer: Signature Care PPO |
$646.00
|
| Rate for Payer: Signature Care PPO |
$646.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$61,200.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$61,200.00
|
| Rate for Payer: United Healthcare Commercial |
$439.89
|
| Rate for Payer: United Healthcare Commercial |
$439.89
|
| Rate for Payer: United Healthcare Medicare |
$405.43
|
| Rate for Payer: United Healthcare Medicare |
$405.43
|
|
|
PR REVISE TOTAL HIP REPLACEMENT
|
Professional
|
Both
|
$3,476.94
|
|
|
Service Code
|
CPT 27134
|
| Hospital Charge Code |
z27134
|
| Min. Negotiated Rate |
$1,710.09 |
| Max. Negotiated Rate |
$263,100.00 |
| Rate for Payer: Aetna Commercial |
$1,765.27
|
| Rate for Payer: Aetna Commercial |
$1,765.27
|
| Rate for Payer: Aetna Medicare |
$1,765.27
|
| Rate for Payer: Aetna Medicare |
$1,765.27
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$2,745.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$2,745.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,745.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,745.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$2,745.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$2,745.50
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,745.50
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,745.50
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$1,710.09
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$1,710.09
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,030.06
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,030.06
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,941.80
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,941.80
|
| Rate for Payer: Cash Price |
$2,086.16
|
| Rate for Payer: Cash Price |
$2,053.16
|
| Rate for Payer: Centivo All Commercial |
$2,736.17
|
| Rate for Payer: Centivo All Commercial |
$2,736.17
|
| Rate for Payer: Cigna All Commercial |
$1,765.27
|
| Rate for Payer: Cigna All Commercial |
$1,765.27
|
| Rate for Payer: CORVEL All Commercial |
$1,765.27
|
| Rate for Payer: CORVEL All Commercial |
$1,765.27
|
| Rate for Payer: Coventry All Commercial |
$2,118.32
|
| Rate for Payer: Coventry All Commercial |
$2,118.32
|
| Rate for Payer: Encore All Commercial |
$1,765.27
|
| Rate for Payer: Encore All Commercial |
$1,765.27
|
| Rate for Payer: Frontpath All Commercial |
$2,482.45
|
| Rate for Payer: Frontpath All Commercial |
$2,482.45
|
| Rate for Payer: Humana ChoiceCare |
$2,043.05
|
| Rate for Payer: Humana ChoiceCare |
$2,043.05
|
| Rate for Payer: Humana Medicare |
$1,765.27
|
| Rate for Payer: Humana Medicare |
$1,765.27
|
| Rate for Payer: Lucent All Commercial |
$2,471.38
|
| Rate for Payer: Lucent All Commercial |
$2,471.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,806.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,806.00
|
| Rate for Payer: Managed Health Services Medicaid |
$1,710.09
|
| Rate for Payer: Managed Health Services Medicaid |
$1,710.09
|
| Rate for Payer: MDWise Medicaid |
$1,710.09
|
| Rate for Payer: MDWise Medicaid |
$1,710.09
|
| Rate for Payer: PHCS All Commercial |
$1,765.27
|
| Rate for Payer: PHCS All Commercial |
$1,765.27
|
| Rate for Payer: PHP All Commercial |
$2,977.09
|
| Rate for Payer: PHP All Commercial |
$2,977.09
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,765.27
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,765.27
|
| Rate for Payer: Sagamore Health Network All Products |
$1,765.27
|
| Rate for Payer: Sagamore Health Network All Products |
$1,765.27
|
| Rate for Payer: Signature Care EPO |
$2,729.35
|
| Rate for Payer: Signature Care EPO |
$2,729.35
|
| Rate for Payer: Signature Care PPO |
$2,729.35
|
| Rate for Payer: Signature Care PPO |
$2,729.35
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$263,100.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$263,100.00
|
| Rate for Payer: United Healthcare Commercial |
$2,158.35
|
| Rate for Payer: United Healthcare Commercial |
$2,158.35
|
| Rate for Payer: United Healthcare Medicare |
$1,710.97
|
| Rate for Payer: United Healthcare Medicare |
$1,710.97
|
|
|
PR REVISE ULNAR NERVE AT ELBOW
|
Professional
|
Both
|
$1,124.68
|
|
|
Service Code
|
CPT 64718
|
| Hospital Charge Code |
z64718
|
| Min. Negotiated Rate |
$548.61 |
| Max. Negotiated Rate |
$84,300.00 |
| Rate for Payer: Aetna Commercial |
$559.71
|
| Rate for Payer: Aetna Commercial |
$559.71
|
| Rate for Payer: Aetna Medicare |
$559.71
|
| Rate for Payer: Aetna Medicare |
$559.71
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$594.70
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$594.70
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$594.70
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$594.70
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$594.70
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$594.70
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$594.70
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$594.70
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$553.17
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$553.17
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$643.67
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$643.67
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$615.68
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$615.68
|
| Rate for Payer: Cash Price |
$674.81
|
| Rate for Payer: Cash Price |
$658.33
|
| Rate for Payer: Centivo All Commercial |
$867.55
|
| Rate for Payer: Centivo All Commercial |
$867.55
|
| Rate for Payer: Cigna All Commercial |
$559.71
|
| Rate for Payer: Cigna All Commercial |
$559.71
|
| Rate for Payer: CORVEL All Commercial |
$559.71
|
| Rate for Payer: CORVEL All Commercial |
$559.71
|
| Rate for Payer: Coventry All Commercial |
$671.65
|
| Rate for Payer: Coventry All Commercial |
$671.65
|
| Rate for Payer: Encore All Commercial |
$559.71
|
| Rate for Payer: Encore All Commercial |
$559.71
|
| Rate for Payer: Frontpath All Commercial |
$773.72
|
| Rate for Payer: Frontpath All Commercial |
$773.72
|
| Rate for Payer: Humana ChoiceCare |
$607.95
|
| Rate for Payer: Humana ChoiceCare |
$607.95
|
| Rate for Payer: Humana Medicare |
$559.71
|
| Rate for Payer: Humana Medicare |
$559.71
|
| Rate for Payer: Lucent All Commercial |
$783.59
|
| Rate for Payer: Lucent All Commercial |
$783.59
|
| Rate for Payer: Lutheran Preferred All Commercial |
$900.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$900.00
|
| Rate for Payer: Managed Health Services Medicaid |
$553.17
|
| Rate for Payer: Managed Health Services Medicaid |
$553.17
|
| Rate for Payer: MDWise Medicaid |
$553.17
|
| Rate for Payer: MDWise Medicaid |
$553.17
|
| Rate for Payer: PHCS All Commercial |
$559.71
|
| Rate for Payer: PHCS All Commercial |
$559.71
|
| Rate for Payer: PHP All Commercial |
$960.07
|
| Rate for Payer: PHP All Commercial |
$960.07
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$559.71
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$559.71
|
| Rate for Payer: Sagamore Health Network All Products |
$559.71
|
| Rate for Payer: Sagamore Health Network All Products |
$559.71
|
| Rate for Payer: Signature Care EPO |
$689.35
|
| Rate for Payer: Signature Care EPO |
$689.35
|
| Rate for Payer: Signature Care PPO |
$689.35
|
| Rate for Payer: Signature Care PPO |
$689.35
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$84,300.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$84,300.00
|
| Rate for Payer: United Healthcare Commercial |
$604.48
|
| Rate for Payer: United Healthcare Commercial |
$604.48
|
| Rate for Payer: United Healthcare Medicare |
$548.61
|
| Rate for Payer: United Healthcare Medicare |
$548.61
|
|
|
PR REVISION CERVIX W PREG,VAG APPRCH
|
Professional
|
Both
|
$264.00
|
|
|
Service Code
|
CPT 59320
|
| Hospital Charge Code |
z59320
|
| Min. Negotiated Rate |
$132.77 |
| Max. Negotiated Rate |
$212.29 |
| Rate for Payer: Aetna Commercial |
$136.96
|
| Rate for Payer: Aetna Medicare |
$136.96
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$133.27
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$157.50
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$150.66
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Centivo All Commercial |
$212.29
|
| Rate for Payer: Cigna All Commercial |
$136.96
|
| Rate for Payer: CORVEL All Commercial |
$136.96
|
| Rate for Payer: Coventry All Commercial |
$164.35
|
| Rate for Payer: Encore All Commercial |
$136.96
|
| Rate for Payer: Frontpath All Commercial |
$196.11
|
| Rate for Payer: Humana ChoiceCare |
$146.31
|
| Rate for Payer: Humana Medicare |
$136.96
|
| Rate for Payer: Lucent All Commercial |
$191.74
|
| Rate for Payer: Managed Health Services Medicaid |
$133.27
|
| Rate for Payer: MDWise Medicaid |
$133.27
|
| Rate for Payer: PHCS All Commercial |
$136.96
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$136.96
|
| Rate for Payer: Sagamore Health Network All Products |
$136.96
|
| Rate for Payer: United Healthcare Commercial |
$172.85
|
| Rate for Payer: United Healthcare Medicare |
$132.77
|
|
|
PR REVISION OF UNSTABLE PATELLA
|
Professional
|
Both
|
$1,392.34
|
|
|
Service Code
|
CPT 27420
|
| Hospital Charge Code |
z27420
|
| Min. Negotiated Rate |
$678.45 |
| Max. Negotiated Rate |
$104,300.00 |
| Rate for Payer: Aetna Commercial |
$693.43
|
| Rate for Payer: Aetna Commercial |
$693.43
|
| Rate for Payer: Aetna Medicare |
$693.43
|
| Rate for Payer: Aetna Medicare |
$693.43
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$987.70
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$987.70
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$987.70
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$987.70
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$987.70
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$987.70
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$987.70
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$987.70
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$684.81
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$684.81
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$797.44
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$797.44
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$762.77
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$762.77
|
| Rate for Payer: Cash Price |
$835.40
|
| Rate for Payer: Cash Price |
$814.14
|
| Rate for Payer: Centivo All Commercial |
$1,074.82
|
| Rate for Payer: Centivo All Commercial |
$1,074.82
|
| Rate for Payer: Cigna All Commercial |
$693.43
|
| Rate for Payer: Cigna All Commercial |
$693.43
|
| Rate for Payer: CORVEL All Commercial |
$693.43
|
| Rate for Payer: CORVEL All Commercial |
$693.43
|
| Rate for Payer: Coventry All Commercial |
$832.12
|
| Rate for Payer: Coventry All Commercial |
$832.12
|
| Rate for Payer: Encore All Commercial |
$693.43
|
| Rate for Payer: Encore All Commercial |
$693.43
|
| Rate for Payer: Frontpath All Commercial |
$964.91
|
| Rate for Payer: Frontpath All Commercial |
$964.91
|
| Rate for Payer: Humana ChoiceCare |
$782.84
|
| Rate for Payer: Humana ChoiceCare |
$782.84
|
| Rate for Payer: Humana Medicare |
$693.43
|
| Rate for Payer: Humana Medicare |
$693.43
|
| Rate for Payer: Lucent All Commercial |
$970.80
|
| Rate for Payer: Lucent All Commercial |
$970.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,113.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,113.00
|
| Rate for Payer: Managed Health Services Medicaid |
$684.81
|
| Rate for Payer: Managed Health Services Medicaid |
$684.81
|
| Rate for Payer: MDWise Medicaid |
$684.81
|
| Rate for Payer: MDWise Medicaid |
$684.81
|
| Rate for Payer: PHCS All Commercial |
$693.43
|
| Rate for Payer: PHCS All Commercial |
$693.43
|
| Rate for Payer: PHP All Commercial |
$1,180.49
|
| Rate for Payer: PHP All Commercial |
$1,180.49
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$693.43
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$693.43
|
| Rate for Payer: Sagamore Health Network All Products |
$693.43
|
| Rate for Payer: Sagamore Health Network All Products |
$693.43
|
| Rate for Payer: Signature Care EPO |
$1,045.50
|
| Rate for Payer: Signature Care EPO |
$1,045.50
|
| Rate for Payer: Signature Care PPO |
$1,045.50
|
| Rate for Payer: Signature Care PPO |
$1,045.50
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$104,300.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$104,300.00
|
| Rate for Payer: United Healthcare Commercial |
$808.61
|
| Rate for Payer: United Healthcare Commercial |
$808.61
|
| Rate for Payer: United Healthcare Medicare |
$678.45
|
| Rate for Payer: United Healthcare Medicare |
$678.45
|
|
|
PR REVIS SHOULDER ARTHRPLSTY HUMERAL&GLENOID COMPNT
|
Professional
|
Both
|
$3,184.02
|
|
|
Service Code
|
CPT 23474
|
| Hospital Charge Code |
z23474
|
| Min. Negotiated Rate |
$1,566.02 |
| Max. Negotiated Rate |
$2,505.67 |
| Rate for Payer: Aetna Commercial |
$1,616.56
|
| Rate for Payer: Aetna Commercial |
$1,616.56
|
| Rate for Payer: Aetna Medicare |
$1,616.56
|
| Rate for Payer: Aetna Medicare |
$1,616.56
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$1,566.02
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$1,566.02
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,859.04
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,859.04
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,778.22
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,778.22
|
| Rate for Payer: Cash Price |
$955.21
|
| Rate for Payer: Cash Price |
$1,910.41
|
| Rate for Payer: Centivo All Commercial |
$2,505.67
|
| Rate for Payer: Centivo All Commercial |
$2,505.67
|
| Rate for Payer: Cigna All Commercial |
$1,616.56
|
| Rate for Payer: Cigna All Commercial |
$1,616.56
|
| Rate for Payer: CORVEL All Commercial |
$1,616.56
|
| Rate for Payer: CORVEL All Commercial |
$1,616.56
|
| Rate for Payer: Coventry All Commercial |
$1,939.87
|
| Rate for Payer: Coventry All Commercial |
$1,939.87
|
| Rate for Payer: Encore All Commercial |
$1,616.56
|
| Rate for Payer: Encore All Commercial |
$1,616.56
|
| Rate for Payer: Frontpath All Commercial |
$2,265.38
|
| Rate for Payer: Frontpath All Commercial |
$2,265.38
|
| Rate for Payer: Humana ChoiceCare |
$1,903.60
|
| Rate for Payer: Humana ChoiceCare |
$1,903.60
|
| Rate for Payer: Humana Medicare |
$1,616.56
|
| Rate for Payer: Humana Medicare |
$1,616.56
|
| Rate for Payer: Lucent All Commercial |
$2,263.18
|
| Rate for Payer: Lucent All Commercial |
$2,263.18
|
| Rate for Payer: Managed Health Services Medicaid |
$1,566.02
|
| Rate for Payer: Managed Health Services Medicaid |
$1,566.02
|
| Rate for Payer: MDWise Medicaid |
$1,566.02
|
| Rate for Payer: MDWise Medicaid |
$1,566.02
|
| Rate for Payer: PHCS All Commercial |
$1,616.56
|
| Rate for Payer: PHCS All Commercial |
$1,616.56
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,616.56
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,616.56
|
| Rate for Payer: Sagamore Health Network All Products |
$1,616.56
|
| Rate for Payer: Sagamore Health Network All Products |
$1,616.56
|
| Rate for Payer: United Healthcare Commercial |
$2,181.81
|
| Rate for Payer: United Healthcare Commercial |
$2,181.81
|
| Rate for Payer: United Healthcare Medicare |
$1,566.94
|
| Rate for Payer: United Healthcare Medicare |
$1,566.94
|
|
|
PR REVIS SHOULDER ARTHRPLSTY HUMERAL/GLENOID COMPNT
|
Professional
|
Both
|
$2,950.82
|
|
|
Service Code
|
CPT 23473
|
| Hospital Charge Code |
z23473
|
| Min. Negotiated Rate |
$1,451.33 |
| Max. Negotiated Rate |
$2,321.85 |
| Rate for Payer: Aetna Commercial |
$1,497.97
|
| Rate for Payer: Aetna Commercial |
$1,497.97
|
| Rate for Payer: Aetna Medicare |
$1,497.97
|
| Rate for Payer: Aetna Medicare |
$1,497.97
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$1,451.33
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$1,451.33
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,722.67
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,722.67
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,647.77
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,647.77
|
| Rate for Payer: Cash Price |
$1,742.44
|
| Rate for Payer: Cash Price |
$1,770.49
|
| Rate for Payer: Centivo All Commercial |
$2,321.85
|
| Rate for Payer: Centivo All Commercial |
$2,321.85
|
| Rate for Payer: Cigna All Commercial |
$1,497.97
|
| Rate for Payer: Cigna All Commercial |
$1,497.97
|
| Rate for Payer: CORVEL All Commercial |
$1,497.97
|
| Rate for Payer: CORVEL All Commercial |
$1,497.97
|
| Rate for Payer: Coventry All Commercial |
$1,797.56
|
| Rate for Payer: Coventry All Commercial |
$1,797.56
|
| Rate for Payer: Encore All Commercial |
$1,497.97
|
| Rate for Payer: Encore All Commercial |
$1,497.97
|
| Rate for Payer: Frontpath All Commercial |
$2,098.37
|
| Rate for Payer: Frontpath All Commercial |
$2,098.37
|
| Rate for Payer: Humana ChoiceCare |
$1,762.40
|
| Rate for Payer: Humana ChoiceCare |
$1,762.40
|
| Rate for Payer: Humana Medicare |
$1,497.97
|
| Rate for Payer: Humana Medicare |
$1,497.97
|
| Rate for Payer: Lucent All Commercial |
$2,097.16
|
| Rate for Payer: Lucent All Commercial |
$2,097.16
|
| Rate for Payer: Managed Health Services Medicaid |
$1,451.33
|
| Rate for Payer: Managed Health Services Medicaid |
$1,451.33
|
| Rate for Payer: MDWise Medicaid |
$1,451.33
|
| Rate for Payer: MDWise Medicaid |
$1,451.33
|
| Rate for Payer: PHCS All Commercial |
$1,497.97
|
| Rate for Payer: PHCS All Commercial |
$1,497.97
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,497.97
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,497.97
|
| Rate for Payer: Sagamore Health Network All Products |
$1,497.97
|
| Rate for Payer: Sagamore Health Network All Products |
$1,497.97
|
| Rate for Payer: United Healthcare Commercial |
$2,019.96
|
| Rate for Payer: United Healthcare Commercial |
$2,019.96
|
| Rate for Payer: United Healthcare Medicare |
$1,452.03
|
| Rate for Payer: United Healthcare Medicare |
$1,452.03
|
|
|
PR RFIBULA NONUNION/MALUNION W INT FIXATION
|
Professional
|
Both
|
$1,765.62
|
|
|
Service Code
|
CPT 27726
|
| Hospital Charge Code |
z27726
|
| Min. Negotiated Rate |
$868.13 |
| Max. Negotiated Rate |
$1,510.54 |
| Rate for Payer: Aetna Commercial |
$894.03
|
| Rate for Payer: Aetna Commercial |
$894.03
|
| Rate for Payer: Aetna Medicare |
$894.03
|
| Rate for Payer: Aetna Medicare |
$894.03
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$868.40
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$868.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,028.13
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,028.13
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$983.43
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$983.43
|
| Rate for Payer: Cash Price |
$1,059.37
|
| Rate for Payer: Cash Price |
$1,041.76
|
| Rate for Payer: Centivo All Commercial |
$1,385.75
|
| Rate for Payer: Centivo All Commercial |
$1,385.75
|
| Rate for Payer: Cigna All Commercial |
$894.03
|
| Rate for Payer: Cigna All Commercial |
$894.03
|
| Rate for Payer: CORVEL All Commercial |
$894.03
|
| Rate for Payer: CORVEL All Commercial |
$894.03
|
| Rate for Payer: Coventry All Commercial |
$1,072.84
|
| Rate for Payer: Coventry All Commercial |
$1,072.84
|
| Rate for Payer: Encore All Commercial |
$894.03
|
| Rate for Payer: Encore All Commercial |
$894.03
|
| Rate for Payer: Frontpath All Commercial |
$1,247.82
|
| Rate for Payer: Frontpath All Commercial |
$1,247.82
|
| Rate for Payer: Humana ChoiceCare |
$888.02
|
| Rate for Payer: Humana ChoiceCare |
$888.02
|
| Rate for Payer: Humana Medicare |
$894.03
|
| Rate for Payer: Humana Medicare |
$894.03
|
| Rate for Payer: Lucent All Commercial |
$1,251.64
|
| Rate for Payer: Lucent All Commercial |
$1,251.64
|
| Rate for Payer: Managed Health Services Medicaid |
$868.40
|
| Rate for Payer: Managed Health Services Medicaid |
$868.40
|
| Rate for Payer: MDWise Medicaid |
$868.40
|
| Rate for Payer: MDWise Medicaid |
$868.40
|
| Rate for Payer: PHCS All Commercial |
$894.03
|
| Rate for Payer: PHCS All Commercial |
$894.03
|
| Rate for Payer: PHP All Commercial |
$1,510.54
|
| Rate for Payer: PHP All Commercial |
$1,510.54
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$894.03
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$894.03
|
| Rate for Payer: Sagamore Health Network All Products |
$894.03
|
| Rate for Payer: Sagamore Health Network All Products |
$894.03
|
| Rate for Payer: Signature Care EPO |
$1,205.61
|
| Rate for Payer: Signature Care EPO |
$1,205.61
|
| Rate for Payer: Signature Care PPO |
$1,205.61
|
| Rate for Payer: Signature Care PPO |
$1,205.61
|
| Rate for Payer: United Healthcare Commercial |
$1,004.51
|
| Rate for Payer: United Healthcare Commercial |
$1,004.51
|
| Rate for Payer: United Healthcare Medicare |
$868.13
|
| Rate for Payer: United Healthcare Medicare |
$868.13
|
|
|
PR RHYTHM ECG WITH REPORT
|
Professional
|
Both
|
$24.14
|
|
|
Service Code
|
CPT 93040
|
| Hospital Charge Code |
z93040
|
| Min. Negotiated Rate |
$11.60 |
| Max. Negotiated Rate |
$1,800.00 |
| Rate for Payer: Aetna Commercial |
$11.74
|
| Rate for Payer: Aetna Commercial |
$11.74
|
| Rate for Payer: Aetna Medicare |
$11.74
|
| Rate for Payer: Aetna Medicare |
$11.74
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$18.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$18.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$18.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$18.80
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$18.80
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$18.80
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$18.80
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$18.80
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$11.87
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$11.87
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$13.50
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$13.50
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$12.91
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$12.91
|
| Rate for Payer: Cash Price |
$14.48
|
| Rate for Payer: Cash Price |
$13.92
|
| Rate for Payer: Centivo All Commercial |
$18.20
|
| Rate for Payer: Centivo All Commercial |
$18.20
|
| Rate for Payer: Cigna All Commercial |
$11.74
|
| Rate for Payer: Cigna All Commercial |
$11.74
|
| Rate for Payer: CORVEL All Commercial |
$11.74
|
| Rate for Payer: CORVEL All Commercial |
$11.74
|
| Rate for Payer: Coventry All Commercial |
$14.09
|
| Rate for Payer: Coventry All Commercial |
$14.09
|
| Rate for Payer: Encore All Commercial |
$11.74
|
| Rate for Payer: Encore All Commercial |
$11.74
|
| Rate for Payer: Frontpath All Commercial |
$13.50
|
| Rate for Payer: Frontpath All Commercial |
$13.50
|
| Rate for Payer: Humana ChoiceCare |
$18.02
|
| Rate for Payer: Humana ChoiceCare |
$18.02
|
| Rate for Payer: Humana Medicare |
$11.74
|
| Rate for Payer: Humana Medicare |
$11.74
|
| Rate for Payer: Lucent All Commercial |
$16.44
|
| Rate for Payer: Lucent All Commercial |
$16.44
|
| Rate for Payer: Lutheran Preferred All Commercial |
$19.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$19.00
|
| Rate for Payer: Managed Health Services Medicaid |
$11.87
|
| Rate for Payer: Managed Health Services Medicaid |
$11.87
|
| Rate for Payer: MDWise Medicaid |
$11.87
|
| Rate for Payer: MDWise Medicaid |
$11.87
|
| Rate for Payer: PHCS All Commercial |
$11.74
|
| Rate for Payer: PHCS All Commercial |
$11.74
|
| Rate for Payer: PHP All Commercial |
$17.05
|
| Rate for Payer: PHP All Commercial |
$17.05
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$11.74
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$11.74
|
| Rate for Payer: Sagamore Health Network All Products |
$11.74
|
| Rate for Payer: Sagamore Health Network All Products |
$11.74
|
| Rate for Payer: Signature Care EPO |
$19.96
|
| Rate for Payer: Signature Care EPO |
$19.96
|
| Rate for Payer: Signature Care PPO |
$19.96
|
| Rate for Payer: Signature Care PPO |
$19.96
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,800.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,800.00
|
| Rate for Payer: United Healthcare Commercial |
$15.61
|
| Rate for Payer: United Healthcare Commercial |
$15.61
|
| Rate for Payer: United Healthcare Medicare |
$11.60
|
| Rate for Payer: United Healthcare Medicare |
$11.60
|
|
|
PR RMV KNEE SYNOVIUM,ANT/POST
|
Professional
|
Both
|
$1,276.82
|
|
|
Service Code
|
CPT 27334
|
| Hospital Charge Code |
z27334
|
| Min. Negotiated Rate |
$625.33 |
| Max. Negotiated Rate |
$96,100.00 |
| Rate for Payer: Aetna Commercial |
$640.42
|
| Rate for Payer: Aetna Commercial |
$640.42
|
| Rate for Payer: Aetna Medicare |
$640.42
|
| Rate for Payer: Aetna Medicare |
$640.42
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$895.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$895.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$895.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$895.80
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$895.80
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$895.80
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$895.80
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$895.80
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$627.99
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$627.99
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$736.48
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$736.48
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$704.46
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$704.46
|
| Rate for Payer: Cash Price |
$766.09
|
| Rate for Payer: Cash Price |
$750.40
|
| Rate for Payer: Centivo All Commercial |
$992.65
|
| Rate for Payer: Centivo All Commercial |
$992.65
|
| Rate for Payer: Cigna All Commercial |
$640.42
|
| Rate for Payer: Cigna All Commercial |
$640.42
|
| Rate for Payer: CORVEL All Commercial |
$640.42
|
| Rate for Payer: CORVEL All Commercial |
$640.42
|
| Rate for Payer: Coventry All Commercial |
$768.50
|
| Rate for Payer: Coventry All Commercial |
$768.50
|
| Rate for Payer: Encore All Commercial |
$640.42
|
| Rate for Payer: Encore All Commercial |
$640.42
|
| Rate for Payer: Frontpath All Commercial |
$890.67
|
| Rate for Payer: Frontpath All Commercial |
$890.67
|
| Rate for Payer: Humana ChoiceCare |
$702.02
|
| Rate for Payer: Humana ChoiceCare |
$702.02
|
| Rate for Payer: Humana Medicare |
$640.42
|
| Rate for Payer: Humana Medicare |
$640.42
|
| Rate for Payer: Lucent All Commercial |
$896.59
|
| Rate for Payer: Lucent All Commercial |
$896.59
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,026.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,026.00
|
| Rate for Payer: Managed Health Services Medicaid |
$627.99
|
| Rate for Payer: Managed Health Services Medicaid |
$627.99
|
| Rate for Payer: MDWise Medicaid |
$627.99
|
| Rate for Payer: MDWise Medicaid |
$627.99
|
| Rate for Payer: PHCS All Commercial |
$640.42
|
| Rate for Payer: PHCS All Commercial |
$640.42
|
| Rate for Payer: PHP All Commercial |
$1,088.07
|
| Rate for Payer: PHP All Commercial |
$1,088.07
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$640.42
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$640.42
|
| Rate for Payer: Sagamore Health Network All Products |
$640.42
|
| Rate for Payer: Sagamore Health Network All Products |
$640.42
|
| Rate for Payer: Signature Care EPO |
$938.40
|
| Rate for Payer: Signature Care EPO |
$938.40
|
| Rate for Payer: Signature Care PPO |
$938.40
|
| Rate for Payer: Signature Care PPO |
$938.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$96,100.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$96,100.00
|
| Rate for Payer: United Healthcare Commercial |
$730.70
|
| Rate for Payer: United Healthcare Commercial |
$730.70
|
| Rate for Payer: United Healthcare Medicare |
$625.33
|
| Rate for Payer: United Healthcare Medicare |
$625.33
|
|
|
PR RMVL IMPLTBL DFB PLSE GEN W/REPL PLSE GEN 1 LEAD
|
Professional
|
Both
|
$666.36
|
|
|
Service Code
|
CPT 33262
|
| Hospital Charge Code |
z33262
|
| Min. Negotiated Rate |
$327.74 |
| Max. Negotiated Rate |
$50,900.00 |
| Rate for Payer: Aetna Commercial |
$345.18
|
| Rate for Payer: Aetna Commercial |
$345.18
|
| Rate for Payer: Aetna Medicare |
$345.18
|
| Rate for Payer: Aetna Medicare |
$345.18
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$468.23
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$468.23
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$468.23
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$468.23
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$468.23
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$468.23
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$468.23
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$468.23
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$327.74
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$327.74
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$396.96
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$396.96
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$379.70
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$379.70
|
| Rate for Payer: Cash Price |
$399.82
|
| Rate for Payer: Cash Price |
$397.21
|
| Rate for Payer: Centivo All Commercial |
$535.03
|
| Rate for Payer: Centivo All Commercial |
$535.03
|
| Rate for Payer: Cigna All Commercial |
$345.18
|
| Rate for Payer: Cigna All Commercial |
$345.18
|
| Rate for Payer: CORVEL All Commercial |
$345.18
|
| Rate for Payer: CORVEL All Commercial |
$345.18
|
| Rate for Payer: Coventry All Commercial |
$414.22
|
| Rate for Payer: Coventry All Commercial |
$414.22
|
| Rate for Payer: Encore All Commercial |
$345.18
|
| Rate for Payer: Encore All Commercial |
$345.18
|
| Rate for Payer: Frontpath All Commercial |
$488.67
|
| Rate for Payer: Frontpath All Commercial |
$488.67
|
| Rate for Payer: Humana ChoiceCare |
$449.43
|
| Rate for Payer: Humana ChoiceCare |
$449.43
|
| Rate for Payer: Humana Medicare |
$345.18
|
| Rate for Payer: Humana Medicare |
$345.18
|
| Rate for Payer: Lucent All Commercial |
$483.25
|
| Rate for Payer: Lucent All Commercial |
$483.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$543.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$543.00
|
| Rate for Payer: Managed Health Services Medicaid |
$327.74
|
| Rate for Payer: Managed Health Services Medicaid |
$327.74
|
| Rate for Payer: MDWise Medicaid |
$327.74
|
| Rate for Payer: MDWise Medicaid |
$327.74
|
| Rate for Payer: PHCS All Commercial |
$345.18
|
| Rate for Payer: PHCS All Commercial |
$345.18
|
| Rate for Payer: PHP All Commercial |
$463.41
|
| Rate for Payer: PHP All Commercial |
$463.41
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$345.18
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$345.18
|
| Rate for Payer: Sagamore Health Network All Products |
$345.18
|
| Rate for Payer: Sagamore Health Network All Products |
$345.18
|
| Rate for Payer: Signature Care EPO |
$439.10
|
| Rate for Payer: Signature Care EPO |
$439.10
|
| Rate for Payer: Signature Care PPO |
$439.10
|
| Rate for Payer: Signature Care PPO |
$439.10
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$50,900.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$50,900.00
|
| Rate for Payer: United Healthcare Commercial |
$454.51
|
| Rate for Payer: United Healthcare Commercial |
$454.51
|
| Rate for Payer: United Healthcare Medicare |
$331.01
|
| Rate for Payer: United Healthcare Medicare |
$331.01
|
|
|
PR RMVL IMPLTBL DFB PLSE GEN W/RPLCMT PLSE GEN 2 LD
|
Professional
|
Both
|
$692.12
|
|
|
Service Code
|
CPT 33263
|
| Hospital Charge Code |
z33263
|
| Min. Negotiated Rate |
$340.41 |
| Max. Negotiated Rate |
$52,800.00 |
| Rate for Payer: Aetna Commercial |
$358.76
|
| Rate for Payer: Aetna Commercial |
$358.76
|
| Rate for Payer: Aetna Medicare |
$358.76
|
| Rate for Payer: Aetna Medicare |
$358.76
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$486.70
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$486.70
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$486.70
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$486.70
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$486.70
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$486.70
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$486.70
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$486.70
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$340.41
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$340.41
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$412.57
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$412.57
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$394.64
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$394.64
|
| Rate for Payer: Cash Price |
$415.27
|
| Rate for Payer: Cash Price |
$412.48
|
| Rate for Payer: Centivo All Commercial |
$556.08
|
| Rate for Payer: Centivo All Commercial |
$556.08
|
| Rate for Payer: Cigna All Commercial |
$358.76
|
| Rate for Payer: Cigna All Commercial |
$358.76
|
| Rate for Payer: CORVEL All Commercial |
$358.76
|
| Rate for Payer: CORVEL All Commercial |
$358.76
|
| Rate for Payer: Coventry All Commercial |
$430.51
|
| Rate for Payer: Coventry All Commercial |
$430.51
|
| Rate for Payer: Encore All Commercial |
$358.76
|
| Rate for Payer: Encore All Commercial |
$358.76
|
| Rate for Payer: Frontpath All Commercial |
$508.36
|
| Rate for Payer: Frontpath All Commercial |
$508.36
|
| Rate for Payer: Humana ChoiceCare |
$467.16
|
| Rate for Payer: Humana ChoiceCare |
$467.16
|
| Rate for Payer: Humana Medicare |
$358.76
|
| Rate for Payer: Humana Medicare |
$358.76
|
| Rate for Payer: Lucent All Commercial |
$502.26
|
| Rate for Payer: Lucent All Commercial |
$502.26
|
| Rate for Payer: Lutheran Preferred All Commercial |
$564.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$564.00
|
| Rate for Payer: Managed Health Services Medicaid |
$340.41
|
| Rate for Payer: Managed Health Services Medicaid |
$340.41
|
| Rate for Payer: MDWise Medicaid |
$340.41
|
| Rate for Payer: MDWise Medicaid |
$340.41
|
| Rate for Payer: PHCS All Commercial |
$358.76
|
| Rate for Payer: PHCS All Commercial |
$358.76
|
| Rate for Payer: PHP All Commercial |
$481.22
|
| Rate for Payer: PHP All Commercial |
$481.22
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$358.76
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$358.76
|
| Rate for Payer: Sagamore Health Network All Products |
$358.76
|
| Rate for Payer: Sagamore Health Network All Products |
$358.76
|
| Rate for Payer: Signature Care EPO |
$456.42
|
| Rate for Payer: Signature Care EPO |
$456.42
|
| Rate for Payer: Signature Care PPO |
$456.42
|
| Rate for Payer: Signature Care PPO |
$456.42
|
| 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 |
$472.45
|
| Rate for Payer: United Healthcare Commercial |
$472.45
|
| Rate for Payer: United Healthcare Medicare |
$343.73
|
| Rate for Payer: United Healthcare Medicare |
$343.73
|
|
|
PR RMVL IMPLTBL DFB PLS GEN W/RPLCMT PLS GEN MLT LD
|
Professional
|
Both
|
$721.56
|
|
|
Service Code
|
CPT 33264
|
| Hospital Charge Code |
z33264
|
| Min. Negotiated Rate |
$354.89 |
| Max. Negotiated Rate |
$55,100.00 |
| Rate for Payer: Aetna Commercial |
$373.59
|
| Rate for Payer: Aetna Commercial |
$373.59
|
| Rate for Payer: Aetna Medicare |
$373.59
|
| Rate for Payer: Aetna Medicare |
$373.59
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$505.17
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$505.17
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$505.17
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$505.17
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$505.17
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$505.17
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$505.17
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$505.17
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$354.89
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$354.89
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$429.63
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$429.63
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$410.95
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$410.95
|
| Rate for Payer: Cash Price |
$432.94
|
| Rate for Payer: Cash Price |
$430.27
|
| Rate for Payer: Centivo All Commercial |
$579.06
|
| Rate for Payer: Centivo All Commercial |
$579.06
|
| Rate for Payer: Cigna All Commercial |
$373.59
|
| Rate for Payer: Cigna All Commercial |
$373.59
|
| Rate for Payer: CORVEL All Commercial |
$373.59
|
| Rate for Payer: CORVEL All Commercial |
$373.59
|
| Rate for Payer: Coventry All Commercial |
$448.31
|
| Rate for Payer: Coventry All Commercial |
$448.31
|
| Rate for Payer: Encore All Commercial |
$373.59
|
| Rate for Payer: Encore All Commercial |
$373.59
|
| Rate for Payer: Frontpath All Commercial |
$529.71
|
| Rate for Payer: Frontpath All Commercial |
$529.71
|
| Rate for Payer: Humana ChoiceCare |
$484.89
|
| Rate for Payer: Humana ChoiceCare |
$484.89
|
| Rate for Payer: Humana Medicare |
$373.59
|
| Rate for Payer: Humana Medicare |
$373.59
|
| Rate for Payer: Lucent All Commercial |
$523.03
|
| Rate for Payer: Lucent All Commercial |
$523.03
|
| Rate for Payer: Lutheran Preferred All Commercial |
$588.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$588.00
|
| Rate for Payer: Managed Health Services Medicaid |
$354.89
|
| Rate for Payer: Managed Health Services Medicaid |
$354.89
|
| Rate for Payer: MDWise Medicaid |
$354.89
|
| Rate for Payer: MDWise Medicaid |
$354.89
|
| Rate for Payer: PHCS All Commercial |
$373.59
|
| Rate for Payer: PHCS All Commercial |
$373.59
|
| Rate for Payer: PHP All Commercial |
$501.99
|
| Rate for Payer: PHP All Commercial |
$501.99
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$373.59
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$373.59
|
| Rate for Payer: Sagamore Health Network All Products |
$373.59
|
| Rate for Payer: Sagamore Health Network All Products |
$373.59
|
| Rate for Payer: Signature Care EPO |
$473.74
|
| Rate for Payer: Signature Care EPO |
$473.74
|
| Rate for Payer: Signature Care PPO |
$473.74
|
| Rate for Payer: Signature Care PPO |
$473.74
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$55,100.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$55,100.00
|
| Rate for Payer: United Healthcare Commercial |
$490.38
|
| Rate for Payer: United Healthcare Commercial |
$490.38
|
| Rate for Payer: United Healthcare Medicare |
$358.56
|
| Rate for Payer: United Healthcare Medicare |
$358.56
|
|
|
PR RMVL PROSTC MATRL/MESH ABDL WALL FOR INFECTION
|
Professional
|
Both
|
$486.14
|
|
|
Service Code
|
CPT 11008
|
| Hospital Charge Code |
z11008
|
| Min. Negotiated Rate |
$239.11 |
| Max. Negotiated Rate |
$29,600.00 |
| Rate for Payer: Aetna Commercial |
$251.21
|
| Rate for Payer: Aetna Commercial |
$251.21
|
| Rate for Payer: Aetna Medicare |
$251.21
|
| Rate for Payer: Aetna Medicare |
$251.21
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$357.85
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$357.85
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$357.85
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$357.85
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$357.85
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$357.85
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$357.85
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$357.85
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$239.11
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$239.11
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$288.89
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$288.89
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$276.33
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$276.33
|
| Rate for Payer: Cash Price |
$291.68
|
| Rate for Payer: Cash Price |
$288.92
|
| Rate for Payer: Centivo All Commercial |
$389.38
|
| Rate for Payer: Centivo All Commercial |
$389.38
|
| Rate for Payer: Cigna All Commercial |
$251.21
|
| Rate for Payer: Cigna All Commercial |
$251.21
|
| Rate for Payer: CORVEL All Commercial |
$251.21
|
| Rate for Payer: CORVEL All Commercial |
$251.21
|
| Rate for Payer: Coventry All Commercial |
$301.45
|
| Rate for Payer: Coventry All Commercial |
$301.45
|
| Rate for Payer: Encore All Commercial |
$251.21
|
| Rate for Payer: Encore All Commercial |
$251.21
|
| Rate for Payer: Frontpath All Commercial |
$361.63
|
| Rate for Payer: Frontpath All Commercial |
$361.63
|
| Rate for Payer: Humana ChoiceCare |
$269.27
|
| Rate for Payer: Humana ChoiceCare |
$269.27
|
| Rate for Payer: Humana Medicare |
$251.21
|
| Rate for Payer: Humana Medicare |
$251.21
|
| Rate for Payer: Lucent All Commercial |
$351.69
|
| Rate for Payer: Lucent All Commercial |
$351.69
|
| Rate for Payer: Lutheran Preferred All Commercial |
$321.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$321.00
|
| Rate for Payer: Managed Health Services Medicaid |
$239.11
|
| Rate for Payer: Managed Health Services Medicaid |
$239.11
|
| Rate for Payer: MDWise Medicaid |
$239.11
|
| Rate for Payer: MDWise Medicaid |
$239.11
|
| Rate for Payer: PHCS All Commercial |
$251.21
|
| Rate for Payer: PHCS All Commercial |
$251.21
|
| Rate for Payer: PHP All Commercial |
$337.08
|
| Rate for Payer: PHP All Commercial |
$337.08
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$251.21
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$251.21
|
| Rate for Payer: Sagamore Health Network All Products |
$251.21
|
| Rate for Payer: Sagamore Health Network All Products |
$251.21
|
| Rate for Payer: Signature Care EPO |
$302.60
|
| Rate for Payer: Signature Care EPO |
$302.60
|
| Rate for Payer: Signature Care PPO |
$302.60
|
| Rate for Payer: Signature Care PPO |
$302.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$29,600.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$29,600.00
|
| Rate for Payer: United Healthcare Commercial |
$306.45
|
| Rate for Payer: United Healthcare Commercial |
$306.45
|
| Rate for Payer: United Healthcare Medicare |
$240.77
|
| Rate for Payer: United Healthcare Medicare |
$240.77
|
|
|
PR RMVL RUPTURED BREAST IMPLANT W/IMPLANT CONTENTS
|
Professional
|
Both
|
$1,191.48
|
|
|
Service Code
|
CPT 19330
|
| Hospital Charge Code |
z19330
|
| Min. Negotiated Rate |
$515.81 |
| Max. Negotiated Rate |
$72,100.00 |
| Rate for Payer: Aetna Commercial |
$601.67
|
| Rate for Payer: Aetna Commercial |
$601.67
|
| Rate for Payer: Aetna Medicare |
$601.67
|
| Rate for Payer: Aetna Medicare |
$601.67
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$606.90
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$606.90
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$606.90
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$606.90
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$606.90
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$606.90
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$606.90
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$606.90
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$586.02
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$586.02
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$691.92
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$691.92
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$661.84
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$661.84
|
| Rate for Payer: Cash Price |
$714.89
|
| Rate for Payer: Cash Price |
$703.50
|
| Rate for Payer: Centivo All Commercial |
$932.59
|
| Rate for Payer: Centivo All Commercial |
$932.59
|
| Rate for Payer: Cigna All Commercial |
$601.67
|
| Rate for Payer: Cigna All Commercial |
$601.67
|
| Rate for Payer: CORVEL All Commercial |
$601.67
|
| Rate for Payer: CORVEL All Commercial |
$601.67
|
| Rate for Payer: Coventry All Commercial |
$722.00
|
| Rate for Payer: Coventry All Commercial |
$722.00
|
| Rate for Payer: Encore All Commercial |
$601.67
|
| Rate for Payer: Encore All Commercial |
$601.67
|
| Rate for Payer: Frontpath All Commercial |
$834.65
|
| Rate for Payer: Frontpath All Commercial |
$834.65
|
| Rate for Payer: Humana ChoiceCare |
$515.81
|
| Rate for Payer: Humana ChoiceCare |
$515.81
|
| Rate for Payer: Humana Medicare |
$601.67
|
| Rate for Payer: Humana Medicare |
$601.67
|
| Rate for Payer: Lucent All Commercial |
$842.34
|
| Rate for Payer: Lucent All Commercial |
$842.34
|
| Rate for Payer: Lutheran Preferred All Commercial |
$781.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$781.00
|
| Rate for Payer: Managed Health Services Medicaid |
$586.02
|
| Rate for Payer: Managed Health Services Medicaid |
$586.02
|
| Rate for Payer: MDWise Medicaid |
$586.02
|
| Rate for Payer: MDWise Medicaid |
$586.02
|
| Rate for Payer: PHCS All Commercial |
$601.67
|
| Rate for Payer: PHCS All Commercial |
$601.67
|
| Rate for Payer: PHP All Commercial |
$820.74
|
| Rate for Payer: PHP All Commercial |
$820.74
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$601.67
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$601.67
|
| Rate for Payer: Sagamore Health Network All Products |
$601.67
|
| Rate for Payer: Sagamore Health Network All Products |
$601.67
|
| Rate for Payer: Signature Care EPO |
$571.20
|
| Rate for Payer: Signature Care EPO |
$571.20
|
| Rate for Payer: Signature Care PPO |
$571.20
|
| Rate for Payer: Signature Care PPO |
$571.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$72,100.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$72,100.00
|
| Rate for Payer: United Healthcare Commercial |
$669.70
|
| Rate for Payer: United Healthcare Commercial |
$669.70
|
| Rate for Payer: United Healthcare Medicare |
$586.25
|
| Rate for Payer: United Healthcare Medicare |
$586.25
|
|
|
PR RMVL SKIN TAGS MLT FIBRQ TAGS ANY EA ADDL 10
|
Professional
|
Both
|
$34.40
|
|
|
Service Code
|
CPT 11201
|
| Hospital Charge Code |
z11201
|
| Min. Negotiated Rate |
$10.46 |
| Max. Negotiated Rate |
$1,800.00 |
| Rate for Payer: Aetna Commercial |
$15.35
|
| Rate for Payer: Aetna Commercial |
$15.35
|
| Rate for Payer: Aetna Medicare |
$15.35
|
| Rate for Payer: Aetna Medicare |
$15.35
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$21.43
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$21.43
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$21.43
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$21.43
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$21.43
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$21.43
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$21.43
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$21.43
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$10.46
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$10.46
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$16.92
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$16.92
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$17.65
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$17.65
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$16.89
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$16.89
|
| Rate for Payer: Cash Price |
$20.21
|
| Rate for Payer: Cash Price |
$20.64
|
| Rate for Payer: Centivo All Commercial |
$23.79
|
| Rate for Payer: Centivo All Commercial |
$23.79
|
| Rate for Payer: Cigna All Commercial |
$15.35
|
| Rate for Payer: Cigna All Commercial |
$15.35
|
| Rate for Payer: CORVEL All Commercial |
$15.35
|
| Rate for Payer: CORVEL All Commercial |
$15.35
|
| Rate for Payer: Coventry All Commercial |
$18.42
|
| Rate for Payer: Coventry All Commercial |
$18.42
|
| Rate for Payer: Encore All Commercial |
$15.35
|
| Rate for Payer: Encore All Commercial |
$15.35
|
| Rate for Payer: Frontpath All Commercial |
$21.18
|
| Rate for Payer: Frontpath All Commercial |
$21.18
|
| Rate for Payer: Humana ChoiceCare |
$15.44
|
| Rate for Payer: Humana ChoiceCare |
$15.44
|
| Rate for Payer: Humana Medicare |
$15.35
|
| Rate for Payer: Humana Medicare |
$15.35
|
| Rate for Payer: Lucent All Commercial |
$21.49
|
| Rate for Payer: Lucent All Commercial |
$21.49
|
| Rate for Payer: Lutheran Preferred All Commercial |
$20.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$20.00
|
| Rate for Payer: Managed Health Services Medicaid |
$16.92
|
| Rate for Payer: Managed Health Services Medicaid |
$16.92
|
| Rate for Payer: MDWise Medicaid |
$16.92
|
| Rate for Payer: MDWise Medicaid |
$16.92
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$10.46
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$10.46
|
| Rate for Payer: PHCS All Commercial |
$15.35
|
| Rate for Payer: PHCS All Commercial |
$15.35
|
| Rate for Payer: PHP All Commercial |
$21.05
|
| Rate for Payer: PHP All Commercial |
$21.05
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$15.35
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$15.35
|
| Rate for Payer: Sagamore Health Network All Products |
$15.35
|
| Rate for Payer: Sagamore Health Network All Products |
$15.35
|
| Rate for Payer: Signature Care EPO |
$18.70
|
| Rate for Payer: Signature Care EPO |
$18.70
|
| Rate for Payer: Signature Care PPO |
$18.70
|
| Rate for Payer: Signature Care PPO |
$18.70
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,800.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,800.00
|
| Rate for Payer: United Healthcare Commercial |
$18.58
|
| Rate for Payer: United Healthcare Commercial |
$18.58
|
| Rate for Payer: United Healthcare Medicare |
$16.84
|
| Rate for Payer: United Healthcare Medicare |
$16.84
|
|
|
PR RMVL SKIN TAGS MLT FIBRQ TAGS ANY UP TO&INC 15
|
Professional
|
Both
|
$172.90
|
|
|
Service Code
|
CPT 11200
|
| Hospital Charge Code |
z11200
|
| Min. Negotiated Rate |
$44.02 |
| Max. Negotiated Rate |
$8,600.00 |
| Rate for Payer: Aetna Commercial |
$70.63
|
| Rate for Payer: Aetna Commercial |
$70.63
|
| Rate for Payer: Aetna Medicare |
$70.63
|
| Rate for Payer: Aetna Medicare |
$70.63
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$85.73
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$85.73
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$85.73
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$85.73
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$85.73
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$85.73
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$85.73
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$85.73
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$44.02
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$44.02
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$85.04
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$85.04
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$81.22
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$81.22
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$77.69
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$77.69
|
| Rate for Payer: Cash Price |
$100.20
|
| Rate for Payer: Cash Price |
$103.74
|
| Rate for Payer: Centivo All Commercial |
$109.48
|
| Rate for Payer: Centivo All Commercial |
$109.48
|
| Rate for Payer: Cigna All Commercial |
$70.63
|
| Rate for Payer: Cigna All Commercial |
$70.63
|
| Rate for Payer: CORVEL All Commercial |
$70.63
|
| Rate for Payer: CORVEL All Commercial |
$70.63
|
| Rate for Payer: Coventry All Commercial |
$84.76
|
| Rate for Payer: Coventry All Commercial |
$84.76
|
| Rate for Payer: Encore All Commercial |
$70.63
|
| Rate for Payer: Encore All Commercial |
$70.63
|
| Rate for Payer: Frontpath All Commercial |
$95.12
|
| Rate for Payer: Frontpath All Commercial |
$95.12
|
| Rate for Payer: Humana ChoiceCare |
$55.94
|
| Rate for Payer: Humana ChoiceCare |
$55.94
|
| Rate for Payer: Humana Medicare |
$70.63
|
| Rate for Payer: Humana Medicare |
$70.63
|
| Rate for Payer: Lucent All Commercial |
$98.88
|
| Rate for Payer: Lucent All Commercial |
$98.88
|
| Rate for Payer: Lutheran Preferred All Commercial |
$93.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$93.00
|
| Rate for Payer: Managed Health Services Medicaid |
$85.04
|
| Rate for Payer: Managed Health Services Medicaid |
$85.04
|
| Rate for Payer: MDWise Medicaid |
$85.04
|
| Rate for Payer: MDWise Medicaid |
$85.04
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$44.02
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$44.02
|
| Rate for Payer: PHCS All Commercial |
$70.63
|
| Rate for Payer: PHCS All Commercial |
$70.63
|
| Rate for Payer: PHP All Commercial |
$97.50
|
| Rate for Payer: PHP All Commercial |
$97.50
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$70.63
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$70.63
|
| Rate for Payer: Sagamore Health Network All Products |
$70.63
|
| Rate for Payer: Sagamore Health Network All Products |
$70.63
|
| Rate for Payer: Signature Care EPO |
$73.95
|
| Rate for Payer: Signature Care EPO |
$73.95
|
| Rate for Payer: Signature Care PPO |
$73.95
|
| Rate for Payer: Signature Care PPO |
$73.95
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$8,600.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$8,600.00
|
| Rate for Payer: United Healthcare Commercial |
$72.70
|
| Rate for Payer: United Healthcare Commercial |
$72.70
|
| Rate for Payer: United Healthcare Medicare |
$83.50
|
| Rate for Payer: United Healthcare Medicare |
$83.50
|
|
|
PR RMVL TRANSVNS PM ELTRD DUAL LEAD SYS
|
Professional
|
Both
|
$1,137.80
|
|
|
Service Code
|
CPT 33235
|
| Hospital Charge Code |
z33235
|
| Min. Negotiated Rate |
$559.62 |
| Max. Negotiated Rate |
$911.60 |
| Rate for Payer: Aetna Commercial |
$588.13
|
| Rate for Payer: Aetna Commercial |
$588.13
|
| Rate for Payer: Aetna Medicare |
$588.13
|
| Rate for Payer: Aetna Medicare |
$588.13
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$559.62
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$559.62
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$676.35
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$676.35
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$646.94
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$646.94
|
| Rate for Payer: Cash Price |
$682.68
|
| Rate for Payer: Cash Price |
$677.83
|
| Rate for Payer: Centivo All Commercial |
$911.60
|
| Rate for Payer: Centivo All Commercial |
$911.60
|
| Rate for Payer: Cigna All Commercial |
$588.13
|
| Rate for Payer: Cigna All Commercial |
$588.13
|
| Rate for Payer: CORVEL All Commercial |
$588.13
|
| Rate for Payer: CORVEL All Commercial |
$588.13
|
| Rate for Payer: Coventry All Commercial |
$705.76
|
| Rate for Payer: Coventry All Commercial |
$705.76
|
| Rate for Payer: Encore All Commercial |
$588.13
|
| Rate for Payer: Encore All Commercial |
$588.13
|
| Rate for Payer: Frontpath All Commercial |
$833.29
|
| Rate for Payer: Frontpath All Commercial |
$833.29
|
| Rate for Payer: Humana ChoiceCare |
$786.17
|
| Rate for Payer: Humana ChoiceCare |
$786.17
|
| Rate for Payer: Humana Medicare |
$588.13
|
| Rate for Payer: Humana Medicare |
$588.13
|
| Rate for Payer: Lucent All Commercial |
$823.38
|
| Rate for Payer: Lucent All Commercial |
$823.38
|
| Rate for Payer: Managed Health Services Medicaid |
$559.62
|
| Rate for Payer: Managed Health Services Medicaid |
$559.62
|
| Rate for Payer: MDWise Medicaid |
$559.62
|
| Rate for Payer: MDWise Medicaid |
$559.62
|
| Rate for Payer: PHCS All Commercial |
$588.13
|
| Rate for Payer: PHCS All Commercial |
$588.13
|
| Rate for Payer: PHP All Commercial |
$790.80
|
| Rate for Payer: PHP All Commercial |
$790.80
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$588.13
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$588.13
|
| Rate for Payer: Sagamore Health Network All Products |
$588.13
|
| Rate for Payer: Sagamore Health Network All Products |
$588.13
|
| Rate for Payer: Signature Care EPO |
$908.65
|
| Rate for Payer: Signature Care EPO |
$908.65
|
| Rate for Payer: Signature Care PPO |
$908.65
|
| Rate for Payer: Signature Care PPO |
$908.65
|
| Rate for Payer: United Healthcare Commercial |
$762.06
|
| Rate for Payer: United Healthcare Commercial |
$762.06
|
| Rate for Payer: United Healthcare Medicare |
$564.86
|
| Rate for Payer: United Healthcare Medicare |
$564.86
|
|
