|
PR REPAIR ROTATOR CUFF,ACUTE
|
Professional
|
Both
|
$1,518.78
|
|
|
Service Code
|
CPT 23410
|
| Hospital Charge Code |
z23410
|
| Min. Negotiated Rate |
$744.70 |
| Max. Negotiated Rate |
$114,500.00 |
| Rate for Payer: Aetna Commercial |
$764.27
|
| Rate for Payer: Aetna Commercial |
$764.27
|
| Rate for Payer: Aetna Medicare |
$764.27
|
| Rate for Payer: Aetna Medicare |
$764.27
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$1,192.70
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$1,192.70
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,192.70
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,192.70
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,192.70
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,192.70
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,192.70
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,192.70
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$746.99
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$746.99
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$878.91
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$878.91
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$840.70
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$840.70
|
| Rate for Payer: Cash Price |
$941.64
|
| Rate for Payer: Cash Price |
$923.43
|
| Rate for Payer: Centivo All Commercial |
$1,184.62
|
| Rate for Payer: Centivo All Commercial |
$1,184.62
|
| Rate for Payer: Cigna All Commercial |
$764.27
|
| Rate for Payer: Cigna All Commercial |
$764.27
|
| Rate for Payer: CORVEL All Commercial |
$764.27
|
| Rate for Payer: CORVEL All Commercial |
$764.27
|
| Rate for Payer: Coventry All Commercial |
$917.12
|
| Rate for Payer: Coventry All Commercial |
$917.12
|
| Rate for Payer: Encore All Commercial |
$764.27
|
| Rate for Payer: Encore All Commercial |
$764.27
|
| Rate for Payer: Frontpath All Commercial |
$1,064.61
|
| Rate for Payer: Frontpath All Commercial |
$1,064.61
|
| Rate for Payer: Humana ChoiceCare |
$956.78
|
| Rate for Payer: Humana ChoiceCare |
$956.78
|
| Rate for Payer: Humana Medicare |
$764.27
|
| Rate for Payer: Humana Medicare |
$764.27
|
| Rate for Payer: Lucent All Commercial |
$1,069.98
|
| Rate for Payer: Lucent All Commercial |
$1,069.98
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,221.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,221.00
|
| Rate for Payer: Managed Health Services Medicaid |
$746.99
|
| Rate for Payer: Managed Health Services Medicaid |
$746.99
|
| Rate for Payer: MDWise Medicaid |
$746.99
|
| Rate for Payer: MDWise Medicaid |
$746.99
|
| Rate for Payer: PHCS All Commercial |
$764.27
|
| Rate for Payer: PHCS All Commercial |
$764.27
|
| Rate for Payer: PHP All Commercial |
$1,295.78
|
| Rate for Payer: PHP All Commercial |
$1,295.78
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$764.27
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$764.27
|
| Rate for Payer: Sagamore Health Network All Products |
$764.27
|
| Rate for Payer: Sagamore Health Network All Products |
$764.27
|
| Rate for Payer: Signature Care EPO |
$1,280.10
|
| Rate for Payer: Signature Care EPO |
$1,280.10
|
| Rate for Payer: Signature Care PPO |
$1,280.10
|
| Rate for Payer: Signature Care PPO |
$1,280.10
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$114,500.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$114,500.00
|
| Rate for Payer: United Healthcare Commercial |
$903.01
|
| Rate for Payer: United Healthcare Commercial |
$903.01
|
| Rate for Payer: United Healthcare Medicare |
$744.70
|
| Rate for Payer: United Healthcare Medicare |
$744.70
|
|
|
PR REPAIR ROTATOR CUFF,CHRONIC
|
Professional
|
Both
|
$1,578.24
|
|
|
Service Code
|
CPT 23412
|
| Hospital Charge Code |
z23412
|
| Min. Negotiated Rate |
$773.32 |
| Max. Negotiated Rate |
$118,900.00 |
| Rate for Payer: Aetna Commercial |
$794.07
|
| Rate for Payer: Aetna Commercial |
$794.07
|
| Rate for Payer: Aetna Medicare |
$794.07
|
| Rate for Payer: Aetna Medicare |
$794.07
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$1,310.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$1,310.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,310.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,310.40
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,310.40
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,310.40
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,310.40
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,310.40
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$776.24
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$776.24
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$913.18
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$913.18
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$873.48
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$873.48
|
| Rate for Payer: Cash Price |
$978.51
|
| Rate for Payer: Cash Price |
$958.92
|
| Rate for Payer: Centivo All Commercial |
$1,230.81
|
| Rate for Payer: Centivo All Commercial |
$1,230.81
|
| Rate for Payer: Cigna All Commercial |
$794.07
|
| Rate for Payer: Cigna All Commercial |
$794.07
|
| Rate for Payer: CORVEL All Commercial |
$794.07
|
| Rate for Payer: CORVEL All Commercial |
$794.07
|
| Rate for Payer: Coventry All Commercial |
$952.88
|
| Rate for Payer: Coventry All Commercial |
$952.88
|
| Rate for Payer: Encore All Commercial |
$794.07
|
| Rate for Payer: Encore All Commercial |
$794.07
|
| Rate for Payer: Frontpath All Commercial |
$1,106.64
|
| Rate for Payer: Frontpath All Commercial |
$1,106.64
|
| Rate for Payer: Humana ChoiceCare |
$1,016.56
|
| Rate for Payer: Humana ChoiceCare |
$1,016.56
|
| Rate for Payer: Humana Medicare |
$794.07
|
| Rate for Payer: Humana Medicare |
$794.07
|
| Rate for Payer: Lucent All Commercial |
$1,111.70
|
| Rate for Payer: Lucent All Commercial |
$1,111.70
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,268.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,268.00
|
| Rate for Payer: Managed Health Services Medicaid |
$776.24
|
| Rate for Payer: Managed Health Services Medicaid |
$776.24
|
| Rate for Payer: MDWise Medicaid |
$776.24
|
| Rate for Payer: MDWise Medicaid |
$776.24
|
| Rate for Payer: PHCS All Commercial |
$794.07
|
| Rate for Payer: PHCS All Commercial |
$794.07
|
| Rate for Payer: PHP All Commercial |
$1,345.57
|
| Rate for Payer: PHP All Commercial |
$1,345.57
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$794.07
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$794.07
|
| Rate for Payer: Sagamore Health Network All Products |
$794.07
|
| Rate for Payer: Sagamore Health Network All Products |
$794.07
|
| Rate for Payer: Signature Care EPO |
$1,349.92
|
| Rate for Payer: Signature Care EPO |
$1,349.92
|
| Rate for Payer: Signature Care PPO |
$1,349.92
|
| Rate for Payer: Signature Care PPO |
$1,349.92
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$118,900.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$118,900.00
|
| Rate for Payer: United Healthcare Commercial |
$943.83
|
| Rate for Payer: United Healthcare Commercial |
$943.83
|
| Rate for Payer: United Healthcare Medicare |
$773.32
|
| Rate for Payer: United Healthcare Medicare |
$773.32
|
|
|
PR REPAIR RUPTURED UTERUS,NON OBSTECTR
|
Professional
|
Both
|
$1,482.66
|
|
|
Service Code
|
CPT 58520
|
| Hospital Charge Code |
z58520
|
| Min. Negotiated Rate |
$729.23 |
| Max. Negotiated Rate |
$1,171.86 |
| Rate for Payer: Aetna Commercial |
$756.04
|
| Rate for Payer: Aetna Commercial |
$756.04
|
| Rate for Payer: Aetna Medicare |
$756.04
|
| Rate for Payer: Aetna Medicare |
$756.04
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$729.23
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$729.23
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$869.45
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$869.45
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$831.64
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$831.64
|
| Rate for Payer: Cash Price |
$919.25
|
| Rate for Payer: Cash Price |
$906.96
|
| Rate for Payer: Centivo All Commercial |
$1,171.86
|
| Rate for Payer: Centivo All Commercial |
$1,171.86
|
| Rate for Payer: Cigna All Commercial |
$756.04
|
| Rate for Payer: Cigna All Commercial |
$756.04
|
| Rate for Payer: CORVEL All Commercial |
$756.04
|
| Rate for Payer: CORVEL All Commercial |
$756.04
|
| Rate for Payer: Coventry All Commercial |
$907.25
|
| Rate for Payer: Coventry All Commercial |
$907.25
|
| Rate for Payer: Encore All Commercial |
$756.04
|
| Rate for Payer: Encore All Commercial |
$756.04
|
| Rate for Payer: Frontpath All Commercial |
$1,049.88
|
| Rate for Payer: Frontpath All Commercial |
$1,049.88
|
| Rate for Payer: Humana ChoiceCare |
$799.11
|
| Rate for Payer: Humana ChoiceCare |
$799.11
|
| Rate for Payer: Humana Medicare |
$756.04
|
| Rate for Payer: Humana Medicare |
$756.04
|
| Rate for Payer: Lucent All Commercial |
$1,058.46
|
| Rate for Payer: Lucent All Commercial |
$1,058.46
|
| Rate for Payer: Managed Health Services Medicaid |
$729.23
|
| Rate for Payer: Managed Health Services Medicaid |
$729.23
|
| Rate for Payer: MDWise Medicaid |
$729.23
|
| Rate for Payer: MDWise Medicaid |
$729.23
|
| Rate for Payer: PHCS All Commercial |
$756.04
|
| Rate for Payer: PHCS All Commercial |
$756.04
|
| Rate for Payer: PHP All Commercial |
$965.47
|
| Rate for Payer: PHP All Commercial |
$965.47
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$756.04
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$756.04
|
| Rate for Payer: Sagamore Health Network All Products |
$756.04
|
| Rate for Payer: Sagamore Health Network All Products |
$756.04
|
| Rate for Payer: Signature Care EPO |
$898.45
|
| Rate for Payer: Signature Care EPO |
$898.45
|
| Rate for Payer: Signature Care PPO |
$898.45
|
| Rate for Payer: Signature Care PPO |
$898.45
|
| Rate for Payer: United Healthcare Commercial |
$882.13
|
| Rate for Payer: United Healthcare Commercial |
$882.13
|
| Rate for Payer: United Healthcare Medicare |
$731.42
|
| Rate for Payer: United Healthcare Medicare |
$731.42
|
|
|
PR REPAIR SLIDING INGUINAL HERNIA
|
Professional
|
Both
|
$1,045.56
|
|
|
Service Code
|
CPT 49525
|
| Hospital Charge Code |
z49525
|
| Min. Negotiated Rate |
$513.95 |
| Max. Negotiated Rate |
$825.95 |
| Rate for Payer: Aetna Commercial |
$532.87
|
| Rate for Payer: Aetna Medicare |
$532.87
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$514.25
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$612.80
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$586.16
|
| Rate for Payer: Cash Price |
$648.25
|
| Rate for Payer: Centivo All Commercial |
$825.95
|
| Rate for Payer: Cigna All Commercial |
$532.87
|
| Rate for Payer: CORVEL All Commercial |
$532.87
|
| Rate for Payer: Coventry All Commercial |
$639.44
|
| Rate for Payer: Encore All Commercial |
$532.87
|
| Rate for Payer: Frontpath All Commercial |
$758.52
|
| Rate for Payer: Humana ChoiceCare |
$578.34
|
| Rate for Payer: Humana Medicare |
$532.87
|
| Rate for Payer: Lucent All Commercial |
$746.02
|
| Rate for Payer: Managed Health Services Medicaid |
$514.25
|
| Rate for Payer: MDWise Medicaid |
$514.25
|
| Rate for Payer: PHCS All Commercial |
$532.87
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$532.87
|
| Rate for Payer: Sagamore Health Network All Products |
$532.87
|
| Rate for Payer: United Healthcare Commercial |
$603.33
|
| Rate for Payer: United Healthcare Medicare |
$513.95
|
|
|
PR REPAIR TYMPANIC MEMBRANE
|
Professional
|
Both
|
$714.82
|
|
|
Service Code
|
CPT 69610
|
| Hospital Charge Code |
z69610
|
| Min. Negotiated Rate |
$146.91 |
| Max. Negotiated Rate |
$40,500.00 |
| Rate for Payer: Aetna Commercial |
$270.26
|
| Rate for Payer: Aetna Commercial |
$270.26
|
| Rate for Payer: Aetna Medicare |
$270.26
|
| Rate for Payer: Aetna Medicare |
$270.26
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$374.01
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$374.01
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$374.01
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$374.01
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$374.01
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$374.01
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$374.01
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$374.01
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$146.91
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$146.91
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$351.57
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$351.57
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$310.80
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$310.80
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$297.29
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$297.29
|
| Rate for Payer: Cash Price |
$436.79
|
| Rate for Payer: Cash Price |
$443.19
|
| Rate for Payer: Centivo All Commercial |
$418.90
|
| Rate for Payer: Centivo All Commercial |
$418.90
|
| Rate for Payer: Cigna All Commercial |
$270.26
|
| Rate for Payer: Cigna All Commercial |
$270.26
|
| Rate for Payer: CORVEL All Commercial |
$270.26
|
| Rate for Payer: CORVEL All Commercial |
$270.26
|
| Rate for Payer: Coventry All Commercial |
$324.31
|
| Rate for Payer: Coventry All Commercial |
$324.31
|
| Rate for Payer: Encore All Commercial |
$270.26
|
| Rate for Payer: Encore All Commercial |
$270.26
|
| Rate for Payer: Frontpath All Commercial |
$371.42
|
| Rate for Payer: Frontpath All Commercial |
$371.42
|
| Rate for Payer: Humana ChoiceCare |
$316.68
|
| Rate for Payer: Humana ChoiceCare |
$316.68
|
| Rate for Payer: Humana Medicare |
$270.26
|
| Rate for Payer: Humana Medicare |
$270.26
|
| Rate for Payer: Lucent All Commercial |
$378.36
|
| Rate for Payer: Lucent All Commercial |
$378.36
|
| Rate for Payer: Lutheran Preferred All Commercial |
$432.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$432.00
|
| Rate for Payer: Managed Health Services Medicaid |
$351.57
|
| Rate for Payer: Managed Health Services Medicaid |
$351.57
|
| Rate for Payer: MDWise Medicaid |
$351.57
|
| Rate for Payer: MDWise Medicaid |
$351.57
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$146.91
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$146.91
|
| Rate for Payer: PHCS All Commercial |
$270.26
|
| Rate for Payer: PHCS All Commercial |
$270.26
|
| Rate for Payer: PHP All Commercial |
$342.82
|
| Rate for Payer: PHP All Commercial |
$342.82
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$270.26
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$270.26
|
| Rate for Payer: Sagamore Health Network All Products |
$270.26
|
| Rate for Payer: Sagamore Health Network All Products |
$270.26
|
| Rate for Payer: Signature Care EPO |
$470.05
|
| Rate for Payer: Signature Care EPO |
$470.05
|
| Rate for Payer: Signature Care PPO |
$470.05
|
| Rate for Payer: Signature Care PPO |
$470.05
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$40,500.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$40,500.00
|
| Rate for Payer: United Healthcare Commercial |
$327.01
|
| Rate for Payer: United Healthcare Commercial |
$327.01
|
| Rate for Payer: United Healthcare Medicare |
$352.25
|
| Rate for Payer: United Healthcare Medicare |
$352.25
|
|
|
PR REPAIR VAGINA/PERINEUM
|
Professional
|
Both
|
$733.68
|
|
|
Service Code
|
CPT 57210
|
| Hospital Charge Code |
z57210
|
| Min. Negotiated Rate |
$359.98 |
| Max. Negotiated Rate |
$48,000.00 |
| Rate for Payer: Aetna Commercial |
$372.97
|
| Rate for Payer: Aetna Commercial |
$372.97
|
| Rate for Payer: Aetna Medicare |
$372.97
|
| Rate for Payer: Aetna Medicare |
$372.97
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$451.31
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$451.31
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$451.31
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$451.31
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$451.31
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$451.31
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$451.31
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$451.31
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$360.86
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$360.86
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$428.92
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$428.92
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$410.27
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$410.27
|
| Rate for Payer: Cash Price |
$454.88
|
| Rate for Payer: Cash Price |
$446.38
|
| Rate for Payer: Centivo All Commercial |
$578.10
|
| Rate for Payer: Centivo All Commercial |
$578.10
|
| Rate for Payer: Cigna All Commercial |
$372.97
|
| Rate for Payer: Cigna All Commercial |
$372.97
|
| Rate for Payer: CORVEL All Commercial |
$372.97
|
| Rate for Payer: CORVEL All Commercial |
$372.97
|
| Rate for Payer: Coventry All Commercial |
$447.56
|
| Rate for Payer: Coventry All Commercial |
$447.56
|
| Rate for Payer: Encore All Commercial |
$372.97
|
| Rate for Payer: Encore All Commercial |
$372.97
|
| Rate for Payer: Frontpath All Commercial |
$514.19
|
| Rate for Payer: Frontpath All Commercial |
$514.19
|
| Rate for Payer: Humana ChoiceCare |
$378.97
|
| Rate for Payer: Humana ChoiceCare |
$378.97
|
| Rate for Payer: Humana Medicare |
$372.97
|
| Rate for Payer: Humana Medicare |
$372.97
|
| Rate for Payer: Lucent All Commercial |
$522.16
|
| Rate for Payer: Lucent All Commercial |
$522.16
|
| Rate for Payer: Lutheran Preferred All Commercial |
$517.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$517.00
|
| Rate for Payer: Managed Health Services Medicaid |
$360.86
|
| Rate for Payer: Managed Health Services Medicaid |
$360.86
|
| Rate for Payer: MDWise Medicaid |
$360.86
|
| Rate for Payer: MDWise Medicaid |
$360.86
|
| Rate for Payer: PHCS All Commercial |
$372.97
|
| Rate for Payer: PHCS All Commercial |
$372.97
|
| Rate for Payer: PHP All Commercial |
$475.18
|
| Rate for Payer: PHP All Commercial |
$475.18
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$372.97
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$372.97
|
| Rate for Payer: Sagamore Health Network All Products |
$372.97
|
| Rate for Payer: Sagamore Health Network All Products |
$372.97
|
| Rate for Payer: Signature Care EPO |
$425.85
|
| Rate for Payer: Signature Care EPO |
$425.85
|
| Rate for Payer: Signature Care PPO |
$425.85
|
| Rate for Payer: Signature Care PPO |
$425.85
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$48,000.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$48,000.00
|
| Rate for Payer: United Healthcare Commercial |
$411.69
|
| Rate for Payer: United Healthcare Commercial |
$411.69
|
| Rate for Payer: United Healthcare Medicare |
$359.98
|
| Rate for Payer: United Healthcare Medicare |
$359.98
|
|
|
PR REPEAT CONTROL OF NOSEBLEED
|
Professional
|
Both
|
$693.48
|
|
|
Service Code
|
CPT 30906
|
| Hospital Charge Code |
z30906
|
| Min. Negotiated Rate |
$69.21 |
| Max. Negotiated Rate |
$18,700.00 |
| Rate for Payer: Aetna Commercial |
$127.19
|
| Rate for Payer: Aetna Commercial |
$127.19
|
| Rate for Payer: Aetna Medicare |
$127.19
|
| Rate for Payer: Aetna Medicare |
$127.19
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$251.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$251.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$251.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$251.40
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$251.40
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$251.40
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$251.40
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$251.40
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$69.21
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$69.21
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$341.08
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$341.08
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$146.27
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$146.27
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$139.91
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$139.91
|
| Rate for Payer: Cash Price |
$423.42
|
| Rate for Payer: Cash Price |
$429.96
|
| Rate for Payer: Centivo All Commercial |
$197.14
|
| Rate for Payer: Centivo All Commercial |
$197.14
|
| Rate for Payer: Cigna All Commercial |
$127.19
|
| Rate for Payer: Cigna All Commercial |
$127.19
|
| Rate for Payer: CORVEL All Commercial |
$127.19
|
| Rate for Payer: CORVEL All Commercial |
$127.19
|
| Rate for Payer: Coventry All Commercial |
$152.63
|
| Rate for Payer: Coventry All Commercial |
$152.63
|
| Rate for Payer: Encore All Commercial |
$127.19
|
| Rate for Payer: Encore All Commercial |
$127.19
|
| Rate for Payer: Frontpath All Commercial |
$177.06
|
| Rate for Payer: Frontpath All Commercial |
$177.06
|
| Rate for Payer: Humana ChoiceCare |
$166.89
|
| Rate for Payer: Humana ChoiceCare |
$166.89
|
| Rate for Payer: Humana Medicare |
$127.19
|
| Rate for Payer: Humana Medicare |
$127.19
|
| Rate for Payer: Lucent All Commercial |
$178.07
|
| Rate for Payer: Lucent All Commercial |
$178.07
|
| 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 |
$341.08
|
| Rate for Payer: Managed Health Services Medicaid |
$341.08
|
| Rate for Payer: MDWise Medicaid |
$341.08
|
| Rate for Payer: MDWise Medicaid |
$341.08
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$69.21
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$69.21
|
| Rate for Payer: PHCS All Commercial |
$127.19
|
| Rate for Payer: PHCS All Commercial |
$127.19
|
| Rate for Payer: PHP All Commercial |
$169.82
|
| Rate for Payer: PHP All Commercial |
$169.82
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$127.19
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$127.19
|
| Rate for Payer: Sagamore Health Network All Products |
$127.19
|
| Rate for Payer: Sagamore Health Network All Products |
$127.19
|
| Rate for Payer: Signature Care EPO |
$332.35
|
| Rate for Payer: Signature Care EPO |
$332.35
|
| Rate for Payer: Signature Care PPO |
$332.35
|
| Rate for Payer: Signature Care PPO |
$332.35
|
| 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 |
$153.93
|
| Rate for Payer: United Healthcare Commercial |
$153.93
|
| Rate for Payer: United Healthcare Medicare |
$341.47
|
| Rate for Payer: United Healthcare Medicare |
$341.47
|
|
|
PR REPR,EYELID,NOSE,EAR,LIP+5 CM
|
Professional
|
Both
|
$341.66
|
|
|
Service Code
|
CPT 13153
|
| Hospital Charge Code |
z13153
|
| Min. Negotiated Rate |
$71.46 |
| Max. Negotiated Rate |
$15,200.00 |
| Rate for Payer: Aetna Commercial |
$127.70
|
| Rate for Payer: Aetna Commercial |
$127.70
|
| Rate for Payer: Aetna Medicare |
$127.70
|
| Rate for Payer: Aetna Medicare |
$127.70
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$190.28
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$190.28
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$190.28
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$190.28
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$190.28
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$190.28
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$190.28
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$190.28
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$71.46
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$71.46
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$168.04
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$168.04
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$146.85
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$146.85
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$140.47
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$140.47
|
| Rate for Payer: Cash Price |
$209.89
|
| Rate for Payer: Cash Price |
$211.83
|
| Rate for Payer: Centivo All Commercial |
$197.94
|
| Rate for Payer: Centivo All Commercial |
$197.94
|
| Rate for Payer: Cigna All Commercial |
$127.70
|
| Rate for Payer: Cigna All Commercial |
$127.70
|
| Rate for Payer: CORVEL All Commercial |
$127.70
|
| Rate for Payer: CORVEL All Commercial |
$127.70
|
| Rate for Payer: Coventry All Commercial |
$153.24
|
| Rate for Payer: Coventry All Commercial |
$153.24
|
| Rate for Payer: Encore All Commercial |
$127.70
|
| Rate for Payer: Encore All Commercial |
$127.70
|
| Rate for Payer: Frontpath All Commercial |
$176.38
|
| Rate for Payer: Frontpath All Commercial |
$176.38
|
| Rate for Payer: Humana ChoiceCare |
$133.30
|
| Rate for Payer: Humana ChoiceCare |
$133.30
|
| Rate for Payer: Humana Medicare |
$127.70
|
| Rate for Payer: Humana Medicare |
$127.70
|
| Rate for Payer: Lucent All Commercial |
$178.78
|
| Rate for Payer: Lucent All Commercial |
$178.78
|
| Rate for Payer: Lutheran Preferred All Commercial |
$165.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$165.00
|
| Rate for Payer: Managed Health Services Medicaid |
$168.04
|
| Rate for Payer: Managed Health Services Medicaid |
$168.04
|
| Rate for Payer: MDWise Medicaid |
$168.04
|
| Rate for Payer: MDWise Medicaid |
$168.04
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$71.46
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$71.46
|
| Rate for Payer: PHCS All Commercial |
$127.70
|
| Rate for Payer: PHCS All Commercial |
$127.70
|
| Rate for Payer: PHP All Commercial |
$173.31
|
| Rate for Payer: PHP All Commercial |
$173.31
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$127.70
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$127.70
|
| Rate for Payer: Sagamore Health Network All Products |
$127.70
|
| Rate for Payer: Sagamore Health Network All Products |
$127.70
|
| Rate for Payer: Signature Care EPO |
$156.34
|
| Rate for Payer: Signature Care EPO |
$156.34
|
| Rate for Payer: Signature Care PPO |
$156.34
|
| Rate for Payer: Signature Care PPO |
$156.34
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$15,200.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$15,200.00
|
| Rate for Payer: United Healthcare Commercial |
$159.30
|
| Rate for Payer: United Healthcare Commercial |
$159.30
|
| Rate for Payer: United Healthcare Medicare |
$169.27
|
| Rate for Payer: United Healthcare Medicare |
$169.27
|
|
|
PR REP,SKIN,SCALP/EXTREM+5 CM/<
|
Professional
|
Both
|
$234.32
|
|
|
Service Code
|
CPT 13122
|
| Hospital Charge Code |
z13122
|
| Min. Negotiated Rate |
$41.76 |
| Max. Negotiated Rate |
$9,200.00 |
| Rate for Payer: Aetna Commercial |
$77.03
|
| Rate for Payer: Aetna Commercial |
$77.03
|
| Rate for Payer: Aetna Medicare |
$77.03
|
| Rate for Payer: Aetna Medicare |
$77.03
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$122.23
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$122.23
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$122.23
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$122.23
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$122.23
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$122.23
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$122.23
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$122.23
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$41.76
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$41.76
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$115.25
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$115.25
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$88.58
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$88.58
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$84.73
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$84.73
|
| Rate for Payer: Cash Price |
$143.99
|
| Rate for Payer: Cash Price |
$145.28
|
| Rate for Payer: Centivo All Commercial |
$119.40
|
| Rate for Payer: Centivo All Commercial |
$119.40
|
| Rate for Payer: Cigna All Commercial |
$77.03
|
| Rate for Payer: Cigna All Commercial |
$77.03
|
| Rate for Payer: CORVEL All Commercial |
$77.03
|
| Rate for Payer: CORVEL All Commercial |
$77.03
|
| Rate for Payer: Coventry All Commercial |
$92.44
|
| Rate for Payer: Coventry All Commercial |
$92.44
|
| Rate for Payer: Encore All Commercial |
$77.03
|
| Rate for Payer: Encore All Commercial |
$77.03
|
| Rate for Payer: Frontpath All Commercial |
$106.25
|
| Rate for Payer: Frontpath All Commercial |
$106.25
|
| Rate for Payer: Humana ChoiceCare |
$78.68
|
| Rate for Payer: Humana ChoiceCare |
$78.68
|
| Rate for Payer: Humana Medicare |
$77.03
|
| Rate for Payer: Humana Medicare |
$77.03
|
| Rate for Payer: Lucent All Commercial |
$107.84
|
| Rate for Payer: Lucent All Commercial |
$107.84
|
| Rate for Payer: Lutheran Preferred All Commercial |
$100.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$100.00
|
| Rate for Payer: Managed Health Services Medicaid |
$115.25
|
| Rate for Payer: Managed Health Services Medicaid |
$115.25
|
| Rate for Payer: MDWise Medicaid |
$115.25
|
| Rate for Payer: MDWise Medicaid |
$115.25
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$41.76
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$41.76
|
| Rate for Payer: PHCS All Commercial |
$77.03
|
| Rate for Payer: PHCS All Commercial |
$77.03
|
| Rate for Payer: PHP All Commercial |
$104.80
|
| Rate for Payer: PHP All Commercial |
$104.80
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$77.03
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$77.03
|
| Rate for Payer: Sagamore Health Network All Products |
$77.03
|
| Rate for Payer: Sagamore Health Network All Products |
$77.03
|
| Rate for Payer: Signature Care EPO |
$107.13
|
| Rate for Payer: Signature Care EPO |
$107.13
|
| Rate for Payer: Signature Care PPO |
$107.13
|
| Rate for Payer: Signature Care PPO |
$107.13
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$9,200.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$9,200.00
|
| Rate for Payer: United Healthcare Commercial |
$94.63
|
| Rate for Payer: United Healthcare Commercial |
$94.63
|
| Rate for Payer: United Healthcare Medicare |
$116.12
|
| Rate for Payer: United Healthcare Medicare |
$116.12
|
|
|
PR REP,SKIN,TRUNK,CMPLX,+5 CM/<
|
Professional
|
Both
|
$214.84
|
|
|
Service Code
|
CPT 13102
|
| Hospital Charge Code |
z13102
|
| Min. Negotiated Rate |
$36.69 |
| Max. Negotiated Rate |
$106.32 |
| Rate for Payer: Aetna Commercial |
$67.31
|
| Rate for Payer: Aetna Commercial |
$67.31
|
| Rate for Payer: Aetna Medicare |
$67.31
|
| Rate for Payer: Aetna Medicare |
$67.31
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$36.69
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$36.69
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$105.67
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$105.67
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$77.41
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$77.41
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$74.04
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$74.04
|
| Rate for Payer: Cash Price |
$131.84
|
| Rate for Payer: Cash Price |
$133.20
|
| Rate for Payer: Centivo All Commercial |
$104.33
|
| Rate for Payer: Centivo All Commercial |
$104.33
|
| Rate for Payer: Cigna All Commercial |
$67.31
|
| Rate for Payer: Cigna All Commercial |
$67.31
|
| Rate for Payer: CORVEL All Commercial |
$67.31
|
| Rate for Payer: CORVEL All Commercial |
$67.31
|
| Rate for Payer: Coventry All Commercial |
$80.77
|
| Rate for Payer: Coventry All Commercial |
$80.77
|
| Rate for Payer: Encore All Commercial |
$67.31
|
| Rate for Payer: Encore All Commercial |
$67.31
|
| Rate for Payer: Frontpath All Commercial |
$93.56
|
| Rate for Payer: Frontpath All Commercial |
$93.56
|
| Rate for Payer: Humana ChoiceCare |
$68.71
|
| Rate for Payer: Humana ChoiceCare |
$68.71
|
| Rate for Payer: Humana Medicare |
$67.31
|
| Rate for Payer: Humana Medicare |
$67.31
|
| Rate for Payer: Lucent All Commercial |
$94.23
|
| Rate for Payer: Lucent All Commercial |
$94.23
|
| Rate for Payer: Managed Health Services Medicaid |
$105.67
|
| Rate for Payer: Managed Health Services Medicaid |
$105.67
|
| Rate for Payer: MDWise Medicaid |
$105.67
|
| Rate for Payer: MDWise Medicaid |
$105.67
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$36.69
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$36.69
|
| Rate for Payer: PHCS All Commercial |
$67.31
|
| Rate for Payer: PHCS All Commercial |
$67.31
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$67.31
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$67.31
|
| Rate for Payer: Sagamore Health Network All Products |
$67.31
|
| Rate for Payer: Sagamore Health Network All Products |
$67.31
|
| Rate for Payer: United Healthcare Commercial |
$82.59
|
| Rate for Payer: United Healthcare Commercial |
$82.59
|
| Rate for Payer: United Healthcare Medicare |
$106.32
|
| Rate for Payer: United Healthcare Medicare |
$106.32
|
|
|
PR RESEC HEAD OF PHALANX,TOE
|
Professional
|
Both
|
$755.34
|
|
|
Service Code
|
CPT 28153
|
| Hospital Charge Code |
z28153
|
| Min. Negotiated Rate |
$134.45 |
| Max. Negotiated Rate |
$37,300.00 |
| Rate for Payer: Aetna Commercial |
$249.58
|
| Rate for Payer: Aetna Commercial |
$249.58
|
| Rate for Payer: Aetna Medicare |
$249.58
|
| Rate for Payer: Aetna Medicare |
$249.58
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$373.81
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$373.81
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$373.81
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$373.81
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$373.81
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$373.81
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$373.81
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$373.81
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$134.45
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$134.45
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$371.51
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$371.51
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$287.02
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$287.02
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$274.54
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$274.54
|
| Rate for Payer: Cash Price |
$457.63
|
| Rate for Payer: Cash Price |
$468.31
|
| Rate for Payer: Centivo All Commercial |
$386.85
|
| Rate for Payer: Centivo All Commercial |
$386.85
|
| Rate for Payer: Cigna All Commercial |
$249.58
|
| Rate for Payer: Cigna All Commercial |
$249.58
|
| Rate for Payer: CORVEL All Commercial |
$249.58
|
| Rate for Payer: CORVEL All Commercial |
$249.58
|
| Rate for Payer: Coventry All Commercial |
$299.50
|
| Rate for Payer: Coventry All Commercial |
$299.50
|
| Rate for Payer: Encore All Commercial |
$249.58
|
| Rate for Payer: Encore All Commercial |
$249.58
|
| Rate for Payer: Frontpath All Commercial |
$337.04
|
| Rate for Payer: Frontpath All Commercial |
$337.04
|
| Rate for Payer: Humana ChoiceCare |
$274.69
|
| Rate for Payer: Humana ChoiceCare |
$274.69
|
| Rate for Payer: Humana Medicare |
$249.58
|
| Rate for Payer: Humana Medicare |
$249.58
|
| Rate for Payer: Lucent All Commercial |
$349.41
|
| Rate for Payer: Lucent All Commercial |
$349.41
|
| Rate for Payer: Lutheran Preferred All Commercial |
$398.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$398.00
|
| Rate for Payer: Managed Health Services Medicaid |
$371.51
|
| Rate for Payer: Managed Health Services Medicaid |
$371.51
|
| Rate for Payer: MDWise Medicaid |
$371.51
|
| Rate for Payer: MDWise Medicaid |
$371.51
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$134.45
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$134.45
|
| Rate for Payer: PHCS All Commercial |
$249.58
|
| Rate for Payer: PHCS All Commercial |
$249.58
|
| Rate for Payer: PHP All Commercial |
$422.59
|
| Rate for Payer: PHP All Commercial |
$422.59
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$249.58
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$249.58
|
| Rate for Payer: Sagamore Health Network All Products |
$249.58
|
| Rate for Payer: Sagamore Health Network All Products |
$249.58
|
| Rate for Payer: Signature Care EPO |
$516.80
|
| Rate for Payer: Signature Care EPO |
$516.80
|
| Rate for Payer: Signature Care PPO |
$516.80
|
| Rate for Payer: Signature Care PPO |
$516.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$37,300.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$37,300.00
|
| Rate for Payer: United Healthcare Commercial |
$296.25
|
| Rate for Payer: United Healthcare Commercial |
$296.25
|
| Rate for Payer: United Healthcare Medicare |
$369.06
|
| Rate for Payer: United Healthcare Medicare |
$369.06
|
|
|
PR RESECT SMALL INTEST,SINGL RESEC/ANAS
|
Professional
|
Both
|
$2,206.88
|
|
|
Service Code
|
CPT 44120
|
| Hospital Charge Code |
z44120
|
| Min. Negotiated Rate |
$1,085.43 |
| Max. Negotiated Rate |
$155,900.00 |
| Rate for Payer: Aetna Commercial |
$1,129.99
|
| Rate for Payer: Aetna Commercial |
$1,129.99
|
| Rate for Payer: Aetna Medicare |
$1,129.99
|
| Rate for Payer: Aetna Medicare |
$1,129.99
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$1,148.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$1,148.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,148.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,148.60
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,148.60
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,148.60
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,148.60
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,148.60
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$1,085.43
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$1,085.43
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,299.49
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,299.49
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,242.99
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,242.99
|
| Rate for Payer: Cash Price |
$1,368.27
|
| Rate for Payer: Cash Price |
$1,347.25
|
| Rate for Payer: Centivo All Commercial |
$1,751.48
|
| Rate for Payer: Centivo All Commercial |
$1,751.48
|
| Rate for Payer: Cigna All Commercial |
$1,129.99
|
| Rate for Payer: Cigna All Commercial |
$1,129.99
|
| Rate for Payer: CORVEL All Commercial |
$1,129.99
|
| Rate for Payer: CORVEL All Commercial |
$1,129.99
|
| Rate for Payer: Coventry All Commercial |
$1,355.99
|
| Rate for Payer: Coventry All Commercial |
$1,355.99
|
| Rate for Payer: Encore All Commercial |
$1,129.99
|
| Rate for Payer: Encore All Commercial |
$1,129.99
|
| Rate for Payer: Frontpath All Commercial |
$1,615.25
|
| Rate for Payer: Frontpath All Commercial |
$1,615.25
|
| Rate for Payer: Humana ChoiceCare |
$1,105.51
|
| Rate for Payer: Humana ChoiceCare |
$1,105.51
|
| Rate for Payer: Humana Medicare |
$1,129.99
|
| Rate for Payer: Humana Medicare |
$1,129.99
|
| Rate for Payer: Lucent All Commercial |
$1,581.99
|
| Rate for Payer: Lucent All Commercial |
$1,581.99
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,670.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,670.00
|
| Rate for Payer: Managed Health Services Medicaid |
$1,085.43
|
| Rate for Payer: Managed Health Services Medicaid |
$1,085.43
|
| Rate for Payer: MDWise Medicaid |
$1,085.43
|
| Rate for Payer: MDWise Medicaid |
$1,085.43
|
| Rate for Payer: PHCS All Commercial |
$1,129.99
|
| Rate for Payer: PHCS All Commercial |
$1,129.99
|
| Rate for Payer: PHP All Commercial |
$1,901.36
|
| Rate for Payer: PHP All Commercial |
$1,901.36
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,129.99
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,129.99
|
| Rate for Payer: Sagamore Health Network All Products |
$1,129.99
|
| Rate for Payer: Sagamore Health Network All Products |
$1,129.99
|
| Rate for Payer: Signature Care EPO |
$1,390.60
|
| Rate for Payer: Signature Care EPO |
$1,390.60
|
| Rate for Payer: Signature Care PPO |
$1,390.60
|
| Rate for Payer: Signature Care PPO |
$1,390.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$155,900.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$155,900.00
|
| Rate for Payer: United Healthcare Commercial |
$1,302.05
|
| Rate for Payer: United Healthcare Commercial |
$1,302.05
|
| Rate for Payer: United Healthcare Medicare |
$1,086.49
|
| Rate for Payer: United Healthcare Medicare |
$1,086.49
|
|
|
PR RESUPERF WND BODY 12.6-20 CM
|
Professional
|
Both
|
$326.38
|
|
|
Service Code
|
CPT 12005
|
| Hospital Charge Code |
z12005
|
| Min. Negotiated Rate |
$67.96 |
| Max. Negotiated Rate |
$10,500.00 |
| Rate for Payer: Aetna Commercial |
$88.47
|
| Rate for Payer: Aetna Commercial |
$88.47
|
| Rate for Payer: Aetna Medicare |
$88.47
|
| Rate for Payer: Aetna Medicare |
$88.47
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$243.08
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$243.08
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$243.08
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$243.08
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$243.08
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$243.08
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$243.08
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$243.08
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$67.96
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$67.96
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$160.52
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$160.52
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$101.74
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$101.74
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$97.32
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$97.32
|
| Rate for Payer: Cash Price |
$198.88
|
| Rate for Payer: Cash Price |
$202.36
|
| Rate for Payer: Centivo All Commercial |
$137.13
|
| Rate for Payer: Centivo All Commercial |
$137.13
|
| Rate for Payer: Cigna All Commercial |
$88.47
|
| Rate for Payer: Cigna All Commercial |
$88.47
|
| Rate for Payer: CORVEL All Commercial |
$88.47
|
| Rate for Payer: CORVEL All Commercial |
$88.47
|
| Rate for Payer: Coventry All Commercial |
$106.16
|
| Rate for Payer: Coventry All Commercial |
$106.16
|
| Rate for Payer: Encore All Commercial |
$88.47
|
| Rate for Payer: Encore All Commercial |
$88.47
|
| Rate for Payer: Frontpath All Commercial |
$126.31
|
| Rate for Payer: Frontpath All Commercial |
$126.31
|
| Rate for Payer: Humana ChoiceCare |
$154.05
|
| Rate for Payer: Humana ChoiceCare |
$154.05
|
| Rate for Payer: Humana Medicare |
$88.47
|
| Rate for Payer: Humana Medicare |
$88.47
|
| Rate for Payer: Lucent All Commercial |
$123.86
|
| Rate for Payer: Lucent All Commercial |
$123.86
|
| Rate for Payer: Lutheran Preferred All Commercial |
$113.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$113.00
|
| Rate for Payer: Managed Health Services Medicaid |
$160.52
|
| Rate for Payer: Managed Health Services Medicaid |
$160.52
|
| Rate for Payer: MDWise Medicaid |
$160.52
|
| Rate for Payer: MDWise Medicaid |
$160.52
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$67.96
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$67.96
|
| Rate for Payer: PHCS All Commercial |
$88.47
|
| Rate for Payer: PHCS All Commercial |
$88.47
|
| Rate for Payer: PHP All Commercial |
$119.13
|
| Rate for Payer: PHP All Commercial |
$119.13
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$88.47
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$88.47
|
| Rate for Payer: Sagamore Health Network All Products |
$88.47
|
| Rate for Payer: Sagamore Health Network All Products |
$88.47
|
| Rate for Payer: Signature Care EPO |
$235.45
|
| Rate for Payer: Signature Care EPO |
$235.45
|
| Rate for Payer: Signature Care PPO |
$235.45
|
| Rate for Payer: Signature Care PPO |
$235.45
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$10,500.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$10,500.00
|
| Rate for Payer: United Healthcare Commercial |
$182.65
|
| Rate for Payer: United Healthcare Commercial |
$182.65
|
| Rate for Payer: United Healthcare Medicare |
$160.39
|
| Rate for Payer: United Healthcare Medicare |
$160.39
|
|
|
PR RESUPERF WND BODY <2.5CM
|
Professional
|
Both
|
$174.04
|
|
|
Service Code
|
CPT 12001
|
| Hospital Charge Code |
z12001
|
| Min. Negotiated Rate |
$30.86 |
| Max. Negotiated Rate |
$5,000.00 |
| Rate for Payer: Aetna Commercial |
$41.77
|
| Rate for Payer: Aetna Commercial |
$41.77
|
| Rate for Payer: Aetna Medicare |
$41.77
|
| Rate for Payer: Aetna Medicare |
$41.77
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$154.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$154.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$154.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$154.80
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$154.80
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$154.80
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$154.80
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$154.80
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$30.86
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$30.86
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$85.60
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$85.60
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$48.04
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$48.04
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$45.95
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$45.95
|
| Rate for Payer: Cash Price |
$105.72
|
| Rate for Payer: Cash Price |
$107.90
|
| Rate for Payer: Centivo All Commercial |
$64.74
|
| Rate for Payer: Centivo All Commercial |
$64.74
|
| Rate for Payer: Cigna All Commercial |
$41.77
|
| Rate for Payer: Cigna All Commercial |
$41.77
|
| Rate for Payer: CORVEL All Commercial |
$41.77
|
| Rate for Payer: CORVEL All Commercial |
$41.77
|
| Rate for Payer: Coventry All Commercial |
$50.12
|
| Rate for Payer: Coventry All Commercial |
$50.12
|
| Rate for Payer: Encore All Commercial |
$41.77
|
| Rate for Payer: Encore All Commercial |
$41.77
|
| Rate for Payer: Frontpath All Commercial |
$59.31
|
| Rate for Payer: Frontpath All Commercial |
$59.31
|
| Rate for Payer: Humana ChoiceCare |
$93.34
|
| Rate for Payer: Humana ChoiceCare |
$93.34
|
| Rate for Payer: Humana Medicare |
$41.77
|
| Rate for Payer: Humana Medicare |
$41.77
|
| Rate for Payer: Lucent All Commercial |
$58.48
|
| Rate for Payer: Lucent All Commercial |
$58.48
|
| Rate for Payer: Lutheran Preferred All Commercial |
$54.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$54.00
|
| Rate for Payer: Managed Health Services Medicaid |
$85.60
|
| Rate for Payer: Managed Health Services Medicaid |
$85.60
|
| Rate for Payer: MDWise Medicaid |
$85.60
|
| Rate for Payer: MDWise Medicaid |
$85.60
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$30.86
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$30.86
|
| Rate for Payer: PHCS All Commercial |
$41.77
|
| Rate for Payer: PHCS All Commercial |
$41.77
|
| Rate for Payer: PHP All Commercial |
$56.53
|
| Rate for Payer: PHP All Commercial |
$56.53
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$41.77
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$41.77
|
| Rate for Payer: Sagamore Health Network All Products |
$41.77
|
| Rate for Payer: Sagamore Health Network All Products |
$41.77
|
| Rate for Payer: Signature Care EPO |
$148.85
|
| Rate for Payer: Signature Care EPO |
$148.85
|
| Rate for Payer: Signature Care PPO |
$148.85
|
| Rate for Payer: Signature Care PPO |
$148.85
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5,000.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5,000.00
|
| Rate for Payer: United Healthcare Commercial |
$112.23
|
| Rate for Payer: United Healthcare Commercial |
$112.23
|
| Rate for Payer: United Healthcare Medicare |
$85.26
|
| Rate for Payer: United Healthcare Medicare |
$85.26
|
|
|
PR RESUPERF WND BODY >30 CM
|
Professional
|
Both
|
$427.24
|
|
|
Service Code
|
CPT 12007
|
| Hospital Charge Code |
z12007
|
| Min. Negotiated Rate |
$101.97 |
| Max. Negotiated Rate |
$329.80 |
| Rate for Payer: Aetna Commercial |
$135.53
|
| Rate for Payer: Aetna Commercial |
$135.53
|
| Rate for Payer: Aetna Medicare |
$135.53
|
| Rate for Payer: Aetna Medicare |
$135.53
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$101.97
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$101.97
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$210.14
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$210.14
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$155.86
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$155.86
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$149.08
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$149.08
|
| Rate for Payer: Cash Price |
$260.13
|
| Rate for Payer: Cash Price |
$264.89
|
| Rate for Payer: Centivo All Commercial |
$210.07
|
| Rate for Payer: Centivo All Commercial |
$210.07
|
| Rate for Payer: Cigna All Commercial |
$135.53
|
| Rate for Payer: Cigna All Commercial |
$135.53
|
| Rate for Payer: CORVEL All Commercial |
$135.53
|
| Rate for Payer: CORVEL All Commercial |
$135.53
|
| Rate for Payer: Coventry All Commercial |
$162.64
|
| Rate for Payer: Coventry All Commercial |
$162.64
|
| Rate for Payer: Encore All Commercial |
$135.53
|
| Rate for Payer: Encore All Commercial |
$135.53
|
| Rate for Payer: Frontpath All Commercial |
$192.53
|
| Rate for Payer: Frontpath All Commercial |
$192.53
|
| Rate for Payer: Humana ChoiceCare |
$225.68
|
| Rate for Payer: Humana ChoiceCare |
$225.68
|
| Rate for Payer: Humana Medicare |
$135.53
|
| Rate for Payer: Humana Medicare |
$135.53
|
| Rate for Payer: Lucent All Commercial |
$189.74
|
| Rate for Payer: Lucent All Commercial |
$189.74
|
| Rate for Payer: Managed Health Services Medicaid |
$210.14
|
| Rate for Payer: Managed Health Services Medicaid |
$210.14
|
| Rate for Payer: MDWise Medicaid |
$210.14
|
| Rate for Payer: MDWise Medicaid |
$210.14
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$101.97
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$101.97
|
| Rate for Payer: PHCS All Commercial |
$135.53
|
| Rate for Payer: PHCS All Commercial |
$135.53
|
| Rate for Payer: PHP All Commercial |
$181.96
|
| Rate for Payer: PHP All Commercial |
$181.96
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$135.53
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$135.53
|
| Rate for Payer: Sagamore Health Network All Products |
$135.53
|
| Rate for Payer: Sagamore Health Network All Products |
$135.53
|
| Rate for Payer: Signature Care EPO |
$329.80
|
| Rate for Payer: Signature Care EPO |
$329.80
|
| Rate for Payer: Signature Care PPO |
$329.80
|
| Rate for Payer: Signature Care PPO |
$329.80
|
| Rate for Payer: United Healthcare Commercial |
$263.74
|
| Rate for Payer: United Healthcare Commercial |
$263.74
|
| Rate for Payer: United Healthcare Medicare |
$209.78
|
| Rate for Payer: United Healthcare Medicare |
$209.78
|
|
|
PR RESUPERF WND BODY 7.6-12.5 CM
|
Professional
|
Both
|
$245.18
|
|
|
Service Code
|
CPT 12004
|
| Hospital Charge Code |
z12004
|
| Min. Negotiated Rate |
$39.32 |
| Max. Negotiated Rate |
$8,100.00 |
| Rate for Payer: Aetna Commercial |
$67.88
|
| Rate for Payer: Aetna Commercial |
$67.88
|
| Rate for Payer: Aetna Medicare |
$67.88
|
| Rate for Payer: Aetna Medicare |
$67.88
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$194.89
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$194.89
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$194.89
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$194.89
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$194.89
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$194.89
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$194.89
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$194.89
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$39.32
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$39.32
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$120.59
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$120.59
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$78.06
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$78.06
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$74.67
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$74.67
|
| Rate for Payer: Cash Price |
$148.69
|
| Rate for Payer: Cash Price |
$152.01
|
| Rate for Payer: Centivo All Commercial |
$105.21
|
| Rate for Payer: Centivo All Commercial |
$105.21
|
| Rate for Payer: Cigna All Commercial |
$67.88
|
| Rate for Payer: Cigna All Commercial |
$67.88
|
| Rate for Payer: CORVEL All Commercial |
$67.88
|
| Rate for Payer: CORVEL All Commercial |
$67.88
|
| Rate for Payer: Coventry All Commercial |
$81.46
|
| Rate for Payer: Coventry All Commercial |
$81.46
|
| Rate for Payer: Encore All Commercial |
$67.88
|
| Rate for Payer: Encore All Commercial |
$67.88
|
| Rate for Payer: Frontpath All Commercial |
$96.15
|
| Rate for Payer: Frontpath All Commercial |
$96.15
|
| Rate for Payer: Humana ChoiceCare |
$123.04
|
| Rate for Payer: Humana ChoiceCare |
$123.04
|
| Rate for Payer: Humana Medicare |
$67.88
|
| Rate for Payer: Humana Medicare |
$67.88
|
| Rate for Payer: Lucent All Commercial |
$95.03
|
| Rate for Payer: Lucent All Commercial |
$95.03
|
| Rate for Payer: Lutheran Preferred All Commercial |
$88.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$88.00
|
| Rate for Payer: Managed Health Services Medicaid |
$120.59
|
| Rate for Payer: Managed Health Services Medicaid |
$120.59
|
| Rate for Payer: MDWise Medicaid |
$120.59
|
| Rate for Payer: MDWise Medicaid |
$120.59
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$39.32
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$39.32
|
| Rate for Payer: PHCS All Commercial |
$67.88
|
| Rate for Payer: PHCS All Commercial |
$67.88
|
| Rate for Payer: PHP All Commercial |
$91.98
|
| Rate for Payer: PHP All Commercial |
$91.98
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$67.88
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$67.88
|
| Rate for Payer: Sagamore Health Network All Products |
$67.88
|
| Rate for Payer: Sagamore Health Network All Products |
$67.88
|
| Rate for Payer: Signature Care EPO |
$188.70
|
| Rate for Payer: Signature Care EPO |
$188.70
|
| Rate for Payer: Signature Care PPO |
$188.70
|
| Rate for Payer: Signature Care PPO |
$188.70
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$8,100.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$8,100.00
|
| Rate for Payer: United Healthcare Commercial |
$146.46
|
| Rate for Payer: United Healthcare Commercial |
$146.46
|
| Rate for Payer: United Healthcare Medicare |
$119.91
|
| Rate for Payer: United Healthcare Medicare |
$119.91
|
|
|
PR RESUPERF WND FACE <2.5 CM
|
Professional
|
Both
|
$206.92
|
|
|
Service Code
|
CPT 12011
|
| Hospital Charge Code |
z12011
|
| Min. Negotiated Rate |
$34.73 |
| Max. Negotiated Rate |
$6,100.00 |
| Rate for Payer: Aetna Commercial |
$51.31
|
| Rate for Payer: Aetna Commercial |
$51.31
|
| Rate for Payer: Aetna Medicare |
$51.31
|
| Rate for Payer: Aetna Medicare |
$51.31
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$197.34
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$197.34
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$197.34
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$197.34
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$197.34
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$197.34
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$197.34
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$197.34
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$34.73
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$34.73
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$101.77
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$101.77
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$59.01
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$59.01
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$56.44
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$56.44
|
| Rate for Payer: Cash Price |
$126.57
|
| Rate for Payer: Cash Price |
$128.29
|
| Rate for Payer: Centivo All Commercial |
$79.53
|
| Rate for Payer: Centivo All Commercial |
$79.53
|
| Rate for Payer: Cigna All Commercial |
$51.31
|
| Rate for Payer: Cigna All Commercial |
$51.31
|
| Rate for Payer: CORVEL All Commercial |
$51.31
|
| Rate for Payer: CORVEL All Commercial |
$51.31
|
| Rate for Payer: Coventry All Commercial |
$61.57
|
| Rate for Payer: Coventry All Commercial |
$61.57
|
| Rate for Payer: Encore All Commercial |
$51.31
|
| Rate for Payer: Encore All Commercial |
$51.31
|
| Rate for Payer: Frontpath All Commercial |
$72.85
|
| Rate for Payer: Frontpath All Commercial |
$72.85
|
| Rate for Payer: Humana ChoiceCare |
$96.12
|
| Rate for Payer: Humana ChoiceCare |
$96.12
|
| Rate for Payer: Humana Medicare |
$51.31
|
| Rate for Payer: Humana Medicare |
$51.31
|
| Rate for Payer: Lucent All Commercial |
$71.83
|
| Rate for Payer: Lucent All Commercial |
$71.83
|
| Rate for Payer: Lutheran Preferred All Commercial |
$66.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$66.00
|
| Rate for Payer: Managed Health Services Medicaid |
$101.77
|
| Rate for Payer: Managed Health Services Medicaid |
$101.77
|
| Rate for Payer: MDWise Medicaid |
$101.77
|
| Rate for Payer: MDWise Medicaid |
$101.77
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$34.73
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$34.73
|
| Rate for Payer: PHCS All Commercial |
$51.31
|
| Rate for Payer: PHCS All Commercial |
$51.31
|
| Rate for Payer: PHP All Commercial |
$69.52
|
| Rate for Payer: PHP All Commercial |
$69.52
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$51.31
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$51.31
|
| Rate for Payer: Sagamore Health Network All Products |
$51.31
|
| Rate for Payer: Sagamore Health Network All Products |
$51.31
|
| 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 |
$6,100.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$6,100.00
|
| Rate for Payer: United Healthcare Commercial |
$116.03
|
| Rate for Payer: United Healthcare Commercial |
$116.03
|
| Rate for Payer: United Healthcare Medicare |
$102.07
|
| Rate for Payer: United Healthcare Medicare |
$102.07
|
|
|
PR RESUPERF WND FACE 2.6-5 CM
|
Professional
|
Both
|
$215.42
|
|
|
Service Code
|
CPT 12013
|
| Hospital Charge Code |
z12013
|
| Min. Negotiated Rate |
$41.80 |
| Max. Negotiated Rate |
$6,400.00 |
| Rate for Payer: Aetna Commercial |
$54.18
|
| Rate for Payer: Aetna Commercial |
$54.18
|
| Rate for Payer: Aetna Medicare |
$54.18
|
| Rate for Payer: Aetna Medicare |
$54.18
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$217.88
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$217.88
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$217.88
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$217.88
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$217.88
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$217.88
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$217.88
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$217.88
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$41.80
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$41.80
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$105.95
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$105.95
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$62.31
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$62.31
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$59.60
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$59.60
|
| Rate for Payer: Cash Price |
$132.18
|
| Rate for Payer: Cash Price |
$133.56
|
| Rate for Payer: Centivo All Commercial |
$83.98
|
| Rate for Payer: Centivo All Commercial |
$83.98
|
| Rate for Payer: Cigna All Commercial |
$54.18
|
| Rate for Payer: Cigna All Commercial |
$54.18
|
| Rate for Payer: CORVEL All Commercial |
$54.18
|
| Rate for Payer: CORVEL All Commercial |
$54.18
|
| Rate for Payer: Coventry All Commercial |
$65.02
|
| Rate for Payer: Coventry All Commercial |
$65.02
|
| Rate for Payer: Encore All Commercial |
$54.18
|
| Rate for Payer: Encore All Commercial |
$54.18
|
| Rate for Payer: Frontpath All Commercial |
$77.38
|
| Rate for Payer: Frontpath All Commercial |
$77.38
|
| Rate for Payer: Humana ChoiceCare |
$110.32
|
| Rate for Payer: Humana ChoiceCare |
$110.32
|
| Rate for Payer: Humana Medicare |
$54.18
|
| Rate for Payer: Humana Medicare |
$54.18
|
| Rate for Payer: Lucent All Commercial |
$75.85
|
| Rate for Payer: Lucent All Commercial |
$75.85
|
| 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 |
$105.95
|
| Rate for Payer: Managed Health Services Medicaid |
$105.95
|
| Rate for Payer: MDWise Medicaid |
$105.95
|
| Rate for Payer: MDWise Medicaid |
$105.95
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$41.80
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$41.80
|
| Rate for Payer: PHCS All Commercial |
$54.18
|
| Rate for Payer: PHCS All Commercial |
$54.18
|
| Rate for Payer: PHP All Commercial |
$73.35
|
| Rate for Payer: PHP All Commercial |
$73.35
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$54.18
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$54.18
|
| Rate for Payer: Sagamore Health Network All Products |
$54.18
|
| Rate for Payer: Sagamore Health Network All Products |
$54.18
|
| Rate for Payer: Signature Care EPO |
$175.95
|
| Rate for Payer: Signature Care EPO |
$175.95
|
| Rate for Payer: Signature Care PPO |
$175.95
|
| Rate for Payer: Signature Care PPO |
$175.95
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$6,400.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$6,400.00
|
| Rate for Payer: United Healthcare Commercial |
$132.31
|
| Rate for Payer: United Healthcare Commercial |
$132.31
|
| Rate for Payer: United Healthcare Medicare |
$106.60
|
| Rate for Payer: United Healthcare Medicare |
$106.60
|
|
|
PR RESUPERF WND FACE 5.1-7.5 CM
|
Professional
|
Both
|
$262.78
|
|
|
Service Code
|
CPT 12014
|
| Hospital Charge Code |
z12014
|
| Min. Negotiated Rate |
$54.08 |
| Max. Negotiated Rate |
$8,300.00 |
| Rate for Payer: Aetna Commercial |
$69.60
|
| Rate for Payer: Aetna Commercial |
$69.60
|
| Rate for Payer: Aetna Medicare |
$69.60
|
| Rate for Payer: Aetna Medicare |
$69.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$257.34
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$257.34
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$257.34
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$257.34
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$257.34
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$257.34
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$257.34
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$257.34
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$54.08
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$54.08
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$129.25
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$129.25
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$80.04
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$80.04
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$76.56
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$76.56
|
| Rate for Payer: Cash Price |
$160.95
|
| Rate for Payer: Cash Price |
$162.92
|
| Rate for Payer: Centivo All Commercial |
$107.88
|
| Rate for Payer: Centivo All Commercial |
$107.88
|
| Rate for Payer: Cigna All Commercial |
$69.60
|
| Rate for Payer: Cigna All Commercial |
$69.60
|
| Rate for Payer: CORVEL All Commercial |
$69.60
|
| Rate for Payer: CORVEL All Commercial |
$69.60
|
| Rate for Payer: Coventry All Commercial |
$83.52
|
| Rate for Payer: Coventry All Commercial |
$83.52
|
| Rate for Payer: Encore All Commercial |
$69.60
|
| Rate for Payer: Encore All Commercial |
$69.60
|
| Rate for Payer: Frontpath All Commercial |
$99.44
|
| Rate for Payer: Frontpath All Commercial |
$99.44
|
| Rate for Payer: Humana ChoiceCare |
$133.42
|
| Rate for Payer: Humana ChoiceCare |
$133.42
|
| Rate for Payer: Humana Medicare |
$69.60
|
| Rate for Payer: Humana Medicare |
$69.60
|
| Rate for Payer: Lucent All Commercial |
$97.44
|
| Rate for Payer: Lucent All Commercial |
$97.44
|
| Rate for Payer: Lutheran Preferred All Commercial |
$89.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$89.00
|
| Rate for Payer: Managed Health Services Medicaid |
$129.25
|
| Rate for Payer: Managed Health Services Medicaid |
$129.25
|
| Rate for Payer: MDWise Medicaid |
$129.25
|
| Rate for Payer: MDWise Medicaid |
$129.25
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$54.08
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$54.08
|
| Rate for Payer: PHCS All Commercial |
$69.60
|
| Rate for Payer: PHCS All Commercial |
$69.60
|
| Rate for Payer: PHP All Commercial |
$94.02
|
| Rate for Payer: PHP All Commercial |
$94.02
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$69.60
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$69.60
|
| Rate for Payer: Sagamore Health Network All Products |
$69.60
|
| Rate for Payer: Sagamore Health Network All Products |
$69.60
|
| Rate for Payer: Signature Care EPO |
$208.25
|
| Rate for Payer: Signature Care EPO |
$208.25
|
| Rate for Payer: Signature Care PPO |
$208.25
|
| Rate for Payer: Signature Care PPO |
$208.25
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$8,300.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$8,300.00
|
| Rate for Payer: United Healthcare Commercial |
$159.40
|
| Rate for Payer: United Healthcare Commercial |
$159.40
|
| Rate for Payer: United Healthcare Medicare |
$129.80
|
| Rate for Payer: United Healthcare Medicare |
$129.80
|
|
|
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 |
$127.96
|
| Rate for Payer: Cash Price |
$130.62
|
| 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 Medicare |
$39.09
|
| Rate for Payer: Molina Healthcare of OH 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 |
$800.58
|
| Rate for Payer: Cash Price |
$788.00
|
| 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 |
$805.13
|
| Rate for Payer: Cash Price |
$793.22
|
| 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 |
$1,662.98
|
| Rate for Payer: Cash Price |
$1,634.49
|
| 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 |
$1,726.90
|
| Rate for Payer: Cash Price |
$1,697.66
|
| 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 |
$1,597.42
|
| Rate for Payer: Cash Price |
$1,568.70
|
| 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
|
|
