|
PR ESOPHAGOSCOPY FLEXIB LESION REMOVAL TUMOR SNARE
|
Professional
|
$769.54
|
|
|
Service Code
|
CPT 43217
|
| Hospital Charge Code |
z43217
|
| Min. Negotiated Rate |
$148.34 |
| Max. Negotiated Rate |
$577.16 |
| Rate for Payer: Aetna Medicare |
$148.34
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$170.59
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$163.17
|
| Rate for Payer: Cash Price |
$477.11
|
| Rate for Payer: Cash Price |
$477.11
|
| Rate for Payer: Coventry All Commercial |
$178.01
|
| Rate for Payer: Frontpath All Commercial |
$205.71
|
| Rate for Payer: Humana ChoiceCare |
$185.61
|
| Rate for Payer: Humana Medicare |
$148.34
|
| Rate for Payer: Lucent All Commercial |
$252.18
|
| Rate for Payer: PHCS All Commercial |
$577.16
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$148.34
|
| Rate for Payer: United Healthcare Commercial |
$194.05
|
| Rate for Payer: United Healthcare Medicare |
$148.34
|
|
|
PR ESOPHAGOSCOPY FLEXIBLE TRANSORAL W SUBMUCOUS INJ
|
Professional
|
$475.16
|
|
|
Service Code
|
CPT 43201
|
| Hospital Charge Code |
z43201
|
| Min. Negotiated Rate |
$95.65 |
| Max. Negotiated Rate |
$356.37 |
| Rate for Payer: Aetna Medicare |
$95.65
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$110.00
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$105.22
|
| Rate for Payer: Cash Price |
$294.60
|
| Rate for Payer: Cash Price |
$294.60
|
| Rate for Payer: Coventry All Commercial |
$114.78
|
| Rate for Payer: Frontpath All Commercial |
$133.22
|
| Rate for Payer: Humana ChoiceCare |
$142.98
|
| Rate for Payer: Humana Medicare |
$95.65
|
| Rate for Payer: Lucent All Commercial |
$162.60
|
| Rate for Payer: PHCS All Commercial |
$356.37
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$95.65
|
| Rate for Payer: United Healthcare Commercial |
$147.94
|
| Rate for Payer: United Healthcare Medicare |
$95.65
|
|
|
PR ESOPHAGOSCOPY FLEXIBLE W/BLEEDING CONTROL
|
Professional
|
$1,086.68
|
|
|
Service Code
|
CPT 43227
|
| Hospital Charge Code |
z43227
|
| Min. Negotiated Rate |
$152.81 |
| Max. Negotiated Rate |
$815.01 |
| Rate for Payer: Aetna Medicare |
$152.81
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$175.73
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$168.09
|
| Rate for Payer: Cash Price |
$673.74
|
| Rate for Payer: Cash Price |
$673.74
|
| Rate for Payer: Coventry All Commercial |
$183.37
|
| Rate for Payer: Frontpath All Commercial |
$212.06
|
| Rate for Payer: Humana ChoiceCare |
$227.98
|
| Rate for Payer: Humana Medicare |
$152.81
|
| Rate for Payer: Lucent All Commercial |
$259.78
|
| Rate for Payer: PHCS All Commercial |
$815.01
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$152.81
|
| Rate for Payer: United Healthcare Commercial |
$241.43
|
| Rate for Payer: United Healthcare Medicare |
$152.81
|
|
|
PR ESOPHAGOSCOPY RIGID TRANSORAL BALLOON DILATION
|
Professional
|
$337.28
|
|
|
Service Code
|
CPT 43195
|
| Hospital Charge Code |
z43195
|
| Min. Negotiated Rate |
$172.86 |
| Max. Negotiated Rate |
$293.86 |
| Rate for Payer: Aetna Medicare |
$172.86
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$198.79
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$190.15
|
| Rate for Payer: Cash Price |
$209.11
|
| Rate for Payer: Cash Price |
$209.11
|
| Rate for Payer: Coventry All Commercial |
$207.43
|
| Rate for Payer: Frontpath All Commercial |
$237.73
|
| Rate for Payer: Humana ChoiceCare |
$210.61
|
| Rate for Payer: Humana Medicare |
$172.86
|
| Rate for Payer: Lucent All Commercial |
$293.86
|
| Rate for Payer: PHCS All Commercial |
$252.96
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$172.86
|
| Rate for Payer: United Healthcare Commercial |
$220.88
|
| Rate for Payer: United Healthcare Medicare |
$172.86
|
|
|
PR EVACUATE MOLE OF UTERUS
|
Professional
|
$960.40
|
|
|
Service Code
|
CPT 59870
|
| Hospital Charge Code |
z59870
|
| Min. Negotiated Rate |
$405.01 |
| Max. Negotiated Rate |
$837.03 |
| Rate for Payer: Aetna Medicare |
$492.37
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$582.98
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$582.98
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$566.23
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$541.61
|
| Rate for Payer: Cash Price |
$595.45
|
| Rate for Payer: Cash Price |
$595.45
|
| Rate for Payer: Coventry All Commercial |
$590.84
|
| Rate for Payer: Frontpath All Commercial |
$689.41
|
| Rate for Payer: Humana ChoiceCare |
$405.01
|
| Rate for Payer: Humana Medicare |
$492.37
|
| Rate for Payer: Lucent All Commercial |
$837.03
|
| Rate for Payer: Lutheran Preferred All Commercial |
$689.00
|
| Rate for Payer: PHCS All Commercial |
$720.30
|
| Rate for Payer: PHP All Commercial |
$633.86
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$492.37
|
| Rate for Payer: Signature Care EPO |
$510.00
|
| Rate for Payer: Signature Care PPO |
$510.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$640.00
|
| Rate for Payer: United Healthcare Commercial |
$518.50
|
| Rate for Payer: United Healthcare Medicare |
$492.37
|
|
|
PR EVOKED AUDITORY TEST,COMPREHSV
|
Professional
|
$63.50
|
|
|
Service Code
|
CPT 92588
|
| Hospital Charge Code |
z92588
|
| Min. Negotiated Rate |
$32.54 |
| Max. Negotiated Rate |
$84.15 |
| Rate for Payer: Aetna Medicare |
$32.54
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$79.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$79.30
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$37.42
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$35.79
|
| Rate for Payer: Cash Price |
$39.37
|
| Rate for Payer: Cash Price |
$39.37
|
| Rate for Payer: Coventry All Commercial |
$39.05
|
| Rate for Payer: Frontpath All Commercial |
$36.72
|
| Rate for Payer: Humana ChoiceCare |
$84.15
|
| Rate for Payer: Humana Medicare |
$32.54
|
| Rate for Payer: Lucent All Commercial |
$55.32
|
| Rate for Payer: Lutheran Preferred All Commercial |
$42.00
|
| Rate for Payer: PHCS All Commercial |
$47.62
|
| Rate for Payer: PHP All Commercial |
$46.04
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$32.54
|
| Rate for Payer: Signature Care EPO |
$54.33
|
| Rate for Payer: Signature Care PPO |
$54.33
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$39.00
|
| Rate for Payer: United Healthcare Commercial |
$71.33
|
| Rate for Payer: United Healthcare Medicare |
$32.54
|
|
|
PR EVOKED AUDITORY TEST,LIMITED
|
Professional
|
$40.64
|
|
|
Service Code
|
CPT 92587
|
| Hospital Charge Code |
z92587
|
| Min. Negotiated Rate |
$20.83 |
| Max. Negotiated Rate |
$63.12 |
| Rate for Payer: Aetna Medicare |
$20.83
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$58.90
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$58.90
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$23.95
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$22.91
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Coventry All Commercial |
$25.00
|
| Rate for Payer: Frontpath All Commercial |
$23.89
|
| Rate for Payer: Humana ChoiceCare |
$63.12
|
| Rate for Payer: Humana Medicare |
$20.83
|
| Rate for Payer: Lucent All Commercial |
$35.41
|
| Rate for Payer: Lutheran Preferred All Commercial |
$27.00
|
| Rate for Payer: PHCS All Commercial |
$30.48
|
| Rate for Payer: PHP All Commercial |
$29.46
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$20.83
|
| Rate for Payer: Signature Care EPO |
$35.46
|
| Rate for Payer: Signature Care PPO |
$35.46
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$25.00
|
| Rate for Payer: United Healthcare Commercial |
$43.04
|
| Rate for Payer: United Healthcare Medicare |
$20.83
|
|
|
PR EXCIS BARTHOLIN GLAND/CYST
|
Professional
|
$576.12
|
|
|
Service Code
|
CPT 56740
|
| Hospital Charge Code |
z56740
|
| Min. Negotiated Rate |
$295.26 |
| Max. Negotiated Rate |
$501.94 |
| Rate for Payer: Aetna Medicare |
$295.26
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$376.42
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$376.42
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$339.55
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$324.79
|
| Rate for Payer: Cash Price |
$357.19
|
| Rate for Payer: Cash Price |
$357.19
|
| Rate for Payer: Coventry All Commercial |
$354.31
|
| Rate for Payer: Frontpath All Commercial |
$413.69
|
| Rate for Payer: Humana ChoiceCare |
$316.26
|
| Rate for Payer: Humana Medicare |
$295.26
|
| Rate for Payer: Lucent All Commercial |
$501.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$413.00
|
| Rate for Payer: PHCS All Commercial |
$432.09
|
| Rate for Payer: PHP All Commercial |
$380.24
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$295.26
|
| Rate for Payer: Signature Care EPO |
$348.50
|
| Rate for Payer: Signature Care PPO |
$348.50
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$384.00
|
| Rate for Payer: United Healthcare Commercial |
$333.45
|
| Rate for Payer: United Healthcare Medicare |
$295.26
|
|
|
PR EXCIS BENIGN BONE LESN,METACARPAL
|
Professional
|
$827.90
|
|
|
Service Code
|
CPT 26200
|
| Hospital Charge Code |
z26200
|
| Min. Negotiated Rate |
$424.62 |
| Max. Negotiated Rate |
$721.85 |
| Rate for Payer: Aetna Medicare |
$424.62
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$651.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$651.00
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$488.31
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$467.08
|
| Rate for Payer: Cash Price |
$513.30
|
| Rate for Payer: Cash Price |
$513.30
|
| Rate for Payer: Coventry All Commercial |
$509.54
|
| Rate for Payer: Frontpath All Commercial |
$580.97
|
| Rate for Payer: Humana ChoiceCare |
$469.28
|
| Rate for Payer: Humana Medicare |
$424.62
|
| Rate for Payer: Lucent All Commercial |
$721.85
|
| Rate for Payer: Lutheran Preferred All Commercial |
$679.00
|
| Rate for Payer: PHCS All Commercial |
$620.92
|
| Rate for Payer: PHP All Commercial |
$720.28
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$424.62
|
| Rate for Payer: Signature Care EPO |
$625.60
|
| Rate for Payer: Signature Care PPO |
$625.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$637.00
|
| Rate for Payer: United Healthcare Commercial |
$477.23
|
| Rate for Payer: United Healthcare Medicare |
$424.62
|
|
|
PR EXCIS BENIGN LESN CARPALS
|
Professional
|
$829.54
|
|
|
Service Code
|
CPT 25130
|
| Hospital Charge Code |
z25130
|
| Min. Negotiated Rate |
$425.14 |
| Max. Negotiated Rate |
$722.74 |
| Rate for Payer: Aetna Medicare |
$425.14
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$488.91
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$467.65
|
| Rate for Payer: Cash Price |
$514.31
|
| Rate for Payer: Cash Price |
$514.31
|
| Rate for Payer: Coventry All Commercial |
$510.17
|
| Rate for Payer: Frontpath All Commercial |
$582.58
|
| Rate for Payer: Humana ChoiceCare |
$499.16
|
| Rate for Payer: Humana Medicare |
$425.14
|
| Rate for Payer: Lucent All Commercial |
$722.74
|
| Rate for Payer: PHCS All Commercial |
$622.16
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$425.14
|
| Rate for Payer: United Healthcare Commercial |
$478.31
|
| Rate for Payer: United Healthcare Medicare |
$425.14
|
|
|
PR EXCIS/CURET BENIGN ELBOW LESN
|
Professional
|
$974.88
|
|
|
Service Code
|
CPT 24120
|
| Hospital Charge Code |
z24120
|
| Min. Negotiated Rate |
$499.62 |
| Max. Negotiated Rate |
$849.35 |
| Rate for Payer: Aetna Medicare |
$499.62
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$574.56
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$549.58
|
| Rate for Payer: Cash Price |
$604.43
|
| Rate for Payer: Cash Price |
$604.43
|
| Rate for Payer: Coventry All Commercial |
$599.54
|
| Rate for Payer: Frontpath All Commercial |
$691.02
|
| Rate for Payer: Humana ChoiceCare |
$545.78
|
| Rate for Payer: Humana Medicare |
$499.62
|
| Rate for Payer: Lucent All Commercial |
$849.35
|
| Rate for Payer: PHCS All Commercial |
$731.16
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$499.62
|
| Rate for Payer: United Healthcare Commercial |
$557.35
|
| Rate for Payer: United Healthcare Medicare |
$499.62
|
|
|
PR EXCIS/CURET BENIGN TUMR CLAV/SCAPULA
|
Professional
|
$1,013.56
|
|
|
Service Code
|
CPT 23140
|
| Hospital Charge Code |
z23140
|
| Min. Negotiated Rate |
$519.45 |
| Max. Negotiated Rate |
$883.06 |
| Rate for Payer: Aetna Medicare |
$519.45
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$636.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$636.00
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$597.37
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$571.40
|
| Rate for Payer: Cash Price |
$628.41
|
| Rate for Payer: Cash Price |
$628.41
|
| Rate for Payer: Coventry All Commercial |
$623.34
|
| Rate for Payer: Frontpath All Commercial |
$720.85
|
| Rate for Payer: Humana ChoiceCare |
$528.19
|
| Rate for Payer: Humana Medicare |
$519.45
|
| Rate for Payer: Lucent All Commercial |
$883.06
|
| Rate for Payer: Lutheran Preferred All Commercial |
$831.00
|
| Rate for Payer: PHCS All Commercial |
$760.17
|
| Rate for Payer: PHP All Commercial |
$881.80
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$519.45
|
| Rate for Payer: Signature Care EPO |
$715.70
|
| Rate for Payer: Signature Care PPO |
$715.70
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$779.00
|
| Rate for Payer: United Healthcare Commercial |
$551.71
|
| Rate for Payer: United Healthcare Medicare |
$519.45
|
|
|
PR EXCIS/DEST INTRANAS LESION; INT APP
|
Professional
|
$1,776.28
|
|
|
Service Code
|
CPT 30117
|
| Hospital Charge Code |
z30117
|
| Min. Negotiated Rate |
$313.29 |
| Max. Negotiated Rate |
$1,332.21 |
| Rate for Payer: Aetna Medicare |
$313.29
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$320.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$320.30
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$360.28
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$344.62
|
| Rate for Payer: Cash Price |
$1,101.29
|
| Rate for Payer: Cash Price |
$1,101.29
|
| Rate for Payer: Coventry All Commercial |
$375.95
|
| Rate for Payer: Frontpath All Commercial |
$422.15
|
| Rate for Payer: Humana ChoiceCare |
$344.29
|
| Rate for Payer: Humana Medicare |
$313.29
|
| Rate for Payer: Lucent All Commercial |
$532.59
|
| Rate for Payer: Lutheran Preferred All Commercial |
$501.00
|
| Rate for Payer: PHCS All Commercial |
$1,332.21
|
| Rate for Payer: PHP All Commercial |
$427.91
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$313.29
|
| Rate for Payer: Signature Care EPO |
$788.11
|
| Rate for Payer: Signature Care PPO |
$788.11
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$470.00
|
| Rate for Payer: United Healthcare Commercial |
$351.19
|
| Rate for Payer: United Healthcare Medicare |
$313.29
|
|
|
PR EXCISE BREAST CYST
|
Professional
|
$933.62
|
|
|
Service Code
|
CPT 19120
|
| Hospital Charge Code |
z19120
|
| Min. Negotiated Rate |
$327.80 |
| Max. Negotiated Rate |
$700.22 |
| Rate for Payer: Aetna Medicare |
$383.70
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$586.43
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$586.43
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$441.26
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$422.07
|
| Rate for Payer: Cash Price |
$578.84
|
| Rate for Payer: Cash Price |
$578.84
|
| Rate for Payer: Coventry All Commercial |
$460.44
|
| Rate for Payer: Frontpath All Commercial |
$545.36
|
| Rate for Payer: Humana ChoiceCare |
$327.80
|
| Rate for Payer: Humana Medicare |
$383.70
|
| Rate for Payer: Lucent All Commercial |
$652.29
|
| Rate for Payer: Lutheran Preferred All Commercial |
$499.00
|
| Rate for Payer: PHCS All Commercial |
$700.22
|
| Rate for Payer: PHP All Commercial |
$524.08
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$383.70
|
| Rate for Payer: Signature Care EPO |
$455.60
|
| Rate for Payer: Signature Care PPO |
$455.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$460.00
|
| Rate for Payer: United Healthcare Commercial |
$421.65
|
| Rate for Payer: United Healthcare Medicare |
$383.70
|
|
|
PR EXCISE BREAST LES W XRAY MARKER
|
Professional
|
$1,027.58
|
|
|
Service Code
|
CPT 19125
|
| Hospital Charge Code |
z19125
|
| Min. Negotiated Rate |
$355.46 |
| Max. Negotiated Rate |
$770.68 |
| Rate for Payer: Aetna Medicare |
$423.83
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$649.64
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$649.64
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$487.40
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$466.21
|
| Rate for Payer: Cash Price |
$637.10
|
| Rate for Payer: Cash Price |
$637.10
|
| Rate for Payer: Coventry All Commercial |
$508.60
|
| Rate for Payer: Frontpath All Commercial |
$606.11
|
| Rate for Payer: Humana ChoiceCare |
$355.46
|
| Rate for Payer: Humana Medicare |
$423.83
|
| Rate for Payer: Lucent All Commercial |
$720.51
|
| Rate for Payer: Lutheran Preferred All Commercial |
$551.00
|
| Rate for Payer: PHCS All Commercial |
$770.68
|
| Rate for Payer: PHP All Commercial |
$579.32
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$423.83
|
| Rate for Payer: Signature Care EPO |
$485.35
|
| Rate for Payer: Signature Care PPO |
$485.35
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$509.00
|
| Rate for Payer: United Healthcare Commercial |
$468.11
|
| Rate for Payer: United Healthcare Medicare |
$423.83
|
|
|
PR EXCISE BREAST LES XRAY MARK ADDNL
|
Professional
|
$282.60
|
|
|
Service Code
|
CPT 19126
|
| Hospital Charge Code |
z19126
|
| Min. Negotiated Rate |
$144.84 |
| Max. Negotiated Rate |
$246.23 |
| Rate for Payer: Aetna Medicare |
$144.84
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$214.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$214.30
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$166.57
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$159.32
|
| Rate for Payer: Cash Price |
$175.21
|
| Rate for Payer: Cash Price |
$175.21
|
| Rate for Payer: Coventry All Commercial |
$173.81
|
| Rate for Payer: Frontpath All Commercial |
$213.33
|
| Rate for Payer: Humana ChoiceCare |
$151.65
|
| Rate for Payer: Humana Medicare |
$144.84
|
| Rate for Payer: Lucent All Commercial |
$246.23
|
| Rate for Payer: Lutheran Preferred All Commercial |
$188.00
|
| Rate for Payer: PHCS All Commercial |
$211.95
|
| Rate for Payer: PHP All Commercial |
$197.83
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$144.84
|
| Rate for Payer: Signature Care EPO |
$168.30
|
| Rate for Payer: Signature Care PPO |
$168.30
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$174.00
|
| Rate for Payer: United Healthcare Commercial |
$177.54
|
| Rate for Payer: United Healthcare Medicare |
$144.84
|
|
|
PR EXCISE CUTANEOUS NEUROMA
|
Professional
|
$775.56
|
|
|
Service Code
|
CPT 64774
|
| Hospital Charge Code |
z64774
|
| Min. Negotiated Rate |
$397.48 |
| Max. Negotiated Rate |
$675.72 |
| Rate for Payer: Aetna Medicare |
$397.48
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$457.10
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$437.23
|
| Rate for Payer: Cash Price |
$480.85
|
| Rate for Payer: Cash Price |
$480.85
|
| Rate for Payer: Coventry All Commercial |
$476.98
|
| Rate for Payer: Frontpath All Commercial |
$540.07
|
| Rate for Payer: Humana ChoiceCare |
$458.50
|
| Rate for Payer: Humana Medicare |
$397.48
|
| Rate for Payer: Lucent All Commercial |
$675.72
|
| Rate for Payer: PHCS All Commercial |
$581.67
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$397.48
|
| Rate for Payer: United Healthcare Commercial |
$441.68
|
| Rate for Payer: United Healthcare Medicare |
$397.48
|
|
|
PR EXCISE DIGITAL NEUROMA
|
Professional
|
$728.62
|
|
|
Service Code
|
CPT 64776
|
| Hospital Charge Code |
z64776
|
| Min. Negotiated Rate |
$373.42 |
| Max. Negotiated Rate |
$637.54 |
| Rate for Payer: Aetna Medicare |
$373.42
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$416.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$416.00
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$429.43
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$410.76
|
| Rate for Payer: Cash Price |
$451.74
|
| Rate for Payer: Cash Price |
$451.74
|
| Rate for Payer: Coventry All Commercial |
$448.10
|
| Rate for Payer: Frontpath All Commercial |
$507.92
|
| Rate for Payer: Humana ChoiceCare |
$449.43
|
| Rate for Payer: Humana Medicare |
$373.42
|
| Rate for Payer: Lucent All Commercial |
$634.81
|
| Rate for Payer: Lutheran Preferred All Commercial |
$597.00
|
| Rate for Payer: PHCS All Commercial |
$546.46
|
| Rate for Payer: PHP All Commercial |
$637.54
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$373.42
|
| Rate for Payer: Signature Care EPO |
$513.40
|
| Rate for Payer: Signature Care PPO |
$513.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$560.00
|
| Rate for Payer: United Healthcare Commercial |
$424.59
|
| Rate for Payer: United Healthcare Medicare |
$373.42
|
|
|
PR EXCISE HAND/FOOT NEUROMA
|
Professional
|
$834.90
|
|
|
Service Code
|
CPT 64782
|
| Hospital Charge Code |
z64782
|
| Min. Negotiated Rate |
$427.88 |
| Max. Negotiated Rate |
$727.40 |
| Rate for Payer: Aetna Medicare |
$427.88
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$492.06
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$470.67
|
| Rate for Payer: Cash Price |
$517.64
|
| Rate for Payer: Cash Price |
$517.64
|
| Rate for Payer: Coventry All Commercial |
$513.46
|
| Rate for Payer: Frontpath All Commercial |
$588.76
|
| Rate for Payer: Humana ChoiceCare |
$512.62
|
| Rate for Payer: Humana Medicare |
$427.88
|
| Rate for Payer: Lucent All Commercial |
$727.40
|
| Rate for Payer: PHCS All Commercial |
$626.18
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$427.88
|
| Rate for Payer: United Healthcare Commercial |
$500.99
|
| Rate for Payer: United Healthcare Medicare |
$427.88
|
|
|
PR EXCISE LIP OR CHEEK FOLD
|
Professional
|
$494.24
|
|
|
Service Code
|
CPT 40819
|
| Hospital Charge Code |
z40819
|
| Min. Negotiated Rate |
$187.24 |
| Max. Negotiated Rate |
$374.00 |
| Rate for Payer: Aetna Medicare |
$187.24
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$250.24
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$250.24
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$215.33
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$205.96
|
| Rate for Payer: Cash Price |
$306.43
|
| Rate for Payer: Cash Price |
$306.43
|
| Rate for Payer: Coventry All Commercial |
$224.69
|
| Rate for Payer: Frontpath All Commercial |
$251.48
|
| Rate for Payer: Humana ChoiceCare |
$242.46
|
| Rate for Payer: Humana Medicare |
$187.24
|
| Rate for Payer: Lucent All Commercial |
$318.31
|
| Rate for Payer: Lutheran Preferred All Commercial |
$281.00
|
| Rate for Payer: PHCS All Commercial |
$370.68
|
| Rate for Payer: PHP All Commercial |
$319.68
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$187.24
|
| Rate for Payer: Signature Care EPO |
$374.00
|
| Rate for Payer: Signature Care PPO |
$374.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$262.00
|
| Rate for Payer: United Healthcare Commercial |
$247.41
|
| Rate for Payer: United Healthcare Medicare |
$187.24
|
|
|
PR EXCISE MAJOR PERIPHERAL NEUROMA
|
Professional
|
$1,315.30
|
|
|
Service Code
|
CPT 64784
|
| Hospital Charge Code |
z64784
|
| Min. Negotiated Rate |
$674.09 |
| Max. Negotiated Rate |
$1,150.89 |
| Rate for Payer: Aetna Medicare |
$674.09
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$800.60
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$800.60
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$775.20
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$741.50
|
| Rate for Payer: Cash Price |
$815.49
|
| Rate for Payer: Cash Price |
$815.49
|
| Rate for Payer: Coventry All Commercial |
$808.91
|
| Rate for Payer: Frontpath All Commercial |
$944.31
|
| Rate for Payer: Humana ChoiceCare |
$839.07
|
| Rate for Payer: Humana Medicare |
$674.09
|
| Rate for Payer: Lucent All Commercial |
$1,145.95
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,079.00
|
| Rate for Payer: PHCS All Commercial |
$986.48
|
| Rate for Payer: PHP All Commercial |
$1,150.89
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$674.09
|
| Rate for Payer: Signature Care EPO |
$958.80
|
| Rate for Payer: Signature Care PPO |
$958.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,011.00
|
| Rate for Payer: United Healthcare Commercial |
$779.61
|
| Rate for Payer: United Healthcare Medicare |
$674.09
|
|
|
PR EXCIS INTERDIGITAL NEUROMA,EA
|
Professional
|
$969.24
|
|
|
Service Code
|
CPT 28080
|
| Hospital Charge Code |
z28080
|
| Min. Negotiated Rate |
$310.76 |
| Max. Negotiated Rate |
$726.93 |
| Rate for Payer: Aetna Medicare |
$355.35
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$408.65
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$390.88
|
| Rate for Payer: Cash Price |
$600.93
|
| Rate for Payer: Cash Price |
$600.93
|
| Rate for Payer: Coventry All Commercial |
$426.42
|
| Rate for Payer: Frontpath All Commercial |
$478.11
|
| Rate for Payer: Humana ChoiceCare |
$310.76
|
| Rate for Payer: Humana Medicare |
$355.35
|
| Rate for Payer: Lucent All Commercial |
$604.10
|
| Rate for Payer: PHCS All Commercial |
$726.93
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$355.35
|
| Rate for Payer: United Healthcare Commercial |
$387.88
|
| Rate for Payer: United Healthcare Medicare |
$355.35
|
|
|
PR EXCISION BRANC CLFT CYST,DEEP
|
Professional
|
$992.30
|
|
|
Service Code
|
CPT 42815
|
| Hospital Charge Code |
z42815
|
| Min. Negotiated Rate |
$508.55 |
| Max. Negotiated Rate |
$868.26 |
| Rate for Payer: Aetna Medicare |
$508.55
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$709.60
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$709.60
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$584.83
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$559.40
|
| Rate for Payer: Cash Price |
$615.23
|
| Rate for Payer: Cash Price |
$615.23
|
| Rate for Payer: Coventry All Commercial |
$610.26
|
| Rate for Payer: Frontpath All Commercial |
$696.49
|
| Rate for Payer: Humana ChoiceCare |
$596.60
|
| Rate for Payer: Humana Medicare |
$508.55
|
| Rate for Payer: Lucent All Commercial |
$864.54
|
| Rate for Payer: Lutheran Preferred All Commercial |
$763.00
|
| Rate for Payer: PHCS All Commercial |
$744.22
|
| Rate for Payer: PHP All Commercial |
$868.26
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$508.55
|
| Rate for Payer: Signature Care EPO |
$705.50
|
| Rate for Payer: Signature Care PPO |
$705.50
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$712.00
|
| Rate for Payer: United Healthcare Commercial |
$605.64
|
| Rate for Payer: United Healthcare Medicare |
$508.55
|
|
|
PR EXCISION HIDRADENITIS AXILLARY COMPLEX REPAIR
|
Professional
|
$956.74
|
|
|
Service Code
|
CPT 11451
|
| Hospital Charge Code |
z11451
|
| Min. Negotiated Rate |
$245.63 |
| Max. Negotiated Rate |
$717.56 |
| Rate for Payer: Aetna Medicare |
$306.64
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$454.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$454.30
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$352.64
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$337.30
|
| Rate for Payer: Cash Price |
$593.18
|
| Rate for Payer: Cash Price |
$593.18
|
| Rate for Payer: Coventry All Commercial |
$367.97
|
| Rate for Payer: Frontpath All Commercial |
$427.12
|
| Rate for Payer: Humana ChoiceCare |
$245.63
|
| Rate for Payer: Humana Medicare |
$306.64
|
| Rate for Payer: Lucent All Commercial |
$521.29
|
| Rate for Payer: Lutheran Preferred All Commercial |
$399.00
|
| Rate for Payer: PHCS All Commercial |
$717.56
|
| Rate for Payer: PHP All Commercial |
$418.83
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$306.64
|
| Rate for Payer: Signature Care EPO |
$434.35
|
| Rate for Payer: Signature Care PPO |
$434.35
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$368.00
|
| Rate for Payer: United Healthcare Commercial |
$327.55
|
| Rate for Payer: United Healthcare Medicare |
$306.64
|
|
|
PR EXCISION HIDRADENITIS AXILLARY SMPL/INTRM RPR
|
Professional
|
$781.90
|
|
|
Service Code
|
CPT 11450
|
| Hospital Charge Code |
z11450
|
| Min. Negotiated Rate |
$178.78 |
| Max. Negotiated Rate |
$586.42 |
| Rate for Payer: Aetna Medicare |
$241.12
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$346.94
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$346.94
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$277.29
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$265.23
|
| Rate for Payer: Cash Price |
$484.78
|
| Rate for Payer: Cash Price |
$484.78
|
| Rate for Payer: Coventry All Commercial |
$289.34
|
| Rate for Payer: Frontpath All Commercial |
$338.27
|
| Rate for Payer: Humana ChoiceCare |
$178.78
|
| Rate for Payer: Humana Medicare |
$241.12
|
| Rate for Payer: Lucent All Commercial |
$409.90
|
| Rate for Payer: Lutheran Preferred All Commercial |
$313.00
|
| Rate for Payer: PHCS All Commercial |
$586.42
|
| Rate for Payer: PHP All Commercial |
$329.33
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$241.12
|
| Rate for Payer: Signature Care EPO |
$347.21
|
| Rate for Payer: Signature Care PPO |
$347.21
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$289.00
|
| Rate for Payer: United Healthcare Commercial |
$247.59
|
| Rate for Payer: United Healthcare Medicare |
$241.12
|
|
