|
PR ALCOHOL/SUBSTANCE SCREEN & INTERVEN 15-30 MIN
|
Professional
|
Both
|
$62.98
|
|
|
Service Code
|
CPT 99408
|
| Hospital Charge Code |
z99408
|
| Min. Negotiated Rate |
$27.12 |
| Max. Negotiated Rate |
$32.90 |
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.88
|
| Rate for Payer: Cash Price |
$37.79
|
| Rate for Payer: Frontpath All Commercial |
$32.90
|
| Rate for Payer: Humana ChoiceCare |
$27.12
|
| Rate for Payer: Managed Health Services Medicaid |
$31.88
|
| Rate for Payer: MDWise Medicaid |
$31.88
|
| Rate for Payer: United Healthcare Commercial |
$32.49
|
| Rate for Payer: United Healthcare Medicare |
$32.36
|
|
|
PR ALD TRANSMITTER MICROPHONE
|
Professional
|
Both
|
$700.00
|
|
|
Service Code
|
CPT V5290
|
| Hospital Charge Code |
zV5290
|
| Min. Negotiated Rate |
$595.00 |
| Max. Negotiated Rate |
$595.00 |
| Rate for Payer: Cash Price |
$420.00
|
| Rate for Payer: Signature Care EPO |
$595.00
|
| Rate for Payer: Signature Care PPO |
$595.00
|
|
|
PR ALLG TEST PERQ & IC DRUG/BIOL IMMED REACT W/ I&R
|
Professional
|
Both
|
$37.26
|
|
|
Service Code
|
CPT 95018
|
| Hospital Charge Code |
z95018
|
| Min. Negotiated Rate |
$5.66 |
| Max. Negotiated Rate |
$800.00 |
| Rate for Payer: Aetna Commercial |
$6.87
|
| Rate for Payer: Aetna Commercial |
$6.87
|
| Rate for Payer: Aetna Medicare |
$6.87
|
| Rate for Payer: Aetna Medicare |
$6.87
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$22.14
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$22.14
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$22.14
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$22.14
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$22.14
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$22.14
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$22.14
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$22.14
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$5.66
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$5.66
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$18.33
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$18.33
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$7.90
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$7.90
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$7.56
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$7.56
|
| Rate for Payer: Cash Price |
$22.01
|
| Rate for Payer: Cash Price |
$22.36
|
| Rate for Payer: Centivo All Commercial |
$10.65
|
| Rate for Payer: Centivo All Commercial |
$10.65
|
| Rate for Payer: Cigna All Commercial |
$6.87
|
| Rate for Payer: Cigna All Commercial |
$6.87
|
| Rate for Payer: CORVEL All Commercial |
$6.87
|
| Rate for Payer: CORVEL All Commercial |
$6.87
|
| Rate for Payer: Coventry All Commercial |
$8.24
|
| Rate for Payer: Coventry All Commercial |
$8.24
|
| Rate for Payer: Encore All Commercial |
$6.87
|
| Rate for Payer: Encore All Commercial |
$6.87
|
| Rate for Payer: Frontpath All Commercial |
$7.40
|
| Rate for Payer: Frontpath All Commercial |
$7.40
|
| Rate for Payer: Humana ChoiceCare |
$26.94
|
| Rate for Payer: Humana ChoiceCare |
$26.94
|
| Rate for Payer: Humana Medicare |
$6.87
|
| Rate for Payer: Humana Medicare |
$6.87
|
| Rate for Payer: Lucent All Commercial |
$9.62
|
| Rate for Payer: Lucent All Commercial |
$9.62
|
| Rate for Payer: Lutheran Preferred All Commercial |
$9.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$9.00
|
| Rate for Payer: Managed Health Services Medicaid |
$18.33
|
| Rate for Payer: Managed Health Services Medicaid |
$18.33
|
| Rate for Payer: MDWise Medicaid |
$18.33
|
| Rate for Payer: MDWise Medicaid |
$18.33
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$5.66
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$5.66
|
| Rate for Payer: PHCS All Commercial |
$6.87
|
| Rate for Payer: PHCS All Commercial |
$6.87
|
| Rate for Payer: PHP All Commercial |
$7.58
|
| Rate for Payer: PHP All Commercial |
$7.58
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$6.87
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$6.87
|
| Rate for Payer: Sagamore Health Network All Products |
$6.87
|
| Rate for Payer: Sagamore Health Network All Products |
$6.87
|
| Rate for Payer: Signature Care EPO |
$23.37
|
| Rate for Payer: Signature Care EPO |
$23.37
|
| Rate for Payer: Signature Care PPO |
$23.37
|
| Rate for Payer: Signature Care PPO |
$23.37
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$800.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$800.00
|
| Rate for Payer: United Healthcare Commercial |
$9.06
|
| Rate for Payer: United Healthcare Commercial |
$9.06
|
| Rate for Payer: United Healthcare Medicare |
$18.34
|
| Rate for Payer: United Healthcare Medicare |
$18.34
|
|
|
PRAMIPEXOLE 0.25 MG ORAL TAB
|
Facility
|
OP
|
$1.06
|
|
|
Service Code
|
NDC 00904670461
|
| Hospital Charge Code |
21290
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.33 |
| Max. Negotiated Rate |
$0.99 |
| Rate for Payer: Aetna Commercial |
$0.90
|
| Rate for Payer: Aetna Medicare |
$0.34
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$0.33
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$0.61
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$0.67
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$0.39
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$0.37
|
| Rate for Payer: Cash Price |
$0.64
|
| Rate for Payer: Centivo All Commercial |
$0.58
|
| Rate for Payer: Cigna All Commercial |
$0.92
|
| Rate for Payer: CORVEL All Commercial |
$0.99
|
| Rate for Payer: Coventry All Commercial |
$0.94
|
| Rate for Payer: Encore All Commercial |
$0.98
|
| Rate for Payer: Frontpath All Commercial |
$0.98
|
| Rate for Payer: Humana ChoiceCare |
$0.92
|
| Rate for Payer: Humana Medicare |
$0.34
|
| Rate for Payer: Lucent All Commercial |
$0.58
|
| Rate for Payer: Lutheran Preferred All Commercial |
$0.96
|
| Rate for Payer: PHCS All Commercial |
$0.80
|
| Rate for Payer: PHP All Commercial |
$0.81
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$0.41
|
| Rate for Payer: Sagamore Health Network All Products |
$0.82
|
| Rate for Payer: Signature Care EPO |
$0.88
|
| Rate for Payer: Signature Care PPO |
$0.94
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$0.90
|
| Rate for Payer: United Healthcare Commercial |
$0.84
|
| Rate for Payer: United Healthcare Medicare |
$0.34
|
|
|
PRAMIPEXOLE 0.25 MG ORAL TAB
|
Facility
|
IP
|
$1.06
|
|
|
Service Code
|
NDC 00904670461
|
| Hospital Charge Code |
21290
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.80 |
| Max. Negotiated Rate |
$0.99 |
| Rate for Payer: Aetna Commercial |
$0.92
|
| Rate for Payer: Cash Price |
$0.64
|
| Rate for Payer: Cigna All Commercial |
$0.92
|
| Rate for Payer: CORVEL All Commercial |
$0.99
|
| Rate for Payer: Coventry All Commercial |
$0.94
|
| Rate for Payer: Encore All Commercial |
$0.98
|
| Rate for Payer: Frontpath All Commercial |
$0.98
|
| Rate for Payer: Humana ChoiceCare |
$0.92
|
| Rate for Payer: Lutheran Preferred All Commercial |
$0.96
|
| Rate for Payer: PHCS All Commercial |
$0.80
|
| Rate for Payer: PHP All Commercial |
$0.81
|
| Rate for Payer: Sagamore Health Network All Products |
$0.82
|
| Rate for Payer: Signature Care EPO |
$0.88
|
| Rate for Payer: Signature Care PPO |
$0.94
|
| Rate for Payer: United Healthcare Commercial |
$0.84
|
|
|
PRAMIPEXOLE 1 MG ORAL TAB
|
Facility
|
OP
|
$6.97
|
|
|
Service Code
|
NDC 60687059221
|
| Hospital Charge Code |
21288
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.16 |
| Max. Negotiated Rate |
$6.48 |
| Rate for Payer: Aetna Commercial |
$5.88
|
| Rate for Payer: Aetna Medicare |
$2.23
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2.16
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$4.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4.35
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2.56
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2.45
|
| Rate for Payer: Cash Price |
$4.18
|
| Rate for Payer: Centivo All Commercial |
$3.79
|
| Rate for Payer: Cigna All Commercial |
$6.01
|
| Rate for Payer: CORVEL All Commercial |
$6.48
|
| Rate for Payer: Coventry All Commercial |
$6.13
|
| Rate for Payer: Encore All Commercial |
$6.41
|
| Rate for Payer: Frontpath All Commercial |
$6.41
|
| Rate for Payer: Humana ChoiceCare |
$6.02
|
| Rate for Payer: Humana Medicare |
$2.23
|
| Rate for Payer: Lucent All Commercial |
$3.79
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6.27
|
| Rate for Payer: PHCS All Commercial |
$5.22
|
| Rate for Payer: PHP All Commercial |
$5.28
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2.72
|
| Rate for Payer: Sagamore Health Network All Products |
$5.38
|
| Rate for Payer: Signature Care EPO |
$5.78
|
| Rate for Payer: Signature Care PPO |
$6.13
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5.92
|
| Rate for Payer: United Healthcare Commercial |
$5.49
|
| Rate for Payer: United Healthcare Medicare |
$2.23
|
|
|
PRAMIPEXOLE 1 MG ORAL TAB
|
Facility
|
IP
|
$6.97
|
|
|
Service Code
|
NDC 60687059221
|
| Hospital Charge Code |
21288
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$6.48 |
| Rate for Payer: Aetna Commercial |
$6.02
|
| Rate for Payer: Cash Price |
$4.18
|
| Rate for Payer: Cigna All Commercial |
$6.01
|
| Rate for Payer: CORVEL All Commercial |
$6.48
|
| Rate for Payer: Coventry All Commercial |
$6.13
|
| Rate for Payer: Encore All Commercial |
$6.41
|
| Rate for Payer: Frontpath All Commercial |
$6.41
|
| Rate for Payer: Humana ChoiceCare |
$6.02
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6.27
|
| Rate for Payer: PHCS All Commercial |
$5.22
|
| Rate for Payer: PHP All Commercial |
$5.28
|
| Rate for Payer: Sagamore Health Network All Products |
$5.38
|
| Rate for Payer: Signature Care EPO |
$5.78
|
| Rate for Payer: Signature Care PPO |
$6.13
|
| Rate for Payer: United Healthcare Commercial |
$5.49
|
|
|
PR AMNIOCENTESIS,DIAGNOSTIC
|
Professional
|
Both
|
$214.24
|
|
|
Service Code
|
CPT 59000
|
| Hospital Charge Code |
z59000
|
| Min. Negotiated Rate |
$41.52 |
| Max. Negotiated Rate |
$9,400.00 |
| Rate for Payer: Aetna Commercial |
$72.43
|
| Rate for Payer: Aetna Commercial |
$72.43
|
| Rate for Payer: Aetna Medicare |
$72.43
|
| Rate for Payer: Aetna Medicare |
$72.43
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$180.62
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$180.62
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$180.62
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$180.62
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$180.62
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$180.62
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$180.62
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$180.62
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$41.52
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$41.52
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$105.38
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$105.38
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$83.29
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$83.29
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$79.67
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$79.67
|
| Rate for Payer: Cash Price |
$125.23
|
| Rate for Payer: Cash Price |
$128.54
|
| Rate for Payer: Centivo All Commercial |
$112.27
|
| Rate for Payer: Centivo All Commercial |
$112.27
|
| Rate for Payer: Cigna All Commercial |
$72.43
|
| Rate for Payer: Cigna All Commercial |
$72.43
|
| Rate for Payer: CORVEL All Commercial |
$72.43
|
| Rate for Payer: CORVEL All Commercial |
$72.43
|
| Rate for Payer: Coventry All Commercial |
$86.92
|
| Rate for Payer: Coventry All Commercial |
$86.92
|
| Rate for Payer: Encore All Commercial |
$72.43
|
| Rate for Payer: Encore All Commercial |
$72.43
|
| Rate for Payer: Frontpath All Commercial |
$103.42
|
| Rate for Payer: Frontpath All Commercial |
$103.42
|
| Rate for Payer: Humana ChoiceCare |
$77.39
|
| Rate for Payer: Humana ChoiceCare |
$77.39
|
| Rate for Payer: Humana Medicare |
$72.43
|
| Rate for Payer: Humana Medicare |
$72.43
|
| Rate for Payer: Lucent All Commercial |
$101.40
|
| Rate for Payer: Lucent All Commercial |
$101.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$101.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$101.00
|
| Rate for Payer: Managed Health Services Medicaid |
$105.38
|
| Rate for Payer: Managed Health Services Medicaid |
$105.38
|
| Rate for Payer: MDWise Medicaid |
$105.38
|
| Rate for Payer: MDWise Medicaid |
$105.38
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$41.52
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$41.52
|
| Rate for Payer: PHCS All Commercial |
$72.43
|
| Rate for Payer: PHCS All Commercial |
$72.43
|
| Rate for Payer: PHP All Commercial |
$93.23
|
| Rate for Payer: PHP All Commercial |
$93.23
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$72.43
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$72.43
|
| Rate for Payer: Sagamore Health Network All Products |
$72.43
|
| Rate for Payer: Sagamore Health Network All Products |
$72.43
|
| Rate for Payer: Signature Care EPO |
$163.20
|
| Rate for Payer: Signature Care EPO |
$163.20
|
| Rate for Payer: Signature Care PPO |
$163.20
|
| Rate for Payer: Signature Care PPO |
$163.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$9,400.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$9,400.00
|
| Rate for Payer: United Healthcare Commercial |
$91.40
|
| Rate for Payer: United Healthcare Commercial |
$91.40
|
| Rate for Payer: United Healthcare Medicare |
$104.36
|
| Rate for Payer: United Healthcare Medicare |
$104.36
|
|
|
PR AMPUTATION FINGER/THUMB
|
Professional
|
Both
|
$1,310.04
|
|
|
Service Code
|
CPT 26951
|
| Hospital Charge Code |
z26951
|
| Min. Negotiated Rate |
$616.12 |
| Max. Negotiated Rate |
$99,000.00 |
| Rate for Payer: Aetna Commercial |
$662.64
|
| Rate for Payer: Aetna Commercial |
$662.64
|
| Rate for Payer: Aetna Medicare |
$662.64
|
| Rate for Payer: Aetna Medicare |
$662.64
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$669.74
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$669.74
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$669.74
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$669.74
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$669.74
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$669.74
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$669.74
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$669.74
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$644.32
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$644.32
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$762.04
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$762.04
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$728.90
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$728.90
|
| Rate for Payer: Cash Price |
$786.02
|
| Rate for Payer: Cash Price |
$772.51
|
| Rate for Payer: Centivo All Commercial |
$1,027.09
|
| Rate for Payer: Centivo All Commercial |
$1,027.09
|
| Rate for Payer: Cigna All Commercial |
$662.64
|
| Rate for Payer: Cigna All Commercial |
$662.64
|
| Rate for Payer: CORVEL All Commercial |
$662.64
|
| Rate for Payer: CORVEL All Commercial |
$662.64
|
| Rate for Payer: Coventry All Commercial |
$795.17
|
| Rate for Payer: Coventry All Commercial |
$795.17
|
| Rate for Payer: Encore All Commercial |
$662.64
|
| Rate for Payer: Encore All Commercial |
$662.64
|
| Rate for Payer: Frontpath All Commercial |
$902.71
|
| Rate for Payer: Frontpath All Commercial |
$902.71
|
| Rate for Payer: Humana ChoiceCare |
$616.12
|
| Rate for Payer: Humana ChoiceCare |
$616.12
|
| Rate for Payer: Humana Medicare |
$662.64
|
| Rate for Payer: Humana Medicare |
$662.64
|
| Rate for Payer: Lucent All Commercial |
$927.70
|
| Rate for Payer: Lucent All Commercial |
$927.70
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,056.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,056.00
|
| Rate for Payer: Managed Health Services Medicaid |
$644.32
|
| Rate for Payer: Managed Health Services Medicaid |
$644.32
|
| Rate for Payer: MDWise Medicaid |
$644.32
|
| Rate for Payer: MDWise Medicaid |
$644.32
|
| Rate for Payer: PHCS All Commercial |
$662.64
|
| Rate for Payer: PHCS All Commercial |
$662.64
|
| Rate for Payer: PHP All Commercial |
$1,120.15
|
| Rate for Payer: PHP All Commercial |
$1,120.15
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$662.64
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$662.64
|
| Rate for Payer: Sagamore Health Network All Products |
$662.64
|
| Rate for Payer: Sagamore Health Network All Products |
$662.64
|
| Rate for Payer: Signature Care EPO |
$852.55
|
| Rate for Payer: Signature Care EPO |
$852.55
|
| Rate for Payer: Signature Care PPO |
$852.55
|
| Rate for Payer: Signature Care PPO |
$852.55
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$99,000.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$99,000.00
|
| Rate for Payer: United Healthcare Commercial |
$647.53
|
| Rate for Payer: United Healthcare Commercial |
$647.53
|
| Rate for Payer: United Healthcare Medicare |
$643.76
|
| Rate for Payer: United Healthcare Medicare |
$643.76
|
|
|
PR AMPUTATION FOOT,TRANSMETATARSAL
|
Professional
|
Both
|
$1,319.20
|
|
|
Service Code
|
CPT 28805
|
| Hospital Charge Code |
z28805
|
| Min. Negotiated Rate |
$612.20 |
| Max. Negotiated Rate |
$1,040.34 |
| Rate for Payer: Aetna Commercial |
$671.19
|
| Rate for Payer: Aetna Commercial |
$671.19
|
| Rate for Payer: Aetna Medicare |
$671.19
|
| Rate for Payer: Aetna Medicare |
$671.19
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$648.84
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$648.84
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$771.87
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$771.87
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$738.31
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$738.31
|
| Rate for Payer: Cash Price |
$776.90
|
| Rate for Payer: Cash Price |
$791.52
|
| Rate for Payer: Centivo All Commercial |
$1,040.34
|
| Rate for Payer: Centivo All Commercial |
$1,040.34
|
| Rate for Payer: Cigna All Commercial |
$671.19
|
| Rate for Payer: Cigna All Commercial |
$671.19
|
| Rate for Payer: CORVEL All Commercial |
$671.19
|
| Rate for Payer: CORVEL All Commercial |
$671.19
|
| Rate for Payer: Coventry All Commercial |
$805.43
|
| Rate for Payer: Coventry All Commercial |
$805.43
|
| Rate for Payer: Encore All Commercial |
$671.19
|
| Rate for Payer: Encore All Commercial |
$671.19
|
| Rate for Payer: Frontpath All Commercial |
$923.92
|
| Rate for Payer: Frontpath All Commercial |
$923.92
|
| Rate for Payer: Humana ChoiceCare |
$612.20
|
| Rate for Payer: Humana ChoiceCare |
$612.20
|
| Rate for Payer: Humana Medicare |
$671.19
|
| Rate for Payer: Humana Medicare |
$671.19
|
| Rate for Payer: Lucent All Commercial |
$939.67
|
| Rate for Payer: Lucent All Commercial |
$939.67
|
| Rate for Payer: Managed Health Services Medicaid |
$648.84
|
| Rate for Payer: Managed Health Services Medicaid |
$648.84
|
| Rate for Payer: MDWise Medicaid |
$648.84
|
| Rate for Payer: MDWise Medicaid |
$648.84
|
| Rate for Payer: PHCS All Commercial |
$671.19
|
| Rate for Payer: PHCS All Commercial |
$671.19
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$671.19
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$671.19
|
| Rate for Payer: Sagamore Health Network All Products |
$671.19
|
| Rate for Payer: Sagamore Health Network All Products |
$671.19
|
| Rate for Payer: United Healthcare Commercial |
$842.66
|
| Rate for Payer: United Healthcare Commercial |
$842.66
|
| Rate for Payer: United Healthcare Medicare |
$647.42
|
| Rate for Payer: United Healthcare Medicare |
$647.42
|
|
|
PR AMPUTATION METATARSAL+TOE,SINGLE
|
Professional
|
Both
|
$787.68
|
|
|
Service Code
|
CPT 28810
|
| Hospital Charge Code |
z28810
|
| Min. Negotiated Rate |
$384.60 |
| Max. Negotiated Rate |
$59,100.00 |
| Rate for Payer: Aetna Commercial |
$397.74
|
| Rate for Payer: Aetna Commercial |
$397.74
|
| Rate for Payer: Aetna Medicare |
$397.74
|
| Rate for Payer: Aetna Medicare |
$397.74
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$483.91
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$483.91
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$483.91
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$483.91
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$483.91
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$483.91
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$483.91
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$483.91
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$387.42
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$387.42
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$457.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$457.40
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$437.51
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$437.51
|
| Rate for Payer: Cash Price |
$472.61
|
| Rate for Payer: Cash Price |
$461.52
|
| Rate for Payer: Centivo All Commercial |
$616.50
|
| Rate for Payer: Centivo All Commercial |
$616.50
|
| Rate for Payer: Cigna All Commercial |
$397.74
|
| Rate for Payer: Cigna All Commercial |
$397.74
|
| Rate for Payer: CORVEL All Commercial |
$397.74
|
| Rate for Payer: CORVEL All Commercial |
$397.74
|
| Rate for Payer: Coventry All Commercial |
$477.29
|
| Rate for Payer: Coventry All Commercial |
$477.29
|
| Rate for Payer: Encore All Commercial |
$397.74
|
| Rate for Payer: Encore All Commercial |
$397.74
|
| Rate for Payer: Frontpath All Commercial |
$549.61
|
| Rate for Payer: Frontpath All Commercial |
$549.61
|
| Rate for Payer: Humana ChoiceCare |
$464.26
|
| Rate for Payer: Humana ChoiceCare |
$464.26
|
| Rate for Payer: Humana Medicare |
$397.74
|
| Rate for Payer: Humana Medicare |
$397.74
|
| Rate for Payer: Lucent All Commercial |
$556.84
|
| Rate for Payer: Lucent All Commercial |
$556.84
|
| Rate for Payer: Lutheran Preferred All Commercial |
$631.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$631.00
|
| Rate for Payer: Managed Health Services Medicaid |
$387.42
|
| Rate for Payer: Managed Health Services Medicaid |
$387.42
|
| Rate for Payer: MDWise Medicaid |
$387.42
|
| Rate for Payer: MDWise Medicaid |
$387.42
|
| Rate for Payer: PHCS All Commercial |
$397.74
|
| Rate for Payer: PHCS All Commercial |
$397.74
|
| Rate for Payer: PHP All Commercial |
$669.21
|
| Rate for Payer: PHP All Commercial |
$669.21
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$397.74
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$397.74
|
| Rate for Payer: Sagamore Health Network All Products |
$397.74
|
| Rate for Payer: Sagamore Health Network All Products |
$397.74
|
| Rate for Payer: Signature Care EPO |
$637.50
|
| Rate for Payer: Signature Care EPO |
$637.50
|
| Rate for Payer: Signature Care PPO |
$637.50
|
| Rate for Payer: Signature Care PPO |
$637.50
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$59,100.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$59,100.00
|
| Rate for Payer: United Healthcare Commercial |
$490.16
|
| Rate for Payer: United Healthcare Commercial |
$490.16
|
| Rate for Payer: United Healthcare Medicare |
$384.60
|
| Rate for Payer: United Healthcare Medicare |
$384.60
|
|
|
PR AMPUTATION TOE,I-P JT
|
Professional
|
Both
|
$543.16
|
|
|
Service Code
|
CPT 28825
|
| Hospital Charge Code |
z28825
|
| Min. Negotiated Rate |
$138.00 |
| Max. Negotiated Rate |
$24,400.00 |
| Rate for Payer: Aetna Commercial |
$164.62
|
| Rate for Payer: Aetna Commercial |
$164.62
|
| Rate for Payer: Aetna Medicare |
$164.62
|
| Rate for Payer: Aetna Medicare |
$164.62
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$429.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$429.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$429.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$429.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$429.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$429.10
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$429.10
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$429.10
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$138.00
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$138.00
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$267.15
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$267.15
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$189.31
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$189.31
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$181.08
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$181.08
|
| Rate for Payer: Cash Price |
$319.91
|
| Rate for Payer: Cash Price |
$325.90
|
| Rate for Payer: Centivo All Commercial |
$255.16
|
| Rate for Payer: Centivo All Commercial |
$255.16
|
| Rate for Payer: Cigna All Commercial |
$164.62
|
| Rate for Payer: Cigna All Commercial |
$164.62
|
| Rate for Payer: CORVEL All Commercial |
$164.62
|
| Rate for Payer: CORVEL All Commercial |
$164.62
|
| Rate for Payer: Coventry All Commercial |
$197.54
|
| Rate for Payer: Coventry All Commercial |
$197.54
|
| Rate for Payer: Encore All Commercial |
$164.62
|
| Rate for Payer: Encore All Commercial |
$164.62
|
| Rate for Payer: Frontpath All Commercial |
$226.08
|
| Rate for Payer: Frontpath All Commercial |
$226.08
|
| Rate for Payer: Humana ChoiceCare |
$303.85
|
| Rate for Payer: Humana ChoiceCare |
$303.85
|
| Rate for Payer: Humana Medicare |
$164.62
|
| Rate for Payer: Humana Medicare |
$164.62
|
| Rate for Payer: Lucent All Commercial |
$230.47
|
| Rate for Payer: Lucent All Commercial |
$230.47
|
| Rate for Payer: Lutheran Preferred All Commercial |
$260.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$260.00
|
| Rate for Payer: Managed Health Services Medicaid |
$267.15
|
| Rate for Payer: Managed Health Services Medicaid |
$267.15
|
| Rate for Payer: MDWise Medicaid |
$267.15
|
| Rate for Payer: MDWise Medicaid |
$267.15
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$138.00
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$138.00
|
| Rate for Payer: PHCS All Commercial |
$164.62
|
| Rate for Payer: PHCS All Commercial |
$164.62
|
| Rate for Payer: PHP All Commercial |
$275.72
|
| Rate for Payer: PHP All Commercial |
$275.72
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$164.62
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$164.62
|
| Rate for Payer: Sagamore Health Network All Products |
$164.62
|
| Rate for Payer: Sagamore Health Network All Products |
$164.62
|
| Rate for Payer: Signature Care EPO |
$473.11
|
| Rate for Payer: Signature Care EPO |
$473.11
|
| Rate for Payer: Signature Care PPO |
$473.11
|
| Rate for Payer: Signature Care PPO |
$473.11
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$24,400.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$24,400.00
|
| Rate for Payer: United Healthcare Commercial |
$440.71
|
| Rate for Payer: United Healthcare Commercial |
$440.71
|
| Rate for Payer: United Healthcare Medicare |
$266.59
|
| Rate for Payer: United Healthcare Medicare |
$266.59
|
|
|
PR AMPUTATION TOE,MT-P JT
|
Professional
|
Both
|
$551.98
|
|
|
Service Code
|
CPT 28820
|
| Hospital Charge Code |
z28820
|
| Min. Negotiated Rate |
$141.02 |
| Max. Negotiated Rate |
$25,100.00 |
| Rate for Payer: Aetna Commercial |
$169.34
|
| Rate for Payer: Aetna Commercial |
$169.34
|
| Rate for Payer: Aetna Medicare |
$169.34
|
| Rate for Payer: Aetna Medicare |
$169.34
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$491.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$491.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$491.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$491.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$491.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$491.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$491.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$491.00
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$141.02
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$141.02
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$271.49
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$271.49
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$194.74
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$194.74
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$186.27
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$186.27
|
| Rate for Payer: Cash Price |
$326.44
|
| Rate for Payer: Cash Price |
$331.19
|
| Rate for Payer: Centivo All Commercial |
$262.48
|
| Rate for Payer: Centivo All Commercial |
$262.48
|
| Rate for Payer: Cigna All Commercial |
$169.34
|
| Rate for Payer: Cigna All Commercial |
$169.34
|
| Rate for Payer: CORVEL All Commercial |
$169.34
|
| Rate for Payer: CORVEL All Commercial |
$169.34
|
| Rate for Payer: Coventry All Commercial |
$203.21
|
| Rate for Payer: Coventry All Commercial |
$203.21
|
| Rate for Payer: Encore All Commercial |
$169.34
|
| Rate for Payer: Encore All Commercial |
$169.34
|
| Rate for Payer: Frontpath All Commercial |
$232.79
|
| Rate for Payer: Frontpath All Commercial |
$232.79
|
| Rate for Payer: Humana ChoiceCare |
$353.62
|
| Rate for Payer: Humana ChoiceCare |
$353.62
|
| Rate for Payer: Humana Medicare |
$169.34
|
| Rate for Payer: Humana Medicare |
$169.34
|
| Rate for Payer: Lucent All Commercial |
$237.08
|
| Rate for Payer: Lucent All Commercial |
$237.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$268.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$268.00
|
| Rate for Payer: Managed Health Services Medicaid |
$271.49
|
| Rate for Payer: Managed Health Services Medicaid |
$271.49
|
| Rate for Payer: MDWise Medicaid |
$271.49
|
| Rate for Payer: MDWise Medicaid |
$271.49
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$141.02
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$141.02
|
| Rate for Payer: PHCS All Commercial |
$169.34
|
| Rate for Payer: PHCS All Commercial |
$169.34
|
| Rate for Payer: PHP All Commercial |
$284.14
|
| Rate for Payer: PHP All Commercial |
$284.14
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$169.34
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$169.34
|
| Rate for Payer: Sagamore Health Network All Products |
$169.34
|
| Rate for Payer: Sagamore Health Network All Products |
$169.34
|
| Rate for Payer: Signature Care EPO |
$482.19
|
| Rate for Payer: Signature Care EPO |
$482.19
|
| Rate for Payer: Signature Care PPO |
$482.19
|
| Rate for Payer: Signature Care PPO |
$482.19
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$25,100.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$25,100.00
|
| Rate for Payer: United Healthcare Commercial |
$385.93
|
| Rate for Payer: United Healthcare Commercial |
$385.93
|
| Rate for Payer: United Healthcare Medicare |
$272.03
|
| Rate for Payer: United Healthcare Medicare |
$272.03
|
|
|
PR ANAL/URINARY MUSCLE STUDY
|
Professional
|
Both
|
$116.32
|
|
|
Service Code
|
CPT 51784
|
| Hospital Charge Code |
z51784
|
| Min. Negotiated Rate |
$59.04 |
| Max. Negotiated Rate |
$239.26 |
| Rate for Payer: Aetna Commercial |
$60.42
|
| Rate for Payer: Aetna Medicare |
$60.42
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$59.04
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$69.48
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$66.46
|
| Rate for Payer: Cash Price |
$69.79
|
| Rate for Payer: Centivo All Commercial |
$93.65
|
| Rate for Payer: Cigna All Commercial |
$60.42
|
| Rate for Payer: CORVEL All Commercial |
$60.42
|
| Rate for Payer: Coventry All Commercial |
$72.50
|
| Rate for Payer: Encore All Commercial |
$60.42
|
| Rate for Payer: Frontpath All Commercial |
$81.70
|
| Rate for Payer: Humana ChoiceCare |
$199.20
|
| Rate for Payer: Humana Medicare |
$60.42
|
| Rate for Payer: Lucent All Commercial |
$84.59
|
| Rate for Payer: Managed Health Services Medicaid |
$59.04
|
| Rate for Payer: MDWise Medicaid |
$59.04
|
| Rate for Payer: PHCS All Commercial |
$60.42
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$60.42
|
| Rate for Payer: Sagamore Health Network All Products |
$60.42
|
| Rate for Payer: United Healthcare Commercial |
$239.26
|
|
|
PR ANES COMP BY EMERGENCY CONDITIONS SPECIFY
|
Professional
|
Both
|
$290.00
|
|
|
Service Code
|
CPT 99140
|
| Hospital Charge Code |
z99140
|
| Min. Negotiated Rate |
$48.67 |
| Max. Negotiated Rate |
$82.00 |
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$48.67
|
| Rate for Payer: Cash Price |
$174.00
|
| Rate for Payer: Humana ChoiceCare |
$82.00
|
| Rate for Payer: Managed Health Services Medicaid |
$48.67
|
| Rate for Payer: MDWise Medicaid |
$48.67
|
|
|
PR ANESTHESIA EXTREME AGE PATIENT<1 YR&>70
|
Professional
|
Both
|
$145.00
|
|
|
Service Code
|
CPT 99100
|
| Hospital Charge Code |
z99100
|
| Min. Negotiated Rate |
$41.00 |
| Max. Negotiated Rate |
$41.00 |
| Rate for Payer: Cash Price |
$87.00
|
| Rate for Payer: Humana ChoiceCare |
$41.00
|
|
|
PR ANKLE SCOPE,EXTENS DEBRIDEMNT
|
Professional
|
Both
|
$1,049.06
|
|
|
Service Code
|
CPT 29898
|
| Hospital Charge Code |
z29898
|
| Min. Negotiated Rate |
$513.84 |
| Max. Negotiated Rate |
$79,000.00 |
| Rate for Payer: Aetna Commercial |
$528.36
|
| Rate for Payer: Aetna Commercial |
$528.36
|
| Rate for Payer: Aetna Medicare |
$528.36
|
| Rate for Payer: Aetna Medicare |
$528.36
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$834.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$834.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$834.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$834.80
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$834.80
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$834.80
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$834.80
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$834.80
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$515.97
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$515.97
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$607.61
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$607.61
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$581.20
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$581.20
|
| Rate for Payer: Cash Price |
$629.44
|
| Rate for Payer: Cash Price |
$616.61
|
| Rate for Payer: Centivo All Commercial |
$818.96
|
| Rate for Payer: Centivo All Commercial |
$818.96
|
| Rate for Payer: Cigna All Commercial |
$528.36
|
| Rate for Payer: Cigna All Commercial |
$528.36
|
| Rate for Payer: CORVEL All Commercial |
$528.36
|
| Rate for Payer: CORVEL All Commercial |
$528.36
|
| Rate for Payer: Coventry All Commercial |
$634.03
|
| Rate for Payer: Coventry All Commercial |
$634.03
|
| Rate for Payer: Encore All Commercial |
$528.36
|
| Rate for Payer: Encore All Commercial |
$528.36
|
| Rate for Payer: Frontpath All Commercial |
$726.56
|
| Rate for Payer: Frontpath All Commercial |
$726.56
|
| Rate for Payer: Humana ChoiceCare |
$632.79
|
| Rate for Payer: Humana ChoiceCare |
$632.79
|
| Rate for Payer: Humana Medicare |
$528.36
|
| Rate for Payer: Humana Medicare |
$528.36
|
| Rate for Payer: Lucent All Commercial |
$739.70
|
| Rate for Payer: Lucent All Commercial |
$739.70
|
| Rate for Payer: Lutheran Preferred All Commercial |
$843.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$843.00
|
| Rate for Payer: Managed Health Services Medicaid |
$515.97
|
| Rate for Payer: Managed Health Services Medicaid |
$515.97
|
| Rate for Payer: MDWise Medicaid |
$515.97
|
| Rate for Payer: MDWise Medicaid |
$515.97
|
| Rate for Payer: PHCS All Commercial |
$528.36
|
| Rate for Payer: PHCS All Commercial |
$528.36
|
| Rate for Payer: PHP All Commercial |
$894.08
|
| Rate for Payer: PHP All Commercial |
$894.08
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$528.36
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$528.36
|
| Rate for Payer: Sagamore Health Network All Products |
$528.36
|
| Rate for Payer: Sagamore Health Network All Products |
$528.36
|
| Rate for Payer: Signature Care EPO |
$846.60
|
| Rate for Payer: Signature Care EPO |
$846.60
|
| Rate for Payer: Signature Care PPO |
$846.60
|
| Rate for Payer: Signature Care PPO |
$846.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$79,000.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$79,000.00
|
| Rate for Payer: United Healthcare Commercial |
$640.81
|
| Rate for Payer: United Healthcare Commercial |
$640.81
|
| Rate for Payer: United Healthcare Medicare |
$513.84
|
| Rate for Payer: United Healthcare Medicare |
$513.84
|
|
|
PR ANKLE SCOPE,PART SYNOVECTOMY
|
Professional
|
Both
|
$868.54
|
|
|
Service Code
|
CPT 29895
|
| Hospital Charge Code |
z29895
|
| Min. Negotiated Rate |
$425.80 |
| Max. Negotiated Rate |
$65,500.00 |
| Rate for Payer: Aetna Commercial |
$441.31
|
| Rate for Payer: Aetna Commercial |
$441.31
|
| Rate for Payer: Aetna Medicare |
$441.31
|
| Rate for Payer: Aetna Medicare |
$441.31
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$723.70
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$723.70
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$723.70
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$723.70
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$723.70
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$723.70
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$723.70
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$723.70
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$427.18
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$427.18
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$507.51
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$507.51
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$485.44
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$485.44
|
| Rate for Payer: Cash Price |
$521.12
|
| Rate for Payer: Cash Price |
$510.96
|
| Rate for Payer: Centivo All Commercial |
$684.03
|
| Rate for Payer: Centivo All Commercial |
$684.03
|
| Rate for Payer: Cigna All Commercial |
$441.31
|
| Rate for Payer: Cigna All Commercial |
$441.31
|
| Rate for Payer: CORVEL All Commercial |
$441.31
|
| Rate for Payer: CORVEL All Commercial |
$441.31
|
| Rate for Payer: Coventry All Commercial |
$529.57
|
| Rate for Payer: Coventry All Commercial |
$529.57
|
| Rate for Payer: Encore All Commercial |
$441.31
|
| Rate for Payer: Encore All Commercial |
$441.31
|
| Rate for Payer: Frontpath All Commercial |
$605.90
|
| Rate for Payer: Frontpath All Commercial |
$605.90
|
| Rate for Payer: Humana ChoiceCare |
$543.02
|
| Rate for Payer: Humana ChoiceCare |
$543.02
|
| Rate for Payer: Humana Medicare |
$441.31
|
| Rate for Payer: Humana Medicare |
$441.31
|
| Rate for Payer: Lucent All Commercial |
$617.83
|
| Rate for Payer: Lucent All Commercial |
$617.83
|
| Rate for Payer: Lutheran Preferred All Commercial |
$698.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$698.00
|
| Rate for Payer: Managed Health Services Medicaid |
$427.18
|
| Rate for Payer: Managed Health Services Medicaid |
$427.18
|
| Rate for Payer: MDWise Medicaid |
$427.18
|
| Rate for Payer: MDWise Medicaid |
$427.18
|
| Rate for Payer: PHCS All Commercial |
$441.31
|
| Rate for Payer: PHCS All Commercial |
$441.31
|
| Rate for Payer: PHP All Commercial |
$740.89
|
| Rate for Payer: PHP All Commercial |
$740.89
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$441.31
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$441.31
|
| Rate for Payer: Sagamore Health Network All Products |
$441.31
|
| Rate for Payer: Sagamore Health Network All Products |
$441.31
|
| Rate for Payer: Signature Care EPO |
$725.05
|
| Rate for Payer: Signature Care EPO |
$725.05
|
| Rate for Payer: Signature Care PPO |
$725.05
|
| Rate for Payer: Signature Care PPO |
$725.05
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$65,500.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$65,500.00
|
| Rate for Payer: United Healthcare Commercial |
$546.85
|
| Rate for Payer: United Healthcare Commercial |
$546.85
|
| Rate for Payer: United Healthcare Medicare |
$425.80
|
| Rate for Payer: United Healthcare Medicare |
$425.80
|
|
|
PR ANNUAL WELLNESS VISIT; PERSONALIZ PPS INIT VISIT
|
Professional
|
Both
|
$391.00
|
|
|
Service Code
|
CPT G0438
|
| Hospital Charge Code |
zG0438
|
| Min. Negotiated Rate |
$133.25 |
| Max. Negotiated Rate |
$246.53 |
| Rate for Payer: Aetna Commercial |
$159.05
|
| Rate for Payer: Aetna Medicare |
$159.05
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$173.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$173.80
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$173.80
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$173.80
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$182.91
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$174.96
|
| Rate for Payer: Cash Price |
$234.60
|
| Rate for Payer: Centivo All Commercial |
$246.53
|
| Rate for Payer: Cigna All Commercial |
$159.05
|
| Rate for Payer: CORVEL All Commercial |
$159.05
|
| Rate for Payer: Coventry All Commercial |
$190.86
|
| Rate for Payer: Encore All Commercial |
$159.05
|
| Rate for Payer: Humana ChoiceCare |
$133.25
|
| Rate for Payer: Humana Medicare |
$159.05
|
| Rate for Payer: Lucent All Commercial |
$222.67
|
| Rate for Payer: PHCS All Commercial |
$159.05
|
| Rate for Payer: PHP All Commercial |
$157.52
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$159.05
|
| Rate for Payer: Sagamore Health Network All Products |
$159.05
|
| Rate for Payer: Signature Care EPO |
$135.19
|
| Rate for Payer: Signature Care PPO |
$135.19
|
| Rate for Payer: United Healthcare Commercial |
$170.88
|
|
|
PR ANOSCOPY DX W/COLLJ SPEC BR/WA SPX WHEN PRFRMD
|
Professional
|
Both
|
$217.54
|
|
|
Service Code
|
CPT 46600
|
| Hospital Charge Code |
z46600
|
| Min. Negotiated Rate |
$37.65 |
| Max. Negotiated Rate |
$5,300.00 |
| Rate for Payer: Aetna Commercial |
$37.92
|
| Rate for Payer: Aetna Commercial |
$37.92
|
| Rate for Payer: Aetna Medicare |
$37.92
|
| Rate for Payer: Aetna Medicare |
$37.92
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$124.37
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$124.37
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$124.37
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$124.37
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$124.37
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$124.37
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$124.37
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$124.37
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$40.40
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$40.40
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$106.99
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$106.99
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$43.61
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$43.61
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$41.71
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$41.71
|
| Rate for Payer: Cash Price |
$130.32
|
| Rate for Payer: Cash Price |
$130.52
|
| Rate for Payer: Centivo All Commercial |
$58.78
|
| Rate for Payer: Centivo All Commercial |
$58.78
|
| Rate for Payer: Cigna All Commercial |
$37.92
|
| Rate for Payer: Cigna All Commercial |
$37.92
|
| Rate for Payer: CORVEL All Commercial |
$37.92
|
| Rate for Payer: CORVEL All Commercial |
$37.92
|
| Rate for Payer: Coventry All Commercial |
$45.50
|
| Rate for Payer: Coventry All Commercial |
$45.50
|
| Rate for Payer: Encore All Commercial |
$37.92
|
| Rate for Payer: Encore All Commercial |
$37.92
|
| Rate for Payer: Frontpath All Commercial |
$52.17
|
| Rate for Payer: Frontpath All Commercial |
$52.17
|
| Rate for Payer: Humana ChoiceCare |
$37.65
|
| Rate for Payer: Humana ChoiceCare |
$37.65
|
| Rate for Payer: Humana Medicare |
$37.92
|
| Rate for Payer: Humana Medicare |
$37.92
|
| Rate for Payer: Lucent All Commercial |
$53.09
|
| Rate for Payer: Lucent All Commercial |
$53.09
|
| Rate for Payer: Lutheran Preferred All Commercial |
$57.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$57.00
|
| Rate for Payer: Managed Health Services Medicaid |
$106.99
|
| Rate for Payer: Managed Health Services Medicaid |
$106.99
|
| Rate for Payer: MDWise Medicaid |
$106.99
|
| Rate for Payer: MDWise Medicaid |
$106.99
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$40.40
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$40.40
|
| Rate for Payer: PHCS All Commercial |
$37.92
|
| Rate for Payer: PHCS All Commercial |
$37.92
|
| Rate for Payer: PHP All Commercial |
$65.14
|
| Rate for Payer: PHP All Commercial |
$65.14
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$37.92
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$37.92
|
| Rate for Payer: Sagamore Health Network All Products |
$37.92
|
| Rate for Payer: Sagamore Health Network All Products |
$37.92
|
| Rate for Payer: Signature Care EPO |
$113.05
|
| Rate for Payer: Signature Care EPO |
$113.05
|
| Rate for Payer: Signature Care PPO |
$113.05
|
| Rate for Payer: Signature Care PPO |
$113.05
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5,300.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5,300.00
|
| Rate for Payer: United Healthcare Commercial |
$41.46
|
| Rate for Payer: United Healthcare Commercial |
$41.46
|
| Rate for Payer: United Healthcare Medicare |
$108.60
|
| Rate for Payer: United Healthcare Medicare |
$108.60
|
|
|
PR ANTEPARTUM CARE, 1-6 VISITS
|
Professional
|
Both
|
$1,021.46
|
|
|
Service Code
|
CPT 59425
|
| Hospital Charge Code |
z59425
|
| Min. Negotiated Rate |
$83.73 |
| Max. Negotiated Rate |
$51,100.00 |
| Rate for Payer: Aetna Commercial |
$396.33
|
| Rate for Payer: Aetna Commercial |
$396.33
|
| Rate for Payer: Aetna Commercial |
$396.33
|
| Rate for Payer: Aetna Medicare |
$396.33
|
| Rate for Payer: Aetna Medicare |
$396.33
|
| Rate for Payer: Aetna Medicare |
$396.33
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$388.71
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$388.71
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$388.71
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$388.71
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$388.71
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$388.71
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$388.71
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$388.71
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$388.71
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$388.71
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$388.71
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$388.71
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$222.00
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$222.00
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$222.00
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$83.73
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$83.73
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$83.73
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$455.78
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$455.78
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$455.78
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$435.96
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$435.96
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$435.96
|
| Rate for Payer: Cash Price |
$51.00
|
| Rate for Payer: Cash Price |
$600.94
|
| Rate for Payer: Cash Price |
$612.88
|
| Rate for Payer: Centivo All Commercial |
$614.31
|
| Rate for Payer: Centivo All Commercial |
$614.31
|
| Rate for Payer: Centivo All Commercial |
$614.31
|
| Rate for Payer: Cigna All Commercial |
$396.33
|
| Rate for Payer: Cigna All Commercial |
$396.33
|
| Rate for Payer: Cigna All Commercial |
$396.33
|
| Rate for Payer: CORVEL All Commercial |
$396.33
|
| Rate for Payer: CORVEL All Commercial |
$396.33
|
| Rate for Payer: CORVEL All Commercial |
$396.33
|
| Rate for Payer: Coventry All Commercial |
$475.60
|
| Rate for Payer: Coventry All Commercial |
$475.60
|
| Rate for Payer: Coventry All Commercial |
$475.60
|
| Rate for Payer: Encore All Commercial |
$396.33
|
| Rate for Payer: Encore All Commercial |
$396.33
|
| Rate for Payer: Encore All Commercial |
$396.33
|
| Rate for Payer: Frontpath All Commercial |
$565.04
|
| Rate for Payer: Frontpath All Commercial |
$565.04
|
| Rate for Payer: Frontpath All Commercial |
$565.04
|
| Rate for Payer: Humana ChoiceCare |
$264.61
|
| Rate for Payer: Humana ChoiceCare |
$264.61
|
| Rate for Payer: Humana ChoiceCare |
$264.61
|
| Rate for Payer: Humana Medicare |
$396.33
|
| Rate for Payer: Humana Medicare |
$396.33
|
| Rate for Payer: Humana Medicare |
$396.33
|
| Rate for Payer: Lucent All Commercial |
$554.86
|
| Rate for Payer: Lucent All Commercial |
$554.86
|
| Rate for Payer: Lucent All Commercial |
$554.86
|
| Rate for Payer: Lutheran Preferred All Commercial |
$550.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$550.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$550.00
|
| Rate for Payer: Managed Health Services Medicaid |
$83.73
|
| Rate for Payer: Managed Health Services Medicaid |
$83.73
|
| Rate for Payer: Managed Health Services Medicaid |
$83.73
|
| Rate for Payer: MDWise Medicaid |
$83.73
|
| Rate for Payer: MDWise Medicaid |
$83.73
|
| Rate for Payer: MDWise Medicaid |
$83.73
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$222.00
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$222.00
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$222.00
|
| Rate for Payer: PHCS All Commercial |
$396.33
|
| Rate for Payer: PHCS All Commercial |
$396.33
|
| Rate for Payer: PHCS All Commercial |
$396.33
|
| Rate for Payer: PHP All Commercial |
$506.37
|
| Rate for Payer: PHP All Commercial |
$506.37
|
| Rate for Payer: PHP All Commercial |
$506.37
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$396.33
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$396.33
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$396.33
|
| Rate for Payer: Sagamore Health Network All Products |
$396.33
|
| Rate for Payer: Sagamore Health Network All Products |
$396.33
|
| Rate for Payer: Sagamore Health Network All Products |
$396.33
|
| Rate for Payer: Signature Care EPO |
$447.10
|
| Rate for Payer: Signature Care EPO |
$447.10
|
| Rate for Payer: Signature Care EPO |
$447.10
|
| Rate for Payer: Signature Care PPO |
$447.10
|
| Rate for Payer: Signature Care PPO |
$447.10
|
| Rate for Payer: Signature Care PPO |
$447.10
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$51,100.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$51,100.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$51,100.00
|
| Rate for Payer: United Healthcare Commercial |
$386.53
|
| Rate for Payer: United Healthcare Commercial |
$386.53
|
| Rate for Payer: United Healthcare Commercial |
$386.53
|
| Rate for Payer: United Healthcare Medicare |
$500.78
|
| Rate for Payer: United Healthcare Medicare |
$500.78
|
| Rate for Payer: United Healthcare Medicare |
$500.78
|
|
|
PR ANTEPARTUM CARE, 7+ VISITS
|
Professional
|
Both
|
$1,867.46
|
|
|
Service Code
|
CPT 59426
|
| Hospital Charge Code |
z59426
|
| Min. Negotiated Rate |
$91.85 |
| Max. Negotiated Rate |
$93,800.00 |
| Rate for Payer: Aetna Commercial |
$726.76
|
| Rate for Payer: Aetna Commercial |
$726.76
|
| Rate for Payer: Aetna Commercial |
$726.76
|
| Rate for Payer: Aetna Medicare |
$726.76
|
| Rate for Payer: Aetna Medicare |
$726.76
|
| Rate for Payer: Aetna Medicare |
$726.76
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$666.27
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$666.27
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$666.27
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$666.27
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$666.27
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$666.27
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$666.27
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$666.27
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$666.27
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$666.27
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$666.27
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$666.27
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$406.63
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$406.63
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$406.63
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$91.85
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$91.85
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$91.85
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$835.77
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$835.77
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$835.77
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$799.44
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$799.44
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$799.44
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cash Price |
$1,098.52
|
| Rate for Payer: Cash Price |
$1,120.48
|
| Rate for Payer: Centivo All Commercial |
$1,126.48
|
| Rate for Payer: Centivo All Commercial |
$1,126.48
|
| Rate for Payer: Centivo All Commercial |
$1,126.48
|
| Rate for Payer: Cigna All Commercial |
$726.76
|
| Rate for Payer: Cigna All Commercial |
$726.76
|
| Rate for Payer: Cigna All Commercial |
$726.76
|
| Rate for Payer: CORVEL All Commercial |
$726.76
|
| Rate for Payer: CORVEL All Commercial |
$726.76
|
| Rate for Payer: CORVEL All Commercial |
$726.76
|
| Rate for Payer: Coventry All Commercial |
$872.11
|
| Rate for Payer: Coventry All Commercial |
$872.11
|
| Rate for Payer: Coventry All Commercial |
$872.11
|
| Rate for Payer: Encore All Commercial |
$726.76
|
| Rate for Payer: Encore All Commercial |
$726.76
|
| Rate for Payer: Encore All Commercial |
$726.76
|
| Rate for Payer: Frontpath All Commercial |
$1,034.60
|
| Rate for Payer: Frontpath All Commercial |
$1,034.60
|
| Rate for Payer: Frontpath All Commercial |
$1,034.60
|
| Rate for Payer: Humana ChoiceCare |
$456.87
|
| Rate for Payer: Humana ChoiceCare |
$456.87
|
| Rate for Payer: Humana ChoiceCare |
$456.87
|
| Rate for Payer: Humana Medicare |
$726.76
|
| Rate for Payer: Humana Medicare |
$726.76
|
| Rate for Payer: Humana Medicare |
$726.76
|
| Rate for Payer: Lucent All Commercial |
$1,017.46
|
| Rate for Payer: Lucent All Commercial |
$1,017.46
|
| Rate for Payer: Lucent All Commercial |
$1,017.46
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,011.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,011.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,011.00
|
| Rate for Payer: Managed Health Services Medicaid |
$91.85
|
| Rate for Payer: Managed Health Services Medicaid |
$91.85
|
| Rate for Payer: Managed Health Services Medicaid |
$91.85
|
| Rate for Payer: MDWise Medicaid |
$91.85
|
| Rate for Payer: MDWise Medicaid |
$91.85
|
| Rate for Payer: MDWise Medicaid |
$91.85
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$406.63
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$406.63
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$406.63
|
| Rate for Payer: PHCS All Commercial |
$726.76
|
| Rate for Payer: PHCS All Commercial |
$726.76
|
| Rate for Payer: PHCS All Commercial |
$726.76
|
| Rate for Payer: PHP All Commercial |
$929.28
|
| Rate for Payer: PHP All Commercial |
$929.28
|
| Rate for Payer: PHP All Commercial |
$929.28
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$726.76
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$726.76
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$726.76
|
| Rate for Payer: Sagamore Health Network All Products |
$726.76
|
| Rate for Payer: Sagamore Health Network All Products |
$726.76
|
| Rate for Payer: Sagamore Health Network All Products |
$726.76
|
| Rate for Payer: Signature Care EPO |
$799.36
|
| Rate for Payer: Signature Care EPO |
$799.36
|
| Rate for Payer: Signature Care EPO |
$799.36
|
| Rate for Payer: Signature Care PPO |
$799.36
|
| Rate for Payer: Signature Care PPO |
$799.36
|
| Rate for Payer: Signature Care PPO |
$799.36
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$93,800.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$93,800.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$93,800.00
|
| Rate for Payer: United Healthcare Commercial |
$684.04
|
| Rate for Payer: United Healthcare Commercial |
$684.04
|
| Rate for Payer: United Healthcare Commercial |
$684.04
|
| Rate for Payer: United Healthcare Medicare |
$915.43
|
| Rate for Payer: United Healthcare Medicare |
$915.43
|
| Rate for Payer: United Healthcare Medicare |
$915.43
|
|
|
PR ANTEPARTUM HEAD MANIPULATION
|
Professional
|
Both
|
$183.42
|
|
|
Service Code
|
CPT 59412
|
| Hospital Charge Code |
z59412
|
| Min. Negotiated Rate |
$90.14 |
| Max. Negotiated Rate |
$12,000.00 |
| Rate for Payer: Aetna Commercial |
$92.76
|
| Rate for Payer: Aetna Commercial |
$92.76
|
| Rate for Payer: Aetna Medicare |
$92.76
|
| Rate for Payer: Aetna Medicare |
$92.76
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$132.26
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$132.26
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$132.26
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$132.26
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$132.26
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$132.26
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$132.26
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$132.26
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$90.21
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$90.21
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$106.67
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$106.67
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$102.04
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$102.04
|
| Rate for Payer: Cash Price |
$110.05
|
| Rate for Payer: Cash Price |
$108.17
|
| Rate for Payer: Centivo All Commercial |
$143.78
|
| Rate for Payer: Centivo All Commercial |
$143.78
|
| Rate for Payer: Cigna All Commercial |
$92.76
|
| Rate for Payer: Cigna All Commercial |
$92.76
|
| Rate for Payer: CORVEL All Commercial |
$92.76
|
| Rate for Payer: CORVEL All Commercial |
$92.76
|
| Rate for Payer: Coventry All Commercial |
$111.31
|
| Rate for Payer: Coventry All Commercial |
$111.31
|
| Rate for Payer: Encore All Commercial |
$92.76
|
| Rate for Payer: Encore All Commercial |
$92.76
|
| Rate for Payer: Frontpath All Commercial |
$133.13
|
| Rate for Payer: Frontpath All Commercial |
$133.13
|
| Rate for Payer: Humana ChoiceCare |
$99.23
|
| Rate for Payer: Humana ChoiceCare |
$99.23
|
| Rate for Payer: Humana Medicare |
$92.76
|
| Rate for Payer: Humana Medicare |
$92.76
|
| Rate for Payer: Lucent All Commercial |
$129.86
|
| Rate for Payer: Lucent All Commercial |
$129.86
|
| Rate for Payer: Lutheran Preferred All Commercial |
$129.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$129.00
|
| Rate for Payer: Managed Health Services Medicaid |
$90.21
|
| Rate for Payer: Managed Health Services Medicaid |
$90.21
|
| Rate for Payer: MDWise Medicaid |
$90.21
|
| Rate for Payer: MDWise Medicaid |
$90.21
|
| Rate for Payer: PHCS All Commercial |
$92.76
|
| Rate for Payer: PHCS All Commercial |
$92.76
|
| Rate for Payer: PHP All Commercial |
$118.99
|
| Rate for Payer: PHP All Commercial |
$118.99
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$92.76
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$92.76
|
| Rate for Payer: Sagamore Health Network All Products |
$92.76
|
| Rate for Payer: Sagamore Health Network All Products |
$92.76
|
| Rate for Payer: Signature Care EPO |
$127.50
|
| Rate for Payer: Signature Care EPO |
$127.50
|
| Rate for Payer: Signature Care PPO |
$127.50
|
| Rate for Payer: Signature Care PPO |
$127.50
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$12,000.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$12,000.00
|
| Rate for Payer: United Healthcare Commercial |
$116.86
|
| Rate for Payer: United Healthcare Commercial |
$116.86
|
| Rate for Payer: United Healthcare Medicare |
$90.14
|
| Rate for Payer: United Healthcare Medicare |
$90.14
|
|
|
PR ANTERIOR COLPORRAPHY RPR CYSTOCELE W/CYSTO
|
Professional
|
Both
|
$1,142.86
|
|
|
Service Code
|
CPT 57240
|
| Hospital Charge Code |
z57240
|
| Min. Negotiated Rate |
$434.14 |
| Max. Negotiated Rate |
$74,900.00 |
| Rate for Payer: Aetna Commercial |
$580.56
|
| Rate for Payer: Aetna Commercial |
$580.56
|
| Rate for Payer: Aetna Medicare |
$580.56
|
| Rate for Payer: Aetna Medicare |
$580.56
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$513.96
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$513.96
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$513.96
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$513.96
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$513.96
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$513.96
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$513.96
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$513.96
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$562.10
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$562.10
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$667.64
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$667.64
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$638.62
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$638.62
|
| Rate for Payer: Cash Price |
$685.72
|
| Rate for Payer: Cash Price |
$674.33
|
| Rate for Payer: Centivo All Commercial |
$899.87
|
| Rate for Payer: Centivo All Commercial |
$899.87
|
| Rate for Payer: Cigna All Commercial |
$580.56
|
| Rate for Payer: Cigna All Commercial |
$580.56
|
| Rate for Payer: CORVEL All Commercial |
$580.56
|
| Rate for Payer: CORVEL All Commercial |
$580.56
|
| Rate for Payer: Coventry All Commercial |
$696.67
|
| Rate for Payer: Coventry All Commercial |
$696.67
|
| Rate for Payer: Encore All Commercial |
$580.56
|
| Rate for Payer: Encore All Commercial |
$580.56
|
| Rate for Payer: Frontpath All Commercial |
$801.35
|
| Rate for Payer: Frontpath All Commercial |
$801.35
|
| Rate for Payer: Humana ChoiceCare |
$434.14
|
| Rate for Payer: Humana ChoiceCare |
$434.14
|
| Rate for Payer: Humana Medicare |
$580.56
|
| Rate for Payer: Humana Medicare |
$580.56
|
| Rate for Payer: Lucent All Commercial |
$812.78
|
| Rate for Payer: Lucent All Commercial |
$812.78
|
| Rate for Payer: Lutheran Preferred All Commercial |
$806.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$806.00
|
| Rate for Payer: Managed Health Services Medicaid |
$562.10
|
| Rate for Payer: Managed Health Services Medicaid |
$562.10
|
| Rate for Payer: MDWise Medicaid |
$562.10
|
| Rate for Payer: MDWise Medicaid |
$562.10
|
| Rate for Payer: PHCS All Commercial |
$580.56
|
| Rate for Payer: PHCS All Commercial |
$580.56
|
| Rate for Payer: PHP All Commercial |
$741.76
|
| Rate for Payer: PHP All Commercial |
$741.76
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$580.56
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$580.56
|
| Rate for Payer: Sagamore Health Network All Products |
$580.56
|
| Rate for Payer: Sagamore Health Network All Products |
$580.56
|
| Rate for Payer: Signature Care EPO |
$549.11
|
| Rate for Payer: Signature Care EPO |
$549.11
|
| Rate for Payer: Signature Care PPO |
$549.11
|
| Rate for Payer: Signature Care PPO |
$549.11
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$74,900.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$74,900.00
|
| Rate for Payer: United Healthcare Commercial |
$748.88
|
| Rate for Payer: United Healthcare Commercial |
$748.88
|
| Rate for Payer: United Healthcare Medicare |
$561.94
|
| Rate for Payer: United Healthcare Medicare |
$561.94
|
|
|
PR APPENDECTOMY
|
Professional
|
Both
|
$1,165.02
|
|
|
Service Code
|
CPT 44950
|
| Hospital Charge Code |
z44950
|
| Min. Negotiated Rate |
$573.00 |
| Max. Negotiated Rate |
$82,200.00 |
| Rate for Payer: Aetna Commercial |
$595.37
|
| Rate for Payer: Aetna Commercial |
$595.37
|
| Rate for Payer: Aetna Medicare |
$595.37
|
| Rate for Payer: Aetna Medicare |
$595.37
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$685.70
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$685.70
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$685.70
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$685.70
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$685.70
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$685.70
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$685.70
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$685.70
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$573.00
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$573.00
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$684.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$684.68
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$654.91
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$654.91
|
| Rate for Payer: Cash Price |
$699.01
|
| Rate for Payer: Cash Price |
$687.61
|
| Rate for Payer: Centivo All Commercial |
$922.82
|
| Rate for Payer: Centivo All Commercial |
$922.82
|
| Rate for Payer: Cigna All Commercial |
$595.37
|
| Rate for Payer: Cigna All Commercial |
$595.37
|
| Rate for Payer: CORVEL All Commercial |
$595.37
|
| Rate for Payer: CORVEL All Commercial |
$595.37
|
| Rate for Payer: Coventry All Commercial |
$714.44
|
| Rate for Payer: Coventry All Commercial |
$714.44
|
| Rate for Payer: Encore All Commercial |
$595.37
|
| Rate for Payer: Encore All Commercial |
$595.37
|
| Rate for Payer: Frontpath All Commercial |
$850.21
|
| Rate for Payer: Frontpath All Commercial |
$850.21
|
| Rate for Payer: Humana ChoiceCare |
$656.64
|
| Rate for Payer: Humana ChoiceCare |
$656.64
|
| Rate for Payer: Humana Medicare |
$595.37
|
| Rate for Payer: Humana Medicare |
$595.37
|
| Rate for Payer: Lucent All Commercial |
$833.52
|
| Rate for Payer: Lucent All Commercial |
$833.52
|
| Rate for Payer: Lutheran Preferred All Commercial |
$881.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$881.00
|
| Rate for Payer: Managed Health Services Medicaid |
$573.00
|
| Rate for Payer: Managed Health Services Medicaid |
$573.00
|
| Rate for Payer: MDWise Medicaid |
$573.00
|
| Rate for Payer: MDWise Medicaid |
$573.00
|
| Rate for Payer: PHCS All Commercial |
$595.37
|
| Rate for Payer: PHCS All Commercial |
$595.37
|
| Rate for Payer: PHP All Commercial |
$1,002.76
|
| Rate for Payer: PHP All Commercial |
$1,002.76
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$595.37
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$595.37
|
| Rate for Payer: Sagamore Health Network All Products |
$595.37
|
| Rate for Payer: Sagamore Health Network All Products |
$595.37
|
| Rate for Payer: Signature Care EPO |
$827.90
|
| Rate for Payer: Signature Care EPO |
$827.90
|
| Rate for Payer: Signature Care PPO |
$827.90
|
| Rate for Payer: Signature Care PPO |
$827.90
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$82,200.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$82,200.00
|
| Rate for Payer: United Healthcare Commercial |
$685.13
|
| Rate for Payer: United Healthcare Commercial |
$685.13
|
| Rate for Payer: United Healthcare Medicare |
$573.01
|
| Rate for Payer: United Healthcare Medicare |
$573.01
|
|
