|
PR DESTR PENIS LESN,SIMPL,ELEC-DESSIC
|
Professional
|
$250.62
|
|
|
Service Code
|
CPT 54055
|
| Hospital Charge Code |
z54055
|
| Min. Negotiated Rate |
$89.55 |
| Max. Negotiated Rate |
$187.96 |
| Rate for Payer: Aetna Medicare |
$89.55
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$140.48
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$140.48
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$102.98
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$98.50
|
| Rate for Payer: Cash Price |
$155.38
|
| Rate for Payer: Cash Price |
$155.38
|
| Rate for Payer: Coventry All Commercial |
$107.46
|
| Rate for Payer: Frontpath All Commercial |
$118.82
|
| Rate for Payer: Humana ChoiceCare |
$95.20
|
| Rate for Payer: Humana Medicare |
$89.55
|
| Rate for Payer: Lucent All Commercial |
$152.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$125.00
|
| Rate for Payer: PHCS All Commercial |
$187.96
|
| Rate for Payer: PHP All Commercial |
$115.32
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$89.55
|
| Rate for Payer: Signature Care EPO |
$124.95
|
| Rate for Payer: Signature Care PPO |
$124.95
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$116.00
|
| Rate for Payer: United Healthcare Commercial |
$105.21
|
| Rate for Payer: United Healthcare Medicare |
$89.55
|
|
|
PR DESTRUC BENIGN/PREMAL,15+ LESIONS
|
Professional
|
$308.56
|
|
|
Service Code
|
CPT 17004
|
| Hospital Charge Code |
z17004
|
| Min. Negotiated Rate |
$92.69 |
| Max. Negotiated Rate |
$231.42 |
| Rate for Payer: Aetna Medicare |
$92.69
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$106.59
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$101.96
|
| Rate for Payer: Cash Price |
$191.31
|
| Rate for Payer: Cash Price |
$191.31
|
| Rate for Payer: Coventry All Commercial |
$111.23
|
| Rate for Payer: Frontpath All Commercial |
$122.99
|
| Rate for Payer: Humana ChoiceCare |
$162.14
|
| Rate for Payer: Humana Medicare |
$92.69
|
| Rate for Payer: Lucent All Commercial |
$157.57
|
| Rate for Payer: PHCS All Commercial |
$231.42
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$92.69
|
| Rate for Payer: United Healthcare Commercial |
$145.86
|
| Rate for Payer: United Healthcare Medicare |
$92.69
|
|
|
PR DESTRUC BENIGN/PREMAL,2-14 LESIONS
|
Professional
|
$12.28
|
|
|
Service Code
|
CPT 17003
|
| Hospital Charge Code |
z17003
|
| Min. Negotiated Rate |
$1.97 |
| Max. Negotiated Rate |
$11.69 |
| Rate for Payer: Aetna Medicare |
$1.97
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$11.69
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$11.69
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2.27
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2.17
|
| Rate for Payer: Cash Price |
$7.61
|
| Rate for Payer: Cash Price |
$7.61
|
| Rate for Payer: Coventry All Commercial |
$2.36
|
| Rate for Payer: Frontpath All Commercial |
$2.63
|
| Rate for Payer: Humana ChoiceCare |
$8.25
|
| Rate for Payer: Humana Medicare |
$1.97
|
| Rate for Payer: Lucent All Commercial |
$3.35
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3.00
|
| Rate for Payer: PHCS All Commercial |
$9.21
|
| Rate for Payer: PHP All Commercial |
$2.69
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1.97
|
| Rate for Payer: Signature Care EPO |
$8.96
|
| Rate for Payer: Signature Care PPO |
$8.96
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2.00
|
| Rate for Payer: United Healthcare Commercial |
$5.09
|
| Rate for Payer: United Healthcare Medicare |
$1.97
|
|
|
PR DESTRUC BENIGN/PREMAL,FIRST LESION
|
Professional
|
$122.94
|
|
|
Service Code
|
CPT 17000
|
| Hospital Charge Code |
z17000
|
| Min. Negotiated Rate |
$41.78 |
| Max. Negotiated Rate |
$92.20 |
| Rate for Payer: Aetna Medicare |
$51.27
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$76.07
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$76.07
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$58.96
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$56.40
|
| Rate for Payer: Cash Price |
$76.22
|
| Rate for Payer: Cash Price |
$76.22
|
| Rate for Payer: Coventry All Commercial |
$61.52
|
| Rate for Payer: Frontpath All Commercial |
$69.08
|
| Rate for Payer: Humana ChoiceCare |
$41.78
|
| Rate for Payer: Humana Medicare |
$51.27
|
| Rate for Payer: Lucent All Commercial |
$87.16
|
| Rate for Payer: Lutheran Preferred All Commercial |
$67.00
|
| Rate for Payer: PHCS All Commercial |
$92.20
|
| Rate for Payer: PHP All Commercial |
$70.03
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$51.27
|
| Rate for Payer: Signature Care EPO |
$53.58
|
| Rate for Payer: Signature Care PPO |
$53.58
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$62.00
|
| Rate for Payer: United Healthcare Commercial |
$57.74
|
| Rate for Payer: United Healthcare Medicare |
$51.27
|
|
|
PR DESTRUC MOUTH LESION/SCAR
|
Professional
|
$473.10
|
|
|
Service Code
|
CPT 40820
|
| Hospital Charge Code |
z40820
|
| Min. Negotiated Rate |
$155.71 |
| Max. Negotiated Rate |
$354.82 |
| Rate for Payer: Aetna Medicare |
$155.71
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$237.65
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$237.65
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$179.07
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$171.28
|
| Rate for Payer: Cash Price |
$293.32
|
| Rate for Payer: Cash Price |
$293.32
|
| Rate for Payer: Coventry All Commercial |
$186.85
|
| Rate for Payer: Frontpath All Commercial |
$211.59
|
| Rate for Payer: Humana ChoiceCare |
$160.94
|
| Rate for Payer: Humana Medicare |
$155.71
|
| Rate for Payer: Lucent All Commercial |
$264.71
|
| Rate for Payer: Lutheran Preferred All Commercial |
$234.00
|
| Rate for Payer: PHCS All Commercial |
$354.82
|
| Rate for Payer: PHP All Commercial |
$265.85
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$155.71
|
| Rate for Payer: Signature Care EPO |
$218.11
|
| Rate for Payer: Signature Care PPO |
$218.11
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$218.00
|
| Rate for Payer: United Healthcare Commercial |
$179.53
|
| Rate for Payer: United Healthcare Medicare |
$155.71
|
|
|
PR DESTRUCT INTERNAL HEMORRHOID, THERMAL
|
Professional
|
$394.68
|
|
|
Service Code
|
CPT 46930
|
| Hospital Charge Code |
z46930
|
| Min. Negotiated Rate |
$141.76 |
| Max. Negotiated Rate |
$311.40 |
| Rate for Payer: Aetna Medicare |
$141.76
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$311.40
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$311.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$163.02
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$155.94
|
| Rate for Payer: Cash Price |
$244.70
|
| Rate for Payer: Cash Price |
$244.70
|
| Rate for Payer: Coventry All Commercial |
$170.11
|
| Rate for Payer: Frontpath All Commercial |
$194.97
|
| Rate for Payer: Humana ChoiceCare |
$154.32
|
| Rate for Payer: Humana Medicare |
$141.76
|
| Rate for Payer: Lucent All Commercial |
$240.99
|
| Rate for Payer: Lutheran Preferred All Commercial |
$213.00
|
| Rate for Payer: PHCS All Commercial |
$296.01
|
| Rate for Payer: PHP All Commercial |
$242.03
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$141.76
|
| Rate for Payer: Signature Care EPO |
$266.19
|
| Rate for Payer: Signature Care PPO |
$266.19
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$198.00
|
| Rate for Payer: United Healthcare Commercial |
$161.15
|
| Rate for Payer: United Healthcare Medicare |
$141.76
|
|
|
PR DESTRUCTION,ANAL LESION(S),EXTENSIVE
|
Professional
|
$1,001.66
|
|
|
Service Code
|
CPT 46924
|
| Hospital Charge Code |
z46924
|
| Min. Negotiated Rate |
$168.52 |
| Max. Negotiated Rate |
$751.24 |
| Rate for Payer: Aetna Medicare |
$168.52
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$413.47
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$413.47
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$193.80
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$185.37
|
| Rate for Payer: Cash Price |
$621.03
|
| Rate for Payer: Cash Price |
$621.03
|
| Rate for Payer: Coventry All Commercial |
$202.22
|
| Rate for Payer: Frontpath All Commercial |
$232.52
|
| Rate for Payer: Humana ChoiceCare |
$185.83
|
| Rate for Payer: Humana Medicare |
$168.52
|
| Rate for Payer: Lucent All Commercial |
$286.48
|
| Rate for Payer: Lutheran Preferred All Commercial |
$253.00
|
| Rate for Payer: PHCS All Commercial |
$751.24
|
| Rate for Payer: PHP All Commercial |
$287.71
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$168.52
|
| Rate for Payer: Signature Care EPO |
$621.35
|
| Rate for Payer: Signature Care PPO |
$621.35
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$236.00
|
| Rate for Payer: United Healthcare Commercial |
$195.26
|
| Rate for Payer: United Healthcare Medicare |
$168.52
|
|
|
PR DESTRUCTION BENIGN LESIONS 15 OR MORE
|
Professional
|
$242.56
|
|
|
Service Code
|
CPT 17111
|
| Hospital Charge Code |
z17111
|
| Min. Negotiated Rate |
$63.50 |
| Max. Negotiated Rate |
$181.92 |
| Rate for Payer: Aetna Medicare |
$77.08
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$120.85
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$120.85
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$88.64
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$84.79
|
| Rate for Payer: Cash Price |
$150.39
|
| Rate for Payer: Cash Price |
$150.39
|
| Rate for Payer: Coventry All Commercial |
$92.50
|
| Rate for Payer: Frontpath All Commercial |
$102.36
|
| Rate for Payer: Humana ChoiceCare |
$63.50
|
| Rate for Payer: Humana Medicare |
$77.08
|
| Rate for Payer: Lucent All Commercial |
$131.04
|
| Rate for Payer: Lutheran Preferred All Commercial |
$100.00
|
| Rate for Payer: PHCS All Commercial |
$181.92
|
| Rate for Payer: PHP All Commercial |
$105.28
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$77.08
|
| Rate for Payer: Signature Care EPO |
$105.88
|
| Rate for Payer: Signature Care PPO |
$105.88
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$92.00
|
| Rate for Payer: United Healthcare Commercial |
$89.66
|
| Rate for Payer: United Healthcare Medicare |
$77.08
|
|
|
PR DESTRUCTION BENIGN LESIONS UP TO 14
|
Professional
|
$207.50
|
|
|
Service Code
|
CPT 17110
|
| Hospital Charge Code |
z17110
|
| Min. Negotiated Rate |
$49.49 |
| Max. Negotiated Rate |
$155.62 |
| Rate for Payer: Aetna Medicare |
$62.82
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$106.25
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$106.25
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$72.24
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$69.10
|
| Rate for Payer: Cash Price |
$128.65
|
| Rate for Payer: Cash Price |
$128.65
|
| Rate for Payer: Coventry All Commercial |
$75.38
|
| Rate for Payer: Frontpath All Commercial |
$83.49
|
| Rate for Payer: Humana ChoiceCare |
$49.49
|
| Rate for Payer: Humana Medicare |
$62.82
|
| Rate for Payer: Lucent All Commercial |
$106.79
|
| Rate for Payer: Lutheran Preferred All Commercial |
$82.00
|
| Rate for Payer: PHCS All Commercial |
$155.62
|
| Rate for Payer: PHP All Commercial |
$85.80
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$62.82
|
| Rate for Payer: Signature Care EPO |
$90.95
|
| Rate for Payer: Signature Care PPO |
$90.95
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$75.00
|
| Rate for Payer: United Healthcare Commercial |
$71.70
|
| Rate for Payer: United Healthcare Medicare |
$62.82
|
|
|
PR DESTRUCTION,LESION(S),VULVA;EXTENSIVE
|
Professional
|
$508.50
|
|
|
Service Code
|
CPT 56515
|
| Hospital Charge Code |
z56515
|
| Min. Negotiated Rate |
$199.48 |
| Max. Negotiated Rate |
$381.38 |
| Rate for Payer: Aetna Medicare |
$199.48
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$276.07
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$276.07
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$229.40
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$219.43
|
| Rate for Payer: Cash Price |
$315.27
|
| Rate for Payer: Cash Price |
$315.27
|
| Rate for Payer: Coventry All Commercial |
$239.38
|
| Rate for Payer: Frontpath All Commercial |
$276.54
|
| Rate for Payer: Humana ChoiceCare |
$201.87
|
| Rate for Payer: Humana Medicare |
$199.48
|
| Rate for Payer: Lucent All Commercial |
$339.12
|
| Rate for Payer: Lutheran Preferred All Commercial |
$279.00
|
| Rate for Payer: PHCS All Commercial |
$381.38
|
| Rate for Payer: PHP All Commercial |
$256.89
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$199.48
|
| Rate for Payer: Signature Care EPO |
$258.40
|
| Rate for Payer: Signature Care PPO |
$258.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$259.00
|
| Rate for Payer: United Healthcare Commercial |
$220.01
|
| Rate for Payer: United Healthcare Medicare |
$199.48
|
|
|
PR DESTRUCTION,LESION(S),VULVA,SIMPLE
|
Professional
|
$353.88
|
|
|
Service Code
|
CPT 56501
|
| Hospital Charge Code |
z56501
|
| Min. Negotiated Rate |
$121.13 |
| Max. Negotiated Rate |
$265.41 |
| Rate for Payer: Aetna Medicare |
$125.48
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$171.32
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$171.32
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$144.30
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$138.03
|
| Rate for Payer: Cash Price |
$219.41
|
| Rate for Payer: Cash Price |
$219.41
|
| Rate for Payer: Coventry All Commercial |
$150.58
|
| Rate for Payer: Frontpath All Commercial |
$171.20
|
| Rate for Payer: Humana ChoiceCare |
$121.13
|
| Rate for Payer: Humana Medicare |
$125.48
|
| Rate for Payer: Lucent All Commercial |
$213.32
|
| Rate for Payer: Lutheran Preferred All Commercial |
$176.00
|
| Rate for Payer: PHCS All Commercial |
$265.41
|
| Rate for Payer: PHP All Commercial |
$161.60
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$125.48
|
| Rate for Payer: Signature Care EPO |
$161.50
|
| Rate for Payer: Signature Care PPO |
$161.50
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$163.00
|
| Rate for Payer: United Healthcare Commercial |
$126.06
|
| Rate for Payer: United Healthcare Medicare |
$125.48
|
|
|
PR DESTRUCTION MALIGNANT LESION F/E/E/N/L/M 0.5CM/<
|
Professional
|
$256.72
|
|
|
Service Code
|
CPT 17280
|
| Hospital Charge Code |
z17280
|
| Min. Negotiated Rate |
$72.98 |
| Max. Negotiated Rate |
$192.54 |
| Rate for Payer: Aetna Medicare |
$80.94
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$141.50
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$141.50
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$93.08
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$89.03
|
| Rate for Payer: Cash Price |
$159.17
|
| Rate for Payer: Cash Price |
$159.17
|
| Rate for Payer: Coventry All Commercial |
$97.13
|
| Rate for Payer: Frontpath All Commercial |
$108.35
|
| Rate for Payer: Humana ChoiceCare |
$72.98
|
| Rate for Payer: Humana Medicare |
$80.94
|
| Rate for Payer: Lucent All Commercial |
$137.60
|
| Rate for Payer: Lutheran Preferred All Commercial |
$105.00
|
| Rate for Payer: PHCS All Commercial |
$192.54
|
| Rate for Payer: PHP All Commercial |
$110.55
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$80.94
|
| Rate for Payer: Signature Care EPO |
$113.05
|
| Rate for Payer: Signature Care PPO |
$113.05
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$97.00
|
| Rate for Payer: United Healthcare Commercial |
$95.98
|
| Rate for Payer: United Healthcare Medicare |
$80.94
|
|
|
PR DESTRUCTION MAL LESION F/E/E/N/L/M 0.6-1.0CM
|
Professional
|
$330.22
|
|
|
Service Code
|
CPT 17281
|
| Hospital Charge Code |
z17281
|
| Min. Negotiated Rate |
$103.77 |
| Max. Negotiated Rate |
$247.66 |
| Rate for Payer: Aetna Medicare |
$110.89
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$178.07
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$178.07
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$127.52
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$121.98
|
| Rate for Payer: Cash Price |
$204.74
|
| Rate for Payer: Cash Price |
$204.74
|
| Rate for Payer: Coventry All Commercial |
$133.07
|
| Rate for Payer: Frontpath All Commercial |
$149.28
|
| Rate for Payer: Humana ChoiceCare |
$103.77
|
| Rate for Payer: Humana Medicare |
$110.89
|
| Rate for Payer: Lucent All Commercial |
$188.51
|
| Rate for Payer: Lutheran Preferred All Commercial |
$144.00
|
| Rate for Payer: PHCS All Commercial |
$247.66
|
| Rate for Payer: PHP All Commercial |
$151.46
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$110.89
|
| Rate for Payer: Signature Care EPO |
$147.05
|
| Rate for Payer: Signature Care PPO |
$147.05
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$133.00
|
| Rate for Payer: United Healthcare Commercial |
$134.14
|
| Rate for Payer: United Healthcare Medicare |
$110.89
|
|
|
PR DESTRUCTION MAL LESION F/E/E/N/L/M 1.1-2.0CM
|
Professional
|
$377.62
|
|
|
Service Code
|
CPT 17282
|
| Hospital Charge Code |
z17282
|
| Min. Negotiated Rate |
$121.21 |
| Max. Negotiated Rate |
$283.22 |
| Rate for Payer: Aetna Medicare |
$128.08
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$204.23
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$204.23
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$147.29
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$140.89
|
| Rate for Payer: Cash Price |
$234.12
|
| Rate for Payer: Cash Price |
$234.12
|
| Rate for Payer: Coventry All Commercial |
$153.70
|
| Rate for Payer: Frontpath All Commercial |
$172.55
|
| Rate for Payer: Humana ChoiceCare |
$121.21
|
| Rate for Payer: Humana Medicare |
$128.08
|
| Rate for Payer: Lucent All Commercial |
$217.74
|
| Rate for Payer: Lutheran Preferred All Commercial |
$167.00
|
| Rate for Payer: PHCS All Commercial |
$283.22
|
| Rate for Payer: PHP All Commercial |
$174.94
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$128.08
|
| Rate for Payer: Signature Care EPO |
$171.70
|
| Rate for Payer: Signature Care PPO |
$171.70
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$154.00
|
| Rate for Payer: United Healthcare Commercial |
$155.88
|
| Rate for Payer: United Healthcare Medicare |
$128.08
|
|
|
PR DESTRUCTION MAL LESION F/E/E/N/L/M 2.1-3.0CM
|
Professional
|
$446.56
|
|
|
Service Code
|
CPT 17283
|
| Hospital Charge Code |
z17283
|
| Min. Negotiated Rate |
$153.03 |
| Max. Negotiated Rate |
$334.92 |
| Rate for Payer: Aetna Medicare |
$159.71
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$244.23
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$244.23
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$183.67
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$175.68
|
| Rate for Payer: Cash Price |
$276.87
|
| Rate for Payer: Cash Price |
$276.87
|
| Rate for Payer: Coventry All Commercial |
$191.65
|
| Rate for Payer: Frontpath All Commercial |
$215.06
|
| Rate for Payer: Humana ChoiceCare |
$153.03
|
| Rate for Payer: Humana Medicare |
$159.71
|
| Rate for Payer: Lucent All Commercial |
$271.51
|
| Rate for Payer: Lutheran Preferred All Commercial |
$208.00
|
| Rate for Payer: PHCS All Commercial |
$334.92
|
| Rate for Payer: PHP All Commercial |
$218.15
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$159.71
|
| Rate for Payer: Signature Care EPO |
$211.65
|
| Rate for Payer: Signature Care PPO |
$211.65
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$192.00
|
| Rate for Payer: United Healthcare Commercial |
$195.31
|
| Rate for Payer: United Healthcare Medicare |
$159.71
|
|
|
PR DESTRUCTION MAL LESION TRUNK/ARM/LEG 1.1-2.0CM
|
Professional
|
$333.76
|
|
|
Service Code
|
CPT 17262
|
| Hospital Charge Code |
z17262
|
| Min. Negotiated Rate |
$95.89 |
| Max. Negotiated Rate |
$250.32 |
| Rate for Payer: Aetna Medicare |
$103.51
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$119.04
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$113.86
|
| Rate for Payer: Cash Price |
$206.93
|
| Rate for Payer: Cash Price |
$206.93
|
| Rate for Payer: Coventry All Commercial |
$124.21
|
| Rate for Payer: Frontpath All Commercial |
$139.20
|
| Rate for Payer: Humana ChoiceCare |
$95.89
|
| Rate for Payer: Humana Medicare |
$103.51
|
| Rate for Payer: Lucent All Commercial |
$175.97
|
| Rate for Payer: PHCS All Commercial |
$250.32
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$103.51
|
| Rate for Payer: United Healthcare Commercial |
$125.08
|
| Rate for Payer: United Healthcare Medicare |
$103.51
|
|
|
PR DESTRUCT,VAGINAL LESION(S),EXTENSIVE
|
Professional
|
$453.22
|
|
|
Service Code
|
CPT 57065
|
| Hospital Charge Code |
z57065
|
| Min. Negotiated Rate |
$174.55 |
| Max. Negotiated Rate |
$339.92 |
| Rate for Payer: Aetna Medicare |
$174.55
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$255.51
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$255.51
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$200.73
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$192.00
|
| Rate for Payer: Cash Price |
$281.00
|
| Rate for Payer: Cash Price |
$281.00
|
| Rate for Payer: Coventry All Commercial |
$209.46
|
| Rate for Payer: Frontpath All Commercial |
$241.38
|
| Rate for Payer: Humana ChoiceCare |
$188.80
|
| Rate for Payer: Humana Medicare |
$174.55
|
| Rate for Payer: Lucent All Commercial |
$296.74
|
| Rate for Payer: Lutheran Preferred All Commercial |
$244.00
|
| Rate for Payer: PHCS All Commercial |
$339.92
|
| Rate for Payer: PHP All Commercial |
$224.78
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$174.55
|
| Rate for Payer: Signature Care EPO |
$241.40
|
| Rate for Payer: Signature Care PPO |
$241.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$227.00
|
| Rate for Payer: United Healthcare Commercial |
$191.50
|
| Rate for Payer: United Healthcare Medicare |
$174.55
|
|
|
PR DESTRUCT,VAGINAL LESION(S),SIMPLE
|
Professional
|
$306.70
|
|
|
Service Code
|
CPT 57061
|
| Hospital Charge Code |
z57061
|
| Min. Negotiated Rate |
$103.32 |
| Max. Negotiated Rate |
$230.02 |
| Rate for Payer: Aetna Medicare |
$108.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$149.29
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$149.29
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$124.32
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$118.91
|
| Rate for Payer: Cash Price |
$190.15
|
| Rate for Payer: Cash Price |
$190.15
|
| Rate for Payer: Coventry All Commercial |
$129.72
|
| Rate for Payer: Frontpath All Commercial |
$147.68
|
| Rate for Payer: Humana ChoiceCare |
$103.32
|
| Rate for Payer: Humana Medicare |
$108.10
|
| Rate for Payer: Lucent All Commercial |
$183.77
|
| Rate for Payer: Lutheran Preferred All Commercial |
$151.00
|
| Rate for Payer: PHCS All Commercial |
$230.02
|
| Rate for Payer: PHP All Commercial |
$139.21
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$108.10
|
| Rate for Payer: Signature Care EPO |
$141.10
|
| Rate for Payer: Signature Care PPO |
$141.10
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$141.00
|
| Rate for Payer: United Healthcare Commercial |
$107.66
|
| Rate for Payer: United Healthcare Medicare |
$108.10
|
|
|
PR DEVELOPMENTAL SCREEN W/SCORING & DOC STD INSTRM
|
Professional
|
$18.98
|
|
|
Service Code
|
CPT 96110
|
| Hospital Charge Code |
z96110
|
| Min. Negotiated Rate |
$9.22 |
| Max. Negotiated Rate |
$14.24 |
| Rate for Payer: Cash Price |
$11.77
|
| Rate for Payer: Cash Price |
$11.77
|
| Rate for Payer: Frontpath All Commercial |
$10.52
|
| Rate for Payer: Humana ChoiceCare |
$9.22
|
| Rate for Payer: PHCS All Commercial |
$14.24
|
| Rate for Payer: United Healthcare Commercial |
$12.31
|
|
|
PR DEVELOPMENTAL TST ADMIN PHYS/QHP 1ST HOUR
|
Professional
|
$237.28
|
|
|
Service Code
|
CPT 96112
|
| Hospital Charge Code |
z96112
|
| Min. Negotiated Rate |
$119.88 |
| Max. Negotiated Rate |
$203.80 |
| Rate for Payer: Aetna Medicare |
$119.88
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$137.86
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$131.87
|
| Rate for Payer: Cash Price |
$147.11
|
| Rate for Payer: Cash Price |
$147.11
|
| Rate for Payer: Coventry All Commercial |
$143.86
|
| Rate for Payer: Frontpath All Commercial |
$137.56
|
| Rate for Payer: Humana ChoiceCare |
$125.30
|
| Rate for Payer: Humana Medicare |
$119.88
|
| Rate for Payer: Lucent All Commercial |
$203.80
|
| Rate for Payer: PHCS All Commercial |
$177.96
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$119.88
|
| Rate for Payer: United Healthcare Commercial |
$156.85
|
| Rate for Payer: United Healthcare Medicare |
$119.88
|
|
|
PR DEVELOPMENTAL TST ADMIN PHYS/QHP EA ADDL 30 MIN
|
Professional
|
$114.48
|
|
|
Service Code
|
CPT 96113
|
| Hospital Charge Code |
z96113
|
| Min. Negotiated Rate |
$53.86 |
| Max. Negotiated Rate |
$91.56 |
| Rate for Payer: Aetna Medicare |
$53.86
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$61.94
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$59.25
|
| Rate for Payer: Cash Price |
$70.98
|
| Rate for Payer: Cash Price |
$70.98
|
| Rate for Payer: Coventry All Commercial |
$64.63
|
| Rate for Payer: Frontpath All Commercial |
$61.67
|
| Rate for Payer: Humana ChoiceCare |
$57.12
|
| Rate for Payer: Humana Medicare |
$53.86
|
| Rate for Payer: Lucent All Commercial |
$91.56
|
| Rate for Payer: PHCS All Commercial |
$85.86
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$53.86
|
| Rate for Payer: United Healthcare Commercial |
$71.58
|
| Rate for Payer: United Healthcare Medicare |
$53.86
|
|
|
PR DEXAMETHASONE SODIUM PHOS
|
Professional
|
$0.20
|
|
|
Service Code
|
CPT J1100
|
| Hospital Charge Code |
zJ1100
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$0.20 |
| Rate for Payer: Humana ChoiceCare |
$0.13
|
| Rate for Payer: PHP All Commercial |
$0.20
|
| Rate for Payer: United Healthcare Commercial |
$0.13
|
|
|
PR DIAB MANAGE TRN IND/GROUP
|
Professional
|
$25.02
|
|
|
Service Code
|
CPT G0109
|
| Hospital Charge Code |
zG0109
|
| Min. Negotiated Rate |
$12.59 |
| Max. Negotiated Rate |
$25.18 |
| Rate for Payer: Aetna Medicare |
$14.81
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$17.03
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$16.29
|
| Rate for Payer: Cash Price |
$15.51
|
| Rate for Payer: Cash Price |
$15.51
|
| Rate for Payer: Coventry All Commercial |
$17.77
|
| Rate for Payer: Humana ChoiceCare |
$12.59
|
| Rate for Payer: Humana Medicare |
$14.81
|
| Rate for Payer: Lucent All Commercial |
$25.18
|
| Rate for Payer: PHCS All Commercial |
$18.76
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$14.81
|
| Rate for Payer: United Healthcare Commercial |
$14.75
|
| Rate for Payer: United Healthcare Medicare |
$14.81
|
|
|
PR DIAB MANAGE TRN PER INDIV
|
Professional
|
$51.82
|
|
|
Service Code
|
CPT G0108
|
| Hospital Charge Code |
zG0108
|
| Min. Negotiated Rate |
$26.34 |
| Max. Negotiated Rate |
$88.62 |
| Rate for Payer: Aetna Medicare |
$52.13
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$59.95
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$57.34
|
| Rate for Payer: Cash Price |
$32.13
|
| Rate for Payer: Cash Price |
$32.13
|
| Rate for Payer: Coventry All Commercial |
$62.56
|
| Rate for Payer: Humana ChoiceCare |
$44.31
|
| Rate for Payer: Humana Medicare |
$52.13
|
| Rate for Payer: Lucent All Commercial |
$88.62
|
| Rate for Payer: PHCS All Commercial |
$38.86
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$52.13
|
| Rate for Payer: United Healthcare Commercial |
$26.34
|
| Rate for Payer: United Healthcare Medicare |
$52.13
|
|
|
PR DIAGNOSTIC LUMBAR SPINAL PUNCTURE
|
Professional
|
$240.30
|
|
|
Service Code
|
CPT 62270
|
| Hospital Charge Code |
z62270
|
| Min. Negotiated Rate |
$57.70 |
| Max. Negotiated Rate |
$201.67 |
| Rate for Payer: Aetna Medicare |
$57.70
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$177.35
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$177.35
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$66.36
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$63.47
|
| Rate for Payer: Cash Price |
$148.99
|
| Rate for Payer: Cash Price |
$148.99
|
| Rate for Payer: Coventry All Commercial |
$69.24
|
| Rate for Payer: Frontpath All Commercial |
$81.16
|
| Rate for Payer: Humana ChoiceCare |
$85.55
|
| Rate for Payer: Humana Medicare |
$57.70
|
| Rate for Payer: Lucent All Commercial |
$98.09
|
| Rate for Payer: Lutheran Preferred All Commercial |
$92.00
|
| Rate for Payer: PHCS All Commercial |
$180.22
|
| Rate for Payer: PHP All Commercial |
$98.52
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$57.70
|
| Rate for Payer: Signature Care EPO |
$201.67
|
| Rate for Payer: Signature Care PPO |
$201.67
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$87.00
|
| Rate for Payer: United Healthcare Commercial |
$88.34
|
| Rate for Payer: United Healthcare Medicare |
$57.70
|
|
