|
PR 1ST HOSPITAL IP/OBS CARE HIGH MDM 75 MINUTES
|
Professional
|
Both
|
$326.12
|
|
|
Service Code
|
CPT 99223
|
| Hospital Charge Code |
z99223
|
| Min. Negotiated Rate |
$150.83 |
| Max. Negotiated Rate |
$19,800.00 |
| Rate for Payer: Aetna Commercial |
$187.46
|
| Rate for Payer: Aetna Commercial |
$187.46
|
| Rate for Payer: Aetna Medicare |
$187.46
|
| Rate for Payer: Aetna Medicare |
$187.46
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$205.76
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$205.76
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$205.76
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$205.76
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$205.76
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$205.76
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$205.76
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$205.76
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$160.40
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$160.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$215.58
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$215.58
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$206.21
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$206.21
|
| Rate for Payer: Cash Price |
$195.67
|
| Rate for Payer: Cash Price |
$193.27
|
| Rate for Payer: Centivo All Commercial |
$290.56
|
| Rate for Payer: Centivo All Commercial |
$290.56
|
| Rate for Payer: Cigna All Commercial |
$187.46
|
| Rate for Payer: Cigna All Commercial |
$187.46
|
| Rate for Payer: CORVEL All Commercial |
$187.46
|
| Rate for Payer: CORVEL All Commercial |
$187.46
|
| Rate for Payer: Coventry All Commercial |
$224.95
|
| Rate for Payer: Coventry All Commercial |
$224.95
|
| Rate for Payer: Encore All Commercial |
$187.46
|
| Rate for Payer: Encore All Commercial |
$187.46
|
| Rate for Payer: Frontpath All Commercial |
$202.26
|
| Rate for Payer: Frontpath All Commercial |
$202.26
|
| Rate for Payer: Humana ChoiceCare |
$150.83
|
| Rate for Payer: Humana ChoiceCare |
$150.83
|
| Rate for Payer: Humana Medicare |
$187.46
|
| Rate for Payer: Humana Medicare |
$187.46
|
| Rate for Payer: Lucent All Commercial |
$262.44
|
| Rate for Payer: Lucent All Commercial |
$262.44
|
| Rate for Payer: Lutheran Preferred All Commercial |
$206.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$206.00
|
| Rate for Payer: Managed Health Services Medicaid |
$160.40
|
| Rate for Payer: Managed Health Services Medicaid |
$160.40
|
| Rate for Payer: MDWise Medicaid |
$160.40
|
| Rate for Payer: MDWise Medicaid |
$160.40
|
| Rate for Payer: PHCS All Commercial |
$187.46
|
| Rate for Payer: PHCS All Commercial |
$187.46
|
| Rate for Payer: PHP All Commercial |
$165.89
|
| Rate for Payer: PHP All Commercial |
$165.89
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$187.46
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$187.46
|
| Rate for Payer: Sagamore Health Network All Products |
$187.46
|
| Rate for Payer: Sagamore Health Network All Products |
$187.46
|
| Rate for Payer: Signature Care EPO |
$166.88
|
| Rate for Payer: Signature Care EPO |
$166.88
|
| Rate for Payer: Signature Care PPO |
$166.88
|
| Rate for Payer: Signature Care PPO |
$166.88
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$19,800.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$19,800.00
|
| Rate for Payer: United Healthcare Commercial |
$183.99
|
| Rate for Payer: United Healthcare Commercial |
$183.99
|
| Rate for Payer: United Healthcare Medicare |
$161.06
|
| Rate for Payer: United Healthcare Medicare |
$161.06
|
|
|
PR 1ST HOSPITAL IP/OBS CARE MODERATE MDM 55 MINUTES
|
Professional
|
Both
|
$244.98
|
|
|
Service Code
|
CPT 99222
|
| Hospital Charge Code |
z99222
|
| Min. Negotiated Rate |
$108.16 |
| Max. Negotiated Rate |
$13,300.00 |
| Rate for Payer: Aetna Commercial |
$127.50
|
| Rate for Payer: Aetna Commercial |
$127.50
|
| Rate for Payer: Aetna Medicare |
$127.50
|
| Rate for Payer: Aetna Medicare |
$127.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$139.44
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$139.44
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$139.44
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$139.44
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$139.44
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$139.44
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$139.44
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$139.44
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$120.49
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$120.49
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$146.62
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$146.62
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$140.25
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$140.25
|
| Rate for Payer: Cash Price |
$146.99
|
| Rate for Payer: Cash Price |
$144.52
|
| Rate for Payer: Centivo All Commercial |
$197.62
|
| Rate for Payer: Centivo All Commercial |
$197.62
|
| Rate for Payer: Cigna All Commercial |
$127.50
|
| Rate for Payer: Cigna All Commercial |
$127.50
|
| Rate for Payer: CORVEL All Commercial |
$127.50
|
| Rate for Payer: CORVEL All Commercial |
$127.50
|
| Rate for Payer: Coventry All Commercial |
$153.00
|
| Rate for Payer: Coventry All Commercial |
$153.00
|
| Rate for Payer: Encore All Commercial |
$127.50
|
| Rate for Payer: Encore All Commercial |
$127.50
|
| Rate for Payer: Frontpath All Commercial |
$138.08
|
| Rate for Payer: Frontpath All Commercial |
$138.08
|
| Rate for Payer: Humana ChoiceCare |
$108.16
|
| Rate for Payer: Humana ChoiceCare |
$108.16
|
| Rate for Payer: Humana Medicare |
$127.50
|
| Rate for Payer: Humana Medicare |
$127.50
|
| Rate for Payer: Lucent All Commercial |
$178.50
|
| Rate for Payer: Lucent All Commercial |
$178.50
|
| Rate for Payer: Lutheran Preferred All Commercial |
$139.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$139.00
|
| Rate for Payer: Managed Health Services Medicaid |
$120.49
|
| Rate for Payer: Managed Health Services Medicaid |
$120.49
|
| Rate for Payer: MDWise Medicaid |
$120.49
|
| Rate for Payer: MDWise Medicaid |
$120.49
|
| Rate for Payer: PHCS All Commercial |
$127.50
|
| Rate for Payer: PHCS All Commercial |
$127.50
|
| Rate for Payer: PHP All Commercial |
$124.05
|
| Rate for Payer: PHP All Commercial |
$124.05
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$127.50
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$127.50
|
| Rate for Payer: Sagamore Health Network All Products |
$127.50
|
| Rate for Payer: Sagamore Health Network All Products |
$127.50
|
| Rate for Payer: Signature Care EPO |
$118.15
|
| Rate for Payer: Signature Care EPO |
$118.15
|
| Rate for Payer: Signature Care PPO |
$118.15
|
| Rate for Payer: Signature Care PPO |
$118.15
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$13,300.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$13,300.00
|
| Rate for Payer: United Healthcare Commercial |
$124.94
|
| Rate for Payer: United Healthcare Commercial |
$124.94
|
| Rate for Payer: United Healthcare Medicare |
$120.43
|
| Rate for Payer: United Healthcare Medicare |
$120.43
|
|
|
PR 1ST HOSPITAL IP/OBS CARE SF/LOW MDM 40 MINUTES
|
Professional
|
Both
|
$154.22
|
|
|
Service Code
|
CPT 99221
|
| Hospital Charge Code |
z99221
|
| Min. Negotiated Rate |
$65.12 |
| Max. Negotiated Rate |
$9,800.00 |
| Rate for Payer: Aetna Commercial |
$94.12
|
| Rate for Payer: Aetna Commercial |
$94.12
|
| Rate for Payer: Aetna Medicare |
$94.12
|
| Rate for Payer: Aetna Medicare |
$94.12
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$97.63
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$97.63
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$97.63
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$97.63
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$97.63
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$97.63
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$97.63
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$97.63
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$75.86
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$75.86
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$108.24
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$108.24
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$103.53
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$103.53
|
| Rate for Payer: Cash Price |
$92.53
|
| Rate for Payer: Cash Price |
$91.55
|
| Rate for Payer: Centivo All Commercial |
$145.89
|
| Rate for Payer: Centivo All Commercial |
$145.89
|
| Rate for Payer: Cigna All Commercial |
$94.12
|
| Rate for Payer: Cigna All Commercial |
$94.12
|
| Rate for Payer: CORVEL All Commercial |
$94.12
|
| Rate for Payer: CORVEL All Commercial |
$94.12
|
| Rate for Payer: Coventry All Commercial |
$112.94
|
| Rate for Payer: Coventry All Commercial |
$112.94
|
| Rate for Payer: Encore All Commercial |
$94.12
|
| Rate for Payer: Encore All Commercial |
$94.12
|
| Rate for Payer: Frontpath All Commercial |
$103.00
|
| Rate for Payer: Frontpath All Commercial |
$103.00
|
| Rate for Payer: Humana ChoiceCare |
$65.12
|
| Rate for Payer: Humana ChoiceCare |
$65.12
|
| Rate for Payer: Humana Medicare |
$94.12
|
| Rate for Payer: Humana Medicare |
$94.12
|
| Rate for Payer: Lucent All Commercial |
$131.77
|
| Rate for Payer: Lucent All Commercial |
$131.77
|
| Rate for Payer: Lutheran Preferred All Commercial |
$102.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$102.00
|
| Rate for Payer: Managed Health Services Medicaid |
$75.86
|
| Rate for Payer: Managed Health Services Medicaid |
$75.86
|
| Rate for Payer: MDWise Medicaid |
$75.86
|
| Rate for Payer: MDWise Medicaid |
$75.86
|
| Rate for Payer: PHCS All Commercial |
$94.12
|
| Rate for Payer: PHCS All Commercial |
$94.12
|
| Rate for Payer: PHP All Commercial |
$78.58
|
| Rate for Payer: PHP All Commercial |
$78.58
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$94.12
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$94.12
|
| Rate for Payer: Sagamore Health Network All Products |
$94.12
|
| Rate for Payer: Sagamore Health Network All Products |
$94.12
|
| Rate for Payer: Signature Care EPO |
$83.19
|
| Rate for Payer: Signature Care EPO |
$83.19
|
| Rate for Payer: Signature Care PPO |
$83.19
|
| Rate for Payer: Signature Care PPO |
$83.19
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$9,800.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$9,800.00
|
| Rate for Payer: United Healthcare Commercial |
$91.56
|
| Rate for Payer: United Healthcare Commercial |
$91.56
|
| Rate for Payer: United Healthcare Medicare |
$76.29
|
| Rate for Payer: United Healthcare Medicare |
$76.29
|
|
|
PR ABDOM PARACENTESIS DX/THER W IMAGING GUIDANCE
|
Professional
|
Both
|
$539.20
|
|
|
Service Code
|
CPT 49083
|
| Hospital Charge Code |
z49083
|
| Min. Negotiated Rate |
$88.65 |
| Max. Negotiated Rate |
$13,900.00 |
| Rate for Payer: Aetna Commercial |
$100.61
|
| Rate for Payer: Aetna Commercial |
$100.61
|
| Rate for Payer: Aetna Medicare |
$100.61
|
| Rate for Payer: Aetna Medicare |
$100.61
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$358.16
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$358.16
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$358.16
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$358.16
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$358.16
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$358.16
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$358.16
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$358.16
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$88.65
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$88.65
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$265.20
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$265.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$115.70
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$115.70
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$110.67
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$110.67
|
| Rate for Payer: Cash Price |
$323.27
|
| Rate for Payer: Cash Price |
$323.52
|
| Rate for Payer: Centivo All Commercial |
$155.95
|
| Rate for Payer: Centivo All Commercial |
$155.95
|
| Rate for Payer: Cigna All Commercial |
$100.61
|
| Rate for Payer: Cigna All Commercial |
$100.61
|
| Rate for Payer: CORVEL All Commercial |
$100.61
|
| Rate for Payer: CORVEL All Commercial |
$100.61
|
| Rate for Payer: Coventry All Commercial |
$120.73
|
| Rate for Payer: Coventry All Commercial |
$120.73
|
| Rate for Payer: Encore All Commercial |
$100.61
|
| Rate for Payer: Encore All Commercial |
$100.61
|
| Rate for Payer: Frontpath All Commercial |
$136.71
|
| Rate for Payer: Frontpath All Commercial |
$136.71
|
| Rate for Payer: Humana ChoiceCare |
$122.84
|
| Rate for Payer: Humana ChoiceCare |
$122.84
|
| Rate for Payer: Humana Medicare |
$100.61
|
| Rate for Payer: Humana Medicare |
$100.61
|
| Rate for Payer: Lucent All Commercial |
$140.85
|
| Rate for Payer: Lucent All Commercial |
$140.85
|
| Rate for Payer: Lutheran Preferred All Commercial |
$149.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$149.00
|
| Rate for Payer: Managed Health Services Medicaid |
$265.20
|
| Rate for Payer: Managed Health Services Medicaid |
$265.20
|
| Rate for Payer: MDWise Medicaid |
$265.20
|
| Rate for Payer: MDWise Medicaid |
$265.20
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$88.65
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$88.65
|
| Rate for Payer: PHCS All Commercial |
$100.61
|
| Rate for Payer: PHCS All Commercial |
$100.61
|
| Rate for Payer: PHP All Commercial |
$169.95
|
| Rate for Payer: PHP All Commercial |
$169.95
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$100.61
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$100.61
|
| Rate for Payer: Sagamore Health Network All Products |
$100.61
|
| Rate for Payer: Sagamore Health Network All Products |
$100.61
|
| Rate for Payer: Signature Care EPO |
$319.26
|
| Rate for Payer: Signature Care EPO |
$319.26
|
| Rate for Payer: Signature Care PPO |
$319.26
|
| Rate for Payer: Signature Care PPO |
$319.26
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$13,900.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$13,900.00
|
| Rate for Payer: United Healthcare Commercial |
$135.59
|
| Rate for Payer: United Healthcare Commercial |
$135.59
|
| Rate for Payer: United Healthcare Medicare |
$269.39
|
| Rate for Payer: United Healthcare Medicare |
$269.39
|
|
|
PR ACOUSTIC IMMIT TEST TYMPANOMETRY/ACOUST REFLEX/DECAY
|
Professional
|
Both
|
$61.20
|
|
|
Service Code
|
CPT 92570
|
| Hospital Charge Code |
z92570
|
| Min. Negotiated Rate |
$16.41 |
| Max. Negotiated Rate |
$3,300.00 |
| Rate for Payer: Aetna Commercial |
$28.40
|
| Rate for Payer: Aetna Commercial |
$28.40
|
| Rate for Payer: Aetna Medicare |
$28.40
|
| Rate for Payer: Aetna Medicare |
$28.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$37.66
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$37.66
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$37.66
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$37.66
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$37.66
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$37.66
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$37.66
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$37.66
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$16.41
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$16.41
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$30.10
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$30.10
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$32.66
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$32.66
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$31.24
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$31.24
|
| Rate for Payer: Cash Price |
$36.29
|
| Rate for Payer: Cash Price |
$36.72
|
| Rate for Payer: Centivo All Commercial |
$44.02
|
| Rate for Payer: Centivo All Commercial |
$44.02
|
| Rate for Payer: Cigna All Commercial |
$28.40
|
| Rate for Payer: Cigna All Commercial |
$28.40
|
| Rate for Payer: CORVEL All Commercial |
$28.40
|
| Rate for Payer: CORVEL All Commercial |
$28.40
|
| Rate for Payer: Coventry All Commercial |
$34.08
|
| Rate for Payer: Coventry All Commercial |
$34.08
|
| Rate for Payer: Encore All Commercial |
$28.40
|
| Rate for Payer: Encore All Commercial |
$28.40
|
| Rate for Payer: Frontpath All Commercial |
$32.33
|
| Rate for Payer: Frontpath All Commercial |
$32.33
|
| Rate for Payer: Humana ChoiceCare |
$35.03
|
| Rate for Payer: Humana ChoiceCare |
$35.03
|
| Rate for Payer: Humana Medicare |
$28.40
|
| Rate for Payer: Humana Medicare |
$28.40
|
| Rate for Payer: Lucent All Commercial |
$39.76
|
| Rate for Payer: Lucent All Commercial |
$39.76
|
| Rate for Payer: Lutheran Preferred All Commercial |
$36.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$36.00
|
| Rate for Payer: Managed Health Services Medicaid |
$30.10
|
| Rate for Payer: Managed Health Services Medicaid |
$30.10
|
| Rate for Payer: MDWise Medicaid |
$30.10
|
| Rate for Payer: MDWise Medicaid |
$30.10
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$16.41
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$16.41
|
| Rate for Payer: PHCS All Commercial |
$28.40
|
| Rate for Payer: PHCS All Commercial |
$28.40
|
| Rate for Payer: PHP All Commercial |
$39.49
|
| Rate for Payer: PHP All Commercial |
$39.49
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$28.40
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$28.40
|
| Rate for Payer: Sagamore Health Network All Products |
$28.40
|
| Rate for Payer: Sagamore Health Network All Products |
$28.40
|
| Rate for Payer: Signature Care EPO |
$33.15
|
| Rate for Payer: Signature Care EPO |
$33.15
|
| Rate for Payer: Signature Care PPO |
$33.15
|
| Rate for Payer: Signature Care PPO |
$33.15
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,300.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,300.00
|
| Rate for Payer: United Healthcare Commercial |
$35.69
|
| Rate for Payer: United Healthcare Commercial |
$35.69
|
| Rate for Payer: United Healthcare Medicare |
$30.24
|
| Rate for Payer: United Healthcare Medicare |
$30.24
|
|
|
PR ACOUSTIC REFLEX TESTING
|
Professional
|
Both
|
$28.84
|
|
|
Service Code
|
CPT 92568
|
| Hospital Charge Code |
z92568
|
| Min. Negotiated Rate |
$14.18 |
| Max. Negotiated Rate |
$1,700.00 |
| Rate for Payer: Aetna Commercial |
$14.72
|
| Rate for Payer: Aetna Medicare |
$14.72
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$15.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$15.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$15.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$15.00
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$14.18
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$16.93
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$16.19
|
| Rate for Payer: Cash Price |
$17.30
|
| Rate for Payer: Centivo All Commercial |
$22.82
|
| Rate for Payer: Cigna All Commercial |
$14.72
|
| Rate for Payer: CORVEL All Commercial |
$14.72
|
| Rate for Payer: Coventry All Commercial |
$17.66
|
| Rate for Payer: Encore All Commercial |
$14.72
|
| Rate for Payer: Frontpath All Commercial |
$16.74
|
| Rate for Payer: Humana ChoiceCare |
$16.04
|
| Rate for Payer: Humana Medicare |
$14.72
|
| Rate for Payer: Lucent All Commercial |
$20.61
|
| Rate for Payer: Lutheran Preferred All Commercial |
$19.00
|
| Rate for Payer: Managed Health Services Medicaid |
$14.18
|
| Rate for Payer: MDWise Medicaid |
$14.18
|
| Rate for Payer: PHCS All Commercial |
$14.72
|
| Rate for Payer: PHP All Commercial |
$20.47
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$14.72
|
| Rate for Payer: Sagamore Health Network All Products |
$14.72
|
| Rate for Payer: Signature Care EPO |
$16.15
|
| Rate for Payer: Signature Care PPO |
$16.15
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,700.00
|
| Rate for Payer: United Healthcare Commercial |
$21.19
|
| Rate for Payer: United Healthcare Medicare |
$14.42
|
|
|
PR ADJ TISS XFER ANY AREA,30.1-60 SQCM
|
Professional
|
Both
|
$2,006.50
|
|
|
Service Code
|
CPT 14301
|
| Hospital Charge Code |
z14301
|
| Min. Negotiated Rate |
$440.71 |
| Max. Negotiated Rate |
$96,800.00 |
| Rate for Payer: Aetna Commercial |
$807.85
|
| Rate for Payer: Aetna Commercial |
$807.85
|
| Rate for Payer: Aetna Medicare |
$807.85
|
| Rate for Payer: Aetna Medicare |
$807.85
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$1,234.46
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$1,234.46
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,234.46
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,234.46
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,234.46
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,234.46
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,234.46
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,234.46
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$440.71
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$440.71
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$986.87
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$986.87
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$929.03
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$929.03
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$888.63
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$888.63
|
| Rate for Payer: Cash Price |
$1,183.75
|
| Rate for Payer: Cash Price |
$1,203.90
|
| Rate for Payer: Centivo All Commercial |
$1,252.17
|
| Rate for Payer: Centivo All Commercial |
$1,252.17
|
| Rate for Payer: Cigna All Commercial |
$807.85
|
| Rate for Payer: Cigna All Commercial |
$807.85
|
| Rate for Payer: CORVEL All Commercial |
$807.85
|
| Rate for Payer: CORVEL All Commercial |
$807.85
|
| Rate for Payer: Coventry All Commercial |
$969.42
|
| Rate for Payer: Coventry All Commercial |
$969.42
|
| Rate for Payer: Encore All Commercial |
$807.85
|
| Rate for Payer: Encore All Commercial |
$807.85
|
| Rate for Payer: Frontpath All Commercial |
$1,111.46
|
| Rate for Payer: Frontpath All Commercial |
$1,111.46
|
| Rate for Payer: Humana ChoiceCare |
$812.65
|
| Rate for Payer: Humana ChoiceCare |
$812.65
|
| Rate for Payer: Humana Medicare |
$807.85
|
| Rate for Payer: Humana Medicare |
$807.85
|
| Rate for Payer: Lucent All Commercial |
$1,130.99
|
| Rate for Payer: Lucent All Commercial |
$1,130.99
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,049.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,049.00
|
| Rate for Payer: Managed Health Services Medicaid |
$986.87
|
| Rate for Payer: Managed Health Services Medicaid |
$986.87
|
| Rate for Payer: MDWise Medicaid |
$986.87
|
| Rate for Payer: MDWise Medicaid |
$986.87
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$440.71
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$440.71
|
| Rate for Payer: PHCS All Commercial |
$807.85
|
| Rate for Payer: PHCS All Commercial |
$807.85
|
| Rate for Payer: PHP All Commercial |
$1,102.34
|
| Rate for Payer: PHP All Commercial |
$1,102.34
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$807.85
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$807.85
|
| Rate for Payer: Sagamore Health Network All Products |
$807.85
|
| Rate for Payer: Sagamore Health Network All Products |
$807.85
|
| Rate for Payer: Signature Care EPO |
$895.90
|
| Rate for Payer: Signature Care EPO |
$895.90
|
| Rate for Payer: Signature Care PPO |
$895.90
|
| Rate for Payer: Signature Care PPO |
$895.90
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$96,800.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$96,800.00
|
| Rate for Payer: United Healthcare Commercial |
$1,025.74
|
| Rate for Payer: United Healthcare Commercial |
$1,025.74
|
| Rate for Payer: United Healthcare Medicare |
$986.46
|
| Rate for Payer: United Healthcare Medicare |
$986.46
|
|
|
PR ADJ TISS XFER ANY AREA,EA ADD 30.0 SQCM
|
Professional
|
Both
|
$392.44
|
|
|
Service Code
|
CPT 14302
|
| Hospital Charge Code |
z14302
|
| Min. Negotiated Rate |
$193.01 |
| Max. Negotiated Rate |
$23,900.00 |
| Rate for Payer: Aetna Commercial |
$200.59
|
| Rate for Payer: Aetna Commercial |
$200.59
|
| Rate for Payer: Aetna Medicare |
$200.59
|
| Rate for Payer: Aetna Medicare |
$200.59
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$270.96
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$270.96
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$270.96
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$270.96
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$270.96
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$270.96
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$270.96
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$270.96
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$193.01
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$193.01
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$230.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$230.68
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$220.65
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$220.65
|
| Rate for Payer: Cash Price |
$235.46
|
| Rate for Payer: Cash Price |
$233.06
|
| Rate for Payer: Centivo All Commercial |
$310.91
|
| Rate for Payer: Centivo All Commercial |
$310.91
|
| Rate for Payer: Cigna All Commercial |
$200.59
|
| Rate for Payer: Cigna All Commercial |
$200.59
|
| Rate for Payer: CORVEL All Commercial |
$200.59
|
| Rate for Payer: CORVEL All Commercial |
$200.59
|
| Rate for Payer: Coventry All Commercial |
$240.71
|
| Rate for Payer: Coventry All Commercial |
$240.71
|
| Rate for Payer: Encore All Commercial |
$200.59
|
| Rate for Payer: Encore All Commercial |
$200.59
|
| Rate for Payer: Frontpath All Commercial |
$280.31
|
| Rate for Payer: Frontpath All Commercial |
$280.31
|
| Rate for Payer: Humana ChoiceCare |
$211.34
|
| Rate for Payer: Humana ChoiceCare |
$211.34
|
| Rate for Payer: Humana Medicare |
$200.59
|
| Rate for Payer: Humana Medicare |
$200.59
|
| Rate for Payer: Lucent All Commercial |
$280.83
|
| Rate for Payer: Lucent All Commercial |
$280.83
|
| Rate for Payer: Lutheran Preferred All Commercial |
$259.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$259.00
|
| Rate for Payer: Managed Health Services Medicaid |
$193.01
|
| Rate for Payer: Managed Health Services Medicaid |
$193.01
|
| Rate for Payer: MDWise Medicaid |
$193.01
|
| Rate for Payer: MDWise Medicaid |
$193.01
|
| Rate for Payer: PHCS All Commercial |
$200.59
|
| Rate for Payer: PHCS All Commercial |
$200.59
|
| Rate for Payer: PHP All Commercial |
$271.91
|
| Rate for Payer: PHP All Commercial |
$271.91
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$200.59
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$200.59
|
| Rate for Payer: Sagamore Health Network All Products |
$200.59
|
| Rate for Payer: Sagamore Health Network All Products |
$200.59
|
| Rate for Payer: Signature Care EPO |
$197.20
|
| Rate for Payer: Signature Care EPO |
$197.20
|
| Rate for Payer: Signature Care PPO |
$197.20
|
| Rate for Payer: Signature Care PPO |
$197.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$23,900.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$23,900.00
|
| Rate for Payer: United Healthcare Commercial |
$267.08
|
| Rate for Payer: United Healthcare Commercial |
$267.08
|
| Rate for Payer: United Healthcare Medicare |
$194.22
|
| Rate for Payer: United Healthcare Medicare |
$194.22
|
|
|
PR ADJ TISS XFER HEAD,FAC,HAND 10.1-30 SQCM
|
Professional
|
Both
|
$1,724.90
|
|
|
Service Code
|
CPT 14041
|
| Hospital Charge Code |
z14041
|
| Min. Negotiated Rate |
$384.45 |
| Max. Negotiated Rate |
$85,400.00 |
| Rate for Payer: Aetna Commercial |
$709.95
|
| Rate for Payer: Aetna Commercial |
$709.95
|
| Rate for Payer: Aetna Medicare |
$709.95
|
| Rate for Payer: Aetna Medicare |
$709.95
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$997.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$997.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$997.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$997.60
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$997.60
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$997.60
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$997.60
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$997.60
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$384.45
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$384.45
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$848.38
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$848.38
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$816.44
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$816.44
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$780.95
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$780.95
|
| Rate for Payer: Cash Price |
$1,012.38
|
| Rate for Payer: Cash Price |
$1,034.94
|
| Rate for Payer: Centivo All Commercial |
$1,100.42
|
| Rate for Payer: Centivo All Commercial |
$1,100.42
|
| Rate for Payer: Cigna All Commercial |
$709.95
|
| Rate for Payer: Cigna All Commercial |
$709.95
|
| Rate for Payer: CORVEL All Commercial |
$709.95
|
| Rate for Payer: CORVEL All Commercial |
$709.95
|
| Rate for Payer: Coventry All Commercial |
$851.94
|
| Rate for Payer: Coventry All Commercial |
$851.94
|
| Rate for Payer: Encore All Commercial |
$709.95
|
| Rate for Payer: Encore All Commercial |
$709.95
|
| Rate for Payer: Frontpath All Commercial |
$965.07
|
| Rate for Payer: Frontpath All Commercial |
$965.07
|
| Rate for Payer: Humana ChoiceCare |
$745.46
|
| Rate for Payer: Humana ChoiceCare |
$745.46
|
| Rate for Payer: Humana Medicare |
$709.95
|
| Rate for Payer: Humana Medicare |
$709.95
|
| Rate for Payer: Lucent All Commercial |
$993.93
|
| Rate for Payer: Lucent All Commercial |
$993.93
|
| Rate for Payer: Lutheran Preferred All Commercial |
$926.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$926.00
|
| Rate for Payer: Managed Health Services Medicaid |
$848.38
|
| Rate for Payer: Managed Health Services Medicaid |
$848.38
|
| Rate for Payer: MDWise Medicaid |
$848.38
|
| Rate for Payer: MDWise Medicaid |
$848.38
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$384.45
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$384.45
|
| Rate for Payer: PHCS All Commercial |
$709.95
|
| Rate for Payer: PHCS All Commercial |
$709.95
|
| Rate for Payer: PHP All Commercial |
$972.38
|
| Rate for Payer: PHP All Commercial |
$972.38
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$709.95
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$709.95
|
| Rate for Payer: Sagamore Health Network All Products |
$709.95
|
| Rate for Payer: Sagamore Health Network All Products |
$709.95
|
| Rate for Payer: Signature Care EPO |
$907.80
|
| Rate for Payer: Signature Care EPO |
$907.80
|
| Rate for Payer: Signature Care PPO |
$907.80
|
| Rate for Payer: Signature Care PPO |
$907.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$85,400.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$85,400.00
|
| Rate for Payer: United Healthcare Commercial |
$858.19
|
| Rate for Payer: United Healthcare Commercial |
$858.19
|
| Rate for Payer: United Healthcare Medicare |
$843.65
|
| Rate for Payer: United Healthcare Medicare |
$843.65
|
|
|
PR ADJ TISS XFER HEAD,FAC,HAND <10 SQCM
|
Professional
|
Both
|
$1,418.96
|
|
|
Service Code
|
CPT 14040
|
| Hospital Charge Code |
z14040
|
| Min. Negotiated Rate |
$314.75 |
| Max. Negotiated Rate |
$69,800.00 |
| Rate for Payer: Aetna Commercial |
$580.34
|
| Rate for Payer: Aetna Commercial |
$580.34
|
| Rate for Payer: Aetna Medicare |
$580.34
|
| Rate for Payer: Aetna Medicare |
$580.34
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$775.49
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$775.49
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$775.49
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$775.49
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$775.49
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$775.49
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$775.49
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$775.49
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$314.75
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$314.75
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$697.90
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$697.90
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$667.39
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$667.39
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$638.37
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$638.37
|
| Rate for Payer: Cash Price |
$832.85
|
| Rate for Payer: Cash Price |
$851.38
|
| Rate for Payer: Centivo All Commercial |
$899.53
|
| Rate for Payer: Centivo All Commercial |
$899.53
|
| Rate for Payer: Cigna All Commercial |
$580.34
|
| Rate for Payer: Cigna All Commercial |
$580.34
|
| Rate for Payer: CORVEL All Commercial |
$580.34
|
| Rate for Payer: CORVEL All Commercial |
$580.34
|
| Rate for Payer: Coventry All Commercial |
$696.41
|
| Rate for Payer: Coventry All Commercial |
$696.41
|
| Rate for Payer: Encore All Commercial |
$580.34
|
| Rate for Payer: Encore All Commercial |
$580.34
|
| Rate for Payer: Frontpath All Commercial |
$789.42
|
| Rate for Payer: Frontpath All Commercial |
$789.42
|
| Rate for Payer: Humana ChoiceCare |
$556.02
|
| Rate for Payer: Humana ChoiceCare |
$556.02
|
| Rate for Payer: Humana Medicare |
$580.34
|
| Rate for Payer: Humana Medicare |
$580.34
|
| Rate for Payer: Lucent All Commercial |
$812.48
|
| Rate for Payer: Lucent All Commercial |
$812.48
|
| Rate for Payer: Lutheran Preferred All Commercial |
$757.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$757.00
|
| Rate for Payer: Managed Health Services Medicaid |
$697.90
|
| Rate for Payer: Managed Health Services Medicaid |
$697.90
|
| Rate for Payer: MDWise Medicaid |
$697.90
|
| Rate for Payer: MDWise Medicaid |
$697.90
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$314.75
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$314.75
|
| Rate for Payer: PHCS All Commercial |
$580.34
|
| Rate for Payer: PHCS All Commercial |
$580.34
|
| Rate for Payer: PHP All Commercial |
$794.98
|
| Rate for Payer: PHP All Commercial |
$794.98
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$580.34
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$580.34
|
| Rate for Payer: Sagamore Health Network All Products |
$580.34
|
| Rate for Payer: Sagamore Health Network All Products |
$580.34
|
| Rate for Payer: Signature Care EPO |
$660.45
|
| Rate for Payer: Signature Care EPO |
$660.45
|
| Rate for Payer: Signature Care PPO |
$660.45
|
| Rate for Payer: Signature Care PPO |
$660.45
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$69,800.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$69,800.00
|
| Rate for Payer: United Healthcare Commercial |
$694.40
|
| Rate for Payer: United Healthcare Commercial |
$694.40
|
| Rate for Payer: United Healthcare Medicare |
$694.04
|
| Rate for Payer: United Healthcare Medicare |
$694.04
|
|
|
PR ADJ TISS XFER LID,NOS,EAR 10.1-30 SQCM
|
Professional
|
Both
|
$1,861.02
|
|
|
Service Code
|
CPT 14061
|
| Hospital Charge Code |
z14061
|
| Min. Negotiated Rate |
$445.57 |
| Max. Negotiated Rate |
$91,700.00 |
| Rate for Payer: Aetna Commercial |
$762.07
|
| Rate for Payer: Aetna Commercial |
$762.07
|
| Rate for Payer: Aetna Medicare |
$762.07
|
| Rate for Payer: Aetna Medicare |
$762.07
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$1,126.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$1,126.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,126.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,126.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,126.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,126.50
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,126.50
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,126.50
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$445.57
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$445.57
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$915.33
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$915.33
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$876.38
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$876.38
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$838.28
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$838.28
|
| Rate for Payer: Cash Price |
$1,090.80
|
| Rate for Payer: Cash Price |
$1,116.61
|
| Rate for Payer: Centivo All Commercial |
$1,181.21
|
| Rate for Payer: Centivo All Commercial |
$1,181.21
|
| Rate for Payer: Cigna All Commercial |
$762.07
|
| Rate for Payer: Cigna All Commercial |
$762.07
|
| Rate for Payer: CORVEL All Commercial |
$762.07
|
| Rate for Payer: CORVEL All Commercial |
$762.07
|
| Rate for Payer: Coventry All Commercial |
$914.48
|
| Rate for Payer: Coventry All Commercial |
$914.48
|
| Rate for Payer: Encore All Commercial |
$762.07
|
| Rate for Payer: Encore All Commercial |
$762.07
|
| Rate for Payer: Frontpath All Commercial |
$1,035.05
|
| Rate for Payer: Frontpath All Commercial |
$1,035.05
|
| Rate for Payer: Humana ChoiceCare |
$804.77
|
| Rate for Payer: Humana ChoiceCare |
$804.77
|
| Rate for Payer: Humana Medicare |
$762.07
|
| Rate for Payer: Humana Medicare |
$762.07
|
| Rate for Payer: Lucent All Commercial |
$1,066.90
|
| Rate for Payer: Lucent All Commercial |
$1,066.90
|
| Rate for Payer: Lutheran Preferred All Commercial |
$993.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$993.00
|
| Rate for Payer: Managed Health Services Medicaid |
$915.33
|
| Rate for Payer: Managed Health Services Medicaid |
$915.33
|
| Rate for Payer: MDWise Medicaid |
$915.33
|
| Rate for Payer: MDWise Medicaid |
$915.33
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$445.57
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$445.57
|
| Rate for Payer: PHCS All Commercial |
$762.07
|
| Rate for Payer: PHCS All Commercial |
$762.07
|
| Rate for Payer: PHP All Commercial |
$1,043.64
|
| Rate for Payer: PHP All Commercial |
$1,043.64
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$762.07
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$762.07
|
| Rate for Payer: Sagamore Health Network All Products |
$762.07
|
| Rate for Payer: Sagamore Health Network All Products |
$762.07
|
| Rate for Payer: Signature Care EPO |
$981.75
|
| Rate for Payer: Signature Care EPO |
$981.75
|
| Rate for Payer: Signature Care PPO |
$981.75
|
| Rate for Payer: Signature Care PPO |
$981.75
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$91,700.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$91,700.00
|
| Rate for Payer: United Healthcare Commercial |
$915.09
|
| Rate for Payer: United Healthcare Commercial |
$915.09
|
| Rate for Payer: United Healthcare Medicare |
$909.00
|
| Rate for Payer: United Healthcare Medicare |
$909.00
|
|
|
PR ADJ TISS XFER LID,NOS,EAR <10 SQCM
|
Professional
|
Both
|
$1,436.38
|
|
|
Service Code
|
CPT 14060
|
| Hospital Charge Code |
z14060
|
| Min. Negotiated Rate |
$340.75 |
| Max. Negotiated Rate |
$74,600.00 |
| Rate for Payer: Aetna Commercial |
$619.45
|
| Rate for Payer: Aetna Commercial |
$619.45
|
| Rate for Payer: Aetna Medicare |
$619.45
|
| Rate for Payer: Aetna Medicare |
$619.45
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$816.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$816.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$816.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$816.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$816.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$816.50
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$816.50
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$816.50
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$340.75
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$340.75
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$706.47
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$706.47
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$712.37
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$712.37
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$681.39
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$681.39
|
| Rate for Payer: Cash Price |
$843.40
|
| Rate for Payer: Cash Price |
$861.83
|
| Rate for Payer: Centivo All Commercial |
$960.15
|
| Rate for Payer: Centivo All Commercial |
$960.15
|
| Rate for Payer: Cigna All Commercial |
$619.45
|
| Rate for Payer: Cigna All Commercial |
$619.45
|
| Rate for Payer: CORVEL All Commercial |
$619.45
|
| Rate for Payer: CORVEL All Commercial |
$619.45
|
| Rate for Payer: Coventry All Commercial |
$743.34
|
| Rate for Payer: Coventry All Commercial |
$743.34
|
| Rate for Payer: Encore All Commercial |
$619.45
|
| Rate for Payer: Encore All Commercial |
$619.45
|
| Rate for Payer: Frontpath All Commercial |
$841.42
|
| Rate for Payer: Frontpath All Commercial |
$841.42
|
| Rate for Payer: Humana ChoiceCare |
$588.78
|
| Rate for Payer: Humana ChoiceCare |
$588.78
|
| Rate for Payer: Humana Medicare |
$619.45
|
| Rate for Payer: Humana Medicare |
$619.45
|
| Rate for Payer: Lucent All Commercial |
$867.23
|
| Rate for Payer: Lucent All Commercial |
$867.23
|
| Rate for Payer: Lutheran Preferred All Commercial |
$808.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$808.00
|
| Rate for Payer: Managed Health Services Medicaid |
$706.47
|
| Rate for Payer: Managed Health Services Medicaid |
$706.47
|
| Rate for Payer: MDWise Medicaid |
$706.47
|
| Rate for Payer: MDWise Medicaid |
$706.47
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$340.75
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$340.75
|
| Rate for Payer: PHCS All Commercial |
$619.45
|
| Rate for Payer: PHCS All Commercial |
$619.45
|
| Rate for Payer: PHP All Commercial |
$849.03
|
| Rate for Payer: PHP All Commercial |
$849.03
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$619.45
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$619.45
|
| Rate for Payer: Sagamore Health Network All Products |
$619.45
|
| Rate for Payer: Sagamore Health Network All Products |
$619.45
|
| Rate for Payer: Signature Care EPO |
$719.95
|
| Rate for Payer: Signature Care EPO |
$719.95
|
| Rate for Payer: Signature Care PPO |
$719.95
|
| Rate for Payer: Signature Care PPO |
$719.95
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$74,600.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$74,600.00
|
| Rate for Payer: United Healthcare Commercial |
$733.53
|
| Rate for Payer: United Healthcare Commercial |
$733.53
|
| Rate for Payer: United Healthcare Medicare |
$702.83
|
| Rate for Payer: United Healthcare Medicare |
$702.83
|
|
|
PR ADJ TISS XFER SCALP,EXTREM <10 SQCM
|
Professional
|
Both
|
$1,310.70
|
|
|
Service Code
|
CPT 14020
|
| Hospital Charge Code |
z14020
|
| Min. Negotiated Rate |
$286.02 |
| Max. Negotiated Rate |
$63,200.00 |
| Rate for Payer: Aetna Commercial |
$524.62
|
| Rate for Payer: Aetna Commercial |
$524.62
|
| Rate for Payer: Aetna Medicare |
$524.62
|
| Rate for Payer: Aetna Medicare |
$524.62
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$696.28
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$696.28
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$696.28
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$696.28
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$696.28
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$696.28
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$696.28
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$696.28
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$286.02
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$286.02
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$644.65
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$644.65
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$603.31
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$603.31
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$577.08
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$577.08
|
| Rate for Payer: Cash Price |
$768.64
|
| Rate for Payer: Cash Price |
$786.42
|
| Rate for Payer: Centivo All Commercial |
$813.16
|
| Rate for Payer: Centivo All Commercial |
$813.16
|
| Rate for Payer: Cigna All Commercial |
$524.62
|
| Rate for Payer: Cigna All Commercial |
$524.62
|
| Rate for Payer: CORVEL All Commercial |
$524.62
|
| Rate for Payer: CORVEL All Commercial |
$524.62
|
| Rate for Payer: Coventry All Commercial |
$629.54
|
| Rate for Payer: Coventry All Commercial |
$629.54
|
| Rate for Payer: Encore All Commercial |
$524.62
|
| Rate for Payer: Encore All Commercial |
$524.62
|
| Rate for Payer: Frontpath All Commercial |
$715.44
|
| Rate for Payer: Frontpath All Commercial |
$715.44
|
| Rate for Payer: Humana ChoiceCare |
$484.84
|
| Rate for Payer: Humana ChoiceCare |
$484.84
|
| Rate for Payer: Humana Medicare |
$524.62
|
| Rate for Payer: Humana Medicare |
$524.62
|
| Rate for Payer: Lucent All Commercial |
$734.47
|
| Rate for Payer: Lucent All Commercial |
$734.47
|
| Rate for Payer: Lutheran Preferred All Commercial |
$685.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$685.00
|
| Rate for Payer: Managed Health Services Medicaid |
$644.65
|
| Rate for Payer: Managed Health Services Medicaid |
$644.65
|
| Rate for Payer: MDWise Medicaid |
$644.65
|
| Rate for Payer: MDWise Medicaid |
$644.65
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$286.02
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$286.02
|
| Rate for Payer: PHCS All Commercial |
$524.62
|
| Rate for Payer: PHCS All Commercial |
$524.62
|
| Rate for Payer: PHP All Commercial |
$719.65
|
| Rate for Payer: PHP All Commercial |
$719.65
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$524.62
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$524.62
|
| Rate for Payer: Sagamore Health Network All Products |
$524.62
|
| Rate for Payer: Sagamore Health Network All Products |
$524.62
|
| Rate for Payer: Signature Care EPO |
$641.75
|
| Rate for Payer: Signature Care EPO |
$641.75
|
| Rate for Payer: Signature Care PPO |
$641.75
|
| Rate for Payer: Signature Care PPO |
$641.75
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$63,200.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$63,200.00
|
| Rate for Payer: United Healthcare Commercial |
$609.40
|
| Rate for Payer: United Healthcare Commercial |
$609.40
|
| Rate for Payer: United Healthcare Medicare |
$640.53
|
| Rate for Payer: United Healthcare Medicare |
$640.53
|
|
|
PR ADJ TISS XFER TRUNK 10.1-30 SQCM
|
Professional
|
Both
|
$1,500.22
|
|
|
Service Code
|
CPT 14001
|
| Hospital Charge Code |
z14001
|
| Min. Negotiated Rate |
$331.88 |
| Max. Negotiated Rate |
$72,500.00 |
| Rate for Payer: Aetna Commercial |
$604.12
|
| Rate for Payer: Aetna Commercial |
$604.12
|
| Rate for Payer: Aetna Medicare |
$604.12
|
| Rate for Payer: Aetna Medicare |
$604.12
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$805.01
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$805.01
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$805.01
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$805.01
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$805.01
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$805.01
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$805.01
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$805.01
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$331.88
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$331.88
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$737.87
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$737.87
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$694.74
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$694.74
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$664.53
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$664.53
|
| Rate for Payer: Cash Price |
$881.21
|
| Rate for Payer: Cash Price |
$900.13
|
| Rate for Payer: Centivo All Commercial |
$936.39
|
| Rate for Payer: Centivo All Commercial |
$936.39
|
| Rate for Payer: Cigna All Commercial |
$604.12
|
| Rate for Payer: Cigna All Commercial |
$604.12
|
| Rate for Payer: CORVEL All Commercial |
$604.12
|
| Rate for Payer: CORVEL All Commercial |
$604.12
|
| Rate for Payer: Coventry All Commercial |
$724.94
|
| Rate for Payer: Coventry All Commercial |
$724.94
|
| Rate for Payer: Encore All Commercial |
$604.12
|
| Rate for Payer: Encore All Commercial |
$604.12
|
| Rate for Payer: Frontpath All Commercial |
$834.95
|
| Rate for Payer: Frontpath All Commercial |
$834.95
|
| Rate for Payer: Humana ChoiceCare |
$577.60
|
| Rate for Payer: Humana ChoiceCare |
$577.60
|
| Rate for Payer: Humana Medicare |
$604.12
|
| Rate for Payer: Humana Medicare |
$604.12
|
| Rate for Payer: Lucent All Commercial |
$845.77
|
| Rate for Payer: Lucent All Commercial |
$845.77
|
| Rate for Payer: Lutheran Preferred All Commercial |
$785.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$785.00
|
| Rate for Payer: Managed Health Services Medicaid |
$737.87
|
| Rate for Payer: Managed Health Services Medicaid |
$737.87
|
| Rate for Payer: MDWise Medicaid |
$737.87
|
| Rate for Payer: MDWise Medicaid |
$737.87
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$331.88
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$331.88
|
| Rate for Payer: PHCS All Commercial |
$604.12
|
| Rate for Payer: PHCS All Commercial |
$604.12
|
| Rate for Payer: PHP All Commercial |
$824.84
|
| Rate for Payer: PHP All Commercial |
$824.84
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$604.12
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$604.12
|
| Rate for Payer: Sagamore Health Network All Products |
$604.12
|
| Rate for Payer: Sagamore Health Network All Products |
$604.12
|
| Rate for Payer: Signature Care EPO |
$753.10
|
| Rate for Payer: Signature Care EPO |
$753.10
|
| Rate for Payer: Signature Care PPO |
$753.10
|
| Rate for Payer: Signature Care PPO |
$753.10
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$72,500.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$72,500.00
|
| Rate for Payer: United Healthcare Commercial |
$707.76
|
| Rate for Payer: United Healthcare Commercial |
$707.76
|
| Rate for Payer: United Healthcare Medicare |
$734.34
|
| Rate for Payer: United Healthcare Medicare |
$734.34
|
|
|
PR ADJ TISS XFER TRUNK <10 SQCM
|
Professional
|
Both
|
$1,179.68
|
|
|
Service Code
|
CPT 14000
|
| Hospital Charge Code |
z14000
|
| Min. Negotiated Rate |
$255.40 |
| Max. Negotiated Rate |
$56,000.00 |
| Rate for Payer: Aetna Commercial |
$465.34
|
| Rate for Payer: Aetna Commercial |
$465.34
|
| Rate for Payer: Aetna Medicare |
$465.34
|
| Rate for Payer: Aetna Medicare |
$465.34
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$618.13
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$618.13
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$618.13
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$618.13
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$618.13
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$618.13
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$618.13
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$618.13
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$255.40
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$255.40
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$580.21
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$580.21
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$535.14
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$535.14
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$511.87
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$511.87
|
| Rate for Payer: Cash Price |
$692.33
|
| Rate for Payer: Cash Price |
$707.81
|
| Rate for Payer: Centivo All Commercial |
$721.28
|
| Rate for Payer: Centivo All Commercial |
$721.28
|
| Rate for Payer: Cigna All Commercial |
$465.34
|
| Rate for Payer: Cigna All Commercial |
$465.34
|
| Rate for Payer: CORVEL All Commercial |
$465.34
|
| Rate for Payer: CORVEL All Commercial |
$465.34
|
| Rate for Payer: Coventry All Commercial |
$558.41
|
| Rate for Payer: Coventry All Commercial |
$558.41
|
| Rate for Payer: Encore All Commercial |
$465.34
|
| Rate for Payer: Encore All Commercial |
$465.34
|
| Rate for Payer: Frontpath All Commercial |
$640.06
|
| Rate for Payer: Frontpath All Commercial |
$640.06
|
| Rate for Payer: Humana ChoiceCare |
$420.74
|
| Rate for Payer: Humana ChoiceCare |
$420.74
|
| Rate for Payer: Humana Medicare |
$465.34
|
| Rate for Payer: Humana Medicare |
$465.34
|
| Rate for Payer: Lucent All Commercial |
$651.48
|
| Rate for Payer: Lucent All Commercial |
$651.48
|
| Rate for Payer: Lutheran Preferred All Commercial |
$607.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$607.00
|
| Rate for Payer: Managed Health Services Medicaid |
$580.21
|
| Rate for Payer: Managed Health Services Medicaid |
$580.21
|
| Rate for Payer: MDWise Medicaid |
$580.21
|
| Rate for Payer: MDWise Medicaid |
$580.21
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$255.40
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$255.40
|
| Rate for Payer: PHCS All Commercial |
$465.34
|
| Rate for Payer: PHCS All Commercial |
$465.34
|
| Rate for Payer: PHP All Commercial |
$637.37
|
| Rate for Payer: PHP All Commercial |
$637.37
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$465.34
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$465.34
|
| Rate for Payer: Sagamore Health Network All Products |
$465.34
|
| Rate for Payer: Sagamore Health Network All Products |
$465.34
|
| Rate for Payer: Signature Care EPO |
$585.65
|
| Rate for Payer: Signature Care EPO |
$585.65
|
| Rate for Payer: Signature Care PPO |
$585.65
|
| Rate for Payer: Signature Care PPO |
$585.65
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$56,000.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$56,000.00
|
| Rate for Payer: United Healthcare Commercial |
$532.56
|
| Rate for Payer: United Healthcare Commercial |
$532.56
|
| Rate for Payer: United Healthcare Medicare |
$576.94
|
| Rate for Payer: United Healthcare Medicare |
$576.94
|
|
|
PR ADMIN HEPATITIS B VACCINE
|
Professional
|
Both
|
$35.00
|
|
|
Service Code
|
CPT G0010
|
| Hospital Charge Code |
zG0010
|
| Min. Negotiated Rate |
$19.59 |
| Max. Negotiated Rate |
$24.17 |
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: Humana ChoiceCare |
$24.17
|
| Rate for Payer: United Healthcare Commercial |
$19.59
|
|
|
PR ADMIN INFLUENZA VIRUS VAC
|
Professional
|
Both
|
$35.00
|
|
|
Service Code
|
CPT G0008
|
| Hospital Charge Code |
zG0008
|
| Min. Negotiated Rate |
$19.59 |
| Max. Negotiated Rate |
$24.17 |
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$20.73
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$20.73
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$20.73
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$20.73
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: Humana ChoiceCare |
$24.17
|
| Rate for Payer: United Healthcare Commercial |
$19.59
|
|
|
PR ADMIN PNEUMOCOCCAL VACCINE
|
Professional
|
Both
|
$35.00
|
|
|
Service Code
|
CPT G0009
|
| Hospital Charge Code |
zG0009
|
| Min. Negotiated Rate |
$19.59 |
| Max. Negotiated Rate |
$35.00 |
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$20.73
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$20.73
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$20.73
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$20.73
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: Humana ChoiceCare |
$24.17
|
| Rate for Payer: Signature Care EPO |
$35.00
|
| Rate for Payer: Signature Care PPO |
$35.00
|
| Rate for Payer: United Healthcare Commercial |
$19.59
|
|
|
PR ADMN RSV MONOC ANTB IM CNSL
|
Professional
|
Both
|
$80.00
|
|
|
Service Code
|
CPT 96380
|
| Hospital Charge Code |
z96380
|
| Min. Negotiated Rate |
$15.00 |
| Max. Negotiated Rate |
$15.00 |
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$15.00
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Managed Health Services Medicaid |
$15.00
|
| Rate for Payer: MDWise Medicaid |
$15.00
|
|
|
PR ADMN RSV MONOC ANTB IM NJX
|
Professional
|
Both
|
$80.00
|
|
|
Service Code
|
CPT 96381
|
| Hospital Charge Code |
z96381
|
| Min. Negotiated Rate |
$15.00 |
| Max. Negotiated Rate |
$15.00 |
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$15.00
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$15.00
|
| Rate for Payer: Cash Price |
$22.08
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Managed Health Services Medicaid |
$15.00
|
| Rate for Payer: Managed Health Services Medicaid |
$15.00
|
| Rate for Payer: MDWise Medicaid |
$15.00
|
| Rate for Payer: MDWise Medicaid |
$15.00
|
|
|
PR ADMN SARSCOV2 VACC 1 DOSE
|
Professional
|
Both
|
$80.00
|
|
|
Service Code
|
CPT 90480
|
| Hospital Charge Code |
z90480
|
| Min. Negotiated Rate |
$40.95 |
| Max. Negotiated Rate |
$40.95 |
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$40.95
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Managed Health Services Medicaid |
$40.95
|
| Rate for Payer: MDWise Medicaid |
$40.95
|
|
|
PR ADM OF SOC DTR ASSESS 5-15 M
|
Professional
|
Both
|
$37.32
|
|
|
Service Code
|
CPT G0136
|
| Hospital Charge Code |
zG0136
|
| Min. Negotiated Rate |
$17.53 |
| Max. Negotiated Rate |
$17.53 |
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$17.53
|
| Rate for Payer: Cash Price |
$22.39
|
| Rate for Payer: Managed Health Services Medicaid |
$17.53
|
| Rate for Payer: MDWise Medicaid |
$17.53
|
|
|
PR ADVANCE CARE PLANNING EA ADDL 30 MINS
|
Professional
|
Both
|
$133.06
|
|
|
Service Code
|
CPT 99498
|
| Hospital Charge Code |
z99498
|
| Min. Negotiated Rate |
$33.27 |
| Max. Negotiated Rate |
$7,000.00 |
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$33.27
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$33.27
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$33.27
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$33.27
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$33.27
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$33.27
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$33.27
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$33.27
|
| Rate for Payer: Cash Price |
$79.84
|
| Rate for Payer: Cash Price |
$81.06
|
| Rate for Payer: Frontpath All Commercial |
$74.63
|
| Rate for Payer: Frontpath All Commercial |
$74.63
|
| Rate for Payer: Humana ChoiceCare |
$76.03
|
| Rate for Payer: Humana ChoiceCare |
$76.03
|
| Rate for Payer: Lutheran Preferred All Commercial |
$71.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$71.00
|
| Rate for Payer: Signature Care EPO |
$75.20
|
| Rate for Payer: Signature Care EPO |
$75.20
|
| Rate for Payer: Signature Care PPO |
$75.20
|
| Rate for Payer: Signature Care PPO |
$75.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$7,000.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$7,000.00
|
| Rate for Payer: United Healthcare Commercial |
$75.45
|
| Rate for Payer: United Healthcare Commercial |
$75.45
|
| Rate for Payer: United Healthcare Medicare |
$66.53
|
| Rate for Payer: United Healthcare Medicare |
$66.53
|
|
|
PR ADVANCE CARE PLANNING FIRST 30 MINS
|
Professional
|
Both
|
$155.88
|
|
|
Service Code
|
CPT 99497
|
| Hospital Charge Code |
z99497
|
| Min. Negotiated Rate |
$66.54 |
| Max. Negotiated Rate |
$7,400.00 |
| Rate for Payer: Aetna Commercial |
$73.76
|
| Rate for Payer: Aetna Commercial |
$73.76
|
| Rate for Payer: Aetna Medicare |
$73.76
|
| Rate for Payer: Aetna Medicare |
$73.76
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$66.54
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$66.54
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$66.54
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$66.54
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$66.54
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$66.54
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$66.54
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$66.54
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$84.82
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$84.82
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$81.14
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$81.14
|
| Rate for Payer: Cash Price |
$92.11
|
| Rate for Payer: Cash Price |
$93.53
|
| Rate for Payer: Centivo All Commercial |
$114.33
|
| Rate for Payer: Centivo All Commercial |
$114.33
|
| Rate for Payer: Cigna All Commercial |
$73.76
|
| Rate for Payer: Cigna All Commercial |
$73.76
|
| Rate for Payer: CORVEL All Commercial |
$73.76
|
| Rate for Payer: CORVEL All Commercial |
$73.76
|
| Rate for Payer: Coventry All Commercial |
$88.51
|
| Rate for Payer: Coventry All Commercial |
$88.51
|
| Rate for Payer: Encore All Commercial |
$73.76
|
| Rate for Payer: Encore All Commercial |
$73.76
|
| Rate for Payer: Frontpath All Commercial |
$79.28
|
| Rate for Payer: Frontpath All Commercial |
$79.28
|
| Rate for Payer: Humana ChoiceCare |
$81.25
|
| Rate for Payer: Humana ChoiceCare |
$81.25
|
| Rate for Payer: Humana Medicare |
$73.76
|
| Rate for Payer: Humana Medicare |
$73.76
|
| Rate for Payer: Lucent All Commercial |
$103.26
|
| Rate for Payer: Lucent All Commercial |
$103.26
|
| Rate for Payer: Lutheran Preferred All Commercial |
$75.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$75.00
|
| Rate for Payer: PHCS All Commercial |
$73.76
|
| Rate for Payer: PHCS All Commercial |
$73.76
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$73.76
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$73.76
|
| Rate for Payer: Sagamore Health Network All Products |
$73.76
|
| Rate for Payer: Sagamore Health Network All Products |
$73.76
|
| Rate for Payer: Signature Care EPO |
$89.55
|
| Rate for Payer: Signature Care EPO |
$89.55
|
| Rate for Payer: Signature Care PPO |
$89.55
|
| Rate for Payer: Signature Care PPO |
$89.55
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$7,400.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$7,400.00
|
| Rate for Payer: United Healthcare Commercial |
$80.63
|
| Rate for Payer: United Healthcare Commercial |
$80.63
|
| Rate for Payer: United Healthcare Medicare |
$76.76
|
| Rate for Payer: United Healthcare Medicare |
$76.76
|
|
|
PR ALCOHOL/DRUG SERVICES C&T PER 15 MINS
|
Professional
|
Both
|
$809.70
|
|
|
Service Code
|
CPT 27788
|
| Hospital Charge Code |
z27788
|
| Min. Negotiated Rate |
$226.79 |
| Max. Negotiated Rate |
$54,700.00 |
| Rate for Payer: Aetna Commercial |
$362.55
|
| Rate for Payer: Aetna Commercial |
$362.55
|
| Rate for Payer: Aetna Medicare |
$362.55
|
| Rate for Payer: Aetna Medicare |
$362.55
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$591.59
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$591.59
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$591.59
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$591.59
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$591.59
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$591.59
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$591.59
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$591.59
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$226.79
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$226.79
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$398.25
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$398.25
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$416.93
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$416.93
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$398.81
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$398.81
|
| Rate for Payer: Cash Price |
$472.64
|
| Rate for Payer: Cash Price |
$485.82
|
| Rate for Payer: Centivo All Commercial |
$561.95
|
| Rate for Payer: Centivo All Commercial |
$561.95
|
| Rate for Payer: Cigna All Commercial |
$362.55
|
| Rate for Payer: Cigna All Commercial |
$362.55
|
| Rate for Payer: CORVEL All Commercial |
$362.55
|
| Rate for Payer: CORVEL All Commercial |
$362.55
|
| Rate for Payer: Coventry All Commercial |
$435.06
|
| Rate for Payer: Coventry All Commercial |
$435.06
|
| Rate for Payer: Encore All Commercial |
$362.55
|
| Rate for Payer: Encore All Commercial |
$362.55
|
| Rate for Payer: Frontpath All Commercial |
$500.31
|
| Rate for Payer: Frontpath All Commercial |
$500.31
|
| Rate for Payer: Humana ChoiceCare |
$392.24
|
| Rate for Payer: Humana ChoiceCare |
$392.24
|
| Rate for Payer: Humana Medicare |
$362.55
|
| Rate for Payer: Humana Medicare |
$362.55
|
| Rate for Payer: Lucent All Commercial |
$507.57
|
| Rate for Payer: Lucent All Commercial |
$507.57
|
| Rate for Payer: Lutheran Preferred All Commercial |
$584.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$584.00
|
| Rate for Payer: Managed Health Services Medicaid |
$398.25
|
| Rate for Payer: Managed Health Services Medicaid |
$398.25
|
| Rate for Payer: MDWise Medicaid |
$398.25
|
| Rate for Payer: MDWise Medicaid |
$398.25
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$226.79
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$226.79
|
| Rate for Payer: PHCS All Commercial |
$362.55
|
| Rate for Payer: PHCS All Commercial |
$362.55
|
| Rate for Payer: PHP All Commercial |
$619.30
|
| Rate for Payer: PHP All Commercial |
$619.30
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$362.55
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$362.55
|
| Rate for Payer: Sagamore Health Network All Products |
$362.55
|
| Rate for Payer: Sagamore Health Network All Products |
$362.55
|
| Rate for Payer: Signature Care EPO |
$623.90
|
| Rate for Payer: Signature Care EPO |
$623.90
|
| Rate for Payer: Signature Care PPO |
$623.90
|
| Rate for Payer: Signature Care PPO |
$623.90
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$54,700.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$54,700.00
|
| Rate for Payer: United Healthcare Commercial |
$404.20
|
| Rate for Payer: United Healthcare Commercial |
$404.20
|
| Rate for Payer: United Healthcare Medicare |
$393.87
|
| Rate for Payer: United Healthcare Medicare |
$393.87
|
|
