|
PR EXC SKIN BENIG <0.5 CM FACE,FACIAL
|
Professional
|
$262.62
|
|
|
Service Code
|
CPT 11440
|
| Hospital Charge Code |
z11440
|
| Min. Negotiated Rate |
$86.47 |
| Max. Negotiated Rate |
$196.96 |
| Rate for Payer: Aetna Medicare |
$99.40
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$156.87
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$156.87
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$114.31
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$109.34
|
| Rate for Payer: Cash Price |
$162.82
|
| Rate for Payer: Cash Price |
$162.82
|
| Rate for Payer: Coventry All Commercial |
$119.28
|
| Rate for Payer: Frontpath All Commercial |
$131.92
|
| Rate for Payer: Humana ChoiceCare |
$86.47
|
| Rate for Payer: Humana Medicare |
$99.40
|
| Rate for Payer: Lucent All Commercial |
$168.98
|
| Rate for Payer: Lutheran Preferred All Commercial |
$129.00
|
| Rate for Payer: PHCS All Commercial |
$196.96
|
| Rate for Payer: PHP All Commercial |
$135.77
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$99.40
|
| Rate for Payer: Signature Care EPO |
$134.30
|
| Rate for Payer: Signature Care PPO |
$134.30
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$119.00
|
| Rate for Payer: United Healthcare Commercial |
$102.78
|
| Rate for Payer: United Healthcare Medicare |
$99.40
|
|
|
PR EXC SKIN BENIG <0.5 CM REMAINDER BODY
|
Professional
|
$233.60
|
|
|
Service Code
|
CPT 11420
|
| Hospital Charge Code |
z11420
|
| Min. Negotiated Rate |
$70.56 |
| Max. Negotiated Rate |
$175.20 |
| Rate for Payer: Aetna Medicare |
$77.12
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$138.84
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$138.84
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$88.69
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$84.83
|
| Rate for Payer: Cash Price |
$144.83
|
| Rate for Payer: Cash Price |
$144.83
|
| Rate for Payer: Coventry All Commercial |
$92.54
|
| Rate for Payer: Frontpath All Commercial |
$103.83
|
| Rate for Payer: Humana ChoiceCare |
$70.56
|
| Rate for Payer: Humana Medicare |
$77.12
|
| Rate for Payer: Lucent All Commercial |
$131.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$100.00
|
| Rate for Payer: PHCS All Commercial |
$175.20
|
| Rate for Payer: PHP All Commercial |
$105.33
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$77.12
|
| Rate for Payer: Signature Care EPO |
$111.35
|
| Rate for Payer: Signature Care PPO |
$111.35
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$93.00
|
| Rate for Payer: United Healthcare Commercial |
$86.00
|
| Rate for Payer: United Healthcare Medicare |
$77.12
|
|
|
PR EXC SKIN BENIG <0.5 CM TRUNK,ARM,LEG
|
Professional
|
$233.74
|
|
|
Service Code
|
CPT 11400
|
| Hospital Charge Code |
z11400
|
| Min. Negotiated Rate |
$63.42 |
| Max. Negotiated Rate |
$175.30 |
| Rate for Payer: Aetna Medicare |
$78.43
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$139.86
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$139.86
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$90.19
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$86.27
|
| Rate for Payer: Cash Price |
$144.92
|
| Rate for Payer: Cash Price |
$144.92
|
| Rate for Payer: Coventry All Commercial |
$94.12
|
| Rate for Payer: Frontpath All Commercial |
$105.05
|
| Rate for Payer: Humana ChoiceCare |
$63.42
|
| Rate for Payer: Humana Medicare |
$78.43
|
| Rate for Payer: Lucent All Commercial |
$133.33
|
| Rate for Payer: Lutheran Preferred All Commercial |
$102.00
|
| Rate for Payer: PHCS All Commercial |
$175.30
|
| Rate for Payer: PHP All Commercial |
$107.12
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$78.43
|
| Rate for Payer: Signature Care EPO |
$113.90
|
| Rate for Payer: Signature Care PPO |
$113.90
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$94.00
|
| Rate for Payer: United Healthcare Commercial |
$79.34
|
| Rate for Payer: United Healthcare Medicare |
$78.43
|
|
|
PR EXC SKIN BENIG 0.6-1 CM FACE,FACIAL
|
Professional
|
$318.56
|
|
|
Service Code
|
CPT 11441
|
| Hospital Charge Code |
z11441
|
| Min. Negotiated Rate |
$109.40 |
| Max. Negotiated Rate |
$238.92 |
| Rate for Payer: Aetna Medicare |
$124.37
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$182.87
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$182.87
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$143.03
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$136.81
|
| Rate for Payer: Cash Price |
$197.51
|
| Rate for Payer: Cash Price |
$197.51
|
| Rate for Payer: Coventry All Commercial |
$149.24
|
| Rate for Payer: Frontpath All Commercial |
$167.40
|
| Rate for Payer: Humana ChoiceCare |
$109.40
|
| Rate for Payer: Humana Medicare |
$124.37
|
| Rate for Payer: Lucent All Commercial |
$211.43
|
| Rate for Payer: Lutheran Preferred All Commercial |
$162.00
|
| Rate for Payer: PHCS All Commercial |
$238.92
|
| Rate for Payer: PHP All Commercial |
$169.87
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$124.37
|
| Rate for Payer: Signature Care EPO |
$157.25
|
| Rate for Payer: Signature Care PPO |
$157.25
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$149.00
|
| Rate for Payer: United Healthcare Commercial |
$135.29
|
| Rate for Payer: United Healthcare Medicare |
$124.37
|
|
|
PR EXC SKIN BENIG 0.6-1 CM REMAINDR BODY
|
Professional
|
$293.20
|
|
|
Service Code
|
CPT 11421
|
| Hospital Charge Code |
z11421
|
| Min. Negotiated Rate |
$94.07 |
| Max. Negotiated Rate |
$219.90 |
| Rate for Payer: Aetna Medicare |
$102.72
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$165.54
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$165.54
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$118.13
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$112.99
|
| Rate for Payer: Cash Price |
$181.78
|
| Rate for Payer: Cash Price |
$181.78
|
| Rate for Payer: Coventry All Commercial |
$123.26
|
| Rate for Payer: Frontpath All Commercial |
$138.58
|
| Rate for Payer: Humana ChoiceCare |
$94.07
|
| Rate for Payer: Humana Medicare |
$102.72
|
| Rate for Payer: Lucent All Commercial |
$174.62
|
| Rate for Payer: Lutheran Preferred All Commercial |
$134.00
|
| Rate for Payer: PHCS All Commercial |
$219.90
|
| Rate for Payer: PHP All Commercial |
$140.30
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$102.72
|
| Rate for Payer: Signature Care EPO |
$141.95
|
| Rate for Payer: Signature Care PPO |
$141.95
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$123.00
|
| Rate for Payer: United Healthcare Commercial |
$116.44
|
| Rate for Payer: United Healthcare Medicare |
$102.72
|
|
|
PR EXC SKIN BENIG 0.6-1 CM TRUNK,ARM,LEG983
|
Professional
|
$285.46
|
|
|
Service Code
|
CPT 11401
|
| Hospital Charge Code |
z11401
|
| Min. Negotiated Rate |
$83.29 |
| Max. Negotiated Rate |
$214.10 |
| Rate for Payer: Aetna Medicare |
$99.06
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$168.46
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$168.46
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$113.92
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$108.97
|
| Rate for Payer: Cash Price |
$176.99
|
| Rate for Payer: Cash Price |
$176.99
|
| Rate for Payer: Coventry All Commercial |
$118.87
|
| Rate for Payer: Frontpath All Commercial |
$133.72
|
| Rate for Payer: Humana ChoiceCare |
$83.29
|
| Rate for Payer: Humana Medicare |
$99.06
|
| Rate for Payer: Lucent All Commercial |
$168.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$129.00
|
| Rate for Payer: PHCS All Commercial |
$214.10
|
| Rate for Payer: PHP All Commercial |
$135.31
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$99.06
|
| Rate for Payer: Signature Care EPO |
$133.45
|
| Rate for Payer: Signature Care PPO |
$133.45
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$119.00
|
| Rate for Payer: United Healthcare Commercial |
$105.83
|
| Rate for Payer: United Healthcare Medicare |
$99.06
|
|
|
PR EXC SKIN BENIG 1.1-2 CM FACE,FACIAL
|
Professional
|
$353.76
|
|
|
Service Code
|
CPT 11442
|
| Hospital Charge Code |
z11442
|
| Min. Negotiated Rate |
$121.73 |
| Max. Negotiated Rate |
$265.32 |
| Rate for Payer: Aetna Medicare |
$137.16
|
| 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 |
$157.73
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$150.88
|
| Rate for Payer: Cash Price |
$219.33
|
| Rate for Payer: Cash Price |
$219.33
|
| Rate for Payer: Coventry All Commercial |
$164.59
|
| Rate for Payer: Frontpath All Commercial |
$185.09
|
| Rate for Payer: Humana ChoiceCare |
$121.73
|
| Rate for Payer: Humana Medicare |
$137.16
|
| Rate for Payer: Lucent All Commercial |
$233.17
|
| Rate for Payer: Lutheran Preferred All Commercial |
$178.00
|
| Rate for Payer: PHCS All Commercial |
$265.32
|
| Rate for Payer: PHP All Commercial |
$187.34
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$137.16
|
| Rate for Payer: Signature Care EPO |
$175.10
|
| Rate for Payer: Signature Care PPO |
$175.10
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$165.00
|
| Rate for Payer: United Healthcare Commercial |
$151.05
|
| Rate for Payer: United Healthcare Medicare |
$137.16
|
|
|
PR EXC SKIN BENIG 1.1-2 CM REMAINDR BODY
|
Professional
|
$328.22
|
|
|
Service Code
|
CPT 11422
|
| Hospital Charge Code |
z11422
|
| Min. Negotiated Rate |
$110.08 |
| Max. Negotiated Rate |
$246.16 |
| Rate for Payer: Aetna Medicare |
$126.84
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$169.80
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$169.80
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$145.87
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$139.52
|
| Rate for Payer: Cash Price |
$203.50
|
| Rate for Payer: Cash Price |
$203.50
|
| Rate for Payer: Coventry All Commercial |
$152.21
|
| Rate for Payer: Frontpath All Commercial |
$171.35
|
| Rate for Payer: Humana ChoiceCare |
$110.08
|
| Rate for Payer: Humana Medicare |
$126.84
|
| Rate for Payer: Lucent All Commercial |
$215.63
|
| Rate for Payer: Lutheran Preferred All Commercial |
$165.00
|
| Rate for Payer: PHCS All Commercial |
$246.16
|
| Rate for Payer: PHP All Commercial |
$173.25
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$126.84
|
| Rate for Payer: Signature Care EPO |
$158.95
|
| Rate for Payer: Signature Care PPO |
$158.95
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$152.00
|
| Rate for Payer: United Healthcare Commercial |
$140.38
|
| Rate for Payer: United Healthcare Medicare |
$126.84
|
|
|
PR EXC SKIN BENIG 1.1-2 CM TRUNK,ARM,LEG
|
Professional
|
$313.88
|
|
|
Service Code
|
CPT 11402
|
| Hospital Charge Code |
z11402
|
| Min. Negotiated Rate |
$96.46 |
| Max. Negotiated Rate |
$235.41 |
| Rate for Payer: Aetna Medicare |
$108.07
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$187.10
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$187.10
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$124.28
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$118.88
|
| Rate for Payer: Cash Price |
$194.61
|
| Rate for Payer: Cash Price |
$194.61
|
| Rate for Payer: Coventry All Commercial |
$129.68
|
| Rate for Payer: Frontpath All Commercial |
$146.95
|
| Rate for Payer: Humana ChoiceCare |
$96.46
|
| Rate for Payer: Humana Medicare |
$108.07
|
| Rate for Payer: Lucent All Commercial |
$183.72
|
| Rate for Payer: Lutheran Preferred All Commercial |
$140.00
|
| Rate for Payer: PHCS All Commercial |
$235.41
|
| Rate for Payer: PHP All Commercial |
$147.61
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$108.07
|
| Rate for Payer: Signature Care EPO |
$153.00
|
| Rate for Payer: Signature Care PPO |
$153.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$130.00
|
| Rate for Payer: United Healthcare Commercial |
$117.19
|
| Rate for Payer: United Healthcare Medicare |
$108.07
|
|
|
PR EXC SKIN BENIG 2.1-3 CM FACE,FACIAL
|
Professional
|
$417.46
|
|
|
Service Code
|
CPT 11443
|
| Hospital Charge Code |
z11443
|
| Min. Negotiated Rate |
$152.91 |
| Max. Negotiated Rate |
$313.10 |
| Rate for Payer: Aetna Medicare |
$167.02
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$235.90
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$235.90
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$192.07
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$183.72
|
| Rate for Payer: Cash Price |
$258.83
|
| Rate for Payer: Cash Price |
$258.83
|
| Rate for Payer: Coventry All Commercial |
$200.42
|
| Rate for Payer: Frontpath All Commercial |
$226.99
|
| Rate for Payer: Humana ChoiceCare |
$152.91
|
| Rate for Payer: Humana Medicare |
$167.02
|
| Rate for Payer: Lucent All Commercial |
$283.93
|
| Rate for Payer: Lutheran Preferred All Commercial |
$217.00
|
| Rate for Payer: PHCS All Commercial |
$313.10
|
| Rate for Payer: PHP All Commercial |
$228.13
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$167.02
|
| Rate for Payer: Signature Care EPO |
$215.05
|
| Rate for Payer: Signature Care PPO |
$215.05
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$200.00
|
| Rate for Payer: United Healthcare Commercial |
$187.06
|
| Rate for Payer: United Healthcare Medicare |
$167.02
|
|
|
PR EXC SKIN BENIG 2.1-3 CM REMAINDR BODY
|
Professional
|
$374.20
|
|
|
Service Code
|
CPT 11423
|
| Hospital Charge Code |
z11423
|
| Min. Negotiated Rate |
$129.26 |
| Max. Negotiated Rate |
$280.65 |
| Rate for Payer: Aetna Medicare |
$146.08
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$207.80
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$207.80
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$167.99
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$160.69
|
| Rate for Payer: Cash Price |
$232.00
|
| Rate for Payer: Cash Price |
$232.00
|
| Rate for Payer: Coventry All Commercial |
$175.30
|
| Rate for Payer: Frontpath All Commercial |
$197.56
|
| Rate for Payer: Humana ChoiceCare |
$129.26
|
| Rate for Payer: Humana Medicare |
$146.08
|
| Rate for Payer: Lucent All Commercial |
$248.34
|
| Rate for Payer: Lutheran Preferred All Commercial |
$190.00
|
| Rate for Payer: PHCS All Commercial |
$280.65
|
| Rate for Payer: PHP All Commercial |
$199.53
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$146.08
|
| Rate for Payer: Signature Care EPO |
$188.70
|
| Rate for Payer: Signature Care PPO |
$188.70
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$175.00
|
| Rate for Payer: United Healthcare Commercial |
$163.96
|
| Rate for Payer: United Healthcare Medicare |
$146.08
|
|
|
PR EXC SKIN BENIG 2.1-3 CM TRUNK,ARM,LEG
|
Professional
|
$360.84
|
|
|
Service Code
|
CPT 11403
|
| Hospital Charge Code |
z11403
|
| Min. Negotiated Rate |
$115.97 |
| Max. Negotiated Rate |
$270.63 |
| Rate for Payer: Aetna Medicare |
$138.94
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$189.90
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$189.90
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$159.78
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$152.83
|
| Rate for Payer: Cash Price |
$223.72
|
| Rate for Payer: Cash Price |
$223.72
|
| Rate for Payer: Coventry All Commercial |
$166.73
|
| Rate for Payer: Frontpath All Commercial |
$187.92
|
| Rate for Payer: Humana ChoiceCare |
$115.97
|
| Rate for Payer: Humana Medicare |
$138.94
|
| Rate for Payer: Lucent All Commercial |
$236.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$181.00
|
| Rate for Payer: PHCS All Commercial |
$270.63
|
| Rate for Payer: PHP All Commercial |
$189.77
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$138.94
|
| Rate for Payer: Signature Care EPO |
$171.70
|
| Rate for Payer: Signature Care PPO |
$171.70
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$167.00
|
| Rate for Payer: United Healthcare Commercial |
$149.10
|
| Rate for Payer: United Healthcare Medicare |
$138.94
|
|
|
PR EXC SKIN BENIG 3.1- 4 CM FACE,FACIAL
|
Professional
|
$517.50
|
|
|
Service Code
|
CPT 11444
|
| Hospital Charge Code |
z11444
|
| Min. Negotiated Rate |
$199.15 |
| Max. Negotiated Rate |
$388.12 |
| Rate for Payer: Aetna Medicare |
$210.57
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$294.10
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$294.10
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$242.16
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$231.63
|
| Rate for Payer: Cash Price |
$320.85
|
| Rate for Payer: Cash Price |
$320.85
|
| Rate for Payer: Coventry All Commercial |
$252.68
|
| Rate for Payer: Frontpath All Commercial |
$288.31
|
| Rate for Payer: Humana ChoiceCare |
$199.15
|
| Rate for Payer: Humana Medicare |
$210.57
|
| Rate for Payer: Lucent All Commercial |
$357.97
|
| Rate for Payer: Lutheran Preferred All Commercial |
$274.00
|
| Rate for Payer: PHCS All Commercial |
$388.12
|
| Rate for Payer: PHP All Commercial |
$287.61
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$210.57
|
| Rate for Payer: Signature Care EPO |
$273.70
|
| Rate for Payer: Signature Care PPO |
$273.70
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$253.00
|
| Rate for Payer: United Healthcare Commercial |
$240.38
|
| Rate for Payer: United Healthcare Medicare |
$210.57
|
|
|
PR EXC SKIN BENIG 3.1-4 CM REMAINDR BODY
|
Professional
|
$430.38
|
|
|
Service Code
|
CPT 11424
|
| Hospital Charge Code |
z11424
|
| Min. Negotiated Rate |
$151.16 |
| Max. Negotiated Rate |
$322.78 |
| Rate for Payer: Aetna Medicare |
$166.54
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$235.90
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$235.90
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$191.52
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$183.19
|
| Rate for Payer: Cash Price |
$266.84
|
| Rate for Payer: Cash Price |
$266.84
|
| Rate for Payer: Coventry All Commercial |
$199.85
|
| Rate for Payer: Frontpath All Commercial |
$226.55
|
| Rate for Payer: Humana ChoiceCare |
$151.16
|
| Rate for Payer: Humana Medicare |
$166.54
|
| Rate for Payer: Lucent All Commercial |
$283.12
|
| Rate for Payer: Lutheran Preferred All Commercial |
$217.00
|
| Rate for Payer: PHCS All Commercial |
$322.78
|
| Rate for Payer: PHP All Commercial |
$227.90
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$166.54
|
| Rate for Payer: Signature Care EPO |
$215.90
|
| Rate for Payer: Signature Care PPO |
$215.90
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$200.00
|
| Rate for Payer: United Healthcare Commercial |
$189.21
|
| Rate for Payer: United Healthcare Medicare |
$166.54
|
|
|
PR EXC SKIN BENIG 3.1-4 CM TRUNK,ARM,LEG
|
Professional
|
$408.32
|
|
|
Service Code
|
CPT 11404
|
| Hospital Charge Code |
z11404
|
| Min. Negotiated Rate |
$129.61 |
| Max. Negotiated Rate |
$306.24 |
| Rate for Payer: Aetna Medicare |
$152.77
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$213.40
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$213.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$175.69
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$168.05
|
| Rate for Payer: Cash Price |
$253.16
|
| Rate for Payer: Cash Price |
$253.16
|
| Rate for Payer: Coventry All Commercial |
$183.32
|
| Rate for Payer: Frontpath All Commercial |
$209.00
|
| Rate for Payer: Humana ChoiceCare |
$129.61
|
| Rate for Payer: Humana Medicare |
$152.77
|
| Rate for Payer: Lucent All Commercial |
$259.71
|
| Rate for Payer: Lutheran Preferred All Commercial |
$199.00
|
| Rate for Payer: PHCS All Commercial |
$306.24
|
| Rate for Payer: PHP All Commercial |
$208.66
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$152.77
|
| Rate for Payer: Signature Care EPO |
$196.35
|
| Rate for Payer: Signature Care PPO |
$196.35
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$183.00
|
| Rate for Payer: United Healthcare Commercial |
$166.08
|
| Rate for Payer: United Healthcare Medicare |
$152.77
|
|
|
PR EXC SKIN BENIG >4 CM FACE,FACIAL
|
Professional
|
$699.82
|
|
|
Service Code
|
CPT 11446
|
| Hospital Charge Code |
z11446
|
| Min. Negotiated Rate |
$272.34 |
| Max. Negotiated Rate |
$524.86 |
| Rate for Payer: Aetna Medicare |
$295.37
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$366.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$366.30
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$339.68
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$324.91
|
| Rate for Payer: Cash Price |
$433.89
|
| Rate for Payer: Cash Price |
$433.89
|
| Rate for Payer: Coventry All Commercial |
$354.44
|
| Rate for Payer: Frontpath All Commercial |
$409.85
|
| Rate for Payer: Humana ChoiceCare |
$272.34
|
| Rate for Payer: Humana Medicare |
$295.37
|
| Rate for Payer: Lucent All Commercial |
$502.13
|
| Rate for Payer: Lutheran Preferred All Commercial |
$384.00
|
| Rate for Payer: PHCS All Commercial |
$524.86
|
| Rate for Payer: PHP All Commercial |
$403.43
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$295.37
|
| Rate for Payer: Signature Care EPO |
$353.60
|
| Rate for Payer: Signature Care PPO |
$353.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$354.00
|
| Rate for Payer: United Healthcare Commercial |
$340.81
|
| Rate for Payer: United Healthcare Medicare |
$295.37
|
|
|
PR EXC SKIN BENIG >4 CM REMAINDR BODY
|
Professional
|
$601.68
|
|
|
Service Code
|
CPT 11426
|
| Hospital Charge Code |
z11426
|
| Min. Negotiated Rate |
$222.59 |
| Max. Negotiated Rate |
$451.26 |
| Rate for Payer: Aetna Medicare |
$250.94
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$328.90
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$328.90
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$288.58
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$276.03
|
| Rate for Payer: Cash Price |
$373.04
|
| Rate for Payer: Cash Price |
$373.04
|
| Rate for Payer: Coventry All Commercial |
$301.13
|
| Rate for Payer: Frontpath All Commercial |
$349.90
|
| Rate for Payer: Humana ChoiceCare |
$222.59
|
| Rate for Payer: Humana Medicare |
$250.94
|
| Rate for Payer: Lucent All Commercial |
$426.60
|
| Rate for Payer: Lutheran Preferred All Commercial |
$326.00
|
| Rate for Payer: PHCS All Commercial |
$451.26
|
| Rate for Payer: PHP All Commercial |
$342.74
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$250.94
|
| Rate for Payer: Signature Care EPO |
$301.75
|
| Rate for Payer: Signature Care PPO |
$301.75
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$301.00
|
| Rate for Payer: United Healthcare Commercial |
$289.63
|
| Rate for Payer: United Healthcare Medicare |
$250.94
|
|
|
PR EXC SKIN BENIG >4 CM TRUNK,ARM,LEG
|
Professional
|
$577.84
|
|
|
Service Code
|
CPT 11406
|
| Hospital Charge Code |
z11406
|
| Min. Negotiated Rate |
$166.54 |
| Max. Negotiated Rate |
$433.38 |
| Rate for Payer: Aetna Medicare |
$229.15
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$295.15
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$295.15
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$263.52
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$252.06
|
| Rate for Payer: Cash Price |
$358.26
|
| Rate for Payer: Cash Price |
$358.26
|
| Rate for Payer: Coventry All Commercial |
$274.98
|
| Rate for Payer: Frontpath All Commercial |
$319.32
|
| Rate for Payer: Humana ChoiceCare |
$166.54
|
| Rate for Payer: Humana Medicare |
$229.15
|
| Rate for Payer: Lucent All Commercial |
$389.56
|
| Rate for Payer: Lutheran Preferred All Commercial |
$298.00
|
| Rate for Payer: PHCS All Commercial |
$433.38
|
| Rate for Payer: PHP All Commercial |
$313.41
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$229.15
|
| Rate for Payer: Signature Care EPO |
$253.80
|
| Rate for Payer: Signature Care PPO |
$253.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$275.00
|
| Rate for Payer: United Healthcare Commercial |
$249.10
|
| Rate for Payer: United Healthcare Medicare |
$229.15
|
|
|
PR EXC SKIN MALIG <0.5 CM FACE,FACIAL
|
Professional
|
$371.50
|
|
|
Service Code
|
CPT 11640
|
| Hospital Charge Code |
z11640
|
| Min. Negotiated Rate |
$91.09 |
| Max. Negotiated Rate |
$278.62 |
| Rate for Payer: Aetna Medicare |
$118.16
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$189.71
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$189.71
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$135.88
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$129.98
|
| Rate for Payer: Cash Price |
$230.33
|
| Rate for Payer: Cash Price |
$230.33
|
| Rate for Payer: Coventry All Commercial |
$141.79
|
| Rate for Payer: Frontpath All Commercial |
$160.22
|
| Rate for Payer: Humana ChoiceCare |
$91.09
|
| Rate for Payer: Humana Medicare |
$118.16
|
| Rate for Payer: Lucent All Commercial |
$200.87
|
| Rate for Payer: Lutheran Preferred All Commercial |
$154.00
|
| Rate for Payer: PHCS All Commercial |
$278.62
|
| Rate for Payer: PHP All Commercial |
$161.39
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$118.16
|
| Rate for Payer: Signature Care EPO |
$162.92
|
| Rate for Payer: Signature Care PPO |
$162.92
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$142.00
|
| Rate for Payer: United Healthcare Commercial |
$128.15
|
| Rate for Payer: United Healthcare Medicare |
$118.16
|
|
|
PR EXC SKIN MALIG <0.5 CM TRUNK,ARM,LEG
|
Professional
|
$361.06
|
|
|
Service Code
|
CPT 11600
|
| Hospital Charge Code |
z11600
|
| Min. Negotiated Rate |
$84.60 |
| Max. Negotiated Rate |
$270.80 |
| Rate for Payer: Aetna Medicare |
$114.04
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$185.60
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$185.60
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$131.15
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$125.44
|
| Rate for Payer: Cash Price |
$223.86
|
| Rate for Payer: Cash Price |
$223.86
|
| Rate for Payer: Coventry All Commercial |
$136.85
|
| Rate for Payer: Frontpath All Commercial |
$155.13
|
| Rate for Payer: Humana ChoiceCare |
$84.60
|
| Rate for Payer: Humana Medicare |
$114.04
|
| Rate for Payer: Lucent All Commercial |
$193.87
|
| Rate for Payer: Lutheran Preferred All Commercial |
$148.00
|
| Rate for Payer: PHCS All Commercial |
$270.80
|
| Rate for Payer: PHP All Commercial |
$155.76
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$114.04
|
| Rate for Payer: Signature Care EPO |
$158.95
|
| Rate for Payer: Signature Care PPO |
$158.95
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$137.00
|
| Rate for Payer: United Healthcare Commercial |
$119.88
|
| Rate for Payer: United Healthcare Medicare |
$114.04
|
|
|
PR EXC SKIN MALIG 0.6-1CM FACE,FACIAL
|
Professional
|
$433.88
|
|
|
Service Code
|
CPT 11641
|
| Hospital Charge Code |
z11641
|
| Min. Negotiated Rate |
$137.04 |
| Max. Negotiated Rate |
$325.41 |
| Rate for Payer: Aetna Medicare |
$145.18
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$246.26
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$246.26
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$166.96
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$159.70
|
| Rate for Payer: Cash Price |
$269.01
|
| Rate for Payer: Cash Price |
$269.01
|
| Rate for Payer: Coventry All Commercial |
$174.22
|
| Rate for Payer: Frontpath All Commercial |
$196.60
|
| Rate for Payer: Humana ChoiceCare |
$137.04
|
| Rate for Payer: Humana Medicare |
$145.18
|
| Rate for Payer: Lucent All Commercial |
$246.81
|
| Rate for Payer: Lutheran Preferred All Commercial |
$189.00
|
| Rate for Payer: PHCS All Commercial |
$325.41
|
| Rate for Payer: PHP All Commercial |
$198.30
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$145.18
|
| Rate for Payer: Signature Care EPO |
$212.50
|
| Rate for Payer: Signature Care PPO |
$212.50
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$174.00
|
| Rate for Payer: United Healthcare Commercial |
$167.36
|
| Rate for Payer: United Healthcare Medicare |
$145.18
|
|
|
PR EXC SKIN MALIG 0.6-1 CM REMAINDR BODY
|
Professional
|
$420.38
|
|
|
Service Code
|
CPT 11621
|
| Hospital Charge Code |
z11621
|
| Min. Negotiated Rate |
$111.26 |
| Max. Negotiated Rate |
$315.28 |
| Rate for Payer: Aetna Medicare |
$139.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$211.14
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$211.14
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$160.42
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$153.45
|
| Rate for Payer: Cash Price |
$260.64
|
| Rate for Payer: Cash Price |
$260.64
|
| Rate for Payer: Coventry All Commercial |
$167.40
|
| Rate for Payer: Frontpath All Commercial |
$189.25
|
| Rate for Payer: Humana ChoiceCare |
$111.26
|
| Rate for Payer: Humana Medicare |
$139.50
|
| Rate for Payer: Lucent All Commercial |
$237.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$181.00
|
| Rate for Payer: PHCS All Commercial |
$315.28
|
| Rate for Payer: PHP All Commercial |
$190.54
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$139.50
|
| Rate for Payer: Signature Care EPO |
$183.88
|
| Rate for Payer: Signature Care PPO |
$183.88
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$167.00
|
| Rate for Payer: United Healthcare Commercial |
$156.84
|
| Rate for Payer: United Healthcare Medicare |
$139.50
|
|
|
PR EXC SKIN MALIG 0.6-1 CM TRUNK,ARM,LEG
|
Professional
|
$418.20
|
|
|
Service Code
|
CPT 11601
|
| Hospital Charge Code |
z11601
|
| Min. Negotiated Rate |
$112.09 |
| Max. Negotiated Rate |
$313.65 |
| Rate for Payer: Aetna Medicare |
$138.69
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$212.51
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$212.51
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$159.49
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$152.56
|
| Rate for Payer: Cash Price |
$259.28
|
| Rate for Payer: Cash Price |
$259.28
|
| Rate for Payer: Coventry All Commercial |
$166.43
|
| Rate for Payer: Frontpath All Commercial |
$188.40
|
| Rate for Payer: Humana ChoiceCare |
$112.09
|
| Rate for Payer: Humana Medicare |
$138.69
|
| Rate for Payer: Lucent All Commercial |
$235.77
|
| Rate for Payer: Lutheran Preferred All Commercial |
$180.00
|
| Rate for Payer: PHCS All Commercial |
$313.65
|
| Rate for Payer: PHP All Commercial |
$189.43
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$138.69
|
| Rate for Payer: Signature Care EPO |
$183.18
|
| Rate for Payer: Signature Care PPO |
$183.18
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$166.00
|
| Rate for Payer: United Healthcare Commercial |
$155.15
|
| Rate for Payer: United Healthcare Medicare |
$138.69
|
|
|
PR EXC SKIN MALIG 1.1-2 CM FACE,FACIAL
|
Professional
|
$490.18
|
|
|
Service Code
|
CPT 11642
|
| Hospital Charge Code |
z11642
|
| Min. Negotiated Rate |
$160.01 |
| Max. Negotiated Rate |
$367.64 |
| Rate for Payer: Aetna Medicare |
$169.72
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$285.02
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$285.02
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$195.18
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$186.69
|
| Rate for Payer: Cash Price |
$303.91
|
| Rate for Payer: Cash Price |
$303.91
|
| Rate for Payer: Coventry All Commercial |
$203.66
|
| Rate for Payer: Frontpath All Commercial |
$230.96
|
| Rate for Payer: Humana ChoiceCare |
$160.01
|
| Rate for Payer: Humana Medicare |
$169.72
|
| Rate for Payer: Lucent All Commercial |
$288.52
|
| Rate for Payer: Lutheran Preferred All Commercial |
$221.00
|
| Rate for Payer: PHCS All Commercial |
$367.64
|
| Rate for Payer: PHP All Commercial |
$231.81
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$169.72
|
| Rate for Payer: Signature Care EPO |
$245.65
|
| Rate for Payer: Signature Care PPO |
$245.65
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$204.00
|
| Rate for Payer: United Healthcare Commercial |
$197.56
|
| Rate for Payer: United Healthcare Medicare |
$169.72
|
|
|
PR EXC SKIN MALIG 1.1-2 CM REMAINDR BODY
|
Professional
|
$463.00
|
|
|
Service Code
|
CPT 11622
|
| Hospital Charge Code |
z11622
|
| Min. Negotiated Rate |
$129.24 |
| Max. Negotiated Rate |
$347.25 |
| Rate for Payer: Aetna Medicare |
$158.25
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$237.80
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$237.80
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$181.99
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$174.08
|
| Rate for Payer: Cash Price |
$287.06
|
| Rate for Payer: Cash Price |
$287.06
|
| Rate for Payer: Coventry All Commercial |
$189.90
|
| Rate for Payer: Frontpath All Commercial |
$214.12
|
| Rate for Payer: Humana ChoiceCare |
$129.24
|
| Rate for Payer: Humana Medicare |
$158.25
|
| Rate for Payer: Lucent All Commercial |
$269.02
|
| Rate for Payer: Lutheran Preferred All Commercial |
$206.00
|
| Rate for Payer: PHCS All Commercial |
$347.25
|
| Rate for Payer: PHP All Commercial |
$216.15
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$158.25
|
| Rate for Payer: Signature Care EPO |
$206.55
|
| Rate for Payer: Signature Care PPO |
$206.55
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$190.00
|
| Rate for Payer: United Healthcare Commercial |
$180.95
|
| Rate for Payer: United Healthcare Medicare |
$158.25
|
|
