|
PR BIOPSY OF FLOOR OF MOUTH
|
Professional
|
Both
|
$312.56
|
|
|
Service Code
|
CPT 41108
|
| Hospital Charge Code |
z41108
|
| Min. Negotiated Rate |
$59.83 |
| Max. Negotiated Rate |
$12,000.00 |
| Rate for Payer: Aetna Commercial |
$84.55
|
| Rate for Payer: Aetna Commercial |
$84.55
|
| Rate for Payer: Aetna Medicare |
$84.55
|
| Rate for Payer: Aetna Medicare |
$84.55
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$195.61
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$195.61
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$195.61
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$195.61
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$195.61
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$195.61
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$195.61
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$195.61
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$59.83
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$59.83
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$153.73
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$153.73
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$97.23
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$97.23
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$93.00
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$93.00
|
| Rate for Payer: Cash Price |
$185.27
|
| Rate for Payer: Cash Price |
$187.54
|
| Rate for Payer: Centivo All Commercial |
$131.05
|
| Rate for Payer: Centivo All Commercial |
$131.05
|
| Rate for Payer: Cigna All Commercial |
$84.55
|
| Rate for Payer: Cigna All Commercial |
$84.55
|
| Rate for Payer: CORVEL All Commercial |
$84.55
|
| Rate for Payer: CORVEL All Commercial |
$84.55
|
| Rate for Payer: Coventry All Commercial |
$101.46
|
| Rate for Payer: Coventry All Commercial |
$101.46
|
| Rate for Payer: Encore All Commercial |
$84.55
|
| Rate for Payer: Encore All Commercial |
$84.55
|
| Rate for Payer: Frontpath All Commercial |
$114.70
|
| Rate for Payer: Frontpath All Commercial |
$114.70
|
| Rate for Payer: Humana ChoiceCare |
$96.05
|
| Rate for Payer: Humana ChoiceCare |
$96.05
|
| Rate for Payer: Humana Medicare |
$84.55
|
| Rate for Payer: Humana Medicare |
$84.55
|
| Rate for Payer: Lucent All Commercial |
$118.37
|
| Rate for Payer: Lucent All Commercial |
$118.37
|
| 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 |
$153.73
|
| Rate for Payer: Managed Health Services Medicaid |
$153.73
|
| Rate for Payer: MDWise Medicaid |
$153.73
|
| Rate for Payer: MDWise Medicaid |
$153.73
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$59.83
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$59.83
|
| Rate for Payer: PHCS All Commercial |
$84.55
|
| Rate for Payer: PHCS All Commercial |
$84.55
|
| Rate for Payer: PHP All Commercial |
$146.32
|
| Rate for Payer: PHP All Commercial |
$146.32
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$84.55
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$84.55
|
| Rate for Payer: Sagamore Health Network All Products |
$84.55
|
| Rate for Payer: Sagamore Health Network All Products |
$84.55
|
| Rate for Payer: Signature Care EPO |
$178.50
|
| Rate for Payer: Signature Care EPO |
$178.50
|
| Rate for Payer: Signature Care PPO |
$178.50
|
| Rate for Payer: Signature Care PPO |
$178.50
|
| 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 |
$96.46
|
| Rate for Payer: United Healthcare Commercial |
$96.46
|
| Rate for Payer: United Healthcare Medicare |
$154.39
|
| Rate for Payer: United Healthcare Medicare |
$154.39
|
|
|
PR BIOPSY OF LIP
|
Professional
|
Both
|
$228.44
|
|
|
Service Code
|
CPT 40490
|
| Hospital Charge Code |
z40490
|
| Min. Negotiated Rate |
$63.27 |
| Max. Negotiated Rate |
$9,100.00 |
| Rate for Payer: Aetna Commercial |
$65.17
|
| Rate for Payer: Aetna Commercial |
$65.17
|
| Rate for Payer: Aetna Medicare |
$65.17
|
| Rate for Payer: Aetna Medicare |
$65.17
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$183.34
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$183.34
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$183.34
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$183.34
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$183.34
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$183.34
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$183.34
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$183.34
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$63.27
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$63.27
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$112.36
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$112.36
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$74.95
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$74.95
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$71.69
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$71.69
|
| Rate for Payer: Cash Price |
$135.24
|
| Rate for Payer: Cash Price |
$137.06
|
| Rate for Payer: Centivo All Commercial |
$101.01
|
| Rate for Payer: Centivo All Commercial |
$101.01
|
| Rate for Payer: Cigna All Commercial |
$65.17
|
| Rate for Payer: Cigna All Commercial |
$65.17
|
| Rate for Payer: CORVEL All Commercial |
$65.17
|
| Rate for Payer: CORVEL All Commercial |
$65.17
|
| Rate for Payer: Coventry All Commercial |
$78.20
|
| Rate for Payer: Coventry All Commercial |
$78.20
|
| Rate for Payer: Encore All Commercial |
$65.17
|
| Rate for Payer: Encore All Commercial |
$65.17
|
| Rate for Payer: Frontpath All Commercial |
$88.23
|
| Rate for Payer: Frontpath All Commercial |
$88.23
|
| Rate for Payer: Humana ChoiceCare |
$81.41
|
| Rate for Payer: Humana ChoiceCare |
$81.41
|
| Rate for Payer: Humana Medicare |
$65.17
|
| Rate for Payer: Humana Medicare |
$65.17
|
| Rate for Payer: Lucent All Commercial |
$91.24
|
| Rate for Payer: Lucent All Commercial |
$91.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$98.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$98.00
|
| Rate for Payer: Managed Health Services Medicaid |
$112.36
|
| Rate for Payer: Managed Health Services Medicaid |
$112.36
|
| Rate for Payer: MDWise Medicaid |
$112.36
|
| Rate for Payer: MDWise Medicaid |
$112.36
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$63.27
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$63.27
|
| Rate for Payer: PHCS All Commercial |
$65.17
|
| Rate for Payer: PHCS All Commercial |
$65.17
|
| Rate for Payer: PHP All Commercial |
$111.30
|
| Rate for Payer: PHP All Commercial |
$111.30
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$65.17
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$65.17
|
| Rate for Payer: Sagamore Health Network All Products |
$65.17
|
| Rate for Payer: Sagamore Health Network All Products |
$65.17
|
| Rate for Payer: Signature Care EPO |
$169.15
|
| Rate for Payer: Signature Care EPO |
$169.15
|
| Rate for Payer: Signature Care PPO |
$169.15
|
| Rate for Payer: Signature Care PPO |
$169.15
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$9,100.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$9,100.00
|
| Rate for Payer: United Healthcare Commercial |
$82.01
|
| Rate for Payer: United Healthcare Commercial |
$82.01
|
| Rate for Payer: United Healthcare Medicare |
$112.70
|
| Rate for Payer: United Healthcare Medicare |
$112.70
|
|
|
PR BIOPSY OF MOUTH LESION
|
Professional
|
Both
|
$314.72
|
|
|
Service Code
|
CPT 40808
|
| Hospital Charge Code |
z40808
|
| Min. Negotiated Rate |
$81.71 |
| Max. Negotiated Rate |
$11,600.00 |
| Rate for Payer: Aetna Commercial |
$81.71
|
| Rate for Payer: Aetna Commercial |
$81.71
|
| Rate for Payer: Aetna Medicare |
$81.71
|
| Rate for Payer: Aetna Medicare |
$81.71
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$194.44
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$194.44
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$194.44
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$194.44
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$194.44
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$194.44
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$194.44
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$194.44
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$83.15
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$83.15
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$154.79
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$154.79
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$93.97
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$93.97
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$89.88
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$89.88
|
| Rate for Payer: Cash Price |
$185.95
|
| Rate for Payer: Cash Price |
$188.83
|
| Rate for Payer: Centivo All Commercial |
$126.65
|
| Rate for Payer: Centivo All Commercial |
$126.65
|
| Rate for Payer: Cigna All Commercial |
$81.71
|
| Rate for Payer: Cigna All Commercial |
$81.71
|
| Rate for Payer: CORVEL All Commercial |
$81.71
|
| Rate for Payer: CORVEL All Commercial |
$81.71
|
| Rate for Payer: Coventry All Commercial |
$98.05
|
| Rate for Payer: Coventry All Commercial |
$98.05
|
| Rate for Payer: Encore All Commercial |
$81.71
|
| Rate for Payer: Encore All Commercial |
$81.71
|
| Rate for Payer: Frontpath All Commercial |
$110.15
|
| Rate for Payer: Frontpath All Commercial |
$110.15
|
| Rate for Payer: Humana ChoiceCare |
$106.35
|
| Rate for Payer: Humana ChoiceCare |
$106.35
|
| Rate for Payer: Humana Medicare |
$81.71
|
| Rate for Payer: Humana Medicare |
$81.71
|
| Rate for Payer: Lucent All Commercial |
$114.39
|
| Rate for Payer: Lucent All Commercial |
$114.39
|
| Rate for Payer: Lutheran Preferred All Commercial |
$125.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$125.00
|
| Rate for Payer: Managed Health Services Medicaid |
$154.79
|
| Rate for Payer: Managed Health Services Medicaid |
$154.79
|
| Rate for Payer: MDWise Medicaid |
$154.79
|
| Rate for Payer: MDWise Medicaid |
$154.79
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$83.15
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$83.15
|
| Rate for Payer: PHCS All Commercial |
$81.71
|
| Rate for Payer: PHCS All Commercial |
$81.71
|
| Rate for Payer: PHP All Commercial |
$142.05
|
| Rate for Payer: PHP All Commercial |
$142.05
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$81.71
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$81.71
|
| Rate for Payer: Sagamore Health Network All Products |
$81.71
|
| Rate for Payer: Sagamore Health Network All Products |
$81.71
|
| Rate for Payer: Signature Care EPO |
$177.65
|
| Rate for Payer: Signature Care EPO |
$177.65
|
| Rate for Payer: Signature Care PPO |
$177.65
|
| Rate for Payer: Signature Care PPO |
$177.65
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$11,600.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$11,600.00
|
| Rate for Payer: United Healthcare Commercial |
$112.69
|
| Rate for Payer: United Healthcare Commercial |
$112.69
|
| Rate for Payer: United Healthcare Medicare |
$154.96
|
| Rate for Payer: United Healthcare Medicare |
$154.96
|
|
|
PR BIOPSY OF PROSTATE,NEEDLE/PUNCH
|
Professional
|
Both
|
$434.48
|
|
|
Service Code
|
CPT 55700
|
| Hospital Charge Code |
z55700
|
| Min. Negotiated Rate |
$65.41 |
| Max. Negotiated Rate |
$220.22 |
| Rate for Payer: Aetna Commercial |
$122.02
|
| Rate for Payer: Aetna Medicare |
$122.02
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$65.41
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$220.22
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$140.32
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$134.22
|
| Rate for Payer: Cash Price |
$260.69
|
| Rate for Payer: Centivo All Commercial |
$189.13
|
| Rate for Payer: Cigna All Commercial |
$122.02
|
| Rate for Payer: CORVEL All Commercial |
$122.02
|
| Rate for Payer: Coventry All Commercial |
$146.42
|
| Rate for Payer: Encore All Commercial |
$122.02
|
| Rate for Payer: Frontpath All Commercial |
$167.40
|
| Rate for Payer: Humana ChoiceCare |
$105.70
|
| Rate for Payer: Humana Medicare |
$122.02
|
| Rate for Payer: Lucent All Commercial |
$170.83
|
| Rate for Payer: Managed Health Services Medicaid |
$220.22
|
| Rate for Payer: MDWise Medicaid |
$220.22
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$65.41
|
| Rate for Payer: PHCS All Commercial |
$122.02
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$122.02
|
| Rate for Payer: Sagamore Health Network All Products |
$122.02
|
| Rate for Payer: United Healthcare Commercial |
$169.78
|
| Rate for Payer: United Healthcare Medicare |
$220.18
|
|
|
PR BIOPSY OF UTERUS LINING
|
Professional
|
Both
|
$188.30
|
|
|
Service Code
|
CPT 58100
|
| Hospital Charge Code |
z58100
|
| Min. Negotiated Rate |
$59.73 |
| Max. Negotiated Rate |
$7,700.00 |
| Rate for Payer: Aetna Commercial |
$59.73
|
| Rate for Payer: Aetna Commercial |
$59.73
|
| Rate for Payer: Aetna Medicare |
$59.73
|
| Rate for Payer: Aetna Medicare |
$59.73
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$148.32
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$148.32
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$148.32
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$148.32
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$148.32
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$148.32
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$148.32
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$148.32
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$59.98
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$59.98
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$92.61
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$92.61
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$68.69
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$68.69
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$65.70
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$65.70
|
| Rate for Payer: Cash Price |
$111.58
|
| Rate for Payer: Cash Price |
$112.98
|
| Rate for Payer: Centivo All Commercial |
$92.58
|
| Rate for Payer: Centivo All Commercial |
$92.58
|
| Rate for Payer: Cigna All Commercial |
$59.73
|
| Rate for Payer: Cigna All Commercial |
$59.73
|
| Rate for Payer: CORVEL All Commercial |
$59.73
|
| Rate for Payer: CORVEL All Commercial |
$59.73
|
| Rate for Payer: Coventry All Commercial |
$71.68
|
| Rate for Payer: Coventry All Commercial |
$71.68
|
| Rate for Payer: Encore All Commercial |
$59.73
|
| Rate for Payer: Encore All Commercial |
$59.73
|
| Rate for Payer: Frontpath All Commercial |
$83.59
|
| Rate for Payer: Frontpath All Commercial |
$83.59
|
| Rate for Payer: Humana ChoiceCare |
$100.25
|
| Rate for Payer: Humana ChoiceCare |
$100.25
|
| Rate for Payer: Humana Medicare |
$59.73
|
| Rate for Payer: Humana Medicare |
$59.73
|
| Rate for Payer: Lucent All Commercial |
$83.62
|
| Rate for Payer: Lucent All Commercial |
$83.62
|
| Rate for Payer: Lutheran Preferred All Commercial |
$82.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$82.00
|
| Rate for Payer: Managed Health Services Medicaid |
$92.61
|
| Rate for Payer: Managed Health Services Medicaid |
$92.61
|
| Rate for Payer: MDWise Medicaid |
$92.61
|
| Rate for Payer: MDWise Medicaid |
$92.61
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$59.98
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$59.98
|
| Rate for Payer: PHCS All Commercial |
$59.73
|
| Rate for Payer: PHCS All Commercial |
$59.73
|
| Rate for Payer: PHP All Commercial |
$75.83
|
| Rate for Payer: PHP All Commercial |
$75.83
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$59.73
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$59.73
|
| Rate for Payer: Sagamore Health Network All Products |
$59.73
|
| Rate for Payer: Sagamore Health Network All Products |
$59.73
|
| Rate for Payer: Signature Care EPO |
$138.55
|
| Rate for Payer: Signature Care EPO |
$138.55
|
| Rate for Payer: Signature Care PPO |
$138.55
|
| Rate for Payer: Signature Care PPO |
$138.55
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$7,700.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$7,700.00
|
| Rate for Payer: United Healthcare Commercial |
$99.91
|
| Rate for Payer: United Healthcare Commercial |
$99.91
|
| Rate for Payer: United Healthcare Medicare |
$92.98
|
| Rate for Payer: United Healthcare Medicare |
$92.98
|
|
|
PR BIOPSY OF VAGINA,EXTENSIVE
|
Professional
|
Both
|
$330.22
|
|
|
Service Code
|
CPT 57105
|
| Hospital Charge Code |
z57105
|
| Min. Negotiated Rate |
$92.84 |
| Max. Negotiated Rate |
$17,900.00 |
| Rate for Payer: Aetna Commercial |
$138.06
|
| Rate for Payer: Aetna Commercial |
$138.06
|
| Rate for Payer: Aetna Medicare |
$138.06
|
| Rate for Payer: Aetna Medicare |
$138.06
|
| 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 |
$92.84
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$92.84
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$162.42
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$162.42
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$158.77
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$158.77
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$151.87
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$151.87
|
| Rate for Payer: Cash Price |
$194.47
|
| Rate for Payer: Cash Price |
$198.13
|
| Rate for Payer: Centivo All Commercial |
$213.99
|
| Rate for Payer: Centivo All Commercial |
$213.99
|
| Rate for Payer: Cigna All Commercial |
$138.06
|
| Rate for Payer: Cigna All Commercial |
$138.06
|
| Rate for Payer: CORVEL All Commercial |
$138.06
|
| Rate for Payer: CORVEL All Commercial |
$138.06
|
| Rate for Payer: Coventry All Commercial |
$165.67
|
| Rate for Payer: Coventry All Commercial |
$165.67
|
| Rate for Payer: Encore All Commercial |
$138.06
|
| Rate for Payer: Encore All Commercial |
$138.06
|
| Rate for Payer: Frontpath All Commercial |
$188.50
|
| Rate for Payer: Frontpath All Commercial |
$188.50
|
| Rate for Payer: Humana ChoiceCare |
$135.85
|
| Rate for Payer: Humana ChoiceCare |
$135.85
|
| Rate for Payer: Humana Medicare |
$138.06
|
| Rate for Payer: Humana Medicare |
$138.06
|
| Rate for Payer: Lucent All Commercial |
$193.28
|
| Rate for Payer: Lucent All Commercial |
$193.28
|
| Rate for Payer: Lutheran Preferred All Commercial |
$192.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$192.00
|
| Rate for Payer: Managed Health Services Medicaid |
$162.42
|
| Rate for Payer: Managed Health Services Medicaid |
$162.42
|
| Rate for Payer: MDWise Medicaid |
$162.42
|
| Rate for Payer: MDWise Medicaid |
$162.42
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$92.84
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$92.84
|
| Rate for Payer: PHCS All Commercial |
$138.06
|
| Rate for Payer: PHCS All Commercial |
$138.06
|
| Rate for Payer: PHP All Commercial |
$176.95
|
| Rate for Payer: PHP All Commercial |
$176.95
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$138.06
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$138.06
|
| Rate for Payer: Sagamore Health Network All Products |
$138.06
|
| Rate for Payer: Sagamore Health Network All Products |
$138.06
|
| Rate for Payer: Signature Care EPO |
$176.80
|
| Rate for Payer: Signature Care EPO |
$176.80
|
| Rate for Payer: Signature Care PPO |
$176.80
|
| Rate for Payer: Signature Care PPO |
$176.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$17,900.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$17,900.00
|
| Rate for Payer: United Healthcare Commercial |
$139.19
|
| Rate for Payer: United Healthcare Commercial |
$139.19
|
| Rate for Payer: United Healthcare Medicare |
$162.06
|
| Rate for Payer: United Healthcare Medicare |
$162.06
|
|
|
PR BIOPSY OF VAGINA,SIMPLE
|
Professional
|
Both
|
$192.54
|
|
|
Service Code
|
CPT 57100
|
| Hospital Charge Code |
z57100
|
| Min. Negotiated Rate |
$39.53 |
| Max. Negotiated Rate |
$7,900.00 |
| Rate for Payer: Aetna Commercial |
$61.56
|
| Rate for Payer: Aetna Commercial |
$61.56
|
| Rate for Payer: Aetna Medicare |
$61.56
|
| Rate for Payer: Aetna Medicare |
$61.56
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$118.46
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$118.46
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$118.46
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$118.46
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$118.46
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$118.46
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$118.46
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$118.46
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$39.53
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$39.53
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$94.70
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$94.70
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$70.79
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$70.79
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$67.72
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$67.72
|
| Rate for Payer: Cash Price |
$113.35
|
| Rate for Payer: Cash Price |
$115.52
|
| Rate for Payer: Centivo All Commercial |
$95.42
|
| Rate for Payer: Centivo All Commercial |
$95.42
|
| Rate for Payer: Cigna All Commercial |
$61.56
|
| Rate for Payer: Cigna All Commercial |
$61.56
|
| Rate for Payer: CORVEL All Commercial |
$61.56
|
| Rate for Payer: CORVEL All Commercial |
$61.56
|
| Rate for Payer: Coventry All Commercial |
$73.87
|
| Rate for Payer: Coventry All Commercial |
$73.87
|
| Rate for Payer: Encore All Commercial |
$61.56
|
| Rate for Payer: Encore All Commercial |
$61.56
|
| Rate for Payer: Frontpath All Commercial |
$86.01
|
| Rate for Payer: Frontpath All Commercial |
$86.01
|
| Rate for Payer: Humana ChoiceCare |
$75.20
|
| Rate for Payer: Humana ChoiceCare |
$75.20
|
| Rate for Payer: Humana Medicare |
$61.56
|
| Rate for Payer: Humana Medicare |
$61.56
|
| Rate for Payer: Lucent All Commercial |
$86.18
|
| Rate for Payer: Lucent All Commercial |
$86.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$85.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$85.00
|
| Rate for Payer: Managed Health Services Medicaid |
$94.70
|
| Rate for Payer: Managed Health Services Medicaid |
$94.70
|
| Rate for Payer: MDWise Medicaid |
$94.70
|
| Rate for Payer: MDWise Medicaid |
$94.70
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$39.53
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$39.53
|
| Rate for Payer: PHCS All Commercial |
$61.56
|
| Rate for Payer: PHCS All Commercial |
$61.56
|
| Rate for Payer: PHP All Commercial |
$78.17
|
| Rate for Payer: PHP All Commercial |
$78.17
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$61.56
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$61.56
|
| Rate for Payer: Sagamore Health Network All Products |
$61.56
|
| Rate for Payer: Sagamore Health Network All Products |
$61.56
|
| Rate for Payer: Signature Care EPO |
$112.20
|
| Rate for Payer: Signature Care EPO |
$112.20
|
| Rate for Payer: Signature Care PPO |
$112.20
|
| Rate for Payer: Signature Care PPO |
$112.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$7,900.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$7,900.00
|
| Rate for Payer: United Healthcare Commercial |
$74.85
|
| Rate for Payer: United Healthcare Commercial |
$74.85
|
| Rate for Payer: United Healthcare Medicare |
$94.46
|
| Rate for Payer: United Healthcare Medicare |
$94.46
|
|
|
PR BIOPSY OROPHARYNX
|
Professional
|
Both
|
$296.00
|
|
|
Service Code
|
CPT 42800
|
| Hospital Charge Code |
z42800
|
| Min. Negotiated Rate |
$67.03 |
| Max. Negotiated Rate |
$15,300.00 |
| Rate for Payer: Aetna Commercial |
$108.49
|
| Rate for Payer: Aetna Commercial |
$108.49
|
| Rate for Payer: Aetna Medicare |
$108.49
|
| Rate for Payer: Aetna Medicare |
$108.49
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$144.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$144.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$144.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$144.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$144.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$144.50
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$144.50
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$144.50
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$67.03
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$67.03
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$145.59
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$145.59
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$124.76
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$124.76
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$119.34
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$119.34
|
| Rate for Payer: Cash Price |
$174.38
|
| Rate for Payer: Cash Price |
$177.60
|
| Rate for Payer: Centivo All Commercial |
$168.16
|
| Rate for Payer: Centivo All Commercial |
$168.16
|
| Rate for Payer: Cigna All Commercial |
$108.49
|
| Rate for Payer: Cigna All Commercial |
$108.49
|
| Rate for Payer: CORVEL All Commercial |
$108.49
|
| Rate for Payer: CORVEL All Commercial |
$108.49
|
| Rate for Payer: Coventry All Commercial |
$130.19
|
| Rate for Payer: Coventry All Commercial |
$130.19
|
| Rate for Payer: Encore All Commercial |
$108.49
|
| Rate for Payer: Encore All Commercial |
$108.49
|
| Rate for Payer: Frontpath All Commercial |
$147.73
|
| Rate for Payer: Frontpath All Commercial |
$147.73
|
| Rate for Payer: Humana ChoiceCare |
$122.76
|
| Rate for Payer: Humana ChoiceCare |
$122.76
|
| Rate for Payer: Humana Medicare |
$108.49
|
| Rate for Payer: Humana Medicare |
$108.49
|
| Rate for Payer: Lucent All Commercial |
$151.89
|
| Rate for Payer: Lucent All Commercial |
$151.89
|
| Rate for Payer: Lutheran Preferred All Commercial |
$164.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$164.00
|
| Rate for Payer: Managed Health Services Medicaid |
$145.59
|
| Rate for Payer: Managed Health Services Medicaid |
$145.59
|
| Rate for Payer: MDWise Medicaid |
$145.59
|
| Rate for Payer: MDWise Medicaid |
$145.59
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$67.03
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$67.03
|
| Rate for Payer: PHCS All Commercial |
$108.49
|
| Rate for Payer: PHCS All Commercial |
$108.49
|
| Rate for Payer: PHP All Commercial |
$186.84
|
| Rate for Payer: PHP All Commercial |
$186.84
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$108.49
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$108.49
|
| Rate for Payer: Sagamore Health Network All Products |
$108.49
|
| Rate for Payer: Sagamore Health Network All Products |
$108.49
|
| Rate for Payer: Signature Care EPO |
$199.75
|
| Rate for Payer: Signature Care EPO |
$199.75
|
| Rate for Payer: Signature Care PPO |
$199.75
|
| Rate for Payer: Signature Care PPO |
$199.75
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$15,300.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$15,300.00
|
| Rate for Payer: United Healthcare Commercial |
$121.59
|
| Rate for Payer: United Healthcare Commercial |
$121.59
|
| Rate for Payer: United Healthcare Medicare |
$145.32
|
| Rate for Payer: United Healthcare Medicare |
$145.32
|
|
|
PR BIOPSY TONGUE,ANTER 2/3
|
Professional
|
Both
|
$348.66
|
|
|
Service Code
|
CPT 41100
|
| Hospital Charge Code |
z41100
|
| Min. Negotiated Rate |
$76.21 |
| Max. Negotiated Rate |
$14,100.00 |
| Rate for Payer: Aetna Commercial |
$100.79
|
| Rate for Payer: Aetna Commercial |
$100.79
|
| Rate for Payer: Aetna Medicare |
$100.79
|
| Rate for Payer: Aetna Medicare |
$100.79
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$252.83
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$252.83
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$252.83
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$252.83
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$252.83
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$252.83
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$252.83
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$252.83
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$76.21
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$76.21
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$171.48
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$171.48
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$115.91
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$115.91
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$110.87
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$110.87
|
| Rate for Payer: Cash Price |
$206.29
|
| Rate for Payer: Cash Price |
$209.20
|
| Rate for Payer: Centivo All Commercial |
$156.22
|
| Rate for Payer: Centivo All Commercial |
$156.22
|
| Rate for Payer: Cigna All Commercial |
$100.79
|
| Rate for Payer: Cigna All Commercial |
$100.79
|
| Rate for Payer: CORVEL All Commercial |
$100.79
|
| Rate for Payer: CORVEL All Commercial |
$100.79
|
| Rate for Payer: Coventry All Commercial |
$120.95
|
| Rate for Payer: Coventry All Commercial |
$120.95
|
| Rate for Payer: Encore All Commercial |
$100.79
|
| Rate for Payer: Encore All Commercial |
$100.79
|
| Rate for Payer: Frontpath All Commercial |
$137.31
|
| Rate for Payer: Frontpath All Commercial |
$137.31
|
| Rate for Payer: Humana ChoiceCare |
$135.27
|
| Rate for Payer: Humana ChoiceCare |
$135.27
|
| Rate for Payer: Humana Medicare |
$100.79
|
| Rate for Payer: Humana Medicare |
$100.79
|
| Rate for Payer: Lucent All Commercial |
$141.11
|
| Rate for Payer: Lucent All Commercial |
$141.11
|
| Rate for Payer: Lutheran Preferred All Commercial |
$151.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$151.00
|
| Rate for Payer: Managed Health Services Medicaid |
$171.48
|
| Rate for Payer: Managed Health Services Medicaid |
$171.48
|
| Rate for Payer: MDWise Medicaid |
$171.48
|
| Rate for Payer: MDWise Medicaid |
$171.48
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$76.21
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$76.21
|
| Rate for Payer: PHCS All Commercial |
$100.79
|
| Rate for Payer: PHCS All Commercial |
$100.79
|
| Rate for Payer: PHP All Commercial |
$172.24
|
| Rate for Payer: PHP All Commercial |
$172.24
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$100.79
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$100.79
|
| Rate for Payer: Sagamore Health Network All Products |
$100.79
|
| Rate for Payer: Sagamore Health Network All Products |
$100.79
|
| Rate for Payer: Signature Care EPO |
$231.20
|
| Rate for Payer: Signature Care EPO |
$231.20
|
| Rate for Payer: Signature Care PPO |
$231.20
|
| Rate for Payer: Signature Care PPO |
$231.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$14,100.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$14,100.00
|
| Rate for Payer: United Healthcare Commercial |
$118.45
|
| Rate for Payer: United Healthcare Commercial |
$118.45
|
| Rate for Payer: United Healthcare Medicare |
$171.91
|
| Rate for Payer: United Healthcare Medicare |
$171.91
|
|
|
PR BIOPSY TONGUE,POSTER 1/3
|
Professional
|
Both
|
$350.14
|
|
|
Service Code
|
CPT 41105
|
| Hospital Charge Code |
z41105
|
| Min. Negotiated Rate |
$75.25 |
| Max. Negotiated Rate |
$14,500.00 |
| Rate for Payer: Aetna Commercial |
$103.14
|
| Rate for Payer: Aetna Commercial |
$103.14
|
| Rate for Payer: Aetna Medicare |
$103.14
|
| Rate for Payer: Aetna Medicare |
$103.14
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$144.90
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$144.90
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$144.90
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$144.90
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$144.90
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$144.90
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$144.90
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$144.90
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$75.25
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$75.25
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$172.21
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$172.21
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$118.61
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$118.61
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$113.45
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$113.45
|
| Rate for Payer: Cash Price |
$206.47
|
| Rate for Payer: Cash Price |
$210.08
|
| Rate for Payer: Centivo All Commercial |
$159.87
|
| Rate for Payer: Centivo All Commercial |
$159.87
|
| Rate for Payer: Cigna All Commercial |
$103.14
|
| Rate for Payer: Cigna All Commercial |
$103.14
|
| Rate for Payer: CORVEL All Commercial |
$103.14
|
| Rate for Payer: CORVEL All Commercial |
$103.14
|
| Rate for Payer: Coventry All Commercial |
$123.77
|
| Rate for Payer: Coventry All Commercial |
$123.77
|
| Rate for Payer: Encore All Commercial |
$103.14
|
| Rate for Payer: Encore All Commercial |
$103.14
|
| Rate for Payer: Frontpath All Commercial |
$140.39
|
| Rate for Payer: Frontpath All Commercial |
$140.39
|
| Rate for Payer: Humana ChoiceCare |
$121.23
|
| Rate for Payer: Humana ChoiceCare |
$121.23
|
| Rate for Payer: Humana Medicare |
$103.14
|
| Rate for Payer: Humana Medicare |
$103.14
|
| Rate for Payer: Lucent All Commercial |
$144.40
|
| Rate for Payer: Lucent All Commercial |
$144.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$155.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$155.00
|
| Rate for Payer: Managed Health Services Medicaid |
$172.21
|
| Rate for Payer: Managed Health Services Medicaid |
$172.21
|
| Rate for Payer: MDWise Medicaid |
$172.21
|
| Rate for Payer: MDWise Medicaid |
$172.21
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$75.25
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$75.25
|
| Rate for Payer: PHCS All Commercial |
$103.14
|
| Rate for Payer: PHCS All Commercial |
$103.14
|
| Rate for Payer: PHP All Commercial |
$176.71
|
| Rate for Payer: PHP All Commercial |
$176.71
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$103.14
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$103.14
|
| Rate for Payer: Sagamore Health Network All Products |
$103.14
|
| Rate for Payer: Sagamore Health Network All Products |
$103.14
|
| Rate for Payer: Signature Care EPO |
$214.20
|
| Rate for Payer: Signature Care EPO |
$214.20
|
| Rate for Payer: Signature Care PPO |
$214.20
|
| Rate for Payer: Signature Care PPO |
$214.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$14,500.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$14,500.00
|
| Rate for Payer: United Healthcare Commercial |
$120.16
|
| Rate for Payer: United Healthcare Commercial |
$120.16
|
| Rate for Payer: United Healthcare Medicare |
$172.06
|
| Rate for Payer: United Healthcare Medicare |
$172.06
|
|
|
PR BIOPSY VULVA/PERINEUM,ONE LESN
|
Professional
|
Both
|
$179.10
|
|
|
Service Code
|
CPT 56605
|
| Hospital Charge Code |
z56605
|
| Min. Negotiated Rate |
$30.31 |
| Max. Negotiated Rate |
$7,200.00 |
| Rate for Payer: Aetna Commercial |
$55.60
|
| Rate for Payer: Aetna Commercial |
$55.60
|
| Rate for Payer: Aetna Medicare |
$55.60
|
| Rate for Payer: Aetna Medicare |
$55.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$112.58
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$112.58
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$112.58
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$112.58
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$112.58
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$112.58
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$112.58
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$112.58
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$30.31
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$30.31
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$88.09
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$88.09
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$63.94
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$63.94
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$61.16
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$61.16
|
| Rate for Payer: Cash Price |
$105.95
|
| Rate for Payer: Cash Price |
$107.46
|
| Rate for Payer: Centivo All Commercial |
$86.18
|
| Rate for Payer: Centivo All Commercial |
$86.18
|
| Rate for Payer: Cigna All Commercial |
$55.60
|
| Rate for Payer: Cigna All Commercial |
$55.60
|
| Rate for Payer: CORVEL All Commercial |
$55.60
|
| Rate for Payer: CORVEL All Commercial |
$55.60
|
| Rate for Payer: Coventry All Commercial |
$66.72
|
| Rate for Payer: Coventry All Commercial |
$66.72
|
| Rate for Payer: Encore All Commercial |
$55.60
|
| Rate for Payer: Encore All Commercial |
$55.60
|
| Rate for Payer: Frontpath All Commercial |
$77.65
|
| Rate for Payer: Frontpath All Commercial |
$77.65
|
| Rate for Payer: Humana ChoiceCare |
$69.77
|
| Rate for Payer: Humana ChoiceCare |
$69.77
|
| Rate for Payer: Humana Medicare |
$55.60
|
| Rate for Payer: Humana Medicare |
$55.60
|
| Rate for Payer: Lucent All Commercial |
$77.84
|
| Rate for Payer: Lucent All Commercial |
$77.84
|
| Rate for Payer: Lutheran Preferred All Commercial |
$77.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$77.00
|
| Rate for Payer: Managed Health Services Medicaid |
$88.09
|
| Rate for Payer: Managed Health Services Medicaid |
$88.09
|
| Rate for Payer: MDWise Medicaid |
$88.09
|
| Rate for Payer: MDWise Medicaid |
$88.09
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$30.31
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$30.31
|
| Rate for Payer: PHCS All Commercial |
$55.60
|
| Rate for Payer: PHCS All Commercial |
$55.60
|
| Rate for Payer: PHP All Commercial |
$71.22
|
| Rate for Payer: PHP All Commercial |
$71.22
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$55.60
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$55.60
|
| Rate for Payer: Sagamore Health Network All Products |
$55.60
|
| Rate for Payer: Sagamore Health Network All Products |
$55.60
|
| Rate for Payer: Signature Care EPO |
$107.10
|
| Rate for Payer: Signature Care EPO |
$107.10
|
| Rate for Payer: Signature Care PPO |
$107.10
|
| Rate for Payer: Signature Care PPO |
$107.10
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$7,200.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$7,200.00
|
| Rate for Payer: United Healthcare Commercial |
$69.24
|
| Rate for Payer: United Healthcare Commercial |
$69.24
|
| Rate for Payer: United Healthcare Medicare |
$88.29
|
| Rate for Payer: United Healthcare Medicare |
$88.29
|
|
|
PR BX/REMV,LYMPH NODE,DEEP AXILL
|
Professional
|
Both
|
$805.38
|
|
|
Service Code
|
CPT 38525
|
| Hospital Charge Code |
z38525
|
| Min. Negotiated Rate |
$393.50 |
| Max. Negotiated Rate |
$60,600.00 |
| Rate for Payer: Aetna Commercial |
$407.88
|
| Rate for Payer: Aetna Commercial |
$407.88
|
| Rate for Payer: Aetna Medicare |
$407.88
|
| Rate for Payer: Aetna Medicare |
$407.88
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$393.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$393.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$393.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$393.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$393.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$393.50
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$393.50
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$393.50
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$396.12
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$396.12
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$469.06
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$469.06
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$448.67
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$448.67
|
| Rate for Payer: Cash Price |
$483.23
|
| Rate for Payer: Cash Price |
$473.34
|
| Rate for Payer: Centivo All Commercial |
$632.21
|
| Rate for Payer: Centivo All Commercial |
$632.21
|
| Rate for Payer: Cigna All Commercial |
$407.88
|
| Rate for Payer: Cigna All Commercial |
$407.88
|
| Rate for Payer: CORVEL All Commercial |
$407.88
|
| Rate for Payer: CORVEL All Commercial |
$407.88
|
| Rate for Payer: Coventry All Commercial |
$489.46
|
| Rate for Payer: Coventry All Commercial |
$489.46
|
| Rate for Payer: Encore All Commercial |
$407.88
|
| Rate for Payer: Encore All Commercial |
$407.88
|
| Rate for Payer: Frontpath All Commercial |
$578.24
|
| Rate for Payer: Frontpath All Commercial |
$578.24
|
| Rate for Payer: Humana ChoiceCare |
$464.81
|
| Rate for Payer: Humana ChoiceCare |
$464.81
|
| Rate for Payer: Humana Medicare |
$407.88
|
| Rate for Payer: Humana Medicare |
$407.88
|
| Rate for Payer: Lucent All Commercial |
$571.03
|
| Rate for Payer: Lucent All Commercial |
$571.03
|
| Rate for Payer: Lutheran Preferred All Commercial |
$647.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$647.00
|
| Rate for Payer: Managed Health Services Medicaid |
$396.12
|
| Rate for Payer: Managed Health Services Medicaid |
$396.12
|
| Rate for Payer: MDWise Medicaid |
$396.12
|
| Rate for Payer: MDWise Medicaid |
$396.12
|
| Rate for Payer: PHCS All Commercial |
$407.88
|
| Rate for Payer: PHCS All Commercial |
$407.88
|
| Rate for Payer: PHP All Commercial |
$552.23
|
| Rate for Payer: PHP All Commercial |
$552.23
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$407.88
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$407.88
|
| Rate for Payer: Sagamore Health Network All Products |
$407.88
|
| Rate for Payer: Sagamore Health Network All Products |
$407.88
|
| Rate for Payer: Signature Care EPO |
$499.80
|
| Rate for Payer: Signature Care EPO |
$499.80
|
| Rate for Payer: Signature Care PPO |
$499.80
|
| Rate for Payer: Signature Care PPO |
$499.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$60,600.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$60,600.00
|
| Rate for Payer: United Healthcare Commercial |
$451.91
|
| Rate for Payer: United Healthcare Commercial |
$451.91
|
| Rate for Payer: United Healthcare Medicare |
$394.45
|
| Rate for Payer: United Healthcare Medicare |
$394.45
|
|
|
PR BX/REMV,LYMPH NODE,DEEP CERV
|
Professional
|
Both
|
$974.06
|
|
|
Service Code
|
CPT 38510
|
| Hospital Charge Code |
z38510
|
| Min. Negotiated Rate |
$214.91 |
| Max. Negotiated Rate |
$58,300.00 |
| Rate for Payer: Aetna Commercial |
$390.73
|
| Rate for Payer: Aetna Commercial |
$390.73
|
| Rate for Payer: Aetna Medicare |
$390.73
|
| Rate for Payer: Aetna Medicare |
$390.73
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$486.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$486.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$486.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$486.60
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$486.60
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$486.60
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$486.60
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$486.60
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$214.91
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$214.91
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$479.08
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$479.08
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$449.34
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$449.34
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$429.80
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$429.80
|
| Rate for Payer: Cash Price |
$576.31
|
| Rate for Payer: Cash Price |
$584.44
|
| Rate for Payer: Centivo All Commercial |
$605.63
|
| Rate for Payer: Centivo All Commercial |
$605.63
|
| Rate for Payer: Cigna All Commercial |
$390.73
|
| Rate for Payer: Cigna All Commercial |
$390.73
|
| Rate for Payer: CORVEL All Commercial |
$390.73
|
| Rate for Payer: CORVEL All Commercial |
$390.73
|
| Rate for Payer: Coventry All Commercial |
$468.88
|
| Rate for Payer: Coventry All Commercial |
$468.88
|
| Rate for Payer: Encore All Commercial |
$390.73
|
| Rate for Payer: Encore All Commercial |
$390.73
|
| Rate for Payer: Frontpath All Commercial |
$547.03
|
| Rate for Payer: Frontpath All Commercial |
$547.03
|
| Rate for Payer: Humana ChoiceCare |
$489.41
|
| Rate for Payer: Humana ChoiceCare |
$489.41
|
| Rate for Payer: Humana Medicare |
$390.73
|
| Rate for Payer: Humana Medicare |
$390.73
|
| Rate for Payer: Lucent All Commercial |
$547.02
|
| Rate for Payer: Lucent All Commercial |
$547.02
|
| Rate for Payer: Lutheran Preferred All Commercial |
$622.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$622.00
|
| Rate for Payer: Managed Health Services Medicaid |
$479.08
|
| Rate for Payer: Managed Health Services Medicaid |
$479.08
|
| Rate for Payer: MDWise Medicaid |
$479.08
|
| Rate for Payer: MDWise Medicaid |
$479.08
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$214.91
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$214.91
|
| Rate for Payer: PHCS All Commercial |
$390.73
|
| Rate for Payer: PHCS All Commercial |
$390.73
|
| Rate for Payer: PHP All Commercial |
$530.69
|
| Rate for Payer: PHP All Commercial |
$530.69
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$390.73
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$390.73
|
| Rate for Payer: Sagamore Health Network All Products |
$390.73
|
| Rate for Payer: Sagamore Health Network All Products |
$390.73
|
| Rate for Payer: Signature Care EPO |
$627.30
|
| Rate for Payer: Signature Care EPO |
$627.30
|
| Rate for Payer: Signature Care PPO |
$627.30
|
| Rate for Payer: Signature Care PPO |
$627.30
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$58,300.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$58,300.00
|
| Rate for Payer: United Healthcare Commercial |
$456.80
|
| Rate for Payer: United Healthcare Commercial |
$456.80
|
| Rate for Payer: United Healthcare Medicare |
$480.26
|
| Rate for Payer: United Healthcare Medicare |
$480.26
|
|
|
PR BX,VULVA/PERINEUM,ADDL LESION
|
Professional
|
Both
|
$70.22
|
|
|
Service Code
|
CPT 56606
|
| Hospital Charge Code |
z56606
|
| Min. Negotiated Rate |
$20.24 |
| Max. Negotiated Rate |
$3,600.00 |
| Rate for Payer: Aetna Commercial |
$27.33
|
| Rate for Payer: Aetna Medicare |
$27.33
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$54.33
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$54.33
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$54.33
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$54.33
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$20.24
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$34.53
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$31.43
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$30.06
|
| Rate for Payer: Cash Price |
$42.13
|
| Rate for Payer: Centivo All Commercial |
$42.36
|
| Rate for Payer: Cigna All Commercial |
$27.33
|
| Rate for Payer: CORVEL All Commercial |
$27.33
|
| Rate for Payer: Coventry All Commercial |
$32.80
|
| Rate for Payer: Encore All Commercial |
$27.33
|
| Rate for Payer: Frontpath All Commercial |
$38.21
|
| Rate for Payer: Humana ChoiceCare |
$34.57
|
| Rate for Payer: Humana Medicare |
$27.33
|
| Rate for Payer: Lucent All Commercial |
$38.26
|
| Rate for Payer: Lutheran Preferred All Commercial |
$38.00
|
| Rate for Payer: Managed Health Services Medicaid |
$34.53
|
| Rate for Payer: MDWise Medicaid |
$34.53
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$20.24
|
| Rate for Payer: PHCS All Commercial |
$27.33
|
| Rate for Payer: PHP All Commercial |
$35.22
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$27.33
|
| Rate for Payer: Sagamore Health Network All Products |
$27.33
|
| Rate for Payer: Signature Care EPO |
$51.00
|
| Rate for Payer: Signature Care PPO |
$51.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,600.00
|
| Rate for Payer: United Healthcare Commercial |
$34.14
|
| Rate for Payer: United Healthcare Medicare |
$35.11
|
|
|
PR CANALITH REPOSITIONING PROCEDURE, PER DAY
|
Professional
|
Both
|
$80.98
|
|
|
Service Code
|
CPT 95992
|
| Hospital Charge Code |
z95992
|
| Min. Negotiated Rate |
$18.52 |
| Max. Negotiated Rate |
$4,200.00 |
| Rate for Payer: Aetna Commercial |
$35.32
|
| Rate for Payer: Aetna Commercial |
$35.32
|
| Rate for Payer: Aetna Medicare |
$35.32
|
| Rate for Payer: Aetna Medicare |
$35.32
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$41.76
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$41.76
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$41.76
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$41.76
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$41.76
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$41.76
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$41.76
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$41.76
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$18.52
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$18.52
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$39.83
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$39.83
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$40.62
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$40.62
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$38.85
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$38.85
|
| Rate for Payer: Cash Price |
$48.58
|
| Rate for Payer: Cash Price |
$48.59
|
| Rate for Payer: Centivo All Commercial |
$54.75
|
| Rate for Payer: Centivo All Commercial |
$54.75
|
| Rate for Payer: Cigna All Commercial |
$35.32
|
| Rate for Payer: Cigna All Commercial |
$35.32
|
| Rate for Payer: CORVEL All Commercial |
$35.32
|
| Rate for Payer: CORVEL All Commercial |
$35.32
|
| Rate for Payer: Coventry All Commercial |
$42.38
|
| Rate for Payer: Coventry All Commercial |
$42.38
|
| Rate for Payer: Encore All Commercial |
$35.32
|
| Rate for Payer: Encore All Commercial |
$35.32
|
| Rate for Payer: Frontpath All Commercial |
$39.95
|
| Rate for Payer: Frontpath All Commercial |
$39.95
|
| Rate for Payer: Humana ChoiceCare |
$46.67
|
| Rate for Payer: Humana ChoiceCare |
$46.67
|
| Rate for Payer: Humana Medicare |
$35.32
|
| Rate for Payer: Humana Medicare |
$35.32
|
| Rate for Payer: Lucent All Commercial |
$49.45
|
| Rate for Payer: Lucent All Commercial |
$49.45
|
| Rate for Payer: Lutheran Preferred All Commercial |
$45.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$45.00
|
| Rate for Payer: Managed Health Services Medicaid |
$39.83
|
| Rate for Payer: Managed Health Services Medicaid |
$39.83
|
| Rate for Payer: MDWise Medicaid |
$39.83
|
| Rate for Payer: MDWise Medicaid |
$39.83
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$18.52
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$18.52
|
| Rate for Payer: PHCS All Commercial |
$35.32
|
| Rate for Payer: PHCS All Commercial |
$35.32
|
| Rate for Payer: PHP All Commercial |
$55.86
|
| Rate for Payer: PHP All Commercial |
$55.86
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$35.32
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$35.32
|
| Rate for Payer: Sagamore Health Network All Products |
$35.32
|
| Rate for Payer: Sagamore Health Network All Products |
$35.32
|
| Rate for Payer: Signature Care EPO |
$45.21
|
| Rate for Payer: Signature Care EPO |
$45.21
|
| Rate for Payer: Signature Care PPO |
$45.21
|
| Rate for Payer: Signature Care PPO |
$45.21
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,200.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,200.00
|
| Rate for Payer: United Healthcare Commercial |
$44.70
|
| Rate for Payer: United Healthcare Commercial |
$44.70
|
| Rate for Payer: United Healthcare Medicare |
$40.48
|
| Rate for Payer: United Healthcare Medicare |
$40.48
|
|
|
PR CARDIAC STRESS TST,INTERP/REPT ONLY
|
Professional
|
Both
|
$26.44
|
|
|
Service Code
|
CPT 93018
|
| Hospital Charge Code |
z93018
|
| Min. Negotiated Rate |
$13.00 |
| Max. Negotiated Rate |
$2,000.00 |
| Rate for Payer: Aetna Commercial |
$13.97
|
| Rate for Payer: Aetna Commercial |
$13.97
|
| Rate for Payer: Aetna Medicare |
$13.97
|
| Rate for Payer: Aetna Medicare |
$13.97
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$24.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$24.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$24.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$24.60
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$24.60
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$24.60
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$24.60
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$24.60
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$13.00
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$13.00
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$16.07
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$16.07
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$15.37
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$15.37
|
| Rate for Payer: Cash Price |
$15.86
|
| Rate for Payer: Cash Price |
$15.71
|
| Rate for Payer: Centivo All Commercial |
$21.65
|
| Rate for Payer: Centivo All Commercial |
$21.65
|
| Rate for Payer: Cigna All Commercial |
$13.97
|
| Rate for Payer: Cigna All Commercial |
$13.97
|
| Rate for Payer: CORVEL All Commercial |
$13.97
|
| Rate for Payer: CORVEL All Commercial |
$13.97
|
| Rate for Payer: Coventry All Commercial |
$16.76
|
| Rate for Payer: Coventry All Commercial |
$16.76
|
| Rate for Payer: Encore All Commercial |
$13.97
|
| Rate for Payer: Encore All Commercial |
$13.97
|
| Rate for Payer: Frontpath All Commercial |
$15.66
|
| Rate for Payer: Frontpath All Commercial |
$15.66
|
| Rate for Payer: Humana ChoiceCare |
$20.81
|
| Rate for Payer: Humana ChoiceCare |
$20.81
|
| Rate for Payer: Humana Medicare |
$13.97
|
| Rate for Payer: Humana Medicare |
$13.97
|
| Rate for Payer: Lucent All Commercial |
$19.56
|
| Rate for Payer: Lucent All Commercial |
$19.56
|
| Rate for Payer: Lutheran Preferred All Commercial |
$21.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$21.00
|
| Rate for Payer: Managed Health Services Medicaid |
$13.00
|
| Rate for Payer: Managed Health Services Medicaid |
$13.00
|
| Rate for Payer: MDWise Medicaid |
$13.00
|
| Rate for Payer: MDWise Medicaid |
$13.00
|
| Rate for Payer: PHCS All Commercial |
$13.97
|
| Rate for Payer: PHCS All Commercial |
$13.97
|
| Rate for Payer: PHP All Commercial |
$19.24
|
| Rate for Payer: PHP All Commercial |
$19.24
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$13.97
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$13.97
|
| Rate for Payer: Sagamore Health Network All Products |
$13.97
|
| Rate for Payer: Sagamore Health Network All Products |
$13.97
|
| Rate for Payer: Signature Care EPO |
$23.75
|
| Rate for Payer: Signature Care EPO |
$23.75
|
| Rate for Payer: Signature Care PPO |
$23.75
|
| Rate for Payer: Signature Care PPO |
$23.75
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,000.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,000.00
|
| Rate for Payer: United Healthcare Commercial |
$19.59
|
| Rate for Payer: United Healthcare Commercial |
$19.59
|
| Rate for Payer: United Healthcare Medicare |
$13.09
|
| Rate for Payer: United Healthcare Medicare |
$13.09
|
|
|
PR CARDIOVERSION ELECTIVE ARRHYTHMIA EXTERNAL
|
Professional
|
Both
|
$287.76
|
|
|
Service Code
|
CPT 92960
|
| Hospital Charge Code |
z92960
|
| Min. Negotiated Rate |
$55.81 |
| Max. Negotiated Rate |
$15,300.00 |
| Rate for Payer: Aetna Commercial |
$103.23
|
| Rate for Payer: Aetna Commercial |
$103.23
|
| Rate for Payer: Aetna Medicare |
$103.23
|
| Rate for Payer: Aetna Medicare |
$103.23
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$239.93
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$239.93
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$239.93
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$239.93
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$239.93
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$239.93
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$239.93
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$239.93
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$55.81
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$55.81
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$141.53
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$141.53
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$118.71
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$118.71
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$113.55
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$113.55
|
| Rate for Payer: Cash Price |
$171.10
|
| Rate for Payer: Cash Price |
$172.66
|
| Rate for Payer: Centivo All Commercial |
$160.01
|
| Rate for Payer: Centivo All Commercial |
$160.01
|
| Rate for Payer: Cigna All Commercial |
$103.23
|
| Rate for Payer: Cigna All Commercial |
$103.23
|
| Rate for Payer: CORVEL All Commercial |
$103.23
|
| Rate for Payer: CORVEL All Commercial |
$103.23
|
| Rate for Payer: Coventry All Commercial |
$123.88
|
| Rate for Payer: Coventry All Commercial |
$123.88
|
| Rate for Payer: Encore All Commercial |
$103.23
|
| Rate for Payer: Encore All Commercial |
$103.23
|
| Rate for Payer: Frontpath All Commercial |
$117.41
|
| Rate for Payer: Frontpath All Commercial |
$117.41
|
| Rate for Payer: Humana ChoiceCare |
$172.05
|
| Rate for Payer: Humana ChoiceCare |
$172.05
|
| Rate for Payer: Humana Medicare |
$103.23
|
| Rate for Payer: Humana Medicare |
$103.23
|
| Rate for Payer: Lucent All Commercial |
$144.52
|
| Rate for Payer: Lucent All Commercial |
$144.52
|
| Rate for Payer: Lutheran Preferred All Commercial |
$163.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$163.00
|
| Rate for Payer: Managed Health Services Medicaid |
$141.53
|
| Rate for Payer: Managed Health Services Medicaid |
$141.53
|
| Rate for Payer: MDWise Medicaid |
$141.53
|
| Rate for Payer: MDWise Medicaid |
$141.53
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$55.81
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$55.81
|
| Rate for Payer: PHCS All Commercial |
$103.23
|
| Rate for Payer: PHCS All Commercial |
$103.23
|
| Rate for Payer: PHP All Commercial |
$146.28
|
| Rate for Payer: PHP All Commercial |
$146.28
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$103.23
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$103.23
|
| Rate for Payer: Sagamore Health Network All Products |
$103.23
|
| Rate for Payer: Sagamore Health Network All Products |
$103.23
|
| Rate for Payer: Signature Care EPO |
$251.74
|
| Rate for Payer: Signature Care EPO |
$251.74
|
| Rate for Payer: Signature Care PPO |
$251.74
|
| Rate for Payer: Signature Care PPO |
$251.74
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$15,300.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$15,300.00
|
| Rate for Payer: United Healthcare Commercial |
$160.44
|
| Rate for Payer: United Healthcare Commercial |
$160.44
|
| Rate for Payer: United Healthcare Medicare |
$142.58
|
| Rate for Payer: United Healthcare Medicare |
$142.58
|
|
|
PR CARE AFTER DELIVERY ONLY
|
Professional
|
Both
|
$473.98
|
|
|
Service Code
|
CPT 59430
|
| Hospital Charge Code |
z59430
|
| Min. Negotiated Rate |
$92.05 |
| Max. Negotiated Rate |
$21,100.00 |
| Rate for Payer: Aetna Commercial |
$164.04
|
| Rate for Payer: Aetna Commercial |
$164.04
|
| Rate for Payer: Aetna Commercial |
$164.04
|
| Rate for Payer: Aetna Medicare |
$164.04
|
| Rate for Payer: Aetna Medicare |
$164.04
|
| Rate for Payer: Aetna Medicare |
$164.04
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$132.90
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$132.90
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$132.90
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$132.90
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$132.90
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$132.90
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$132.90
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$132.90
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$132.90
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$132.90
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$132.90
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$132.90
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$92.05
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$92.05
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$92.05
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$236.57
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$236.57
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$236.57
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$188.65
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$188.65
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$188.65
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$180.44
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$180.44
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$180.44
|
| Rate for Payer: Cash Price |
$288.59
|
| Rate for Payer: Cash Price |
$114.00
|
| Rate for Payer: Cash Price |
$284.39
|
| Rate for Payer: Centivo All Commercial |
$254.26
|
| Rate for Payer: Centivo All Commercial |
$254.26
|
| Rate for Payer: Centivo All Commercial |
$254.26
|
| Rate for Payer: Cigna All Commercial |
$164.04
|
| Rate for Payer: Cigna All Commercial |
$164.04
|
| Rate for Payer: Cigna All Commercial |
$164.04
|
| Rate for Payer: CORVEL All Commercial |
$164.04
|
| Rate for Payer: CORVEL All Commercial |
$164.04
|
| Rate for Payer: CORVEL All Commercial |
$164.04
|
| Rate for Payer: Coventry All Commercial |
$196.85
|
| Rate for Payer: Coventry All Commercial |
$196.85
|
| Rate for Payer: Coventry All Commercial |
$196.85
|
| Rate for Payer: Encore All Commercial |
$164.04
|
| Rate for Payer: Encore All Commercial |
$164.04
|
| Rate for Payer: Encore All Commercial |
$164.04
|
| Rate for Payer: Frontpath All Commercial |
$234.38
|
| Rate for Payer: Frontpath All Commercial |
$234.38
|
| Rate for Payer: Frontpath All Commercial |
$234.38
|
| Rate for Payer: Humana ChoiceCare |
$121.26
|
| Rate for Payer: Humana ChoiceCare |
$121.26
|
| Rate for Payer: Humana ChoiceCare |
$121.26
|
| Rate for Payer: Humana Medicare |
$164.04
|
| Rate for Payer: Humana Medicare |
$164.04
|
| Rate for Payer: Humana Medicare |
$164.04
|
| Rate for Payer: Lucent All Commercial |
$229.66
|
| Rate for Payer: Lucent All Commercial |
$229.66
|
| Rate for Payer: Lucent All Commercial |
$229.66
|
| Rate for Payer: Lutheran Preferred All Commercial |
$228.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$228.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$228.00
|
| Rate for Payer: Managed Health Services Medicaid |
$236.57
|
| Rate for Payer: Managed Health Services Medicaid |
$236.57
|
| Rate for Payer: Managed Health Services Medicaid |
$236.57
|
| Rate for Payer: MDWise Medicaid |
$236.57
|
| Rate for Payer: MDWise Medicaid |
$236.57
|
| Rate for Payer: MDWise Medicaid |
$236.57
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$92.05
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$92.05
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$92.05
|
| Rate for Payer: PHCS All Commercial |
$164.04
|
| Rate for Payer: PHCS All Commercial |
$164.04
|
| Rate for Payer: PHCS All Commercial |
$164.04
|
| Rate for Payer: PHP All Commercial |
$209.46
|
| Rate for Payer: PHP All Commercial |
$209.46
|
| Rate for Payer: PHP All Commercial |
$209.46
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$164.04
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$164.04
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$164.04
|
| Rate for Payer: Sagamore Health Network All Products |
$164.04
|
| Rate for Payer: Sagamore Health Network All Products |
$164.04
|
| Rate for Payer: Sagamore Health Network All Products |
$164.04
|
| Rate for Payer: Signature Care EPO |
$208.00
|
| Rate for Payer: Signature Care EPO |
$208.00
|
| Rate for Payer: Signature Care EPO |
$208.00
|
| Rate for Payer: Signature Care PPO |
$208.00
|
| Rate for Payer: Signature Care PPO |
$208.00
|
| Rate for Payer: Signature Care PPO |
$208.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$21,100.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$21,100.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$21,100.00
|
| Rate for Payer: United Healthcare Commercial |
$142.23
|
| Rate for Payer: United Healthcare Commercial |
$142.23
|
| Rate for Payer: United Healthcare Commercial |
$142.23
|
| Rate for Payer: United Healthcare Medicare |
$236.99
|
| Rate for Payer: United Healthcare Medicare |
$236.99
|
| Rate for Payer: United Healthcare Medicare |
$236.99
|
|
|
PR CAREGIVER HLTH RISK ASSMT SCORE DOC STND INSTRM
|
Professional
|
Both
|
$5.52
|
|
|
Service Code
|
CPT 96161
|
| Hospital Charge Code |
z96161
|
| Min. Negotiated Rate |
$2.41 |
| Max. Negotiated Rate |
$5.38 |
| Rate for Payer: Aetna Commercial |
$2.49
|
| Rate for Payer: Aetna Commercial |
$2.49
|
| Rate for Payer: Aetna Medicare |
$2.49
|
| Rate for Payer: Aetna Medicare |
$2.49
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$2.72
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$2.72
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2.86
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2.86
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2.74
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2.74
|
| Rate for Payer: Cash Price |
$2.89
|
| Rate for Payer: Cash Price |
$3.31
|
| Rate for Payer: Centivo All Commercial |
$3.86
|
| Rate for Payer: Centivo All Commercial |
$3.86
|
| Rate for Payer: Cigna All Commercial |
$2.49
|
| Rate for Payer: Cigna All Commercial |
$2.49
|
| Rate for Payer: CORVEL All Commercial |
$2.49
|
| Rate for Payer: CORVEL All Commercial |
$2.49
|
| Rate for Payer: Coventry All Commercial |
$2.99
|
| Rate for Payer: Coventry All Commercial |
$2.99
|
| Rate for Payer: Encore All Commercial |
$2.49
|
| Rate for Payer: Encore All Commercial |
$2.49
|
| Rate for Payer: Frontpath All Commercial |
$2.63
|
| Rate for Payer: Frontpath All Commercial |
$2.63
|
| Rate for Payer: Humana ChoiceCare |
$5.17
|
| Rate for Payer: Humana ChoiceCare |
$5.17
|
| Rate for Payer: Humana Medicare |
$2.49
|
| Rate for Payer: Humana Medicare |
$2.49
|
| Rate for Payer: Lucent All Commercial |
$3.49
|
| Rate for Payer: Lucent All Commercial |
$3.49
|
| Rate for Payer: Managed Health Services Medicaid |
$2.72
|
| Rate for Payer: Managed Health Services Medicaid |
$2.72
|
| Rate for Payer: MDWise Medicaid |
$2.72
|
| Rate for Payer: MDWise Medicaid |
$2.72
|
| Rate for Payer: PHCS All Commercial |
$2.49
|
| Rate for Payer: PHCS All Commercial |
$2.49
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2.49
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2.49
|
| Rate for Payer: Sagamore Health Network All Products |
$2.49
|
| Rate for Payer: Sagamore Health Network All Products |
$2.49
|
| Rate for Payer: United Healthcare Commercial |
$5.38
|
| Rate for Payer: United Healthcare Commercial |
$5.38
|
| Rate for Payer: United Healthcare Medicare |
$2.41
|
| Rate for Payer: United Healthcare Medicare |
$2.41
|
|
|
PR CA SCREEN;PELVIC/BREAST EXAM
|
Professional
|
Both
|
$89.00
|
|
|
Service Code
|
CPT G0101
|
| Hospital Charge Code |
zG0101
|
| Min. Negotiated Rate |
$21.57 |
| Max. Negotiated Rate |
$54.19 |
| Rate for Payer: Aetna Commercial |
$25.89
|
| Rate for Payer: Aetna Medicare |
$25.89
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$41.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$41.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$41.50
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$41.50
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$21.57
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$35.77
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$29.77
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$28.48
|
| Rate for Payer: Cash Price |
$53.40
|
| Rate for Payer: Centivo All Commercial |
$40.13
|
| Rate for Payer: Cigna All Commercial |
$25.89
|
| Rate for Payer: CORVEL All Commercial |
$25.89
|
| Rate for Payer: Coventry All Commercial |
$31.07
|
| Rate for Payer: Encore All Commercial |
$25.89
|
| Rate for Payer: Humana ChoiceCare |
$30.97
|
| Rate for Payer: Humana Medicare |
$25.89
|
| Rate for Payer: Lucent All Commercial |
$36.25
|
| Rate for Payer: Managed Health Services Medicaid |
$35.77
|
| Rate for Payer: MDWise Medicaid |
$35.77
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$21.57
|
| Rate for Payer: PHCS All Commercial |
$25.89
|
| Rate for Payer: PHP All Commercial |
$35.77
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$25.89
|
| Rate for Payer: Sagamore Health Network All Products |
$25.89
|
| Rate for Payer: Signature Care EPO |
$54.19
|
| Rate for Payer: Signature Care PPO |
$54.19
|
| Rate for Payer: United Healthcare Commercial |
$41.11
|
|
|
PR CAST SUP LNG ARM SPLINT FBRG
|
Professional
|
Both
|
$94.79
|
|
|
Service Code
|
CPT Q4018
|
| Hospital Charge Code |
zQ4018
|
| Min. Negotiated Rate |
$11.13 |
| Max. Negotiated Rate |
$64.46 |
| Rate for Payer: Aetna Commercial |
$15.87
|
| Rate for Payer: Aetna Medicare |
$15.87
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$17.70
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$18.25
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$17.46
|
| Rate for Payer: Cash Price |
$56.87
|
| Rate for Payer: Centivo All Commercial |
$24.60
|
| Rate for Payer: Cigna All Commercial |
$15.87
|
| Rate for Payer: CORVEL All Commercial |
$15.87
|
| Rate for Payer: Coventry All Commercial |
$19.04
|
| Rate for Payer: Encore All Commercial |
$15.87
|
| Rate for Payer: Humana ChoiceCare |
$14.66
|
| Rate for Payer: Humana Medicare |
$15.87
|
| Rate for Payer: Lucent All Commercial |
$22.22
|
| Rate for Payer: Managed Health Services Medicaid |
$17.70
|
| Rate for Payer: MDWise Medicaid |
$17.70
|
| Rate for Payer: PHCS All Commercial |
$15.87
|
| Rate for Payer: PHP All Commercial |
$14.66
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$15.87
|
| Rate for Payer: Sagamore Health Network All Products |
$15.87
|
| Rate for Payer: Signature Care EPO |
$64.46
|
| Rate for Payer: Signature Care PPO |
$64.46
|
| Rate for Payer: United Healthcare Commercial |
$11.13
|
|
|
PR CAST SUP LNG ARM SPLNT PED F
|
Professional
|
Both
|
$56.38
|
|
|
Service Code
|
CPT Q4020
|
| Hospital Charge Code |
zQ4020
|
| Min. Negotiated Rate |
$5.57 |
| Max. Negotiated Rate |
$38.34 |
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$8.89
|
| Rate for Payer: Cash Price |
$33.83
|
| Rate for Payer: Humana ChoiceCare |
$7.36
|
| Rate for Payer: Managed Health Services Medicaid |
$8.89
|
| Rate for Payer: MDWise Medicaid |
$8.89
|
| Rate for Payer: PHP All Commercial |
$7.36
|
| Rate for Payer: Signature Care EPO |
$38.34
|
| Rate for Payer: Signature Care PPO |
$38.34
|
| Rate for Payer: United Healthcare Commercial |
$5.57
|
|
|
PR CAST SUP LNG LEG PED FBRGLS
|
Professional
|
Both
|
$16.17
|
|
|
Service Code
|
CPT Q4032
|
| Hospital Charge Code |
zQ4032
|
| Min. Negotiated Rate |
$11.00 |
| Max. Negotiated Rate |
$46.40 |
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$46.40
|
| Rate for Payer: Cash Price |
$9.70
|
| Rate for Payer: Humana ChoiceCare |
$38.44
|
| Rate for Payer: Managed Health Services Medicaid |
$46.40
|
| Rate for Payer: MDWise Medicaid |
$46.40
|
| Rate for Payer: PHP All Commercial |
$38.44
|
| Rate for Payer: Signature Care EPO |
$11.00
|
| Rate for Payer: Signature Care PPO |
$11.00
|
| Rate for Payer: United Healthcare Commercial |
$29.14
|
|
|
PR CAST SUP LNG LEG SPLNT FBRGL
|
Professional
|
Both
|
$153.76
|
|
|
Service Code
|
CPT Q4042
|
| Hospital Charge Code |
zQ4042
|
| Min. Negotiated Rate |
$26.15 |
| Max. Negotiated Rate |
$104.56 |
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$41.64
|
| Rate for Payer: Cash Price |
$92.26
|
| Rate for Payer: Humana ChoiceCare |
$34.49
|
| Rate for Payer: Managed Health Services Medicaid |
$41.64
|
| Rate for Payer: MDWise Medicaid |
$41.64
|
| Rate for Payer: PHP All Commercial |
$34.49
|
| Rate for Payer: Signature Care EPO |
$104.56
|
| Rate for Payer: Signature Care PPO |
$104.56
|
| Rate for Payer: United Healthcare Commercial |
$26.15
|
|
|
PR CAST SUP LNG LEG SPLNT PED F
|
Professional
|
Both
|
$67.07
|
|
|
Service Code
|
CPT Q4044
|
| Hospital Charge Code |
zQ4044
|
| Min. Negotiated Rate |
$13.08 |
| Max. Negotiated Rate |
$45.61 |
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$20.85
|
| Rate for Payer: Cash Price |
$40.24
|
| Rate for Payer: Humana ChoiceCare |
$17.27
|
| Rate for Payer: Managed Health Services Medicaid |
$20.85
|
| Rate for Payer: MDWise Medicaid |
$20.85
|
| Rate for Payer: PHP All Commercial |
$17.27
|
| Rate for Payer: Signature Care EPO |
$45.61
|
| Rate for Payer: Signature Care PPO |
$45.61
|
| Rate for Payer: United Healthcare Commercial |
$13.08
|
|
