|
PR EXC SKIN MALIG 1.1-2 CM TRUNK,ARM,LEG
|
Professional
|
$448.28
|
|
|
Service Code
|
CPT 11602
|
| Hospital Charge Code |
z11602
|
| Min. Negotiated Rate |
$119.15 |
| Max. Negotiated Rate |
$336.21 |
| Rate for Payer: Aetna Medicare |
$151.03
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$226.65
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$226.65
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$173.68
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$166.13
|
| Rate for Payer: Cash Price |
$277.93
|
| Rate for Payer: Cash Price |
$277.93
|
| Rate for Payer: Coventry All Commercial |
$181.24
|
| Rate for Payer: Frontpath All Commercial |
$204.37
|
| Rate for Payer: Humana ChoiceCare |
$119.15
|
| Rate for Payer: Humana Medicare |
$151.03
|
| Rate for Payer: Lucent All Commercial |
$256.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$196.00
|
| Rate for Payer: PHCS All Commercial |
$336.21
|
| Rate for Payer: PHP All Commercial |
$206.28
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$151.03
|
| Rate for Payer: Signature Care EPO |
$197.96
|
| Rate for Payer: Signature Care PPO |
$197.96
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$181.00
|
| Rate for Payer: United Healthcare Commercial |
$170.79
|
| Rate for Payer: United Healthcare Medicare |
$151.03
|
|
|
PR EXC SKIN MALIG 2.1-3 CM FACE,FACIAL
|
Professional
|
$576.08
|
|
|
Service Code
|
CPT 11643
|
| Hospital Charge Code |
z11643
|
| Min. Negotiated Rate |
$189.42 |
| Max. Negotiated Rate |
$432.06 |
| Rate for Payer: Aetna Medicare |
$211.89
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$325.50
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$325.50
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$243.67
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$233.08
|
| Rate for Payer: Cash Price |
$357.17
|
| Rate for Payer: Cash Price |
$357.17
|
| Rate for Payer: Coventry All Commercial |
$254.27
|
| Rate for Payer: Frontpath All Commercial |
$289.61
|
| Rate for Payer: Humana ChoiceCare |
$189.42
|
| Rate for Payer: Humana Medicare |
$211.89
|
| Rate for Payer: Lucent All Commercial |
$360.21
|
| Rate for Payer: Lutheran Preferred All Commercial |
$275.00
|
| Rate for Payer: PHCS All Commercial |
$432.06
|
| Rate for Payer: PHP All Commercial |
$289.41
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$211.89
|
| Rate for Payer: Signature Care EPO |
$283.90
|
| Rate for Payer: Signature Care PPO |
$283.90
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$254.00
|
| Rate for Payer: United Healthcare Commercial |
$247.10
|
| Rate for Payer: United Healthcare Medicare |
$211.89
|
|
|
PR EXC SKIN MALIG 2.1-3 CM TRUNK,ARM,LEG
|
Professional
|
$510.68
|
|
|
Service Code
|
CPT 11603
|
| Hospital Charge Code |
z11603
|
| Min. Negotiated Rate |
$131.30 |
| Max. Negotiated Rate |
$383.01 |
| Rate for Payer: Aetna Medicare |
$180.53
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$250.36
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$250.36
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$207.61
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$198.58
|
| Rate for Payer: Cash Price |
$316.62
|
| Rate for Payer: Cash Price |
$316.62
|
| Rate for Payer: Coventry All Commercial |
$216.64
|
| Rate for Payer: Frontpath All Commercial |
$244.97
|
| Rate for Payer: Humana ChoiceCare |
$131.30
|
| Rate for Payer: Humana Medicare |
$180.53
|
| Rate for Payer: Lucent All Commercial |
$306.90
|
| Rate for Payer: Lutheran Preferred All Commercial |
$235.00
|
| Rate for Payer: PHCS All Commercial |
$383.01
|
| Rate for Payer: PHP All Commercial |
$246.58
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$180.53
|
| Rate for Payer: Signature Care EPO |
$226.63
|
| Rate for Payer: Signature Care PPO |
$226.63
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$217.00
|
| Rate for Payer: United Healthcare Commercial |
$203.29
|
| Rate for Payer: United Healthcare Medicare |
$180.53
|
|
|
PR EXC SKIN MALIG 3.1-4 CM FACE,FACIAL
|
Professional
|
$709.40
|
|
|
Service Code
|
CPT 11644
|
| Hospital Charge Code |
z11644
|
| Min. Negotiated Rate |
$242.93 |
| Max. Negotiated Rate |
$532.05 |
| Rate for Payer: Aetna Medicare |
$262.31
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$405.20
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$405.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$301.66
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$288.54
|
| Rate for Payer: Cash Price |
$439.83
|
| Rate for Payer: Cash Price |
$439.83
|
| Rate for Payer: Coventry All Commercial |
$314.77
|
| Rate for Payer: Frontpath All Commercial |
$361.14
|
| Rate for Payer: Humana ChoiceCare |
$242.93
|
| Rate for Payer: Humana Medicare |
$262.31
|
| Rate for Payer: Lucent All Commercial |
$445.93
|
| Rate for Payer: Lutheran Preferred All Commercial |
$341.00
|
| Rate for Payer: PHCS All Commercial |
$532.05
|
| Rate for Payer: PHP All Commercial |
$358.27
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$262.31
|
| Rate for Payer: Signature Care EPO |
$359.55
|
| Rate for Payer: Signature Care PPO |
$359.55
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$315.00
|
| Rate for Payer: United Healthcare Commercial |
$308.11
|
| Rate for Payer: United Healthcare Medicare |
$262.31
|
|
|
PR EXC SKIN MALIG >4 CM FACE,FACIAL
|
Professional
|
$920.54
|
|
|
Service Code
|
CPT 11646
|
| Hospital Charge Code |
z11646
|
| Min. Negotiated Rate |
$354.68 |
| Max. Negotiated Rate |
$690.40 |
| Rate for Payer: Aetna Medicare |
$361.88
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$526.20
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$526.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$416.16
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$398.07
|
| Rate for Payer: Cash Price |
$570.73
|
| Rate for Payer: Cash Price |
$570.73
|
| Rate for Payer: Coventry All Commercial |
$434.26
|
| Rate for Payer: Frontpath All Commercial |
$502.94
|
| Rate for Payer: Humana ChoiceCare |
$354.68
|
| Rate for Payer: Humana Medicare |
$361.88
|
| Rate for Payer: Lucent All Commercial |
$615.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$470.00
|
| Rate for Payer: PHCS All Commercial |
$690.40
|
| Rate for Payer: PHP All Commercial |
$494.27
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$361.88
|
| Rate for Payer: Signature Care EPO |
$483.65
|
| Rate for Payer: Signature Care PPO |
$483.65
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$434.00
|
| Rate for Payer: United Healthcare Commercial |
$433.84
|
| Rate for Payer: United Healthcare Medicare |
$361.88
|
|
|
PR EXC SKIN MALIG >4 CM TRUNK,ARM,LEG
|
Professional
|
$812.78
|
|
|
Service Code
|
CPT 11606
|
| Hospital Charge Code |
z11606
|
| Min. Negotiated Rate |
$195.30 |
| Max. Negotiated Rate |
$609.58 |
| Rate for Payer: Aetna Medicare |
$292.76
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$429.84
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$429.84
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$336.67
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$322.04
|
| Rate for Payer: Cash Price |
$503.92
|
| Rate for Payer: Cash Price |
$503.92
|
| Rate for Payer: Coventry All Commercial |
$351.31
|
| Rate for Payer: Frontpath All Commercial |
$409.31
|
| Rate for Payer: Humana ChoiceCare |
$195.30
|
| Rate for Payer: Humana Medicare |
$292.76
|
| Rate for Payer: Lucent All Commercial |
$497.69
|
| Rate for Payer: Lutheran Preferred All Commercial |
$381.00
|
| Rate for Payer: PHCS All Commercial |
$609.58
|
| Rate for Payer: PHP All Commercial |
$399.86
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$292.76
|
| Rate for Payer: Signature Care EPO |
$360.99
|
| Rate for Payer: Signature Care PPO |
$360.99
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$351.00
|
| Rate for Payer: United Healthcare Commercial |
$331.88
|
| Rate for Payer: United Healthcare Medicare |
$292.76
|
|
|
PR EXC TUMOR SOFT TISS BACK/FLANK SUBFASCIAL 5+CM
|
Professional
|
$1,326.22
|
|
|
Service Code
|
CPT 21933
|
| Hospital Charge Code |
z21933
|
| Min. Negotiated Rate |
$679.69 |
| Max. Negotiated Rate |
$1,155.47 |
| Rate for Payer: Aetna Medicare |
$679.69
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$872.17
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$872.17
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$781.64
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$747.66
|
| Rate for Payer: Cash Price |
$822.26
|
| Rate for Payer: Cash Price |
$822.26
|
| Rate for Payer: Coventry All Commercial |
$815.63
|
| Rate for Payer: Frontpath All Commercial |
$969.59
|
| Rate for Payer: Humana ChoiceCare |
$776.98
|
| Rate for Payer: Humana Medicare |
$679.69
|
| Rate for Payer: Lucent All Commercial |
$1,155.47
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,088.00
|
| Rate for Payer: PHCS All Commercial |
$994.66
|
| Rate for Payer: PHP All Commercial |
$1,153.82
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$679.69
|
| Rate for Payer: Signature Care EPO |
$745.45
|
| Rate for Payer: Signature Care PPO |
$745.45
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,020.00
|
| Rate for Payer: United Healthcare Commercial |
$851.03
|
| Rate for Payer: United Healthcare Medicare |
$679.69
|
|
|
PR EXC TUMOR SOFT TISS FACE&SCALP SUBFASCIAL 2+CM
|
Professional
|
$949.02
|
|
|
Service Code
|
CPT 21014
|
| Hospital Charge Code |
z21014
|
| Min. Negotiated Rate |
$486.37 |
| Max. Negotiated Rate |
$826.83 |
| Rate for Payer: Aetna Medicare |
$486.37
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$607.71
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$607.71
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$559.33
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$535.01
|
| Rate for Payer: Cash Price |
$588.39
|
| Rate for Payer: Cash Price |
$588.39
|
| Rate for Payer: Coventry All Commercial |
$583.64
|
| Rate for Payer: Frontpath All Commercial |
$673.74
|
| Rate for Payer: Humana ChoiceCare |
$544.80
|
| Rate for Payer: Humana Medicare |
$486.37
|
| Rate for Payer: Lucent All Commercial |
$826.83
|
| Rate for Payer: Lutheran Preferred All Commercial |
$778.00
|
| Rate for Payer: PHCS All Commercial |
$711.76
|
| Rate for Payer: PHP All Commercial |
$825.64
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$486.37
|
| Rate for Payer: Signature Care EPO |
$522.75
|
| Rate for Payer: Signature Care PPO |
$522.75
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$730.00
|
| Rate for Payer: United Healthcare Commercial |
$596.85
|
| Rate for Payer: United Healthcare Medicare |
$486.37
|
|
|
PR EXC TUMOR SOFT TISS FOREARM AND/WRIST SUBQ 3+CM
|
Professional
|
$767.68
|
|
|
Service Code
|
CPT 25071
|
| Hospital Charge Code |
z25071
|
| Min. Negotiated Rate |
$393.43 |
| Max. Negotiated Rate |
$668.83 |
| Rate for Payer: Aetna Medicare |
$393.43
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$496.90
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$496.90
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$452.44
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$432.77
|
| Rate for Payer: Cash Price |
$475.96
|
| Rate for Payer: Cash Price |
$475.96
|
| Rate for Payer: Coventry All Commercial |
$472.12
|
| Rate for Payer: Frontpath All Commercial |
$552.66
|
| Rate for Payer: Humana ChoiceCare |
$443.53
|
| Rate for Payer: Humana Medicare |
$393.43
|
| Rate for Payer: Lucent All Commercial |
$668.83
|
| Rate for Payer: Lutheran Preferred All Commercial |
$629.00
|
| Rate for Payer: PHCS All Commercial |
$575.76
|
| Rate for Payer: PHP All Commercial |
$667.88
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$393.43
|
| Rate for Payer: Signature Care EPO |
$425.85
|
| Rate for Payer: Signature Care PPO |
$425.85
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$590.00
|
| Rate for Payer: United Healthcare Commercial |
$485.84
|
| Rate for Payer: United Healthcare Medicare |
$393.43
|
|
|
PR EXC TUMOR SOFT TISSUE ABDL WALL SUBFASCIAL 5+CM
|
Professional
|
$1,194.40
|
|
|
Service Code
|
CPT 22901
|
| Hospital Charge Code |
z22901
|
| Min. Negotiated Rate |
$612.13 |
| Max. Negotiated Rate |
$1,040.62 |
| Rate for Payer: Aetna Medicare |
$612.13
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$778.25
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$778.25
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$703.95
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$673.34
|
| Rate for Payer: Cash Price |
$740.53
|
| Rate for Payer: Cash Price |
$740.53
|
| Rate for Payer: Coventry All Commercial |
$734.56
|
| Rate for Payer: Frontpath All Commercial |
$878.05
|
| Rate for Payer: Humana ChoiceCare |
$694.18
|
| Rate for Payer: Humana Medicare |
$612.13
|
| Rate for Payer: Lucent All Commercial |
$1,040.62
|
| Rate for Payer: Lutheran Preferred All Commercial |
$979.00
|
| Rate for Payer: PHCS All Commercial |
$895.80
|
| Rate for Payer: PHP All Commercial |
$1,039.14
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$612.13
|
| Rate for Payer: Signature Care EPO |
$665.55
|
| Rate for Payer: Signature Care PPO |
$665.55
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$918.00
|
| Rate for Payer: United Healthcare Commercial |
$760.60
|
| Rate for Payer: United Healthcare Medicare |
$612.13
|
|
|
PR EXC TUMOR SOFT TISSUE FOREARM &/WRIST SUBQ <3CM
|
Professional
|
$947.44
|
|
|
Service Code
|
CPT 25075
|
| Hospital Charge Code |
z25075
|
| Min. Negotiated Rate |
$295.09 |
| Max. Negotiated Rate |
$710.58 |
| Rate for Payer: Aetna Medicare |
$295.09
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$394.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$394.00
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$339.35
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$324.60
|
| Rate for Payer: Cash Price |
$587.41
|
| Rate for Payer: Cash Price |
$587.41
|
| Rate for Payer: Coventry All Commercial |
$354.11
|
| Rate for Payer: Frontpath All Commercial |
$407.95
|
| Rate for Payer: Humana ChoiceCare |
$407.08
|
| Rate for Payer: Humana Medicare |
$295.09
|
| Rate for Payer: Lucent All Commercial |
$501.65
|
| Rate for Payer: Lutheran Preferred All Commercial |
$472.00
|
| Rate for Payer: PHCS All Commercial |
$710.58
|
| Rate for Payer: PHP All Commercial |
$500.94
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$295.09
|
| Rate for Payer: Signature Care EPO |
$557.60
|
| Rate for Payer: Signature Care PPO |
$557.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$443.00
|
| Rate for Payer: United Healthcare Commercial |
$349.99
|
| Rate for Payer: United Healthcare Medicare |
$295.09
|
|
|
PR EXC TUMOR SOFT TISSUE LEG/ANKLE SUBFASC 5+CM
|
Professional
|
$1,225.92
|
|
|
Service Code
|
CPT 27634
|
| Hospital Charge Code |
z27634
|
| Min. Negotiated Rate |
$628.28 |
| Max. Negotiated Rate |
$1,068.08 |
| Rate for Payer: Aetna Medicare |
$628.28
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$788.63
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$788.63
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$722.52
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$691.11
|
| Rate for Payer: Cash Price |
$760.07
|
| Rate for Payer: Cash Price |
$760.07
|
| Rate for Payer: Coventry All Commercial |
$753.94
|
| Rate for Payer: Frontpath All Commercial |
$880.37
|
| Rate for Payer: Humana ChoiceCare |
$706.45
|
| Rate for Payer: Humana Medicare |
$628.28
|
| Rate for Payer: Lucent All Commercial |
$1,068.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,005.00
|
| Rate for Payer: PHCS All Commercial |
$919.44
|
| Rate for Payer: PHP All Commercial |
$1,066.54
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$628.28
|
| Rate for Payer: Signature Care EPO |
$677.45
|
| Rate for Payer: Signature Care PPO |
$677.45
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$942.00
|
| Rate for Payer: United Healthcare Commercial |
$774.19
|
| Rate for Payer: United Healthcare Medicare |
$628.28
|
|
|
PR EXC TUMOR SOFT TISSUE NECK/ANT THORAX SUBFASCIAL 5+CM
|
Professional
|
$1,319.34
|
|
|
Service Code
|
CPT 21554
|
| Hospital Charge Code |
z21554
|
| Min. Negotiated Rate |
$676.16 |
| Max. Negotiated Rate |
$1,149.47 |
| Rate for Payer: Aetna Medicare |
$676.16
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$863.08
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$863.08
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$777.58
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$743.78
|
| Rate for Payer: Cash Price |
$817.99
|
| Rate for Payer: Cash Price |
$817.99
|
| Rate for Payer: Coventry All Commercial |
$811.39
|
| Rate for Payer: Frontpath All Commercial |
$956.31
|
| Rate for Payer: Humana ChoiceCare |
$772.00
|
| Rate for Payer: Humana Medicare |
$676.16
|
| Rate for Payer: Lucent All Commercial |
$1,149.47
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,082.00
|
| Rate for Payer: PHCS All Commercial |
$989.50
|
| Rate for Payer: PHP All Commercial |
$1,147.83
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$676.16
|
| Rate for Payer: Signature Care EPO |
$740.35
|
| Rate for Payer: Signature Care PPO |
$740.35
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,014.00
|
| Rate for Payer: United Healthcare Commercial |
$846.04
|
| Rate for Payer: United Healthcare Medicare |
$676.16
|
|
|
PR EXC TUMOR SOFT TISSUE NECK/ANT THORAX SUBFASCIAL <5CM
|
Professional
|
$964.38
|
|
|
Service Code
|
CPT 21556
|
| Hospital Charge Code |
z21556
|
| Min. Negotiated Rate |
$417.68 |
| Max. Negotiated Rate |
$840.22 |
| Rate for Payer: Aetna Medicare |
$494.25
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$459.60
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$459.60
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$568.39
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$543.68
|
| Rate for Payer: Cash Price |
$597.92
|
| Rate for Payer: Cash Price |
$597.92
|
| Rate for Payer: Coventry All Commercial |
$593.10
|
| Rate for Payer: Frontpath All Commercial |
$691.00
|
| Rate for Payer: Humana ChoiceCare |
$417.68
|
| Rate for Payer: Humana Medicare |
$494.25
|
| Rate for Payer: Lucent All Commercial |
$840.22
|
| Rate for Payer: Lutheran Preferred All Commercial |
$791.00
|
| Rate for Payer: PHCS All Commercial |
$723.28
|
| Rate for Payer: PHP All Commercial |
$839.02
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$494.25
|
| Rate for Payer: Signature Care EPO |
$559.30
|
| Rate for Payer: Signature Care PPO |
$559.30
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$741.00
|
| Rate for Payer: United Healthcare Commercial |
$444.36
|
| Rate for Payer: United Healthcare Medicare |
$494.25
|
|
|
PR EXC TUMOR SOFT TISSUE NECK/ANT THORAX SUBQ 3+CM
|
Professional
|
$805.10
|
|
|
Service Code
|
CPT 21552
|
| Hospital Charge Code |
z21552
|
| Min. Negotiated Rate |
$412.62 |
| Max. Negotiated Rate |
$701.45 |
| Rate for Payer: Aetna Medicare |
$412.62
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$525.47
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$525.47
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$474.51
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$453.88
|
| Rate for Payer: Cash Price |
$499.16
|
| Rate for Payer: Cash Price |
$499.16
|
| Rate for Payer: Coventry All Commercial |
$495.14
|
| Rate for Payer: Frontpath All Commercial |
$584.97
|
| Rate for Payer: Humana ChoiceCare |
$469.56
|
| Rate for Payer: Humana Medicare |
$412.62
|
| Rate for Payer: Lucent All Commercial |
$701.45
|
| Rate for Payer: Lutheran Preferred All Commercial |
$660.00
|
| Rate for Payer: PHCS All Commercial |
$603.82
|
| Rate for Payer: PHP All Commercial |
$700.44
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$412.62
|
| Rate for Payer: Signature Care EPO |
$450.50
|
| Rate for Payer: Signature Care PPO |
$450.50
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$619.00
|
| Rate for Payer: United Healthcare Commercial |
$514.15
|
| Rate for Payer: United Healthcare Medicare |
$412.62
|
|
|
PR EXC TUMOR SOFT TISSUE NECK/ANT THORAX SUBQ <3CM
|
Professional
|
$789.62
|
|
|
Service Code
|
CPT 21555
|
| Hospital Charge Code |
z21555
|
| Min. Negotiated Rate |
$285.52 |
| Max. Negotiated Rate |
$592.22 |
| Rate for Payer: Aetna Medicare |
$285.52
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$450.64
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$450.64
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$328.35
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$314.07
|
| Rate for Payer: Cash Price |
$489.56
|
| Rate for Payer: Cash Price |
$489.56
|
| Rate for Payer: Coventry All Commercial |
$342.62
|
| Rate for Payer: Frontpath All Commercial |
$396.53
|
| Rate for Payer: Humana ChoiceCare |
$326.71
|
| Rate for Payer: Humana Medicare |
$285.52
|
| Rate for Payer: Lucent All Commercial |
$485.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$457.00
|
| Rate for Payer: PHCS All Commercial |
$592.22
|
| Rate for Payer: PHP All Commercial |
$484.69
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$285.52
|
| Rate for Payer: Signature Care EPO |
$536.35
|
| Rate for Payer: Signature Care PPO |
$536.35
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$428.00
|
| Rate for Payer: United Healthcare Commercial |
$355.03
|
| Rate for Payer: United Healthcare Medicare |
$285.52
|
|
|
PR EXC TUMOR SOFT TISSUE SHOULDER SUBFASCIAL 5+CM
|
Professional
|
$1,256.40
|
|
|
Service Code
|
CPT 23073
|
| Hospital Charge Code |
z23073
|
| Min. Negotiated Rate |
$643.90 |
| Max. Negotiated Rate |
$1,094.63 |
| Rate for Payer: Aetna Medicare |
$643.90
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$810.28
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$810.28
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$740.48
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$708.29
|
| Rate for Payer: Cash Price |
$778.97
|
| Rate for Payer: Cash Price |
$778.97
|
| Rate for Payer: Coventry All Commercial |
$772.68
|
| Rate for Payer: Frontpath All Commercial |
$910.34
|
| Rate for Payer: Humana ChoiceCare |
$722.88
|
| Rate for Payer: Humana Medicare |
$643.90
|
| Rate for Payer: Lucent All Commercial |
$1,094.63
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,030.00
|
| Rate for Payer: PHCS All Commercial |
$942.30
|
| Rate for Payer: PHP All Commercial |
$1,093.06
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$643.90
|
| Rate for Payer: Signature Care EPO |
$693.60
|
| Rate for Payer: Signature Care PPO |
$693.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$966.00
|
| Rate for Payer: United Healthcare Commercial |
$791.46
|
| Rate for Payer: United Healthcare Medicare |
$643.90
|
|
|
PR EXC TUMOR SOFT TISSUE THIGH/KNEE SUBFASC 5+CM
|
Professional
|
$1,356.82
|
|
|
Service Code
|
CPT 27339
|
| Hospital Charge Code |
z27339
|
| Min. Negotiated Rate |
$695.37 |
| Max. Negotiated Rate |
$1,182.13 |
| Rate for Payer: Aetna Medicare |
$695.37
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$882.56
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$882.56
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$799.68
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$764.91
|
| Rate for Payer: Cash Price |
$841.23
|
| Rate for Payer: Cash Price |
$841.23
|
| Rate for Payer: Coventry All Commercial |
$834.44
|
| Rate for Payer: Frontpath All Commercial |
$987.26
|
| Rate for Payer: Humana ChoiceCare |
$787.45
|
| Rate for Payer: Humana Medicare |
$695.37
|
| Rate for Payer: Lucent All Commercial |
$1,182.13
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,113.00
|
| Rate for Payer: PHCS All Commercial |
$1,017.62
|
| Rate for Payer: PHP All Commercial |
$1,180.43
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$695.37
|
| Rate for Payer: Signature Care EPO |
$755.65
|
| Rate for Payer: Signature Care PPO |
$755.65
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,043.00
|
| Rate for Payer: United Healthcare Commercial |
$862.80
|
| Rate for Payer: United Healthcare Medicare |
$695.37
|
|
|
PR EXC TUMOR SOFT TISSUE THIGH/KNEE SUBFASC <5CM
|
Professional
|
$1,127.08
|
|
|
Service Code
|
CPT 27328
|
| Hospital Charge Code |
z27328
|
| Min. Negotiated Rate |
$431.98 |
| Max. Negotiated Rate |
$981.97 |
| Rate for Payer: Aetna Medicare |
$577.63
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$664.27
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$635.39
|
| Rate for Payer: Cash Price |
$698.79
|
| Rate for Payer: Cash Price |
$698.79
|
| Rate for Payer: Coventry All Commercial |
$693.16
|
| Rate for Payer: Frontpath All Commercial |
$811.95
|
| Rate for Payer: Humana ChoiceCare |
$431.98
|
| Rate for Payer: Humana Medicare |
$577.63
|
| Rate for Payer: Lucent All Commercial |
$981.97
|
| Rate for Payer: PHCS All Commercial |
$845.31
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$577.63
|
| Rate for Payer: United Healthcare Commercial |
$450.29
|
| Rate for Payer: United Healthcare Medicare |
$577.63
|
|
|
PR EXC TUMOR SOFT TISSUE UPPER ARM/ELBOW SUBQ 3+CM
|
Professional
|
$731.52
|
|
|
Service Code
|
CPT 24071
|
| Hospital Charge Code |
z24071
|
| Min. Negotiated Rate |
$374.91 |
| Max. Negotiated Rate |
$637.35 |
| Rate for Payer: Aetna Medicare |
$374.91
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$431.15
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$412.40
|
| Rate for Payer: Cash Price |
$453.54
|
| Rate for Payer: Cash Price |
$453.54
|
| Rate for Payer: Coventry All Commercial |
$449.89
|
| Rate for Payer: Frontpath All Commercial |
$530.22
|
| Rate for Payer: Humana ChoiceCare |
$423.23
|
| Rate for Payer: Humana Medicare |
$374.91
|
| Rate for Payer: Lucent All Commercial |
$637.35
|
| Rate for Payer: PHCS All Commercial |
$548.64
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$374.91
|
| Rate for Payer: United Healthcare Commercial |
$463.69
|
| Rate for Payer: United Healthcare Medicare |
$374.91
|
|
|
PR EXC TUMOR SOFT TISS UPPER ARM/ELBOW SUBQ <3CM
|
Professional
|
$979.18
|
|
|
Service Code
|
CPT 24075
|
| Hospital Charge Code |
z24075
|
| Min. Negotiated Rate |
$307.12 |
| Max. Negotiated Rate |
$734.38 |
| Rate for Payer: Aetna Medicare |
$307.12
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$353.19
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$337.83
|
| Rate for Payer: Cash Price |
$607.09
|
| Rate for Payer: Cash Price |
$607.09
|
| Rate for Payer: Coventry All Commercial |
$368.54
|
| Rate for Payer: Frontpath All Commercial |
$427.69
|
| Rate for Payer: Humana ChoiceCare |
$316.25
|
| Rate for Payer: Humana Medicare |
$307.12
|
| Rate for Payer: Lucent All Commercial |
$522.10
|
| Rate for Payer: PHCS All Commercial |
$734.38
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$307.12
|
| Rate for Payer: United Healthcare Commercial |
$331.89
|
| Rate for Payer: United Healthcare Medicare |
$307.12
|
|
|
PR EXC TUMOR SOFT TISS UPPER ARM/ELBW SUBFASC 5+CM
|
Professional
|
$1,250.60
|
|
|
Service Code
|
CPT 24073
|
| Hospital Charge Code |
z24073
|
| Min. Negotiated Rate |
$640.93 |
| Max. Negotiated Rate |
$1,089.58 |
| Rate for Payer: Aetna Medicare |
$640.93
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$814.17
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$814.17
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$737.07
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$705.02
|
| Rate for Payer: Cash Price |
$775.37
|
| Rate for Payer: Cash Price |
$775.37
|
| Rate for Payer: Coventry All Commercial |
$769.12
|
| Rate for Payer: Frontpath All Commercial |
$904.92
|
| Rate for Payer: Humana ChoiceCare |
$726.96
|
| Rate for Payer: Humana Medicare |
$640.93
|
| Rate for Payer: Lucent All Commercial |
$1,089.58
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,025.00
|
| Rate for Payer: PHCS All Commercial |
$937.95
|
| Rate for Payer: PHP All Commercial |
$1,088.03
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$640.93
|
| Rate for Payer: Signature Care EPO |
$697.00
|
| Rate for Payer: Signature Care PPO |
$697.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$961.00
|
| Rate for Payer: United Healthcare Commercial |
$795.89
|
| Rate for Payer: United Healthcare Medicare |
$640.93
|
|
|
PR EXC TUM/VASC MAL SFT TISS HAND/FNGR SUBQ <1.5CM
|
Professional
|
$1,005.80
|
|
|
Service Code
|
CPT 26115
|
| Hospital Charge Code |
z26115
|
| Min. Negotiated Rate |
$311.72 |
| Max. Negotiated Rate |
$808.67 |
| Rate for Payer: Aetna Medicare |
$311.72
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$630.11
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$630.11
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$358.48
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$342.89
|
| Rate for Payer: Cash Price |
$623.60
|
| Rate for Payer: Cash Price |
$623.60
|
| Rate for Payer: Coventry All Commercial |
$374.06
|
| Rate for Payer: Frontpath All Commercial |
$426.02
|
| Rate for Payer: Humana ChoiceCare |
$368.39
|
| Rate for Payer: Humana Medicare |
$311.72
|
| Rate for Payer: Lucent All Commercial |
$529.92
|
| Rate for Payer: Lutheran Preferred All Commercial |
$499.00
|
| Rate for Payer: PHCS All Commercial |
$754.35
|
| Rate for Payer: PHP All Commercial |
$529.17
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$311.72
|
| Rate for Payer: Signature Care EPO |
$808.67
|
| Rate for Payer: Signature Care PPO |
$808.67
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$468.00
|
| Rate for Payer: United Healthcare Commercial |
$374.35
|
| Rate for Payer: United Healthcare Medicare |
$311.72
|
|
|
PR EXPLOR ANKLE JOINT
|
Professional
|
$814.72
|
|
|
Service Code
|
CPT 27620
|
| Hospital Charge Code |
z27620
|
| Min. Negotiated Rate |
$417.54 |
| Max. Negotiated Rate |
$709.82 |
| Rate for Payer: Aetna Medicare |
$417.54
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$625.60
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$625.60
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$480.17
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$459.29
|
| Rate for Payer: Cash Price |
$505.13
|
| Rate for Payer: Cash Price |
$505.13
|
| Rate for Payer: Coventry All Commercial |
$501.05
|
| Rate for Payer: Frontpath All Commercial |
$581.62
|
| Rate for Payer: Humana ChoiceCare |
$495.86
|
| Rate for Payer: Humana Medicare |
$417.54
|
| Rate for Payer: Lucent All Commercial |
$709.82
|
| Rate for Payer: Lutheran Preferred All Commercial |
$668.00
|
| Rate for Payer: PHCS All Commercial |
$611.04
|
| Rate for Payer: PHP All Commercial |
$708.80
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$417.54
|
| Rate for Payer: Signature Care EPO |
$668.10
|
| Rate for Payer: Signature Care PPO |
$668.10
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$626.00
|
| Rate for Payer: United Healthcare Commercial |
$499.23
|
| Rate for Payer: United Healthcare Medicare |
$417.54
|
|
|
PR EXPLOR/DRAIN KNEE,INFECTN
|
Professional
|
$1,332.42
|
|
|
Service Code
|
CPT 27310
|
| Hospital Charge Code |
z27310
|
| Min. Negotiated Rate |
$682.70 |
| Max. Negotiated Rate |
$1,160.59 |
| Rate for Payer: Aetna Medicare |
$682.70
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$934.70
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$934.70
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$785.10
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$750.97
|
| Rate for Payer: Cash Price |
$826.10
|
| Rate for Payer: Cash Price |
$826.10
|
| Rate for Payer: Coventry All Commercial |
$819.24
|
| Rate for Payer: Frontpath All Commercial |
$951.08
|
| Rate for Payer: Humana ChoiceCare |
$735.53
|
| Rate for Payer: Humana Medicare |
$682.70
|
| Rate for Payer: Lucent All Commercial |
$1,160.59
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,092.00
|
| Rate for Payer: PHCS All Commercial |
$999.32
|
| Rate for Payer: PHP All Commercial |
$1,159.20
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$682.70
|
| Rate for Payer: Signature Care EPO |
$983.45
|
| Rate for Payer: Signature Care PPO |
$983.45
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,024.00
|
| Rate for Payer: United Healthcare Commercial |
$784.40
|
| Rate for Payer: United Healthcare Medicare |
$682.70
|
|
