|
PR EXCISION HIDRADENITIS INGUINAL SMPL/INTRM RPR
|
Professional
|
$757.30
|
|
|
Service Code
|
CPT 11462
|
| Hospital Charge Code |
z11462
|
| Min. Negotiated Rate |
$169.77 |
| Max. Negotiated Rate |
$567.98 |
| Rate for Payer: Aetna Medicare |
$229.13
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$342.07
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$342.07
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$263.50
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$252.04
|
| Rate for Payer: Cash Price |
$469.53
|
| Rate for Payer: Cash Price |
$469.53
|
| Rate for Payer: Coventry All Commercial |
$274.96
|
| Rate for Payer: Frontpath All Commercial |
$320.66
|
| Rate for Payer: Humana ChoiceCare |
$169.77
|
| Rate for Payer: Humana Medicare |
$229.13
|
| Rate for Payer: Lucent All Commercial |
$389.52
|
| Rate for Payer: Lutheran Preferred All Commercial |
$298.00
|
| Rate for Payer: PHCS All Commercial |
$567.98
|
| Rate for Payer: PHP All Commercial |
$312.95
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$229.13
|
| Rate for Payer: Signature Care EPO |
$337.39
|
| Rate for Payer: Signature Care PPO |
$337.39
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$275.00
|
| Rate for Payer: United Healthcare Commercial |
$237.96
|
| Rate for Payer: United Healthcare Medicare |
$229.13
|
|
|
PR EXCISION H/P/P/U SIMPLE/INTERMEDIATE REPAIR
|
Professional
|
$831.06
|
|
|
Service Code
|
CPT 11470
|
| Hospital Charge Code |
z11470
|
| Min. Negotiated Rate |
$207.72 |
| Max. Negotiated Rate |
$623.30 |
| Rate for Payer: Aetna Medicare |
$266.31
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$381.34
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$381.34
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$306.26
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$292.94
|
| Rate for Payer: Cash Price |
$515.26
|
| Rate for Payer: Cash Price |
$515.26
|
| Rate for Payer: Coventry All Commercial |
$319.57
|
| Rate for Payer: Frontpath All Commercial |
$368.64
|
| Rate for Payer: Humana ChoiceCare |
$207.72
|
| Rate for Payer: Humana Medicare |
$266.31
|
| Rate for Payer: Lucent All Commercial |
$452.73
|
| Rate for Payer: Lutheran Preferred All Commercial |
$346.00
|
| Rate for Payer: PHCS All Commercial |
$623.30
|
| Rate for Payer: PHP All Commercial |
$363.74
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$266.31
|
| Rate for Payer: Signature Care EPO |
$365.15
|
| Rate for Payer: Signature Care PPO |
$365.15
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$320.00
|
| Rate for Payer: United Healthcare Commercial |
$282.18
|
| Rate for Payer: United Healthcare Medicare |
$266.31
|
|
|
PR EXCISION NOSE POLYP(S),SIMPLE
|
Professional
|
$456.84
|
|
|
Service Code
|
CPT 30110
|
| Hospital Charge Code |
z30110
|
| Min. Negotiated Rate |
$124.54 |
| Max. Negotiated Rate |
$342.63 |
| Rate for Payer: Aetna Medicare |
$124.54
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$241.95
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$241.95
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$143.22
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$136.99
|
| Rate for Payer: Cash Price |
$283.24
|
| Rate for Payer: Cash Price |
$283.24
|
| Rate for Payer: Coventry All Commercial |
$149.45
|
| Rate for Payer: Frontpath All Commercial |
$168.71
|
| Rate for Payer: Humana ChoiceCare |
$143.36
|
| Rate for Payer: Humana Medicare |
$124.54
|
| Rate for Payer: Lucent All Commercial |
$211.72
|
| Rate for Payer: Lutheran Preferred All Commercial |
$199.00
|
| Rate for Payer: PHCS All Commercial |
$342.63
|
| Rate for Payer: PHP All Commercial |
$170.10
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$124.54
|
| Rate for Payer: Signature Care EPO |
$256.70
|
| Rate for Payer: Signature Care PPO |
$256.70
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$187.00
|
| Rate for Payer: United Healthcare Commercial |
$140.25
|
| Rate for Payer: United Healthcare Medicare |
$124.54
|
|
|
PR EXCISION OF MESENTERY LESION
|
Professional
|
$1,515.82
|
|
|
Service Code
|
CPT 44820
|
| Hospital Charge Code |
z44820
|
| Min. Negotiated Rate |
$777.18 |
| Max. Negotiated Rate |
$1,326.35 |
| Rate for Payer: Aetna Medicare |
$777.18
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$804.80
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$804.80
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$893.76
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$854.90
|
| Rate for Payer: Cash Price |
$939.81
|
| Rate for Payer: Cash Price |
$939.81
|
| Rate for Payer: Coventry All Commercial |
$932.62
|
| Rate for Payer: Frontpath All Commercial |
$1,128.23
|
| Rate for Payer: Humana ChoiceCare |
$805.03
|
| Rate for Payer: Humana Medicare |
$777.18
|
| Rate for Payer: Lucent All Commercial |
$1,321.21
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,166.00
|
| Rate for Payer: PHCS All Commercial |
$1,136.86
|
| Rate for Payer: PHP All Commercial |
$1,326.35
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$777.18
|
| Rate for Payer: Signature Care EPO |
$1,013.20
|
| Rate for Payer: Signature Care PPO |
$1,013.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,088.00
|
| Rate for Payer: United Healthcare Commercial |
$894.56
|
| Rate for Payer: United Healthcare Medicare |
$777.18
|
|
|
PR EXCISION OF NAIL FOLD, TOE
|
Professional
|
$302.46
|
|
|
Service Code
|
CPT 11765
|
| Hospital Charge Code |
z11765
|
| Min. Negotiated Rate |
$53.57 |
| Max. Negotiated Rate |
$226.84 |
| Rate for Payer: Aetna Medicare |
$86.79
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$86.19
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$86.19
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$99.81
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$95.47
|
| Rate for Payer: Cash Price |
$187.53
|
| Rate for Payer: Cash Price |
$187.53
|
| Rate for Payer: Coventry All Commercial |
$104.15
|
| Rate for Payer: Frontpath All Commercial |
$116.08
|
| Rate for Payer: Humana ChoiceCare |
$53.57
|
| Rate for Payer: Humana Medicare |
$86.79
|
| Rate for Payer: Lucent All Commercial |
$147.54
|
| Rate for Payer: Lutheran Preferred All Commercial |
$113.00
|
| Rate for Payer: PHCS All Commercial |
$226.84
|
| Rate for Payer: PHP All Commercial |
$118.54
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$86.79
|
| Rate for Payer: Signature Care EPO |
$134.50
|
| Rate for Payer: Signature Care PPO |
$134.50
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$104.00
|
| Rate for Payer: United Healthcare Commercial |
$72.25
|
| Rate for Payer: United Healthcare Medicare |
$86.79
|
|
|
PR EXCISION THROMBOSED HEMORRHOID, EXTERNAL
|
Professional
|
$389.18
|
|
|
Service Code
|
CPT 46320
|
| Hospital Charge Code |
z46320
|
| Min. Negotiated Rate |
$105.30 |
| Max. Negotiated Rate |
$291.88 |
| Rate for Payer: Aetna Medicare |
$105.30
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$185.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$185.30
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$121.10
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$115.83
|
| Rate for Payer: Cash Price |
$241.29
|
| Rate for Payer: Cash Price |
$241.29
|
| Rate for Payer: Coventry All Commercial |
$126.36
|
| Rate for Payer: Frontpath All Commercial |
$146.70
|
| Rate for Payer: Humana ChoiceCare |
$111.52
|
| Rate for Payer: Humana Medicare |
$105.30
|
| Rate for Payer: Lucent All Commercial |
$179.01
|
| Rate for Payer: Lutheran Preferred All Commercial |
$158.00
|
| Rate for Payer: PHCS All Commercial |
$291.88
|
| Rate for Payer: PHP All Commercial |
$179.78
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$105.30
|
| Rate for Payer: Signature Care EPO |
$208.25
|
| Rate for Payer: Signature Care PPO |
$208.25
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$147.00
|
| Rate for Payer: United Healthcare Commercial |
$114.73
|
| Rate for Payer: United Healthcare Medicare |
$105.30
|
|
|
PR EXCISION TUMOR SOFT TISS FACE/SCALP SUBQ 2+CM
|
Professional
|
$614.66
|
|
|
Service Code
|
CPT 21012
|
| Hospital Charge Code |
z21012
|
| Min. Negotiated Rate |
$315.01 |
| Max. Negotiated Rate |
$535.52 |
| Rate for Payer: Aetna Medicare |
$315.01
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$393.45
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$393.45
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$362.26
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$346.51
|
| Rate for Payer: Cash Price |
$381.09
|
| Rate for Payer: Cash Price |
$381.09
|
| Rate for Payer: Coventry All Commercial |
$378.01
|
| Rate for Payer: Frontpath All Commercial |
$438.36
|
| Rate for Payer: Humana ChoiceCare |
$352.57
|
| Rate for Payer: Humana Medicare |
$315.01
|
| Rate for Payer: Lucent All Commercial |
$535.52
|
| Rate for Payer: Lutheran Preferred All Commercial |
$504.00
|
| Rate for Payer: PHCS All Commercial |
$461.00
|
| Rate for Payer: PHP All Commercial |
$534.75
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$315.01
|
| Rate for Payer: Signature Care EPO |
$338.30
|
| Rate for Payer: Signature Care PPO |
$338.30
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$473.00
|
| Rate for Payer: United Healthcare Commercial |
$385.86
|
| Rate for Payer: United Healthcare Medicare |
$315.01
|
|
|
PR EXCISION TUMOR SOFT TISSUE BACK/FLANK SUBQ 3+CM
|
Professional
|
$844.30
|
|
|
Service Code
|
CPT 21931
|
| Hospital Charge Code |
z21931
|
| Min. Negotiated Rate |
$432.70 |
| Max. Negotiated Rate |
$735.59 |
| Rate for Payer: Aetna Medicare |
$432.70
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$550.14
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$550.14
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$497.60
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$475.97
|
| Rate for Payer: Cash Price |
$523.47
|
| Rate for Payer: Cash Price |
$523.47
|
| Rate for Payer: Coventry All Commercial |
$519.24
|
| Rate for Payer: Frontpath All Commercial |
$615.90
|
| Rate for Payer: Humana ChoiceCare |
$491.07
|
| Rate for Payer: Humana Medicare |
$432.70
|
| Rate for Payer: Lucent All Commercial |
$735.59
|
| Rate for Payer: Lutheran Preferred All Commercial |
$692.00
|
| Rate for Payer: PHCS All Commercial |
$633.22
|
| Rate for Payer: PHP All Commercial |
$734.54
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$432.70
|
| Rate for Payer: Signature Care EPO |
$470.90
|
| Rate for Payer: Signature Care PPO |
$470.90
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$649.00
|
| Rate for Payer: United Healthcare Commercial |
$537.74
|
| Rate for Payer: United Healthcare Medicare |
$432.70
|
|
|
PR EXCISION TUMOR SOFT TISSUE FOOT/TOE SUBQ 1.5+CM
|
Professional
|
$878.76
|
|
|
Service Code
|
CPT 28039
|
| Hospital Charge Code |
z28039
|
| Min. Negotiated Rate |
$321.32 |
| Max. Negotiated Rate |
$659.07 |
| Rate for Payer: Aetna Medicare |
$321.32
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$369.52
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$353.45
|
| Rate for Payer: Cash Price |
$544.83
|
| Rate for Payer: Cash Price |
$544.83
|
| Rate for Payer: Coventry All Commercial |
$385.58
|
| Rate for Payer: Frontpath All Commercial |
$448.16
|
| Rate for Payer: Humana ChoiceCare |
$360.84
|
| Rate for Payer: Humana Medicare |
$321.32
|
| Rate for Payer: Lucent All Commercial |
$546.24
|
| Rate for Payer: PHCS All Commercial |
$659.07
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$321.32
|
| Rate for Payer: United Healthcare Commercial |
$395.04
|
| Rate for Payer: United Healthcare Medicare |
$321.32
|
|
|
PR EXCISION TUMOR SOFT TISSUE PELVIS&HIP SUBQ 3+CM
|
Professional
|
$844.30
|
|
|
Service Code
|
CPT 27043
|
| Hospital Charge Code |
z27043
|
| Min. Negotiated Rate |
$432.70 |
| Max. Negotiated Rate |
$735.59 |
| Rate for Payer: Aetna Medicare |
$432.70
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$549.27
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$549.27
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$497.60
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$475.97
|
| Rate for Payer: Cash Price |
$523.47
|
| Rate for Payer: Cash Price |
$523.47
|
| Rate for Payer: Coventry All Commercial |
$519.24
|
| Rate for Payer: Frontpath All Commercial |
$614.74
|
| Rate for Payer: Humana ChoiceCare |
$490.31
|
| Rate for Payer: Humana Medicare |
$432.70
|
| Rate for Payer: Lucent All Commercial |
$735.59
|
| Rate for Payer: Lutheran Preferred All Commercial |
$692.00
|
| Rate for Payer: PHCS All Commercial |
$633.22
|
| Rate for Payer: PHP All Commercial |
$734.54
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$432.70
|
| Rate for Payer: Signature Care EPO |
$470.05
|
| Rate for Payer: Signature Care PPO |
$470.05
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$649.00
|
| Rate for Payer: United Healthcare Commercial |
$536.91
|
| Rate for Payer: United Healthcare Medicare |
$432.70
|
|
|
PR EXCISION TUMOR SOFT TISSUE THIGH/KNEE SUBQ <3CM
|
Professional
|
$911.96
|
|
|
Service Code
|
CPT 27327
|
| Hospital Charge Code |
z27327
|
| Min. Negotiated Rate |
$292.65 |
| Max. Negotiated Rate |
$683.97 |
| Rate for Payer: Aetna Medicare |
$292.65
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$457.70
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$457.70
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$336.55
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$321.92
|
| Rate for Payer: Cash Price |
$565.42
|
| Rate for Payer: Cash Price |
$565.42
|
| Rate for Payer: Coventry All Commercial |
$351.18
|
| Rate for Payer: Frontpath All Commercial |
$407.86
|
| Rate for Payer: Humana ChoiceCare |
$354.44
|
| Rate for Payer: Humana Medicare |
$292.65
|
| Rate for Payer: Lucent All Commercial |
$497.50
|
| Rate for Payer: Lutheran Preferred All Commercial |
$468.00
|
| Rate for Payer: PHCS All Commercial |
$683.97
|
| Rate for Payer: PHP All Commercial |
$496.79
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$292.65
|
| Rate for Payer: Signature Care EPO |
$561.00
|
| Rate for Payer: Signature Care PPO |
$561.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$439.00
|
| Rate for Payer: United Healthcare Commercial |
$372.54
|
| Rate for Payer: United Healthcare Medicare |
$292.65
|
|
|
PR EXCISION TURBINATE,SUBMUCOUS
|
Professional
|
$544.38
|
|
|
Service Code
|
CPT 30140
|
| Hospital Charge Code |
z30140
|
| Min. Negotiated Rate |
$166.93 |
| Max. Negotiated Rate |
$1,156.62 |
| Rate for Payer: Aetna Medicare |
$166.93
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,156.62
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,156.62
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$191.97
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$183.62
|
| Rate for Payer: Cash Price |
$337.52
|
| Rate for Payer: Cash Price |
$337.52
|
| Rate for Payer: Coventry All Commercial |
$200.32
|
| Rate for Payer: Frontpath All Commercial |
$229.98
|
| Rate for Payer: Humana ChoiceCare |
$423.56
|
| Rate for Payer: Humana Medicare |
$166.93
|
| Rate for Payer: Lucent All Commercial |
$283.78
|
| Rate for Payer: Lutheran Preferred All Commercial |
$267.00
|
| Rate for Payer: PHCS All Commercial |
$408.28
|
| Rate for Payer: PHP All Commercial |
$228.00
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$166.93
|
| Rate for Payer: Signature Care EPO |
$386.75
|
| Rate for Payer: Signature Care PPO |
$386.75
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$250.00
|
| Rate for Payer: United Healthcare Commercial |
$449.43
|
| Rate for Payer: United Healthcare Medicare |
$166.93
|
|
|
PR EXCISISON BONE CYST BENIGN TUMOR,PELVIS/HIP,DEEP
|
Professional
|
$1,488.94
|
|
|
Service Code
|
CPT 27066
|
| Hospital Charge Code |
z27066
|
| Min. Negotiated Rate |
$762.77 |
| Max. Negotiated Rate |
$1,296.71 |
| Rate for Payer: Aetna Medicare |
$762.77
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$992.90
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$992.90
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$877.19
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$839.05
|
| Rate for Payer: Cash Price |
$923.14
|
| Rate for Payer: Cash Price |
$923.14
|
| Rate for Payer: Coventry All Commercial |
$915.32
|
| Rate for Payer: Frontpath All Commercial |
$1,058.53
|
| Rate for Payer: Humana ChoiceCare |
$818.82
|
| Rate for Payer: Humana Medicare |
$762.77
|
| Rate for Payer: Lucent All Commercial |
$1,296.71
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,220.00
|
| Rate for Payer: PHCS All Commercial |
$1,116.70
|
| Rate for Payer: PHP All Commercial |
$1,295.38
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$762.77
|
| Rate for Payer: Signature Care EPO |
$1,099.90
|
| Rate for Payer: Signature Care PPO |
$1,099.90
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,144.00
|
| Rate for Payer: United Healthcare Commercial |
$873.76
|
| Rate for Payer: United Healthcare Medicare |
$762.77
|
|
|
PR EXCIS LESN,PALATE/UVULA
|
Professional
|
$398.76
|
|
|
Service Code
|
CPT 42104
|
| Hospital Charge Code |
z42104
|
| Min. Negotiated Rate |
$126.57 |
| Max. Negotiated Rate |
$299.07 |
| Rate for Payer: Aetna Medicare |
$126.57
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$172.59
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$172.59
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$145.56
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$139.23
|
| Rate for Payer: Cash Price |
$247.23
|
| Rate for Payer: Cash Price |
$247.23
|
| Rate for Payer: Coventry All Commercial |
$151.88
|
| Rate for Payer: Frontpath All Commercial |
$171.47
|
| Rate for Payer: Humana ChoiceCare |
$141.27
|
| Rate for Payer: Humana Medicare |
$126.57
|
| Rate for Payer: Lucent All Commercial |
$215.17
|
| Rate for Payer: Lutheran Preferred All Commercial |
$190.00
|
| Rate for Payer: PHCS All Commercial |
$299.07
|
| Rate for Payer: PHP All Commercial |
$216.09
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$126.57
|
| Rate for Payer: Signature Care EPO |
$243.10
|
| Rate for Payer: Signature Care PPO |
$243.10
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$177.00
|
| Rate for Payer: United Healthcare Commercial |
$147.45
|
| Rate for Payer: United Healthcare Medicare |
$126.57
|
|
|
PR EXCIS MOUTH MUCOSA/SUB,NO REPAIR
|
Professional
|
$397.36
|
|
|
Service Code
|
CPT 40810
|
| Hospital Charge Code |
z40810
|
| Min. Negotiated Rate |
$115.36 |
| Max. Negotiated Rate |
$298.02 |
| Rate for Payer: Aetna Medicare |
$115.36
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$221.88
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$221.88
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$132.66
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$126.90
|
| Rate for Payer: Cash Price |
$246.36
|
| Rate for Payer: Cash Price |
$246.36
|
| Rate for Payer: Coventry All Commercial |
$138.43
|
| Rate for Payer: Frontpath All Commercial |
$154.99
|
| Rate for Payer: Humana ChoiceCare |
$130.22
|
| Rate for Payer: Humana Medicare |
$115.36
|
| Rate for Payer: Lucent All Commercial |
$196.11
|
| Rate for Payer: Lutheran Preferred All Commercial |
$173.00
|
| Rate for Payer: PHCS All Commercial |
$298.02
|
| Rate for Payer: PHP All Commercial |
$196.95
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$115.36
|
| Rate for Payer: Signature Care EPO |
$203.15
|
| Rate for Payer: Signature Care PPO |
$203.15
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$161.00
|
| Rate for Payer: United Healthcare Commercial |
$134.24
|
| Rate for Payer: United Healthcare Medicare |
$115.36
|
|
|
PR EXCIS MOUTH MUCOSA/SUB,SIMPL REPAIR
|
Professional
|
$516.66
|
|
|
Service Code
|
CPT 40812
|
| Hospital Charge Code |
z40812
|
| Min. Negotiated Rate |
$173.10 |
| Max. Negotiated Rate |
$387.50 |
| Rate for Payer: Aetna Medicare |
$173.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$336.32
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$336.32
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$199.06
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$190.41
|
| Rate for Payer: Cash Price |
$320.33
|
| Rate for Payer: Cash Price |
$320.33
|
| Rate for Payer: Coventry All Commercial |
$207.72
|
| Rate for Payer: Frontpath All Commercial |
$235.99
|
| Rate for Payer: Humana ChoiceCare |
$209.38
|
| Rate for Payer: Humana Medicare |
$173.10
|
| Rate for Payer: Lucent All Commercial |
$294.27
|
| Rate for Payer: Lutheran Preferred All Commercial |
$260.00
|
| Rate for Payer: PHCS All Commercial |
$387.50
|
| Rate for Payer: PHP All Commercial |
$295.53
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$173.10
|
| Rate for Payer: Signature Care EPO |
$307.70
|
| Rate for Payer: Signature Care PPO |
$307.70
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$242.00
|
| Rate for Payer: United Healthcare Commercial |
$209.45
|
| Rate for Payer: United Healthcare Medicare |
$173.10
|
|
|
PR EXCISON TUMOR SOFT TISSUE THIGH/KNEE SUBQ 3+CM
|
Professional
|
$756.34
|
|
|
Service Code
|
CPT 27337
|
| Hospital Charge Code |
z27337
|
| Min. Negotiated Rate |
$387.46 |
| Max. Negotiated Rate |
$658.68 |
| Rate for Payer: Aetna Medicare |
$387.46
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$489.97
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$489.97
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$445.58
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$426.21
|
| Rate for Payer: Cash Price |
$468.93
|
| Rate for Payer: Cash Price |
$468.93
|
| Rate for Payer: Coventry All Commercial |
$464.95
|
| Rate for Payer: Frontpath All Commercial |
$548.54
|
| Rate for Payer: Humana ChoiceCare |
$437.03
|
| Rate for Payer: Humana Medicare |
$387.46
|
| Rate for Payer: Lucent All Commercial |
$658.68
|
| Rate for Payer: Lutheran Preferred All Commercial |
$620.00
|
| Rate for Payer: PHCS All Commercial |
$567.26
|
| Rate for Payer: PHP All Commercial |
$658.01
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$387.46
|
| Rate for Payer: Signature Care EPO |
$419.05
|
| Rate for Payer: Signature Care PPO |
$419.05
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$581.00
|
| Rate for Payer: United Healthcare Commercial |
$478.79
|
| Rate for Payer: United Healthcare Medicare |
$387.46
|
|
|
PR EXCIS PRIMARY GANGLION WRIST
|
Professional
|
$597.48
|
|
|
Service Code
|
CPT 25111
|
| Hospital Charge Code |
z25111
|
| Min. Negotiated Rate |
$306.21 |
| Max. Negotiated Rate |
$520.56 |
| Rate for Payer: Aetna Medicare |
$306.21
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$379.40
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$379.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$352.14
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$336.83
|
| Rate for Payer: Cash Price |
$370.44
|
| Rate for Payer: Cash Price |
$370.44
|
| Rate for Payer: Coventry All Commercial |
$367.45
|
| Rate for Payer: Frontpath All Commercial |
$416.79
|
| Rate for Payer: Humana ChoiceCare |
$343.95
|
| Rate for Payer: Humana Medicare |
$306.21
|
| Rate for Payer: Lucent All Commercial |
$520.56
|
| Rate for Payer: Lutheran Preferred All Commercial |
$490.00
|
| Rate for Payer: PHCS All Commercial |
$448.11
|
| Rate for Payer: PHP All Commercial |
$519.81
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$306.21
|
| Rate for Payer: Signature Care EPO |
$516.41
|
| Rate for Payer: Signature Care PPO |
$516.41
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$459.00
|
| Rate for Payer: United Healthcare Commercial |
$331.64
|
| Rate for Payer: United Healthcare Medicare |
$306.21
|
|
|
PR EXCIS RECURRENT GANGLION WRIST
|
Professional
|
$717.12
|
|
|
Service Code
|
CPT 25112
|
| Hospital Charge Code |
z25112
|
| Min. Negotiated Rate |
$367.52 |
| Max. Negotiated Rate |
$624.78 |
| Rate for Payer: Aetna Medicare |
$367.52
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$470.40
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$470.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$422.65
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$404.27
|
| Rate for Payer: Cash Price |
$444.61
|
| Rate for Payer: Cash Price |
$444.61
|
| Rate for Payer: Coventry All Commercial |
$441.02
|
| Rate for Payer: Frontpath All Commercial |
$504.04
|
| Rate for Payer: Humana ChoiceCare |
$419.11
|
| Rate for Payer: Humana Medicare |
$367.52
|
| Rate for Payer: Lucent All Commercial |
$624.78
|
| Rate for Payer: Lutheran Preferred All Commercial |
$588.00
|
| Rate for Payer: PHCS All Commercial |
$537.84
|
| Rate for Payer: PHP All Commercial |
$623.90
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$367.52
|
| Rate for Payer: Signature Care EPO |
$570.35
|
| Rate for Payer: Signature Care PPO |
$570.35
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$551.00
|
| Rate for Payer: United Healthcare Commercial |
$406.66
|
| Rate for Payer: United Healthcare Medicare |
$367.52
|
|
|
PR EXCIS TENDN/CAPSULE LESN,FOOT
|
Professional
|
$847.80
|
|
|
Service Code
|
CPT 28090
|
| Hospital Charge Code |
z28090
|
| Min. Negotiated Rate |
$290.94 |
| Max. Negotiated Rate |
$635.85 |
| Rate for Payer: Aetna Medicare |
$290.94
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$440.90
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$440.90
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$334.58
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$320.03
|
| Rate for Payer: Cash Price |
$525.64
|
| Rate for Payer: Cash Price |
$525.64
|
| Rate for Payer: Coventry All Commercial |
$349.13
|
| Rate for Payer: Frontpath All Commercial |
$392.54
|
| Rate for Payer: Humana ChoiceCare |
$340.19
|
| Rate for Payer: Humana Medicare |
$290.94
|
| Rate for Payer: Lucent All Commercial |
$494.60
|
| Rate for Payer: Lutheran Preferred All Commercial |
$466.00
|
| Rate for Payer: PHCS All Commercial |
$635.85
|
| Rate for Payer: PHP All Commercial |
$493.89
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$290.94
|
| Rate for Payer: Signature Care EPO |
$596.70
|
| Rate for Payer: Signature Care PPO |
$596.70
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$436.00
|
| Rate for Payer: United Healthcare Commercial |
$350.26
|
| Rate for Payer: United Healthcare Medicare |
$290.94
|
|
|
PR EXCIS TENDON SHEATH LESION, HAND/FINGER
|
Professional
|
$1,127.20
|
|
|
Service Code
|
CPT 26160
|
| Hospital Charge Code |
z26160
|
| Min. Negotiated Rate |
$297.69 |
| Max. Negotiated Rate |
$1,050.00 |
| Rate for Payer: Aetna Medicare |
$297.69
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,050.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,050.00
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$342.34
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$327.46
|
| Rate for Payer: Cash Price |
$698.86
|
| Rate for Payer: Cash Price |
$698.86
|
| Rate for Payer: Coventry All Commercial |
$357.23
|
| Rate for Payer: Frontpath All Commercial |
$405.86
|
| Rate for Payer: Humana ChoiceCare |
$310.21
|
| Rate for Payer: Humana Medicare |
$297.69
|
| Rate for Payer: Lucent All Commercial |
$506.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$476.00
|
| Rate for Payer: PHCS All Commercial |
$845.40
|
| Rate for Payer: PHP All Commercial |
$505.34
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$297.69
|
| Rate for Payer: Signature Care EPO |
$874.65
|
| Rate for Payer: Signature Care PPO |
$874.65
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$447.00
|
| Rate for Payer: United Healthcare Commercial |
$335.18
|
| Rate for Payer: United Healthcare Medicare |
$297.69
|
|
|
PR EXCIS TENDON SHEATH LESN,WRIST/FORE
|
Professional
|
$638.26
|
|
|
Service Code
|
CPT 25110
|
| Hospital Charge Code |
z25110
|
| Min. Negotiated Rate |
$327.10 |
| Max. Negotiated Rate |
$556.07 |
| Rate for Payer: Aetna Medicare |
$327.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$433.40
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$433.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$376.16
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$359.81
|
| Rate for Payer: Cash Price |
$395.72
|
| Rate for Payer: Cash Price |
$395.72
|
| Rate for Payer: Coventry All Commercial |
$392.52
|
| Rate for Payer: Frontpath All Commercial |
$448.02
|
| Rate for Payer: Humana ChoiceCare |
$462.15
|
| Rate for Payer: Humana Medicare |
$327.10
|
| Rate for Payer: Lucent All Commercial |
$556.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$523.00
|
| Rate for Payer: PHCS All Commercial |
$478.70
|
| Rate for Payer: PHP All Commercial |
$555.28
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$327.10
|
| Rate for Payer: Signature Care EPO |
$550.61
|
| Rate for Payer: Signature Care PPO |
$550.61
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$491.00
|
| Rate for Payer: United Healthcare Commercial |
$382.34
|
| Rate for Payer: United Healthcare Medicare |
$327.10
|
|
|
PR EXCIS TONGUE FOLD
|
Professional
|
$480.40
|
|
|
Service Code
|
CPT 41115
|
| Hospital Charge Code |
z41115
|
| Min. Negotiated Rate |
$137.54 |
| Max. Negotiated Rate |
$360.30 |
| Rate for Payer: Aetna Medicare |
$137.54
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$200.80
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$200.80
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$158.17
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$151.29
|
| Rate for Payer: Cash Price |
$297.85
|
| Rate for Payer: Cash Price |
$297.85
|
| Rate for Payer: Coventry All Commercial |
$165.05
|
| Rate for Payer: Frontpath All Commercial |
$186.89
|
| Rate for Payer: Humana ChoiceCare |
$158.94
|
| Rate for Payer: Humana Medicare |
$137.54
|
| Rate for Payer: Lucent All Commercial |
$233.82
|
| Rate for Payer: Lutheran Preferred All Commercial |
$206.00
|
| Rate for Payer: PHCS All Commercial |
$360.30
|
| Rate for Payer: PHP All Commercial |
$234.82
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$137.54
|
| Rate for Payer: Signature Care EPO |
$283.90
|
| Rate for Payer: Signature Care PPO |
$283.90
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$193.00
|
| Rate for Payer: United Healthcare Commercial |
$159.11
|
| Rate for Payer: United Healthcare Medicare |
$137.54
|
|
|
PR EXCIS TONGUE LESN,ANT 2/3+CLOS
|
Professional
|
$622.78
|
|
|
Service Code
|
CPT 41112
|
| Hospital Charge Code |
z41112
|
| Min. Negotiated Rate |
$228.72 |
| Max. Negotiated Rate |
$467.08 |
| Rate for Payer: Aetna Medicare |
$228.72
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$263.03
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$251.59
|
| Rate for Payer: Cash Price |
$386.12
|
| Rate for Payer: Cash Price |
$386.12
|
| Rate for Payer: Coventry All Commercial |
$274.46
|
| Rate for Payer: Frontpath All Commercial |
$308.76
|
| Rate for Payer: Humana ChoiceCare |
$262.13
|
| Rate for Payer: Humana Medicare |
$228.72
|
| Rate for Payer: Lucent All Commercial |
$388.82
|
| Rate for Payer: PHCS All Commercial |
$467.08
|
| Rate for Payer: PHP All Commercial |
$390.50
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$228.72
|
| Rate for Payer: Signature Care EPO |
$385.90
|
| Rate for Payer: Signature Care PPO |
$385.90
|
| Rate for Payer: United Healthcare Commercial |
$266.95
|
| Rate for Payer: United Healthcare Medicare |
$228.72
|
|
|
PR EXCIS UTERINE FIBROID,VAG APPRCH
|
Professional
|
$1,038.60
|
|
|
Service Code
|
CPT 58145
|
| Hospital Charge Code |
z58145
|
| Min. Negotiated Rate |
$532.29 |
| Max. Negotiated Rate |
$904.89 |
| Rate for Payer: Aetna Medicare |
$532.29
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$675.59
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$675.59
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$612.13
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$585.52
|
| Rate for Payer: Cash Price |
$643.93
|
| Rate for Payer: Cash Price |
$643.93
|
| Rate for Payer: Coventry All Commercial |
$638.75
|
| Rate for Payer: Frontpath All Commercial |
$744.04
|
| Rate for Payer: Humana ChoiceCare |
$567.63
|
| Rate for Payer: Humana Medicare |
$532.29
|
| Rate for Payer: Lucent All Commercial |
$904.89
|
| Rate for Payer: Lutheran Preferred All Commercial |
$745.00
|
| Rate for Payer: PHCS All Commercial |
$778.95
|
| Rate for Payer: PHP All Commercial |
$685.48
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$532.29
|
| Rate for Payer: Signature Care EPO |
$640.05
|
| Rate for Payer: Signature Care PPO |
$640.05
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$692.00
|
| Rate for Payer: United Healthcare Commercial |
$608.79
|
| Rate for Payer: United Healthcare Medicare |
$532.29
|
|
