|
PR SHAV SKIN LES <0.5 CM FACE,FACIAL
|
Professional
|
Both
|
$215.14
|
|
|
Service Code
|
CPT 11310
|
| Hospital Charge Code |
z11310
|
| Min. Negotiated Rate |
$37.60 |
| Max. Negotiated Rate |
$106.63 |
| Rate for Payer: Aetna Commercial |
$42.84
|
| Rate for Payer: Aetna Commercial |
$42.84
|
| Rate for Payer: Aetna Medicare |
$42.84
|
| Rate for Payer: Aetna Medicare |
$42.84
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$37.60
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$37.60
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$105.82
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$105.82
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$49.27
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$49.27
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$47.12
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$47.12
|
| Rate for Payer: Cash Price |
$132.22
|
| Rate for Payer: Cash Price |
$133.39
|
| Rate for Payer: Centivo All Commercial |
$66.40
|
| Rate for Payer: Centivo All Commercial |
$66.40
|
| Rate for Payer: Cigna All Commercial |
$42.84
|
| Rate for Payer: Cigna All Commercial |
$42.84
|
| Rate for Payer: CORVEL All Commercial |
$42.84
|
| Rate for Payer: CORVEL All Commercial |
$42.84
|
| Rate for Payer: Coventry All Commercial |
$51.41
|
| Rate for Payer: Coventry All Commercial |
$51.41
|
| Rate for Payer: Encore All Commercial |
$42.84
|
| Rate for Payer: Encore All Commercial |
$42.84
|
| Rate for Payer: Frontpath All Commercial |
$58.49
|
| Rate for Payer: Frontpath All Commercial |
$58.49
|
| Rate for Payer: Humana ChoiceCare |
$39.31
|
| Rate for Payer: Humana ChoiceCare |
$39.31
|
| Rate for Payer: Humana Medicare |
$42.84
|
| Rate for Payer: Humana Medicare |
$42.84
|
| Rate for Payer: Lucent All Commercial |
$59.98
|
| Rate for Payer: Lucent All Commercial |
$59.98
|
| Rate for Payer: Managed Health Services Medicaid |
$105.82
|
| Rate for Payer: Managed Health Services Medicaid |
$105.82
|
| Rate for Payer: MDWise Medicaid |
$105.82
|
| Rate for Payer: MDWise Medicaid |
$105.82
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$37.60
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$37.60
|
| Rate for Payer: PHCS All Commercial |
$42.84
|
| Rate for Payer: PHCS All Commercial |
$42.84
|
| Rate for Payer: PHP All Commercial |
$58.62
|
| Rate for Payer: PHP All Commercial |
$58.62
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$42.84
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$42.84
|
| Rate for Payer: Sagamore Health Network All Products |
$42.84
|
| Rate for Payer: Sagamore Health Network All Products |
$42.84
|
| Rate for Payer: Signature Care EPO |
$93.59
|
| Rate for Payer: Signature Care EPO |
$93.59
|
| Rate for Payer: Signature Care PPO |
$93.59
|
| Rate for Payer: Signature Care PPO |
$93.59
|
| Rate for Payer: United Healthcare Commercial |
$47.65
|
| Rate for Payer: United Healthcare Commercial |
$47.65
|
| Rate for Payer: United Healthcare Medicare |
$106.63
|
| Rate for Payer: United Healthcare Medicare |
$106.63
|
|
|
PR SHAV SKIN LES <0.5 CM REMAINDER BODY
|
Professional
|
Both
|
$196.08
|
|
|
Service Code
|
CPT 11305
|
| Hospital Charge Code |
z11305
|
| Min. Negotiated Rate |
$30.62 |
| Max. Negotiated Rate |
$97.12 |
| Rate for Payer: Aetna Commercial |
$36.45
|
| Rate for Payer: Aetna Commercial |
$36.45
|
| Rate for Payer: Aetna Medicare |
$36.45
|
| Rate for Payer: Aetna Medicare |
$36.45
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$30.62
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$30.62
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$96.44
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$96.44
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$41.92
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$41.92
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$40.09
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$40.09
|
| Rate for Payer: Cash Price |
$120.43
|
| Rate for Payer: Cash Price |
$121.57
|
| Rate for Payer: Centivo All Commercial |
$56.50
|
| Rate for Payer: Centivo All Commercial |
$56.50
|
| Rate for Payer: Cigna All Commercial |
$36.45
|
| Rate for Payer: Cigna All Commercial |
$36.45
|
| Rate for Payer: CORVEL All Commercial |
$36.45
|
| Rate for Payer: CORVEL All Commercial |
$36.45
|
| Rate for Payer: Coventry All Commercial |
$43.74
|
| Rate for Payer: Coventry All Commercial |
$43.74
|
| Rate for Payer: Encore All Commercial |
$36.45
|
| Rate for Payer: Encore All Commercial |
$36.45
|
| Rate for Payer: Frontpath All Commercial |
$49.79
|
| Rate for Payer: Frontpath All Commercial |
$49.79
|
| Rate for Payer: Humana ChoiceCare |
$35.82
|
| Rate for Payer: Humana ChoiceCare |
$35.82
|
| Rate for Payer: Humana Medicare |
$36.45
|
| Rate for Payer: Humana Medicare |
$36.45
|
| Rate for Payer: Lucent All Commercial |
$51.03
|
| Rate for Payer: Lucent All Commercial |
$51.03
|
| Rate for Payer: Managed Health Services Medicaid |
$96.44
|
| Rate for Payer: Managed Health Services Medicaid |
$96.44
|
| Rate for Payer: MDWise Medicaid |
$96.44
|
| Rate for Payer: MDWise Medicaid |
$96.44
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$30.62
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$30.62
|
| Rate for Payer: PHCS All Commercial |
$36.45
|
| Rate for Payer: PHCS All Commercial |
$36.45
|
| Rate for Payer: PHP All Commercial |
$48.69
|
| Rate for Payer: PHP All Commercial |
$48.69
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$36.45
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$36.45
|
| Rate for Payer: Sagamore Health Network All Products |
$36.45
|
| Rate for Payer: Sagamore Health Network All Products |
$36.45
|
| Rate for Payer: Signature Care EPO |
$86.31
|
| Rate for Payer: Signature Care EPO |
$86.31
|
| Rate for Payer: Signature Care PPO |
$86.31
|
| Rate for Payer: Signature Care PPO |
$86.31
|
| Rate for Payer: United Healthcare Commercial |
$41.61
|
| Rate for Payer: United Healthcare Commercial |
$41.61
|
| Rate for Payer: United Healthcare Medicare |
$97.12
|
| Rate for Payer: United Healthcare Medicare |
$97.12
|
|
|
PR SHAV SKIN LES < 0.5 CM TRUNK,ARM,LEG
|
Professional
|
Both
|
$186.46
|
|
|
Service Code
|
CPT 11300
|
| Hospital Charge Code |
z11300
|
| Min. Negotiated Rate |
$27.03 |
| Max. Negotiated Rate |
$92.62 |
| Rate for Payer: Aetna Commercial |
$32.17
|
| Rate for Payer: Aetna Commercial |
$32.17
|
| Rate for Payer: Aetna Medicare |
$32.17
|
| Rate for Payer: Aetna Medicare |
$32.17
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$27.86
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$27.86
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$91.71
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$91.71
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$37.00
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$37.00
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$35.39
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$35.39
|
| Rate for Payer: Cash Price |
$114.85
|
| Rate for Payer: Cash Price |
$115.61
|
| Rate for Payer: Centivo All Commercial |
$49.86
|
| Rate for Payer: Centivo All Commercial |
$49.86
|
| Rate for Payer: Cigna All Commercial |
$32.17
|
| Rate for Payer: Cigna All Commercial |
$32.17
|
| Rate for Payer: CORVEL All Commercial |
$32.17
|
| Rate for Payer: CORVEL All Commercial |
$32.17
|
| Rate for Payer: Coventry All Commercial |
$38.60
|
| Rate for Payer: Coventry All Commercial |
$38.60
|
| Rate for Payer: Encore All Commercial |
$32.17
|
| Rate for Payer: Encore All Commercial |
$32.17
|
| Rate for Payer: Frontpath All Commercial |
$43.99
|
| Rate for Payer: Frontpath All Commercial |
$43.99
|
| Rate for Payer: Humana ChoiceCare |
$27.03
|
| Rate for Payer: Humana ChoiceCare |
$27.03
|
| Rate for Payer: Humana Medicare |
$32.17
|
| Rate for Payer: Humana Medicare |
$32.17
|
| Rate for Payer: Lucent All Commercial |
$45.04
|
| Rate for Payer: Lucent All Commercial |
$45.04
|
| Rate for Payer: Managed Health Services Medicaid |
$91.71
|
| Rate for Payer: Managed Health Services Medicaid |
$91.71
|
| Rate for Payer: MDWise Medicaid |
$91.71
|
| Rate for Payer: MDWise Medicaid |
$91.71
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$27.86
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$27.86
|
| Rate for Payer: PHCS All Commercial |
$32.17
|
| Rate for Payer: PHCS All Commercial |
$32.17
|
| Rate for Payer: PHP All Commercial |
$43.65
|
| Rate for Payer: PHP All Commercial |
$43.65
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$32.17
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$32.17
|
| Rate for Payer: Sagamore Health Network All Products |
$32.17
|
| Rate for Payer: Sagamore Health Network All Products |
$32.17
|
| Rate for Payer: Signature Care EPO |
$81.88
|
| Rate for Payer: Signature Care EPO |
$81.88
|
| Rate for Payer: Signature Care PPO |
$81.88
|
| Rate for Payer: Signature Care PPO |
$81.88
|
| Rate for Payer: United Healthcare Commercial |
$32.91
|
| Rate for Payer: United Healthcare Commercial |
$32.91
|
| Rate for Payer: United Healthcare Medicare |
$92.62
|
| Rate for Payer: United Healthcare Medicare |
$92.62
|
|
|
PR SHAV SKIN LES 0.6-1.0 CM REMAINDER BODY
|
Professional
|
Both
|
$217.90
|
|
|
Service Code
|
CPT 11306
|
| Hospital Charge Code |
z11306
|
| Min. Negotiated Rate |
$38.69 |
| Max. Negotiated Rate |
$112.82 |
| Rate for Payer: Aetna Commercial |
$46.82
|
| Rate for Payer: Aetna Medicare |
$46.82
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$38.69
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$112.26
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$53.84
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$51.50
|
| Rate for Payer: Cash Price |
$135.10
|
| Rate for Payer: Centivo All Commercial |
$72.57
|
| Rate for Payer: Cigna All Commercial |
$46.82
|
| Rate for Payer: CORVEL All Commercial |
$46.82
|
| Rate for Payer: Coventry All Commercial |
$56.18
|
| Rate for Payer: Encore All Commercial |
$46.82
|
| Rate for Payer: Frontpath All Commercial |
$63.64
|
| Rate for Payer: Humana ChoiceCare |
$53.10
|
| Rate for Payer: Humana Medicare |
$46.82
|
| Rate for Payer: Lucent All Commercial |
$65.55
|
| Rate for Payer: Managed Health Services Medicaid |
$112.26
|
| Rate for Payer: MDWise Medicaid |
$112.26
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$38.69
|
| Rate for Payer: PHCS All Commercial |
$46.82
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$46.82
|
| Rate for Payer: Sagamore Health Network All Products |
$46.82
|
| Rate for Payer: United Healthcare Commercial |
$63.08
|
| Rate for Payer: United Healthcare Medicare |
$112.82
|
|
|
PR SHAV SKIN LES 0.6-1.0 CM TRUNK,ARM,LEG
|
Professional
|
Both
|
$225.80
|
|
|
Service Code
|
CPT 11301
|
| Hospital Charge Code |
z11301
|
| Min. Negotiated Rate |
$34.73 |
| Max. Negotiated Rate |
$5,800.00 |
| Rate for Payer: Aetna Commercial |
$48.17
|
| Rate for Payer: Aetna Commercial |
$48.17
|
| Rate for Payer: Aetna Medicare |
$48.17
|
| Rate for Payer: Aetna Medicare |
$48.17
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$92.12
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$92.12
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$92.12
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$92.12
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$92.12
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$92.12
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$92.12
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$92.12
|
| 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 |
$111.06
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$111.06
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$55.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$55.40
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$52.99
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$52.99
|
| Rate for Payer: Cash Price |
$138.56
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Centivo All Commercial |
$74.66
|
| Rate for Payer: Centivo All Commercial |
$74.66
|
| Rate for Payer: Cigna All Commercial |
$48.17
|
| Rate for Payer: Cigna All Commercial |
$48.17
|
| Rate for Payer: CORVEL All Commercial |
$48.17
|
| Rate for Payer: CORVEL All Commercial |
$48.17
|
| Rate for Payer: Coventry All Commercial |
$57.80
|
| Rate for Payer: Coventry All Commercial |
$57.80
|
| Rate for Payer: Encore All Commercial |
$48.17
|
| Rate for Payer: Encore All Commercial |
$48.17
|
| Rate for Payer: Frontpath All Commercial |
$65.46
|
| Rate for Payer: Frontpath All Commercial |
$65.46
|
| Rate for Payer: Humana ChoiceCare |
$45.92
|
| Rate for Payer: Humana ChoiceCare |
$45.92
|
| Rate for Payer: Humana Medicare |
$48.17
|
| Rate for Payer: Humana Medicare |
$48.17
|
| Rate for Payer: Lucent All Commercial |
$67.44
|
| Rate for Payer: Lucent All Commercial |
$67.44
|
| Rate for Payer: Lutheran Preferred All Commercial |
$63.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$63.00
|
| Rate for Payer: Managed Health Services Medicaid |
$111.06
|
| Rate for Payer: Managed Health Services Medicaid |
$111.06
|
| Rate for Payer: MDWise Medicaid |
$111.06
|
| Rate for Payer: MDWise Medicaid |
$111.06
|
| 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 |
$48.17
|
| Rate for Payer: PHCS All Commercial |
$48.17
|
| Rate for Payer: PHP All Commercial |
$65.78
|
| Rate for Payer: PHP All Commercial |
$65.78
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$48.17
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$48.17
|
| Rate for Payer: Sagamore Health Network All Products |
$48.17
|
| Rate for Payer: Sagamore Health Network All Products |
$48.17
|
| Rate for Payer: Signature Care EPO |
$98.39
|
| Rate for Payer: Signature Care EPO |
$98.39
|
| Rate for Payer: Signature Care PPO |
$98.39
|
| Rate for Payer: Signature Care PPO |
$98.39
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5,800.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5,800.00
|
| Rate for Payer: United Healthcare Commercial |
$55.95
|
| Rate for Payer: United Healthcare Commercial |
$55.95
|
| Rate for Payer: United Healthcare Medicare |
$111.74
|
| Rate for Payer: United Healthcare Medicare |
$111.74
|
|
|
PR SHAV SKIN LES 1.1-2.0 CM FACE,FACIAL
|
Professional
|
Both
|
$278.00
|
|
|
Service Code
|
CPT 11312
|
| Hospital Charge Code |
z11312
|
| Min. Negotiated Rate |
$49.48 |
| Max. Negotiated Rate |
$143.23 |
| Rate for Payer: Aetna Commercial |
$69.66
|
| Rate for Payer: Aetna Medicare |
$69.66
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$49.48
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$142.30
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$80.11
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$76.63
|
| Rate for Payer: Cash Price |
$172.36
|
| Rate for Payer: Centivo All Commercial |
$107.97
|
| Rate for Payer: Cigna All Commercial |
$69.66
|
| Rate for Payer: CORVEL All Commercial |
$69.66
|
| Rate for Payer: Coventry All Commercial |
$83.59
|
| Rate for Payer: Encore All Commercial |
$69.66
|
| Rate for Payer: Frontpath All Commercial |
$94.38
|
| Rate for Payer: Humana ChoiceCare |
$65.35
|
| Rate for Payer: Humana Medicare |
$69.66
|
| Rate for Payer: Lucent All Commercial |
$97.52
|
| Rate for Payer: Managed Health Services Medicaid |
$142.30
|
| Rate for Payer: MDWise Medicaid |
$142.30
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$49.48
|
| Rate for Payer: PHCS All Commercial |
$69.66
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$69.66
|
| Rate for Payer: Sagamore Health Network All Products |
$69.66
|
| Rate for Payer: United Healthcare Commercial |
$80.14
|
| Rate for Payer: United Healthcare Medicare |
$143.23
|
|
|
PR SHAV SKIN LES 1.1-2.0 CM REMAINDER BODY
|
Professional
|
Both
|
$256.00
|
|
|
Service Code
|
CPT 11307
|
| Hospital Charge Code |
z11307
|
| Min. Negotiated Rate |
$45.31 |
| Max. Negotiated Rate |
$128.00 |
| Rate for Payer: Aetna Commercial |
$59.80
|
| Rate for Payer: Aetna Commercial |
$59.80
|
| Rate for Payer: Aetna Medicare |
$59.80
|
| Rate for Payer: Aetna Medicare |
$59.80
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$45.31
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$45.31
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$126.94
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$126.94
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$68.77
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$68.77
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$65.78
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$65.78
|
| Rate for Payer: Cash Price |
$160.01
|
| Rate for Payer: Cash Price |
$158.72
|
| Rate for Payer: Centivo All Commercial |
$92.69
|
| Rate for Payer: Centivo All Commercial |
$92.69
|
| Rate for Payer: Cigna All Commercial |
$59.80
|
| Rate for Payer: Cigna All Commercial |
$59.80
|
| Rate for Payer: CORVEL All Commercial |
$59.80
|
| Rate for Payer: CORVEL All Commercial |
$59.80
|
| Rate for Payer: Coventry All Commercial |
$71.76
|
| Rate for Payer: Coventry All Commercial |
$71.76
|
| Rate for Payer: Encore All Commercial |
$59.80
|
| Rate for Payer: Encore All Commercial |
$59.80
|
| Rate for Payer: Frontpath All Commercial |
$81.17
|
| Rate for Payer: Frontpath All Commercial |
$81.17
|
| Rate for Payer: Humana ChoiceCare |
$61.18
|
| Rate for Payer: Humana ChoiceCare |
$61.18
|
| Rate for Payer: Humana Medicare |
$59.80
|
| Rate for Payer: Humana Medicare |
$59.80
|
| Rate for Payer: Lucent All Commercial |
$83.72
|
| Rate for Payer: Lucent All Commercial |
$83.72
|
| Rate for Payer: Managed Health Services Medicaid |
$126.94
|
| Rate for Payer: Managed Health Services Medicaid |
$126.94
|
| Rate for Payer: MDWise Medicaid |
$126.94
|
| Rate for Payer: MDWise Medicaid |
$126.94
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$45.31
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$45.31
|
| Rate for Payer: PHCS All Commercial |
$59.80
|
| Rate for Payer: PHCS All Commercial |
$59.80
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$59.80
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$59.80
|
| Rate for Payer: Sagamore Health Network All Products |
$59.80
|
| Rate for Payer: Sagamore Health Network All Products |
$59.80
|
| Rate for Payer: United Healthcare Commercial |
$74.39
|
| Rate for Payer: United Healthcare Commercial |
$74.39
|
| Rate for Payer: United Healthcare Medicare |
$128.00
|
| Rate for Payer: United Healthcare Medicare |
$128.00
|
|
|
PR SHAV SKIN LES 1.1-2.0 CM TRUNK,ARM,LEG
|
Professional
|
Both
|
$255.14
|
|
|
Service Code
|
CPT 11302
|
| Hospital Charge Code |
z11302
|
| Min. Negotiated Rate |
$42.62 |
| Max. Negotiated Rate |
$125.89 |
| Rate for Payer: Aetna Commercial |
$56.48
|
| Rate for Payer: Aetna Commercial |
$56.48
|
| Rate for Payer: Aetna Medicare |
$56.48
|
| Rate for Payer: Aetna Medicare |
$56.48
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$42.62
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$42.62
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$125.49
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$125.49
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$64.95
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$64.95
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$62.13
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$62.13
|
| Rate for Payer: Cash Price |
$156.10
|
| Rate for Payer: Cash Price |
$158.19
|
| Rate for Payer: Centivo All Commercial |
$87.54
|
| Rate for Payer: Centivo All Commercial |
$87.54
|
| Rate for Payer: Cigna All Commercial |
$56.48
|
| Rate for Payer: Cigna All Commercial |
$56.48
|
| Rate for Payer: CORVEL All Commercial |
$56.48
|
| Rate for Payer: CORVEL All Commercial |
$56.48
|
| Rate for Payer: Coventry All Commercial |
$67.78
|
| Rate for Payer: Coventry All Commercial |
$67.78
|
| Rate for Payer: Encore All Commercial |
$56.48
|
| Rate for Payer: Encore All Commercial |
$56.48
|
| Rate for Payer: Frontpath All Commercial |
$76.88
|
| Rate for Payer: Frontpath All Commercial |
$76.88
|
| Rate for Payer: Humana ChoiceCare |
$56.41
|
| Rate for Payer: Humana ChoiceCare |
$56.41
|
| Rate for Payer: Humana Medicare |
$56.48
|
| Rate for Payer: Humana Medicare |
$56.48
|
| Rate for Payer: Lucent All Commercial |
$79.07
|
| Rate for Payer: Lucent All Commercial |
$79.07
|
| Rate for Payer: Managed Health Services Medicaid |
$125.49
|
| Rate for Payer: Managed Health Services Medicaid |
$125.49
|
| Rate for Payer: MDWise Medicaid |
$125.49
|
| Rate for Payer: MDWise Medicaid |
$125.49
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$42.62
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$42.62
|
| Rate for Payer: PHCS All Commercial |
$56.48
|
| Rate for Payer: PHCS All Commercial |
$56.48
|
| Rate for Payer: PHP All Commercial |
$76.74
|
| Rate for Payer: PHP All Commercial |
$76.74
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$56.48
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$56.48
|
| Rate for Payer: Sagamore Health Network All Products |
$56.48
|
| Rate for Payer: Sagamore Health Network All Products |
$56.48
|
| Rate for Payer: Signature Care EPO |
$111.28
|
| Rate for Payer: Signature Care EPO |
$111.28
|
| Rate for Payer: Signature Care PPO |
$111.28
|
| Rate for Payer: Signature Care PPO |
$111.28
|
| Rate for Payer: United Healthcare Commercial |
$69.38
|
| Rate for Payer: United Healthcare Commercial |
$69.38
|
| Rate for Payer: United Healthcare Medicare |
$125.89
|
| Rate for Payer: United Healthcare Medicare |
$125.89
|
|
|
PR SHLDR ARTHROSCOP,PART ACROMIOPLAS
|
Professional
|
Both
|
$311.76
|
|
|
Service Code
|
CPT 29826
|
| Hospital Charge Code |
z29826
|
| Min. Negotiated Rate |
$153.33 |
| Max. Negotiated Rate |
$23,700.00 |
| Rate for Payer: Aetna Commercial |
$160.19
|
| Rate for Payer: Aetna Commercial |
$160.19
|
| Rate for Payer: Aetna Medicare |
$160.19
|
| Rate for Payer: Aetna Medicare |
$160.19
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$940.30
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$940.30
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$940.30
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$940.30
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$940.30
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$940.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$940.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$940.30
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$153.33
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$153.33
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$184.22
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$184.22
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$176.21
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$176.21
|
| Rate for Payer: Cash Price |
$193.29
|
| Rate for Payer: Cash Price |
$191.42
|
| Rate for Payer: Centivo All Commercial |
$248.29
|
| Rate for Payer: Centivo All Commercial |
$248.29
|
| Rate for Payer: Cigna All Commercial |
$160.19
|
| Rate for Payer: Cigna All Commercial |
$160.19
|
| Rate for Payer: CORVEL All Commercial |
$160.19
|
| Rate for Payer: CORVEL All Commercial |
$160.19
|
| Rate for Payer: Coventry All Commercial |
$192.23
|
| Rate for Payer: Coventry All Commercial |
$192.23
|
| Rate for Payer: Encore All Commercial |
$160.19
|
| Rate for Payer: Encore All Commercial |
$160.19
|
| Rate for Payer: Frontpath All Commercial |
$226.11
|
| Rate for Payer: Frontpath All Commercial |
$226.11
|
| Rate for Payer: Humana ChoiceCare |
$720.18
|
| Rate for Payer: Humana ChoiceCare |
$720.18
|
| Rate for Payer: Humana Medicare |
$160.19
|
| Rate for Payer: Humana Medicare |
$160.19
|
| Rate for Payer: Lucent All Commercial |
$224.27
|
| Rate for Payer: Lucent All Commercial |
$224.27
|
| Rate for Payer: Lutheran Preferred All Commercial |
$253.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$253.00
|
| Rate for Payer: Managed Health Services Medicaid |
$153.33
|
| Rate for Payer: Managed Health Services Medicaid |
$153.33
|
| Rate for Payer: MDWise Medicaid |
$153.33
|
| Rate for Payer: MDWise Medicaid |
$153.33
|
| Rate for Payer: PHCS All Commercial |
$160.19
|
| Rate for Payer: PHCS All Commercial |
$160.19
|
| Rate for Payer: PHP All Commercial |
$268.61
|
| Rate for Payer: PHP All Commercial |
$268.61
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$160.19
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$160.19
|
| Rate for Payer: Sagamore Health Network All Products |
$160.19
|
| Rate for Payer: Sagamore Health Network All Products |
$160.19
|
| Rate for Payer: Signature Care EPO |
$272.32
|
| Rate for Payer: Signature Care EPO |
$272.32
|
| Rate for Payer: Signature Care PPO |
$272.32
|
| Rate for Payer: Signature Care PPO |
$272.32
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$23,700.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$23,700.00
|
| Rate for Payer: United Healthcare Commercial |
$725.91
|
| Rate for Payer: United Healthcare Commercial |
$725.91
|
| Rate for Payer: United Healthcare Medicare |
$154.37
|
| Rate for Payer: United Healthcare Medicare |
$154.37
|
|
|
PR SHLDR ARTHROSCOP,SURG,CAPSULORRHAPHY
|
Professional
|
Both
|
$1,956.22
|
|
|
Service Code
|
CPT 29806
|
| Hospital Charge Code |
z29806
|
| Min. Negotiated Rate |
$957.82 |
| Max. Negotiated Rate |
$147,300.00 |
| Rate for Payer: Aetna Commercial |
$986.15
|
| Rate for Payer: Aetna Commercial |
$986.15
|
| Rate for Payer: Aetna Medicare |
$986.15
|
| Rate for Payer: Aetna Medicare |
$986.15
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$1,299.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$1,299.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,299.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,299.60
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,299.60
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,299.60
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,299.60
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,299.60
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$962.14
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$962.14
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,134.07
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,134.07
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,084.77
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,084.77
|
| Rate for Payer: Cash Price |
$1,212.86
|
| Rate for Payer: Cash Price |
$1,187.70
|
| Rate for Payer: Centivo All Commercial |
$1,528.53
|
| Rate for Payer: Centivo All Commercial |
$1,528.53
|
| Rate for Payer: Cigna All Commercial |
$986.15
|
| Rate for Payer: Cigna All Commercial |
$986.15
|
| Rate for Payer: CORVEL All Commercial |
$986.15
|
| Rate for Payer: CORVEL All Commercial |
$986.15
|
| Rate for Payer: Coventry All Commercial |
$1,183.38
|
| Rate for Payer: Coventry All Commercial |
$1,183.38
|
| Rate for Payer: Encore All Commercial |
$986.15
|
| Rate for Payer: Encore All Commercial |
$986.15
|
| Rate for Payer: Frontpath All Commercial |
$1,375.22
|
| Rate for Payer: Frontpath All Commercial |
$1,375.22
|
| Rate for Payer: Humana ChoiceCare |
$1,116.50
|
| Rate for Payer: Humana ChoiceCare |
$1,116.50
|
| Rate for Payer: Humana Medicare |
$986.15
|
| Rate for Payer: Humana Medicare |
$986.15
|
| Rate for Payer: Lucent All Commercial |
$1,380.61
|
| Rate for Payer: Lucent All Commercial |
$1,380.61
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,571.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,571.00
|
| Rate for Payer: Managed Health Services Medicaid |
$962.14
|
| Rate for Payer: Managed Health Services Medicaid |
$962.14
|
| Rate for Payer: MDWise Medicaid |
$962.14
|
| Rate for Payer: MDWise Medicaid |
$962.14
|
| Rate for Payer: PHCS All Commercial |
$986.15
|
| Rate for Payer: PHCS All Commercial |
$986.15
|
| Rate for Payer: PHP All Commercial |
$1,666.61
|
| Rate for Payer: PHP All Commercial |
$1,666.61
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$986.15
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$986.15
|
| Rate for Payer: Sagamore Health Network All Products |
$986.15
|
| Rate for Payer: Sagamore Health Network All Products |
$986.15
|
| Rate for Payer: Signature Care EPO |
$1,483.25
|
| Rate for Payer: Signature Care EPO |
$1,483.25
|
| Rate for Payer: Signature Care PPO |
$1,483.25
|
| Rate for Payer: Signature Care PPO |
$1,483.25
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$147,300.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$147,300.00
|
| Rate for Payer: United Healthcare Commercial |
$1,159.10
|
| Rate for Payer: United Healthcare Commercial |
$1,159.10
|
| Rate for Payer: United Healthcare Medicare |
$957.82
|
| Rate for Payer: United Healthcare Medicare |
$957.82
|
|
|
PR SHLDR ARTHROSCOP,SURG,DIS CLAVICULECTOMY
|
Professional
|
Both
|
$1,259.00
|
|
|
Service Code
|
CPT 29824
|
| Hospital Charge Code |
z29824
|
| Min. Negotiated Rate |
$616.36 |
| Max. Negotiated Rate |
$94,800.00 |
| Rate for Payer: Aetna Commercial |
$631.86
|
| Rate for Payer: Aetna Commercial |
$631.86
|
| Rate for Payer: Aetna Medicare |
$631.86
|
| Rate for Payer: Aetna Medicare |
$631.86
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$792.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$792.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$792.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$792.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$792.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$792.10
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$792.10
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$792.10
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$619.22
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$619.22
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$726.64
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$726.64
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$695.05
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$695.05
|
| Rate for Payer: Cash Price |
$780.58
|
| Rate for Payer: Cash Price |
$764.29
|
| Rate for Payer: Centivo All Commercial |
$979.38
|
| Rate for Payer: Centivo All Commercial |
$979.38
|
| Rate for Payer: Cigna All Commercial |
$631.86
|
| Rate for Payer: Cigna All Commercial |
$631.86
|
| Rate for Payer: CORVEL All Commercial |
$631.86
|
| Rate for Payer: CORVEL All Commercial |
$631.86
|
| Rate for Payer: Coventry All Commercial |
$758.23
|
| Rate for Payer: Coventry All Commercial |
$758.23
|
| Rate for Payer: Encore All Commercial |
$631.86
|
| Rate for Payer: Encore All Commercial |
$631.86
|
| Rate for Payer: Frontpath All Commercial |
$877.28
|
| Rate for Payer: Frontpath All Commercial |
$877.28
|
| Rate for Payer: Humana ChoiceCare |
$685.41
|
| Rate for Payer: Humana ChoiceCare |
$685.41
|
| Rate for Payer: Humana Medicare |
$631.86
|
| Rate for Payer: Humana Medicare |
$631.86
|
| Rate for Payer: Lucent All Commercial |
$884.60
|
| Rate for Payer: Lucent All Commercial |
$884.60
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,011.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,011.00
|
| Rate for Payer: Managed Health Services Medicaid |
$619.22
|
| Rate for Payer: Managed Health Services Medicaid |
$619.22
|
| Rate for Payer: MDWise Medicaid |
$619.22
|
| Rate for Payer: MDWise Medicaid |
$619.22
|
| Rate for Payer: PHCS All Commercial |
$631.86
|
| Rate for Payer: PHCS All Commercial |
$631.86
|
| Rate for Payer: PHP All Commercial |
$1,072.46
|
| Rate for Payer: PHP All Commercial |
$1,072.46
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$631.86
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$631.86
|
| Rate for Payer: Sagamore Health Network All Products |
$631.86
|
| Rate for Payer: Sagamore Health Network All Products |
$631.86
|
| Rate for Payer: Signature Care EPO |
$907.80
|
| Rate for Payer: Signature Care EPO |
$907.80
|
| Rate for Payer: Signature Care PPO |
$907.80
|
| Rate for Payer: Signature Care PPO |
$907.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$94,800.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$94,800.00
|
| Rate for Payer: United Healthcare Commercial |
$722.38
|
| Rate for Payer: United Healthcare Commercial |
$722.38
|
| Rate for Payer: United Healthcare Medicare |
$616.36
|
| Rate for Payer: United Healthcare Medicare |
$616.36
|
|
|
PR SHLDR ARTHROSCOP,SURG,REPAIR,SLAP LESION
|
Professional
|
Both
|
$1,910.36
|
|
|
Service Code
|
CPT 29807
|
| Hospital Charge Code |
z29807
|
| Min. Negotiated Rate |
$936.80 |
| Max. Negotiated Rate |
$144,100.00 |
| Rate for Payer: Aetna Commercial |
$962.05
|
| Rate for Payer: Aetna Commercial |
$962.05
|
| Rate for Payer: Aetna Medicare |
$962.05
|
| Rate for Payer: Aetna Medicare |
$962.05
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$1,264.90
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$1,264.90
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,264.90
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,264.90
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,264.90
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,264.90
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,264.90
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,264.90
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$939.59
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$939.59
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,106.36
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,106.36
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,058.26
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,058.26
|
| Rate for Payer: Cash Price |
$1,184.42
|
| Rate for Payer: Cash Price |
$1,161.63
|
| Rate for Payer: Centivo All Commercial |
$1,491.18
|
| Rate for Payer: Centivo All Commercial |
$1,491.18
|
| Rate for Payer: Cigna All Commercial |
$962.05
|
| Rate for Payer: Cigna All Commercial |
$962.05
|
| Rate for Payer: CORVEL All Commercial |
$962.05
|
| Rate for Payer: CORVEL All Commercial |
$962.05
|
| Rate for Payer: Coventry All Commercial |
$1,154.46
|
| Rate for Payer: Coventry All Commercial |
$1,154.46
|
| Rate for Payer: Encore All Commercial |
$962.05
|
| Rate for Payer: Encore All Commercial |
$962.05
|
| Rate for Payer: Frontpath All Commercial |
$1,340.94
|
| Rate for Payer: Frontpath All Commercial |
$1,340.94
|
| Rate for Payer: Humana ChoiceCare |
$1,087.73
|
| Rate for Payer: Humana ChoiceCare |
$1,087.73
|
| Rate for Payer: Humana Medicare |
$962.05
|
| Rate for Payer: Humana Medicare |
$962.05
|
| Rate for Payer: Lucent All Commercial |
$1,346.87
|
| Rate for Payer: Lucent All Commercial |
$1,346.87
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,537.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,537.00
|
| Rate for Payer: Managed Health Services Medicaid |
$939.59
|
| Rate for Payer: Managed Health Services Medicaid |
$939.59
|
| Rate for Payer: MDWise Medicaid |
$939.59
|
| Rate for Payer: MDWise Medicaid |
$939.59
|
| Rate for Payer: PHCS All Commercial |
$962.05
|
| Rate for Payer: PHCS All Commercial |
$962.05
|
| Rate for Payer: PHP All Commercial |
$1,630.03
|
| Rate for Payer: PHP All Commercial |
$1,630.03
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$962.05
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$962.05
|
| Rate for Payer: Sagamore Health Network All Products |
$962.05
|
| Rate for Payer: Sagamore Health Network All Products |
$962.05
|
| Rate for Payer: Signature Care EPO |
$1,445.85
|
| Rate for Payer: Signature Care EPO |
$1,445.85
|
| Rate for Payer: Signature Care PPO |
$1,445.85
|
| Rate for Payer: Signature Care PPO |
$1,445.85
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$144,100.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$144,100.00
|
| Rate for Payer: United Healthcare Commercial |
$1,128.71
|
| Rate for Payer: United Healthcare Commercial |
$1,128.71
|
| Rate for Payer: United Healthcare Medicare |
$936.80
|
| Rate for Payer: United Healthcare Medicare |
$936.80
|
|
|
PR SHLDR ARTHROSCOP,SURG,W/ROTAT CUFF REPR
|
Professional
|
Both
|
$1,971.82
|
|
|
Service Code
|
CPT 29827
|
| Hospital Charge Code |
z29827
|
| Min. Negotiated Rate |
$967.78 |
| Max. Negotiated Rate |
$148,800.00 |
| Rate for Payer: Aetna Commercial |
$995.51
|
| Rate for Payer: Aetna Commercial |
$995.51
|
| Rate for Payer: Aetna Medicare |
$995.51
|
| Rate for Payer: Aetna Medicare |
$995.51
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$1,294.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$1,294.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,294.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,294.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,294.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,294.10
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,294.10
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,294.10
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$969.82
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$969.82
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,144.84
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,144.84
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,095.06
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,095.06
|
| Rate for Payer: Cash Price |
$1,222.53
|
| Rate for Payer: Cash Price |
$1,200.05
|
| Rate for Payer: Centivo All Commercial |
$1,543.04
|
| Rate for Payer: Centivo All Commercial |
$1,543.04
|
| Rate for Payer: Cigna All Commercial |
$995.51
|
| Rate for Payer: Cigna All Commercial |
$995.51
|
| Rate for Payer: CORVEL All Commercial |
$995.51
|
| Rate for Payer: CORVEL All Commercial |
$995.51
|
| Rate for Payer: Coventry All Commercial |
$1,194.61
|
| Rate for Payer: Coventry All Commercial |
$1,194.61
|
| Rate for Payer: Encore All Commercial |
$995.51
|
| Rate for Payer: Encore All Commercial |
$995.51
|
| Rate for Payer: Frontpath All Commercial |
$1,388.40
|
| Rate for Payer: Frontpath All Commercial |
$1,388.40
|
| Rate for Payer: Humana ChoiceCare |
$1,177.59
|
| Rate for Payer: Humana ChoiceCare |
$1,177.59
|
| Rate for Payer: Humana Medicare |
$995.51
|
| Rate for Payer: Humana Medicare |
$995.51
|
| Rate for Payer: Lucent All Commercial |
$1,393.71
|
| Rate for Payer: Lucent All Commercial |
$1,393.71
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,587.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,587.00
|
| Rate for Payer: Managed Health Services Medicaid |
$969.82
|
| Rate for Payer: Managed Health Services Medicaid |
$969.82
|
| Rate for Payer: MDWise Medicaid |
$969.82
|
| Rate for Payer: MDWise Medicaid |
$969.82
|
| Rate for Payer: PHCS All Commercial |
$995.51
|
| Rate for Payer: PHCS All Commercial |
$995.51
|
| Rate for Payer: PHP All Commercial |
$1,683.93
|
| Rate for Payer: PHP All Commercial |
$1,683.93
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$995.51
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$995.51
|
| Rate for Payer: Sagamore Health Network All Products |
$995.51
|
| Rate for Payer: Sagamore Health Network All Products |
$995.51
|
| Rate for Payer: Signature Care EPO |
$1,557.20
|
| Rate for Payer: Signature Care EPO |
$1,557.20
|
| Rate for Payer: Signature Care PPO |
$1,557.20
|
| Rate for Payer: Signature Care PPO |
$1,557.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$148,800.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$148,800.00
|
| Rate for Payer: United Healthcare Commercial |
$1,188.68
|
| Rate for Payer: United Healthcare Commercial |
$1,188.68
|
| Rate for Payer: United Healthcare Medicare |
$967.78
|
| Rate for Payer: United Healthcare Medicare |
$967.78
|
|
|
PR SHORT ARM CAST, ADULT
|
Professional
|
Both
|
$36.92
|
|
|
Service Code
|
CPT Q4050
|
| Hospital Charge Code |
zQ4050C
|
| Min. Negotiated Rate |
$25.11 |
| Max. Negotiated Rate |
$25.11 |
| Rate for Payer: Cash Price |
$22.89
|
| Rate for Payer: Signature Care EPO |
$25.11
|
| Rate for Payer: Signature Care PPO |
$25.11
|
|
|
PR SHORT ARM CAST, PEDIATRIC
|
Professional
|
Both
|
$18.36
|
|
|
Service Code
|
CPT Q4050
|
| Hospital Charge Code |
zQ4050D
|
| Min. Negotiated Rate |
$12.48 |
| Max. Negotiated Rate |
$12.48 |
| Rate for Payer: Cash Price |
$11.38
|
| Rate for Payer: Signature Care EPO |
$12.48
|
| Rate for Payer: Signature Care PPO |
$12.48
|
|
|
PR SHORT LEG CAST, ADULT
|
Professional
|
Both
|
$40.92
|
|
|
Service Code
|
CPT Q4050
|
| Hospital Charge Code |
zQ4050G
|
| Min. Negotiated Rate |
$27.83 |
| Max. Negotiated Rate |
$27.83 |
| Rate for Payer: Cash Price |
$25.37
|
| Rate for Payer: Signature Care EPO |
$27.83
|
| Rate for Payer: Signature Care PPO |
$27.83
|
|
|
PR SHORT LEG CAST, PEDIATRIC
|
Professional
|
Both
|
$36.92
|
|
|
Service Code
|
CPT Q4050
|
| Hospital Charge Code |
zQ4050H
|
| Min. Negotiated Rate |
$25.11 |
| Max. Negotiated Rate |
$25.11 |
| Rate for Payer: Cash Price |
$22.89
|
| Rate for Payer: Signature Care EPO |
$25.11
|
| Rate for Payer: Signature Care PPO |
$25.11
|
|
|
PR SIGMOIDOSCOPY,BIOPSY
|
Professional
|
Both
|
$528.22
|
|
|
Service Code
|
CPT 45331
|
| Hospital Charge Code |
z45331
|
| Min. Negotiated Rate |
$63.50 |
| Max. Negotiated Rate |
$9,400.00 |
| Rate for Payer: Aetna Commercial |
$67.23
|
| Rate for Payer: Aetna Commercial |
$67.23
|
| Rate for Payer: Aetna Medicare |
$67.23
|
| Rate for Payer: Aetna Medicare |
$67.23
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$151.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$151.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$151.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$151.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$151.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$151.50
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$151.50
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$151.50
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$63.50
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$63.50
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$259.80
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$259.80
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$77.31
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$77.31
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$73.95
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$73.95
|
| Rate for Payer: Cash Price |
$323.96
|
| Rate for Payer: Cash Price |
$327.50
|
| Rate for Payer: Centivo All Commercial |
$104.21
|
| Rate for Payer: Centivo All Commercial |
$104.21
|
| Rate for Payer: Cigna All Commercial |
$67.23
|
| Rate for Payer: Cigna All Commercial |
$67.23
|
| Rate for Payer: CORVEL All Commercial |
$67.23
|
| Rate for Payer: CORVEL All Commercial |
$67.23
|
| Rate for Payer: Coventry All Commercial |
$80.68
|
| Rate for Payer: Coventry All Commercial |
$80.68
|
| Rate for Payer: Encore All Commercial |
$67.23
|
| Rate for Payer: Encore All Commercial |
$67.23
|
| Rate for Payer: Frontpath All Commercial |
$91.29
|
| Rate for Payer: Frontpath All Commercial |
$91.29
|
| Rate for Payer: Humana ChoiceCare |
$78.20
|
| Rate for Payer: Humana ChoiceCare |
$78.20
|
| Rate for Payer: Humana Medicare |
$67.23
|
| Rate for Payer: Humana Medicare |
$67.23
|
| Rate for Payer: Lucent All Commercial |
$94.12
|
| Rate for Payer: Lucent All Commercial |
$94.12
|
| 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 |
$259.80
|
| Rate for Payer: Managed Health Services Medicaid |
$259.80
|
| Rate for Payer: MDWise Medicaid |
$259.80
|
| Rate for Payer: MDWise Medicaid |
$259.80
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$63.50
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$63.50
|
| Rate for Payer: PHCS All Commercial |
$67.23
|
| Rate for Payer: PHCS All Commercial |
$67.23
|
| Rate for Payer: PHP All Commercial |
$114.08
|
| Rate for Payer: PHP All Commercial |
$114.08
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$67.23
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$67.23
|
| Rate for Payer: Sagamore Health Network All Products |
$67.23
|
| Rate for Payer: Sagamore Health Network All Products |
$67.23
|
| Rate for Payer: Signature Care EPO |
$235.85
|
| Rate for Payer: Signature Care EPO |
$235.85
|
| Rate for Payer: Signature Care PPO |
$235.85
|
| Rate for Payer: Signature Care PPO |
$235.85
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$9,400.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$9,400.00
|
| Rate for Payer: United Healthcare Commercial |
$85.31
|
| Rate for Payer: United Healthcare Commercial |
$85.31
|
| Rate for Payer: United Healthcare Medicare |
$261.26
|
| Rate for Payer: United Healthcare Medicare |
$261.26
|
|
|
PR SIGMOIDOSCOPY FLX CONTROL BLEEDING
|
Professional
|
Both
|
$904.50
|
|
|
Service Code
|
CPT 45334
|
| Hospital Charge Code |
z45334
|
| Min. Negotiated Rate |
$110.60 |
| Max. Negotiated Rate |
$450.44 |
| Rate for Payer: Aetna Commercial |
$110.60
|
| Rate for Payer: Aetna Commercial |
$110.60
|
| Rate for Payer: Aetna Medicare |
$110.60
|
| Rate for Payer: Aetna Medicare |
$110.60
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$119.05
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$119.05
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$444.87
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$444.87
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$127.19
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$127.19
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$121.66
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$121.66
|
| Rate for Payer: Cash Price |
$558.55
|
| Rate for Payer: Cash Price |
$560.79
|
| Rate for Payer: Centivo All Commercial |
$171.43
|
| Rate for Payer: Centivo All Commercial |
$171.43
|
| Rate for Payer: Cigna All Commercial |
$110.60
|
| Rate for Payer: Cigna All Commercial |
$110.60
|
| Rate for Payer: CORVEL All Commercial |
$110.60
|
| Rate for Payer: CORVEL All Commercial |
$110.60
|
| Rate for Payer: Coventry All Commercial |
$132.72
|
| Rate for Payer: Coventry All Commercial |
$132.72
|
| Rate for Payer: Encore All Commercial |
$110.60
|
| Rate for Payer: Encore All Commercial |
$110.60
|
| Rate for Payer: Frontpath All Commercial |
$151.00
|
| Rate for Payer: Frontpath All Commercial |
$151.00
|
| Rate for Payer: Humana ChoiceCare |
$174.65
|
| Rate for Payer: Humana ChoiceCare |
$174.65
|
| Rate for Payer: Humana Medicare |
$110.60
|
| Rate for Payer: Humana Medicare |
$110.60
|
| Rate for Payer: Lucent All Commercial |
$154.84
|
| Rate for Payer: Lucent All Commercial |
$154.84
|
| Rate for Payer: Managed Health Services Medicaid |
$444.87
|
| Rate for Payer: Managed Health Services Medicaid |
$444.87
|
| Rate for Payer: MDWise Medicaid |
$444.87
|
| Rate for Payer: MDWise Medicaid |
$444.87
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$119.05
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$119.05
|
| Rate for Payer: PHCS All Commercial |
$110.60
|
| Rate for Payer: PHCS All Commercial |
$110.60
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$110.60
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$110.60
|
| Rate for Payer: Sagamore Health Network All Products |
$110.60
|
| Rate for Payer: Sagamore Health Network All Products |
$110.60
|
| Rate for Payer: United Healthcare Commercial |
$188.90
|
| Rate for Payer: United Healthcare Commercial |
$188.90
|
| Rate for Payer: United Healthcare Medicare |
$450.44
|
| Rate for Payer: United Healthcare Medicare |
$450.44
|
|
|
PR SIGMOIDOSCOPY FLX DX W/COLLJ SPEC BR/WA IF PFRMD
|
Professional
|
Both
|
$344.00
|
|
|
Service Code
|
CPT 45330
|
| Hospital Charge Code |
z45330
|
| Min. Negotiated Rate |
$52.33 |
| Max. Negotiated Rate |
$7,300.00 |
| Rate for Payer: Aetna Commercial |
$52.33
|
| Rate for Payer: Aetna Commercial |
$52.33
|
| Rate for Payer: Aetna Medicare |
$52.33
|
| Rate for Payer: Aetna Medicare |
$52.33
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$111.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$111.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$111.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$111.20
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$111.20
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$111.20
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$111.20
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$111.20
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$52.42
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$52.42
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$169.19
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$169.19
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$60.18
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$60.18
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$57.56
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$57.56
|
| Rate for Payer: Cash Price |
$210.06
|
| Rate for Payer: Cash Price |
$213.28
|
| Rate for Payer: Centivo All Commercial |
$81.11
|
| Rate for Payer: Centivo All Commercial |
$81.11
|
| Rate for Payer: Cigna All Commercial |
$52.33
|
| Rate for Payer: Cigna All Commercial |
$52.33
|
| Rate for Payer: CORVEL All Commercial |
$52.33
|
| Rate for Payer: CORVEL All Commercial |
$52.33
|
| Rate for Payer: Coventry All Commercial |
$62.80
|
| Rate for Payer: Coventry All Commercial |
$62.80
|
| Rate for Payer: Encore All Commercial |
$52.33
|
| Rate for Payer: Encore All Commercial |
$52.33
|
| Rate for Payer: Frontpath All Commercial |
$71.54
|
| Rate for Payer: Frontpath All Commercial |
$71.54
|
| Rate for Payer: Humana ChoiceCare |
$65.68
|
| Rate for Payer: Humana ChoiceCare |
$65.68
|
| Rate for Payer: Humana Medicare |
$52.33
|
| Rate for Payer: Humana Medicare |
$52.33
|
| Rate for Payer: Lucent All Commercial |
$73.26
|
| Rate for Payer: Lucent All Commercial |
$73.26
|
| Rate for Payer: Lutheran Preferred All Commercial |
$78.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$78.00
|
| Rate for Payer: Managed Health Services Medicaid |
$169.19
|
| Rate for Payer: Managed Health Services Medicaid |
$169.19
|
| Rate for Payer: MDWise Medicaid |
$169.19
|
| Rate for Payer: MDWise Medicaid |
$169.19
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$52.42
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$52.42
|
| Rate for Payer: PHCS All Commercial |
$52.33
|
| Rate for Payer: PHCS All Commercial |
$52.33
|
| Rate for Payer: PHP All Commercial |
$88.79
|
| Rate for Payer: PHP All Commercial |
$88.79
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$52.33
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$52.33
|
| Rate for Payer: Sagamore Health Network All Products |
$52.33
|
| Rate for Payer: Sagamore Health Network All Products |
$52.33
|
| Rate for Payer: Signature Care EPO |
$172.55
|
| Rate for Payer: Signature Care EPO |
$172.55
|
| Rate for Payer: Signature Care PPO |
$172.55
|
| Rate for Payer: Signature Care PPO |
$172.55
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$7,300.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$7,300.00
|
| Rate for Payer: United Healthcare Commercial |
$70.28
|
| Rate for Payer: United Healthcare Commercial |
$70.28
|
| Rate for Payer: United Healthcare Medicare |
$169.40
|
| Rate for Payer: United Healthcare Medicare |
$169.40
|
|
|
PR SIGMOIDOSCOPY FLX TNDSC BALO DILAT
|
Professional
|
Both
|
$836.66
|
|
|
Service Code
|
CPT 45340
|
| Hospital Charge Code |
z45340
|
| Min. Negotiated Rate |
$72.94 |
| Max. Negotiated Rate |
$10,100.00 |
| Rate for Payer: Aetna Commercial |
$72.94
|
| Rate for Payer: Aetna Commercial |
$72.94
|
| Rate for Payer: Aetna Medicare |
$72.94
|
| Rate for Payer: Aetna Medicare |
$72.94
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$371.38
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$371.38
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$371.38
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$371.38
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$371.38
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$371.38
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$371.38
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$371.38
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$79.25
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$79.25
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$411.50
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$411.50
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$83.88
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$83.88
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$80.23
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$80.23
|
| Rate for Payer: Cash Price |
$517.48
|
| Rate for Payer: Cash Price |
$518.73
|
| Rate for Payer: Centivo All Commercial |
$113.06
|
| Rate for Payer: Centivo All Commercial |
$113.06
|
| Rate for Payer: Cigna All Commercial |
$72.94
|
| Rate for Payer: Cigna All Commercial |
$72.94
|
| Rate for Payer: CORVEL All Commercial |
$72.94
|
| Rate for Payer: CORVEL All Commercial |
$72.94
|
| Rate for Payer: Coventry All Commercial |
$87.53
|
| Rate for Payer: Coventry All Commercial |
$87.53
|
| Rate for Payer: Encore All Commercial |
$72.94
|
| Rate for Payer: Encore All Commercial |
$72.94
|
| Rate for Payer: Frontpath All Commercial |
$100.41
|
| Rate for Payer: Frontpath All Commercial |
$100.41
|
| Rate for Payer: Humana ChoiceCare |
$122.81
|
| Rate for Payer: Humana ChoiceCare |
$122.81
|
| Rate for Payer: Humana Medicare |
$72.94
|
| Rate for Payer: Humana Medicare |
$72.94
|
| Rate for Payer: Lucent All Commercial |
$102.12
|
| Rate for Payer: Lucent All Commercial |
$102.12
|
| Rate for Payer: Lutheran Preferred All Commercial |
$109.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$109.00
|
| Rate for Payer: Managed Health Services Medicaid |
$411.50
|
| Rate for Payer: Managed Health Services Medicaid |
$411.50
|
| Rate for Payer: MDWise Medicaid |
$411.50
|
| Rate for Payer: MDWise Medicaid |
$411.50
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$79.25
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$79.25
|
| Rate for Payer: PHCS All Commercial |
$72.94
|
| Rate for Payer: PHCS All Commercial |
$72.94
|
| Rate for Payer: PHP All Commercial |
$123.65
|
| Rate for Payer: PHP All Commercial |
$123.65
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$72.94
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$72.94
|
| Rate for Payer: Sagamore Health Network All Products |
$72.94
|
| Rate for Payer: Sagamore Health Network All Products |
$72.94
|
| Rate for Payer: Signature Care EPO |
$464.10
|
| Rate for Payer: Signature Care EPO |
$464.10
|
| Rate for Payer: Signature Care PPO |
$464.10
|
| Rate for Payer: Signature Care PPO |
$464.10
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$10,100.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$10,100.00
|
| Rate for Payer: United Healthcare Commercial |
$131.06
|
| Rate for Payer: United Healthcare Commercial |
$131.06
|
| Rate for Payer: United Healthcare Medicare |
$417.32
|
| Rate for Payer: United Healthcare Medicare |
$417.32
|
|
|
PR SLING OPER STRES INCONTINENCE
|
Professional
|
Both
|
$1,346.82
|
|
|
Service Code
|
CPT 57288
|
| Hospital Charge Code |
z57288
|
| Min. Negotiated Rate |
$680.02 |
| Max. Negotiated Rate |
$1,089.46 |
| Rate for Payer: Aetna Commercial |
$702.88
|
| Rate for Payer: Aetna Medicare |
$702.88
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$681.37
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$808.31
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$773.17
|
| Rate for Payer: Cash Price |
$835.03
|
| Rate for Payer: Centivo All Commercial |
$1,089.46
|
| Rate for Payer: Cigna All Commercial |
$702.88
|
| Rate for Payer: CORVEL All Commercial |
$702.88
|
| Rate for Payer: Coventry All Commercial |
$843.46
|
| Rate for Payer: Encore All Commercial |
$702.88
|
| Rate for Payer: Frontpath All Commercial |
$968.89
|
| Rate for Payer: Humana ChoiceCare |
$835.89
|
| Rate for Payer: Humana Medicare |
$702.88
|
| Rate for Payer: Lucent All Commercial |
$984.03
|
| Rate for Payer: Managed Health Services Medicaid |
$681.37
|
| Rate for Payer: MDWise Medicaid |
$681.37
|
| Rate for Payer: PHCS All Commercial |
$702.88
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$702.88
|
| Rate for Payer: Sagamore Health Network All Products |
$702.88
|
| Rate for Payer: United Healthcare Commercial |
$836.54
|
| Rate for Payer: United Healthcare Medicare |
$680.02
|
|
|
PR SPEECH AUDIOMETRY, COMPLETE
|
Professional
|
Both
|
$82.58
|
|
|
Service Code
|
CPT 92556
|
| Hospital Charge Code |
z92556
|
| Min. Negotiated Rate |
$22.50 |
| Max. Negotiated Rate |
$4,700.00 |
| Rate for Payer: Aetna Commercial |
$36.60
|
| Rate for Payer: Aetna Commercial |
$36.60
|
| Rate for Payer: Aetna Medicare |
$36.60
|
| Rate for Payer: Aetna Medicare |
$36.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$22.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$22.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$22.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$22.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$22.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$22.50
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$22.50
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$22.50
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$40.61
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$40.61
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$42.09
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$42.09
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$40.26
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$40.26
|
| Rate for Payer: Cash Price |
$51.20
|
| Rate for Payer: Cash Price |
$47.26
|
| Rate for Payer: Centivo All Commercial |
$56.73
|
| Rate for Payer: Centivo All Commercial |
$56.73
|
| Rate for Payer: Cigna All Commercial |
$36.60
|
| Rate for Payer: Cigna All Commercial |
$36.60
|
| Rate for Payer: CORVEL All Commercial |
$36.60
|
| Rate for Payer: CORVEL All Commercial |
$36.60
|
| Rate for Payer: Coventry All Commercial |
$43.92
|
| Rate for Payer: Coventry All Commercial |
$43.92
|
| Rate for Payer: Encore All Commercial |
$36.60
|
| Rate for Payer: Encore All Commercial |
$36.60
|
| Rate for Payer: Frontpath All Commercial |
$41.09
|
| Rate for Payer: Frontpath All Commercial |
$41.09
|
| Rate for Payer: Humana ChoiceCare |
$24.06
|
| Rate for Payer: Humana ChoiceCare |
$24.06
|
| Rate for Payer: Humana Medicare |
$36.60
|
| Rate for Payer: Humana Medicare |
$36.60
|
| Rate for Payer: Lucent All Commercial |
$51.24
|
| Rate for Payer: Lucent All Commercial |
$51.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$51.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$51.00
|
| Rate for Payer: Managed Health Services Medicaid |
$40.61
|
| Rate for Payer: Managed Health Services Medicaid |
$40.61
|
| Rate for Payer: MDWise Medicaid |
$40.61
|
| Rate for Payer: MDWise Medicaid |
$40.61
|
| Rate for Payer: PHCS All Commercial |
$36.60
|
| Rate for Payer: PHCS All Commercial |
$36.60
|
| Rate for Payer: PHP All Commercial |
$55.25
|
| Rate for Payer: PHP All Commercial |
$55.25
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$36.60
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$36.60
|
| Rate for Payer: Sagamore Health Network All Products |
$36.60
|
| Rate for Payer: Sagamore Health Network All Products |
$36.60
|
| Rate for Payer: Signature Care EPO |
$31.11
|
| Rate for Payer: Signature Care EPO |
$31.11
|
| Rate for Payer: Signature Care PPO |
$31.11
|
| Rate for Payer: Signature Care PPO |
$31.11
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,700.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,700.00
|
| Rate for Payer: United Healthcare Commercial |
$27.28
|
| Rate for Payer: United Healthcare Commercial |
$27.28
|
| Rate for Payer: United Healthcare Medicare |
$38.11
|
| Rate for Payer: United Healthcare Medicare |
$38.11
|
|
|
PR SPEECH THRESHOLD AUDIOMETRY
|
Professional
|
Both
|
$53.12
|
|
|
Service Code
|
CPT 92555
|
| Hospital Charge Code |
z92555
|
| Min. Negotiated Rate |
$16.04 |
| Max. Negotiated Rate |
$3,000.00 |
| Rate for Payer: Aetna Commercial |
$23.21
|
| Rate for Payer: Aetna Commercial |
$23.21
|
| Rate for Payer: Aetna Medicare |
$23.21
|
| Rate for Payer: Aetna Medicare |
$23.21
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$17.76
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$17.76
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$17.76
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$17.76
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$17.76
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$17.76
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$17.76
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$17.76
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$26.12
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$26.12
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$26.69
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$26.69
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$25.53
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$25.53
|
| Rate for Payer: Cash Price |
$32.93
|
| Rate for Payer: Cash Price |
$30.44
|
| Rate for Payer: Centivo All Commercial |
$35.98
|
| Rate for Payer: Centivo All Commercial |
$35.98
|
| Rate for Payer: Cigna All Commercial |
$23.21
|
| Rate for Payer: Cigna All Commercial |
$23.21
|
| Rate for Payer: CORVEL All Commercial |
$23.21
|
| Rate for Payer: CORVEL All Commercial |
$23.21
|
| Rate for Payer: Coventry All Commercial |
$27.85
|
| Rate for Payer: Coventry All Commercial |
$27.85
|
| Rate for Payer: Encore All Commercial |
$23.21
|
| Rate for Payer: Encore All Commercial |
$23.21
|
| Rate for Payer: Frontpath All Commercial |
$26.14
|
| Rate for Payer: Frontpath All Commercial |
$26.14
|
| Rate for Payer: Humana ChoiceCare |
$16.04
|
| Rate for Payer: Humana ChoiceCare |
$16.04
|
| Rate for Payer: Humana Medicare |
$23.21
|
| Rate for Payer: Humana Medicare |
$23.21
|
| Rate for Payer: Lucent All Commercial |
$32.49
|
| Rate for Payer: Lucent All Commercial |
$32.49
|
| Rate for Payer: Lutheran Preferred All Commercial |
$33.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$33.00
|
| Rate for Payer: Managed Health Services Medicaid |
$26.12
|
| Rate for Payer: Managed Health Services Medicaid |
$26.12
|
| Rate for Payer: MDWise Medicaid |
$26.12
|
| Rate for Payer: MDWise Medicaid |
$26.12
|
| Rate for Payer: PHCS All Commercial |
$23.21
|
| Rate for Payer: PHCS All Commercial |
$23.21
|
| Rate for Payer: PHP All Commercial |
$35.60
|
| Rate for Payer: PHP All Commercial |
$35.60
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$23.21
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$23.21
|
| Rate for Payer: Sagamore Health Network All Products |
$23.21
|
| Rate for Payer: Sagamore Health Network All Products |
$23.21
|
| Rate for Payer: Signature Care EPO |
$19.73
|
| Rate for Payer: Signature Care EPO |
$19.73
|
| Rate for Payer: Signature Care PPO |
$19.73
|
| Rate for Payer: Signature Care PPO |
$19.73
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,000.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,000.00
|
| Rate for Payer: United Healthcare Commercial |
$17.64
|
| Rate for Payer: United Healthcare Commercial |
$17.64
|
| Rate for Payer: United Healthcare Medicare |
$24.55
|
| Rate for Payer: United Healthcare Medicare |
$24.55
|
|
|
PR SPLINT FINGER FOAM 3 INCH
|
Professional
|
Both
|
$4.77
|
|
|
Service Code
|
CPT L3927
|
| Hospital Charge Code |
zL3927A
|
| Min. Negotiated Rate |
$4.77 |
| Max. Negotiated Rate |
$52.10 |
| Rate for Payer: Aetna Commercial |
$33.61
|
| Rate for Payer: Aetna Medicare |
$33.61
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$37.48
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$38.65
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$36.97
|
| Rate for Payer: Cash Price |
$2.96
|
| Rate for Payer: Cash Price |
$2.96
|
| Rate for Payer: Centivo All Commercial |
$52.10
|
| Rate for Payer: Cigna All Commercial |
$33.61
|
| Rate for Payer: CORVEL All Commercial |
$33.61
|
| Rate for Payer: Coventry All Commercial |
$40.33
|
| Rate for Payer: Encore All Commercial |
$33.61
|
| Rate for Payer: Humana ChoiceCare |
$31.05
|
| Rate for Payer: Humana Medicare |
$33.61
|
| Rate for Payer: Lucent All Commercial |
$47.05
|
| Rate for Payer: Managed Health Services Medicaid |
$37.48
|
| Rate for Payer: MDWise Medicaid |
$37.48
|
| Rate for Payer: PHCS All Commercial |
$33.61
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$33.61
|
| Rate for Payer: Sagamore Health Network All Products |
$33.61
|
| Rate for Payer: Signature Care EPO |
$4.77
|
| Rate for Payer: Signature Care PPO |
$4.77
|
| Rate for Payer: United Healthcare Commercial |
$24.52
|
|
