|
PR CAST SUP LONG ARM ADULT FBRG
|
Professional
|
Both
|
$13.10
|
|
|
Service Code
|
CPT Q4006
|
| Hospital Charge Code |
zQ4006
|
| Min. Negotiated Rate |
$8.91 |
| Max. Negotiated Rate |
$49.51 |
| Rate for Payer: Aetna Commercial |
$31.94
|
| Rate for Payer: Aetna Medicare |
$31.94
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$35.62
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$36.73
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$35.13
|
| Rate for Payer: Cash Price |
$7.86
|
| Rate for Payer: Centivo All Commercial |
$49.51
|
| Rate for Payer: Cigna All Commercial |
$31.94
|
| Rate for Payer: CORVEL All Commercial |
$31.94
|
| Rate for Payer: Coventry All Commercial |
$38.33
|
| Rate for Payer: Encore All Commercial |
$31.94
|
| Rate for Payer: Humana ChoiceCare |
$29.51
|
| Rate for Payer: Humana Medicare |
$31.94
|
| Rate for Payer: Lucent All Commercial |
$44.72
|
| Rate for Payer: Managed Health Services Medicaid |
$35.62
|
| Rate for Payer: MDWise Medicaid |
$35.62
|
| Rate for Payer: PHCS All Commercial |
$31.94
|
| Rate for Payer: PHP All Commercial |
$29.51
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$31.94
|
| Rate for Payer: Sagamore Health Network All Products |
$31.94
|
| Rate for Payer: Signature Care EPO |
$8.91
|
| Rate for Payer: Signature Care PPO |
$8.91
|
| Rate for Payer: United Healthcare Commercial |
$22.38
|
|
|
PR CAST SUP LONG ARM PED FBRGLS
|
Professional
|
Both
|
$9.19
|
|
|
Service Code
|
CPT Q4008
|
| Hospital Charge Code |
zQ4008
|
| Min. Negotiated Rate |
$6.25 |
| Max. Negotiated Rate |
$17.80 |
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$17.80
|
| Rate for Payer: Cash Price |
$5.51
|
| Rate for Payer: Humana ChoiceCare |
$14.75
|
| Rate for Payer: Managed Health Services Medicaid |
$17.80
|
| Rate for Payer: MDWise Medicaid |
$17.80
|
| Rate for Payer: PHP All Commercial |
$14.75
|
| Rate for Payer: Signature Care EPO |
$6.25
|
| Rate for Payer: Signature Care PPO |
$6.25
|
| Rate for Payer: United Healthcare Commercial |
$11.19
|
|
|
PR CAST SUP LONG LEG FIBERGLASS
|
Professional
|
Both
|
$28.23
|
|
|
Service Code
|
CPT Q4030
|
| Hospital Charge Code |
zQ4030
|
| Min. Negotiated Rate |
$19.20 |
| Max. Negotiated Rate |
$92.79 |
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$92.79
|
| Rate for Payer: Cash Price |
$16.94
|
| Rate for Payer: Humana ChoiceCare |
$76.87
|
| Rate for Payer: Managed Health Services Medicaid |
$92.79
|
| Rate for Payer: MDWise Medicaid |
$92.79
|
| Rate for Payer: PHP All Commercial |
$76.87
|
| Rate for Payer: Signature Care EPO |
$19.20
|
| Rate for Payer: Signature Care PPO |
$19.20
|
| Rate for Payer: United Healthcare Commercial |
$58.29
|
|
|
PR CAST SUP SHRT LEG FIBERGLASS
|
Professional
|
Both
|
$14.96
|
|
|
Service Code
|
CPT Q4038
|
| Hospital Charge Code |
zQ4038
|
| Min. Negotiated Rate |
$10.17 |
| Max. Negotiated Rate |
$69.83 |
| Rate for Payer: Aetna Commercial |
$45.05
|
| Rate for Payer: Aetna Medicare |
$45.05
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$50.24
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$51.81
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$49.55
|
| Rate for Payer: Cash Price |
$8.98
|
| Rate for Payer: Centivo All Commercial |
$69.83
|
| Rate for Payer: Cigna All Commercial |
$45.05
|
| Rate for Payer: CORVEL All Commercial |
$45.05
|
| Rate for Payer: Coventry All Commercial |
$54.06
|
| Rate for Payer: Encore All Commercial |
$45.05
|
| Rate for Payer: Humana ChoiceCare |
$41.62
|
| Rate for Payer: Humana Medicare |
$45.05
|
| Rate for Payer: Lucent All Commercial |
$63.07
|
| Rate for Payer: Managed Health Services Medicaid |
$50.24
|
| Rate for Payer: MDWise Medicaid |
$50.24
|
| Rate for Payer: PHCS All Commercial |
$45.05
|
| Rate for Payer: PHP All Commercial |
$41.62
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$45.05
|
| Rate for Payer: Sagamore Health Network All Products |
$45.05
|
| Rate for Payer: Signature Care EPO |
$10.17
|
| Rate for Payer: Signature Care PPO |
$10.17
|
| Rate for Payer: United Healthcare Commercial |
$31.57
|
|
|
PR CAST SUP SHRT LEG PED FBRGLS
|
Professional
|
Both
|
$12.00
|
|
|
Service Code
|
CPT Q4040
|
| Hospital Charge Code |
zQ4040
|
| Min. Negotiated Rate |
$8.16 |
| Max. Negotiated Rate |
$25.12 |
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$25.12
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Humana ChoiceCare |
$20.81
|
| Rate for Payer: Managed Health Services Medicaid |
$25.12
|
| Rate for Payer: MDWise Medicaid |
$25.12
|
| Rate for Payer: PHP All Commercial |
$20.81
|
| Rate for Payer: Signature Care EPO |
$8.16
|
| Rate for Payer: Signature Care PPO |
$8.16
|
| Rate for Payer: United Healthcare Commercial |
$15.78
|
|
|
PR CAST SUP SHT ARM ADULT FBRGL
|
Professional
|
Both
|
$9.19
|
|
|
Service Code
|
CPT Q4010
|
| Hospital Charge Code |
zQ4010
|
| Min. Negotiated Rate |
$6.25 |
| Max. Negotiated Rate |
$23.74 |
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$23.74
|
| Rate for Payer: Cash Price |
$5.51
|
| Rate for Payer: Humana ChoiceCare |
$19.67
|
| Rate for Payer: Managed Health Services Medicaid |
$23.74
|
| Rate for Payer: MDWise Medicaid |
$23.74
|
| Rate for Payer: PHP All Commercial |
$19.67
|
| Rate for Payer: Signature Care EPO |
$6.25
|
| Rate for Payer: Signature Care PPO |
$6.25
|
| Rate for Payer: United Healthcare Commercial |
$14.93
|
|
|
PR CAST SUP SHT ARM PED FBRGLAS
|
Professional
|
Both
|
$5.62
|
|
|
Service Code
|
CPT Q4012
|
| Hospital Charge Code |
zQ4012
|
| Min. Negotiated Rate |
$3.82 |
| Max. Negotiated Rate |
$11.90 |
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$11.90
|
| Rate for Payer: Cash Price |
$3.37
|
| Rate for Payer: Humana ChoiceCare |
$9.86
|
| Rate for Payer: Managed Health Services Medicaid |
$11.90
|
| Rate for Payer: MDWise Medicaid |
$11.90
|
| Rate for Payer: PHP All Commercial |
$9.86
|
| Rate for Payer: Signature Care EPO |
$3.82
|
| Rate for Payer: Signature Care PPO |
$3.82
|
| Rate for Payer: United Healthcare Commercial |
$7.46
|
|
|
PR CAST SUP SHT ARM SPLINT FBRG
|
Professional
|
Both
|
$43.34
|
|
|
Service Code
|
CPT Q4022
|
| Hospital Charge Code |
zQ4022
|
| Min. Negotiated Rate |
$9.32 |
| Max. Negotiated Rate |
$29.47 |
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$14.84
|
| Rate for Payer: Cash Price |
$26.00
|
| Rate for Payer: Humana ChoiceCare |
$12.29
|
| Rate for Payer: Managed Health Services Medicaid |
$14.84
|
| Rate for Payer: MDWise Medicaid |
$14.84
|
| Rate for Payer: PHP All Commercial |
$12.29
|
| Rate for Payer: Signature Care EPO |
$29.47
|
| Rate for Payer: Signature Care PPO |
$29.47
|
| Rate for Payer: United Healthcare Commercial |
$9.32
|
|
|
PR CAST SUP SHT ARM SPLNT PED F
|
Professional
|
Both
|
$25.74
|
|
|
Service Code
|
CPT Q4024
|
| Hospital Charge Code |
zQ4024
|
| Min. Negotiated Rate |
$4.66 |
| Max. Negotiated Rate |
$17.50 |
| Rate for Payer: Aetna Commercial |
$6.66
|
| Rate for Payer: Aetna Medicare |
$6.66
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$7.43
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$7.66
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$7.33
|
| Rate for Payer: Cash Price |
$15.44
|
| Rate for Payer: Centivo All Commercial |
$10.32
|
| Rate for Payer: Cigna All Commercial |
$6.66
|
| Rate for Payer: CORVEL All Commercial |
$6.66
|
| Rate for Payer: Coventry All Commercial |
$7.99
|
| Rate for Payer: Encore All Commercial |
$6.66
|
| Rate for Payer: Humana ChoiceCare |
$6.15
|
| Rate for Payer: Humana Medicare |
$6.66
|
| Rate for Payer: Lucent All Commercial |
$9.32
|
| Rate for Payer: Managed Health Services Medicaid |
$7.43
|
| Rate for Payer: MDWise Medicaid |
$7.43
|
| Rate for Payer: PHCS All Commercial |
$6.66
|
| Rate for Payer: PHP All Commercial |
$6.15
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$6.66
|
| Rate for Payer: Sagamore Health Network All Products |
$6.66
|
| Rate for Payer: Signature Care EPO |
$17.50
|
| Rate for Payer: Signature Care PPO |
$17.50
|
| Rate for Payer: United Healthcare Commercial |
$4.66
|
|
|
PR CAST SUP SHT LEG SPLNT FBRGL
|
Professional
|
Both
|
$96.37
|
|
|
Service Code
|
CPT Q4046
|
| Hospital Charge Code |
zQ4046
|
| Min. Negotiated Rate |
$14.31 |
| Max. Negotiated Rate |
$65.53 |
| Rate for Payer: Aetna Commercial |
$20.41
|
| Rate for Payer: Aetna Medicare |
$20.41
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$22.77
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$23.47
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$22.45
|
| Rate for Payer: Cash Price |
$57.82
|
| Rate for Payer: Centivo All Commercial |
$31.64
|
| Rate for Payer: Cigna All Commercial |
$20.41
|
| Rate for Payer: CORVEL All Commercial |
$20.41
|
| Rate for Payer: Coventry All Commercial |
$24.49
|
| Rate for Payer: Encore All Commercial |
$20.41
|
| Rate for Payer: Humana ChoiceCare |
$18.86
|
| Rate for Payer: Humana Medicare |
$20.41
|
| Rate for Payer: Lucent All Commercial |
$28.57
|
| Rate for Payer: Managed Health Services Medicaid |
$22.77
|
| Rate for Payer: MDWise Medicaid |
$22.77
|
| Rate for Payer: PHCS All Commercial |
$20.41
|
| Rate for Payer: PHP All Commercial |
$18.86
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$20.41
|
| Rate for Payer: Sagamore Health Network All Products |
$20.41
|
| Rate for Payer: Signature Care EPO |
$65.53
|
| Rate for Payer: Signature Care PPO |
$65.53
|
| Rate for Payer: United Healthcare Commercial |
$14.31
|
|
|
PR CAST SUP SHT LEG SPLNT PED F
|
Professional
|
Both
|
$47.23
|
|
|
Service Code
|
CPT Q4048
|
| Hospital Charge Code |
zQ4048
|
| Min. Negotiated Rate |
$7.16 |
| Max. Negotiated Rate |
$32.12 |
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$11.40
|
| Rate for Payer: Cash Price |
$28.34
|
| Rate for Payer: Humana ChoiceCare |
$9.44
|
| Rate for Payer: Managed Health Services Medicaid |
$11.40
|
| Rate for Payer: MDWise Medicaid |
$11.40
|
| Rate for Payer: PHP All Commercial |
$9.44
|
| Rate for Payer: Signature Care EPO |
$32.12
|
| Rate for Payer: Signature Care PPO |
$32.12
|
| Rate for Payer: United Healthcare Commercial |
$7.16
|
|
|
PR CATH/INJECT HYSTEROSALPINGOGRAM
|
Professional
|
Both
|
$448.10
|
|
|
Service Code
|
CPT 58340
|
| Hospital Charge Code |
z58340
|
| Min. Negotiated Rate |
$28.73 |
| Max. Negotiated Rate |
$6,900.00 |
| Rate for Payer: Aetna Commercial |
$52.94
|
| Rate for Payer: Aetna Commercial |
$52.94
|
| Rate for Payer: Aetna Medicare |
$52.94
|
| Rate for Payer: Aetna Medicare |
$52.94
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$202.65
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$202.65
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$202.65
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$202.65
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$202.65
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$202.65
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$202.65
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$202.65
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$28.73
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$28.73
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$219.42
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$219.42
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$60.88
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$60.88
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$58.23
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$58.23
|
| Rate for Payer: Cash Price |
$267.68
|
| Rate for Payer: Cash Price |
$268.86
|
| Rate for Payer: Centivo All Commercial |
$82.06
|
| Rate for Payer: Centivo All Commercial |
$82.06
|
| Rate for Payer: Cigna All Commercial |
$52.94
|
| Rate for Payer: Cigna All Commercial |
$52.94
|
| Rate for Payer: CORVEL All Commercial |
$52.94
|
| Rate for Payer: CORVEL All Commercial |
$52.94
|
| Rate for Payer: Coventry All Commercial |
$63.53
|
| Rate for Payer: Coventry All Commercial |
$63.53
|
| Rate for Payer: Encore All Commercial |
$52.94
|
| Rate for Payer: Encore All Commercial |
$52.94
|
| Rate for Payer: Frontpath All Commercial |
$72.60
|
| Rate for Payer: Frontpath All Commercial |
$72.60
|
| Rate for Payer: Humana ChoiceCare |
$66.87
|
| Rate for Payer: Humana ChoiceCare |
$66.87
|
| Rate for Payer: Humana Medicare |
$52.94
|
| Rate for Payer: Humana Medicare |
$52.94
|
| Rate for Payer: Lucent All Commercial |
$74.12
|
| Rate for Payer: Lucent All Commercial |
$74.12
|
| Rate for Payer: Lutheran Preferred All Commercial |
$75.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$75.00
|
| Rate for Payer: Managed Health Services Medicaid |
$219.42
|
| Rate for Payer: Managed Health Services Medicaid |
$219.42
|
| Rate for Payer: MDWise Medicaid |
$219.42
|
| Rate for Payer: MDWise Medicaid |
$219.42
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$28.73
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$28.73
|
| Rate for Payer: PHCS All Commercial |
$52.94
|
| Rate for Payer: PHCS All Commercial |
$52.94
|
| Rate for Payer: PHP All Commercial |
$68.74
|
| Rate for Payer: PHP All Commercial |
$68.74
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$52.94
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$52.94
|
| Rate for Payer: Sagamore Health Network All Products |
$52.94
|
| Rate for Payer: Sagamore Health Network All Products |
$52.94
|
| Rate for Payer: Signature Care EPO |
$201.46
|
| Rate for Payer: Signature Care EPO |
$201.46
|
| Rate for Payer: Signature Care PPO |
$201.46
|
| Rate for Payer: Signature Care PPO |
$201.46
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$6,900.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$6,900.00
|
| Rate for Payer: United Healthcare Commercial |
$66.94
|
| Rate for Payer: United Healthcare Commercial |
$66.94
|
| Rate for Payer: United Healthcare Medicare |
$224.05
|
| Rate for Payer: United Healthcare Medicare |
$224.05
|
|
|
PR CAUTERIZATION,CERVIX,ELECTRO/THERMAL
|
Professional
|
Both
|
$311.16
|
|
|
Service Code
|
CPT 57510
|
| Hospital Charge Code |
z57510
|
| Min. Negotiated Rate |
$61.67 |
| Max. Negotiated Rate |
$13,700.00 |
| Rate for Payer: Aetna Commercial |
$105.62
|
| Rate for Payer: Aetna Commercial |
$105.62
|
| Rate for Payer: Aetna Medicare |
$105.62
|
| Rate for Payer: Aetna Medicare |
$105.62
|
| 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 |
$61.67
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$61.67
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$153.04
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$153.04
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$121.46
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$121.46
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$116.18
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$116.18
|
| Rate for Payer: Cash Price |
$184.03
|
| Rate for Payer: Cash Price |
$186.70
|
| Rate for Payer: Centivo All Commercial |
$163.71
|
| Rate for Payer: Centivo All Commercial |
$163.71
|
| Rate for Payer: Cigna All Commercial |
$105.62
|
| Rate for Payer: Cigna All Commercial |
$105.62
|
| Rate for Payer: CORVEL All Commercial |
$105.62
|
| Rate for Payer: CORVEL All Commercial |
$105.62
|
| Rate for Payer: Coventry All Commercial |
$126.74
|
| Rate for Payer: Coventry All Commercial |
$126.74
|
| Rate for Payer: Encore All Commercial |
$105.62
|
| Rate for Payer: Encore All Commercial |
$105.62
|
| Rate for Payer: Frontpath All Commercial |
$146.74
|
| Rate for Payer: Frontpath All Commercial |
$146.74
|
| Rate for Payer: Humana ChoiceCare |
$130.47
|
| Rate for Payer: Humana ChoiceCare |
$130.47
|
| Rate for Payer: Humana Medicare |
$105.62
|
| Rate for Payer: Humana Medicare |
$105.62
|
| Rate for Payer: Lucent All Commercial |
$147.87
|
| Rate for Payer: Lucent All Commercial |
$147.87
|
| Rate for Payer: Lutheran Preferred All Commercial |
$147.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$147.00
|
| Rate for Payer: Managed Health Services Medicaid |
$153.04
|
| Rate for Payer: Managed Health Services Medicaid |
$153.04
|
| Rate for Payer: MDWise Medicaid |
$153.04
|
| Rate for Payer: MDWise Medicaid |
$153.04
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$61.67
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$61.67
|
| Rate for Payer: PHCS All Commercial |
$105.62
|
| Rate for Payer: PHCS All Commercial |
$105.62
|
| Rate for Payer: PHP All Commercial |
$135.25
|
| Rate for Payer: PHP All Commercial |
$135.25
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$105.62
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$105.62
|
| Rate for Payer: Sagamore Health Network All Products |
$105.62
|
| Rate for Payer: Sagamore Health Network All Products |
$105.62
|
| Rate for Payer: Signature Care EPO |
$170.85
|
| Rate for Payer: Signature Care EPO |
$170.85
|
| Rate for Payer: Signature Care PPO |
$170.85
|
| Rate for Payer: Signature Care PPO |
$170.85
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$13,700.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$13,700.00
|
| Rate for Payer: United Healthcare Commercial |
$131.19
|
| Rate for Payer: United Healthcare Commercial |
$131.19
|
| Rate for Payer: United Healthcare Medicare |
$153.36
|
| Rate for Payer: United Healthcare Medicare |
$153.36
|
|
|
PR CAUTER TURBINATE MUCOSA,SUPERFICIAL
|
Professional
|
Both
|
$405.48
|
|
|
Service Code
|
CPT 30801
|
| Hospital Charge Code |
z30801
|
| Min. Negotiated Rate |
$79.77 |
| Max. Negotiated Rate |
$21,500.00 |
| Rate for Payer: Aetna Commercial |
$144.97
|
| Rate for Payer: Aetna Commercial |
$144.97
|
| Rate for Payer: Aetna Medicare |
$144.97
|
| Rate for Payer: Aetna Medicare |
$144.97
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$214.58
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$214.58
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$214.58
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$214.58
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$214.58
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$214.58
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$214.58
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$214.58
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$79.77
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$79.77
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$199.43
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$199.43
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$166.72
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$166.72
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$159.47
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$159.47
|
| Rate for Payer: Cash Price |
$241.07
|
| Rate for Payer: Cash Price |
$243.29
|
| Rate for Payer: Centivo All Commercial |
$224.70
|
| Rate for Payer: Centivo All Commercial |
$224.70
|
| Rate for Payer: Cigna All Commercial |
$144.97
|
| Rate for Payer: Cigna All Commercial |
$144.97
|
| Rate for Payer: CORVEL All Commercial |
$144.97
|
| Rate for Payer: CORVEL All Commercial |
$144.97
|
| Rate for Payer: Coventry All Commercial |
$173.96
|
| Rate for Payer: Coventry All Commercial |
$173.96
|
| Rate for Payer: Encore All Commercial |
$144.97
|
| Rate for Payer: Encore All Commercial |
$144.97
|
| Rate for Payer: Frontpath All Commercial |
$195.20
|
| Rate for Payer: Frontpath All Commercial |
$195.20
|
| Rate for Payer: Humana ChoiceCare |
$132.51
|
| Rate for Payer: Humana ChoiceCare |
$132.51
|
| Rate for Payer: Humana Medicare |
$144.97
|
| Rate for Payer: Humana Medicare |
$144.97
|
| Rate for Payer: Lucent All Commercial |
$202.96
|
| Rate for Payer: Lucent All Commercial |
$202.96
|
| Rate for Payer: Lutheran Preferred All Commercial |
$230.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$230.00
|
| Rate for Payer: Managed Health Services Medicaid |
$199.43
|
| Rate for Payer: Managed Health Services Medicaid |
$199.43
|
| Rate for Payer: MDWise Medicaid |
$199.43
|
| Rate for Payer: MDWise Medicaid |
$199.43
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$79.77
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$79.77
|
| Rate for Payer: PHCS All Commercial |
$144.97
|
| Rate for Payer: PHCS All Commercial |
$144.97
|
| Rate for Payer: PHP All Commercial |
$196.07
|
| Rate for Payer: PHP All Commercial |
$196.07
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$144.97
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$144.97
|
| Rate for Payer: Sagamore Health Network All Products |
$144.97
|
| Rate for Payer: Sagamore Health Network All Products |
$144.97
|
| Rate for Payer: Signature Care EPO |
$183.76
|
| Rate for Payer: Signature Care EPO |
$183.76
|
| Rate for Payer: Signature Care PPO |
$183.76
|
| Rate for Payer: Signature Care PPO |
$183.76
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$21,500.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$21,500.00
|
| Rate for Payer: United Healthcare Commercial |
$138.56
|
| Rate for Payer: United Healthcare Commercial |
$138.56
|
| Rate for Payer: United Healthcare Medicare |
$200.89
|
| Rate for Payer: United Healthcare Medicare |
$200.89
|
|
|
PR CCM/BHI BY RHC/FQHC 20MIN MO
|
Professional
|
Both
|
$133.54
|
|
|
Service Code
|
CPT G0511
|
| Hospital Charge Code |
zG0511
|
| Min. Negotiated Rate |
$34.71 |
| Max. Negotiated Rate |
$57.59 |
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$57.59
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$57.59
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$57.59
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$57.59
|
| Rate for Payer: Cash Price |
$80.12
|
| Rate for Payer: Humana ChoiceCare |
$36.66
|
| Rate for Payer: PHP All Commercial |
$43.34
|
| Rate for Payer: United Healthcare Commercial |
$34.71
|
|
|
PR CESAREAN DELIVERY ONLY
|
Professional
|
Both
|
$1,616.14
|
|
|
Service Code
|
CPT 59514
|
| Hospital Charge Code |
z59514
|
| Min. Negotiated Rate |
$794.88 |
| Max. Negotiated Rate |
$106,200.00 |
| Rate for Payer: Aetna Commercial |
$823.56
|
| Rate for Payer: Aetna Commercial |
$823.56
|
| Rate for Payer: Aetna Medicare |
$823.56
|
| Rate for Payer: Aetna Medicare |
$823.56
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$987.53
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$987.53
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$987.53
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$987.53
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$987.53
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$987.53
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$987.53
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$987.53
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$794.88
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$794.88
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$947.09
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$947.09
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$905.92
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$905.92
|
| Rate for Payer: Cash Price |
$969.68
|
| Rate for Payer: Cash Price |
$956.70
|
| Rate for Payer: Centivo All Commercial |
$1,276.52
|
| Rate for Payer: Centivo All Commercial |
$1,276.52
|
| Rate for Payer: Cigna All Commercial |
$823.56
|
| Rate for Payer: Cigna All Commercial |
$823.56
|
| Rate for Payer: CORVEL All Commercial |
$823.56
|
| Rate for Payer: CORVEL All Commercial |
$823.56
|
| Rate for Payer: Coventry All Commercial |
$988.27
|
| Rate for Payer: Coventry All Commercial |
$988.27
|
| Rate for Payer: Encore All Commercial |
$823.56
|
| Rate for Payer: Encore All Commercial |
$823.56
|
| Rate for Payer: Frontpath All Commercial |
$1,183.39
|
| Rate for Payer: Frontpath All Commercial |
$1,183.39
|
| Rate for Payer: Humana ChoiceCare |
$881.00
|
| Rate for Payer: Humana ChoiceCare |
$881.00
|
| Rate for Payer: Humana Medicare |
$823.56
|
| Rate for Payer: Humana Medicare |
$823.56
|
| Rate for Payer: Lucent All Commercial |
$1,152.98
|
| Rate for Payer: Lucent All Commercial |
$1,152.98
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,144.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,144.00
|
| Rate for Payer: Managed Health Services Medicaid |
$794.88
|
| Rate for Payer: Managed Health Services Medicaid |
$794.88
|
| Rate for Payer: MDWise Medicaid |
$794.88
|
| Rate for Payer: MDWise Medicaid |
$794.88
|
| Rate for Payer: PHCS All Commercial |
$823.56
|
| Rate for Payer: PHCS All Commercial |
$823.56
|
| Rate for Payer: PHP All Commercial |
$1,052.38
|
| Rate for Payer: PHP All Commercial |
$1,052.38
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$823.56
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$823.56
|
| Rate for Payer: Sagamore Health Network All Products |
$823.56
|
| Rate for Payer: Sagamore Health Network All Products |
$823.56
|
| Rate for Payer: Signature Care EPO |
$1,130.50
|
| Rate for Payer: Signature Care EPO |
$1,130.50
|
| Rate for Payer: Signature Care PPO |
$1,130.50
|
| Rate for Payer: Signature Care PPO |
$1,130.50
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$106,200.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$106,200.00
|
| Rate for Payer: United Healthcare Commercial |
$1,032.76
|
| Rate for Payer: United Healthcare Commercial |
$1,032.76
|
| Rate for Payer: United Healthcare Medicare |
$797.25
|
| Rate for Payer: United Healthcare Medicare |
$797.25
|
|
|
PR CESAREAN DELIVERY+POSTPARTUM CARE
|
Professional
|
Both
|
$2,395.88
|
|
|
Service Code
|
CPT 59515
|
| Hospital Charge Code |
z59515
|
| Min. Negotiated Rate |
$994.75 |
| Max. Negotiated Rate |
$153,000.00 |
| Rate for Payer: Aetna Commercial |
$1,185.53
|
| Rate for Payer: Aetna Commercial |
$1,185.53
|
| Rate for Payer: Aetna Medicare |
$1,185.53
|
| Rate for Payer: Aetna Medicare |
$1,185.53
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$1,089.77
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$1,089.77
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,089.77
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,089.77
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,089.77
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,089.77
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,089.77
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,089.77
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$1,178.39
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$1,178.39
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,363.36
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,363.36
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,304.08
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,304.08
|
| Rate for Payer: Cash Price |
$1,437.53
|
| Rate for Payer: Cash Price |
$1,377.60
|
| Rate for Payer: Centivo All Commercial |
$1,837.57
|
| Rate for Payer: Centivo All Commercial |
$1,837.57
|
| Rate for Payer: Cigna All Commercial |
$1,185.53
|
| Rate for Payer: Cigna All Commercial |
$1,185.53
|
| Rate for Payer: CORVEL All Commercial |
$1,185.53
|
| Rate for Payer: CORVEL All Commercial |
$1,185.53
|
| Rate for Payer: Coventry All Commercial |
$1,422.64
|
| Rate for Payer: Coventry All Commercial |
$1,422.64
|
| Rate for Payer: Encore All Commercial |
$1,185.53
|
| Rate for Payer: Encore All Commercial |
$1,185.53
|
| Rate for Payer: Frontpath All Commercial |
$1,699.44
|
| Rate for Payer: Frontpath All Commercial |
$1,699.44
|
| Rate for Payer: Humana ChoiceCare |
$994.75
|
| Rate for Payer: Humana ChoiceCare |
$994.75
|
| Rate for Payer: Humana Medicare |
$1,185.53
|
| Rate for Payer: Humana Medicare |
$1,185.53
|
| Rate for Payer: Lucent All Commercial |
$1,659.74
|
| Rate for Payer: Lucent All Commercial |
$1,659.74
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,647.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,647.00
|
| Rate for Payer: Managed Health Services Medicaid |
$1,178.39
|
| Rate for Payer: Managed Health Services Medicaid |
$1,178.39
|
| Rate for Payer: MDWise Medicaid |
$1,178.39
|
| Rate for Payer: MDWise Medicaid |
$1,178.39
|
| Rate for Payer: PHCS All Commercial |
$1,185.53
|
| Rate for Payer: PHCS All Commercial |
$1,185.53
|
| Rate for Payer: PHP All Commercial |
$1,515.36
|
| Rate for Payer: PHP All Commercial |
$1,515.36
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,185.53
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,185.53
|
| Rate for Payer: Sagamore Health Network All Products |
$1,185.53
|
| Rate for Payer: Sagamore Health Network All Products |
$1,185.53
|
| Rate for Payer: Signature Care EPO |
$1,278.40
|
| Rate for Payer: Signature Care EPO |
$1,278.40
|
| Rate for Payer: Signature Care PPO |
$1,278.40
|
| Rate for Payer: Signature Care PPO |
$1,278.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$153,000.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$153,000.00
|
| Rate for Payer: United Healthcare Commercial |
$1,217.84
|
| Rate for Payer: United Healthcare Commercial |
$1,217.84
|
| Rate for Payer: United Healthcare Medicare |
$1,148.00
|
| Rate for Payer: United Healthcare Medicare |
$1,148.00
|
|
|
PR CHEMICAL CAUTERIZATION OF GRANULATION TISSUE
|
Professional
|
Both
|
$161.10
|
|
|
Service Code
|
CPT 17250
|
| Hospital Charge Code |
z17250
|
| Min. Negotiated Rate |
$20.41 |
| Max. Negotiated Rate |
$4,200.00 |
| Rate for Payer: Aetna Commercial |
$34.64
|
| Rate for Payer: Aetna Commercial |
$34.64
|
| Rate for Payer: Aetna Medicare |
$34.64
|
| Rate for Payer: Aetna Medicare |
$34.64
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$81.17
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$81.17
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$81.17
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$81.17
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$81.17
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$81.17
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$81.17
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$81.17
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$20.41
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$20.41
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$79.23
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$79.23
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$39.84
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$39.84
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$38.10
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$38.10
|
| Rate for Payer: Cash Price |
$95.44
|
| Rate for Payer: Cash Price |
$96.66
|
| Rate for Payer: Centivo All Commercial |
$53.69
|
| Rate for Payer: Centivo All Commercial |
$53.69
|
| Rate for Payer: Cigna All Commercial |
$34.64
|
| Rate for Payer: Cigna All Commercial |
$34.64
|
| Rate for Payer: CORVEL All Commercial |
$34.64
|
| Rate for Payer: CORVEL All Commercial |
$34.64
|
| Rate for Payer: Coventry All Commercial |
$41.57
|
| Rate for Payer: Coventry All Commercial |
$41.57
|
| Rate for Payer: Encore All Commercial |
$34.64
|
| Rate for Payer: Encore All Commercial |
$34.64
|
| Rate for Payer: Frontpath All Commercial |
$47.87
|
| Rate for Payer: Frontpath All Commercial |
$47.87
|
| Rate for Payer: Humana ChoiceCare |
$31.61
|
| Rate for Payer: Humana ChoiceCare |
$31.61
|
| Rate for Payer: Humana Medicare |
$34.64
|
| Rate for Payer: Humana Medicare |
$34.64
|
| Rate for Payer: Lucent All Commercial |
$48.50
|
| Rate for Payer: Lucent All Commercial |
$48.50
|
| 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 |
$79.23
|
| Rate for Payer: Managed Health Services Medicaid |
$79.23
|
| Rate for Payer: MDWise Medicaid |
$79.23
|
| Rate for Payer: MDWise Medicaid |
$79.23
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$20.41
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$20.41
|
| Rate for Payer: PHCS All Commercial |
$34.64
|
| Rate for Payer: PHCS All Commercial |
$34.64
|
| Rate for Payer: PHP All Commercial |
$47.25
|
| Rate for Payer: PHP All Commercial |
$47.25
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$34.64
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$34.64
|
| Rate for Payer: Sagamore Health Network All Products |
$34.64
|
| Rate for Payer: Sagamore Health Network All Products |
$34.64
|
| Rate for Payer: Signature Care EPO |
$71.27
|
| Rate for Payer: Signature Care EPO |
$71.27
|
| Rate for Payer: Signature Care PPO |
$71.27
|
| Rate for Payer: Signature Care PPO |
$71.27
|
| 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 |
$39.48
|
| Rate for Payer: United Healthcare Commercial |
$39.48
|
| Rate for Payer: United Healthcare Medicare |
$79.53
|
| Rate for Payer: United Healthcare Medicare |
$79.53
|
|
|
PR CHEMOTHER, IV INFUSION, 1 HR
|
Professional
|
Both
|
$237.58
|
|
|
Service Code
|
CPT 96413
|
| Hospital Charge Code |
z96413
|
| Min. Negotiated Rate |
$116.85 |
| Max. Negotiated Rate |
$224.84 |
| Rate for Payer: Aetna Commercial |
$125.75
|
| Rate for Payer: Aetna Medicare |
$125.75
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$116.85
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$144.61
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$138.32
|
| Rate for Payer: Cash Price |
$142.55
|
| Rate for Payer: Centivo All Commercial |
$194.91
|
| Rate for Payer: Cigna All Commercial |
$125.75
|
| Rate for Payer: CORVEL All Commercial |
$125.75
|
| Rate for Payer: Coventry All Commercial |
$150.90
|
| Rate for Payer: Encore All Commercial |
$125.75
|
| Rate for Payer: Frontpath All Commercial |
$142.31
|
| Rate for Payer: Humana ChoiceCare |
$224.84
|
| Rate for Payer: Humana Medicare |
$125.75
|
| Rate for Payer: Lucent All Commercial |
$176.05
|
| Rate for Payer: Managed Health Services Medicaid |
$116.85
|
| Rate for Payer: MDWise Medicaid |
$116.85
|
| Rate for Payer: PHCS All Commercial |
$125.75
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$125.75
|
| Rate for Payer: Sagamore Health Network All Products |
$125.75
|
| Rate for Payer: United Healthcare Commercial |
$169.15
|
| Rate for Payer: United Healthcare Medicare |
$117.28
|
|
|
PR CHEMOTHER, IV INFUSION, EA ADD HR
|
Professional
|
Both
|
$51.36
|
|
|
Service Code
|
CPT 96415
|
| Hospital Charge Code |
z96415
|
| Min. Negotiated Rate |
$25.26 |
| Max. Negotiated Rate |
$50.11 |
| Rate for Payer: Aetna Commercial |
$27.14
|
| Rate for Payer: Aetna Medicare |
$27.14
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$25.26
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$31.21
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$29.85
|
| Rate for Payer: Cash Price |
$30.82
|
| Rate for Payer: Centivo All Commercial |
$42.07
|
| Rate for Payer: Cigna All Commercial |
$27.14
|
| Rate for Payer: CORVEL All Commercial |
$27.14
|
| Rate for Payer: Coventry All Commercial |
$32.57
|
| Rate for Payer: Encore All Commercial |
$27.14
|
| Rate for Payer: Frontpath All Commercial |
$30.66
|
| Rate for Payer: Humana ChoiceCare |
$50.11
|
| Rate for Payer: Humana Medicare |
$27.14
|
| Rate for Payer: Lucent All Commercial |
$38.00
|
| Rate for Payer: Managed Health Services Medicaid |
$25.26
|
| Rate for Payer: MDWise Medicaid |
$25.26
|
| Rate for Payer: PHCS All Commercial |
$27.14
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$27.14
|
| Rate for Payer: Sagamore Health Network All Products |
$27.14
|
| Rate for Payer: United Healthcare Commercial |
$38.19
|
| Rate for Payer: United Healthcare Medicare |
$25.57
|
|
|
PR CHRONIC CARE MGMT SVC PHYS 1ST 30 MIN CAL MONTH
|
Professional
|
Both
|
$253.26
|
|
|
Service Code
|
CPT 99491
|
| Hospital Charge Code |
z99491
|
| Min. Negotiated Rate |
$72.24 |
| Max. Negotiated Rate |
$7,400.00 |
| Rate for Payer: Aetna Commercial |
$73.45
|
| Rate for Payer: Aetna Commercial |
$73.45
|
| Rate for Payer: Aetna Medicare |
$73.45
|
| Rate for Payer: Aetna Medicare |
$73.45
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$79.65
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$79.65
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$79.65
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$79.65
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$79.65
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$79.65
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$79.65
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$79.65
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$84.47
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$84.47
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$80.80
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$80.80
|
| Rate for Payer: Cash Price |
$94.28
|
| Rate for Payer: Cash Price |
$151.96
|
| Rate for Payer: Centivo All Commercial |
$113.85
|
| Rate for Payer: Centivo All Commercial |
$113.85
|
| Rate for Payer: Cigna All Commercial |
$73.45
|
| Rate for Payer: Cigna All Commercial |
$73.45
|
| Rate for Payer: CORVEL All Commercial |
$73.45
|
| Rate for Payer: CORVEL All Commercial |
$73.45
|
| Rate for Payer: Coventry All Commercial |
$88.14
|
| Rate for Payer: Coventry All Commercial |
$88.14
|
| Rate for Payer: Encore All Commercial |
$73.45
|
| Rate for Payer: Encore All Commercial |
$73.45
|
| Rate for Payer: Frontpath All Commercial |
$78.96
|
| Rate for Payer: Frontpath All Commercial |
$78.96
|
| Rate for Payer: Humana ChoiceCare |
$84.75
|
| Rate for Payer: Humana ChoiceCare |
$84.75
|
| Rate for Payer: Humana Medicare |
$73.45
|
| Rate for Payer: Humana Medicare |
$73.45
|
| Rate for Payer: Lucent All Commercial |
$102.83
|
| Rate for Payer: Lucent All Commercial |
$102.83
|
| Rate for Payer: Lutheran Preferred All Commercial |
$75.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$75.00
|
| Rate for Payer: PHCS All Commercial |
$73.45
|
| Rate for Payer: PHCS All Commercial |
$73.45
|
| Rate for Payer: PHP All Commercial |
$72.24
|
| Rate for Payer: PHP All Commercial |
$72.24
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$73.45
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$73.45
|
| Rate for Payer: Sagamore Health Network All Products |
$73.45
|
| Rate for Payer: Sagamore Health Network All Products |
$73.45
|
| Rate for Payer: Signature Care EPO |
$82.95
|
| Rate for Payer: Signature Care EPO |
$82.95
|
| Rate for Payer: Signature Care PPO |
$82.95
|
| Rate for Payer: Signature Care PPO |
$82.95
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$7,400.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$7,400.00
|
| Rate for Payer: United Healthcare Commercial |
$84.42
|
| Rate for Payer: United Healthcare Commercial |
$84.42
|
| Rate for Payer: United Healthcare Medicare |
$78.57
|
| Rate for Payer: United Healthcare Medicare |
$78.57
|
|
|
PR CHRONIC CARE MGMT SVCS STAFF 1ST 20 MIN CAL MO
|
Professional
|
Both
|
$118.56
|
|
|
Service Code
|
CPT 99490
|
| Hospital Charge Code |
z99490
|
| Min. Negotiated Rate |
$33.27 |
| Max. Negotiated Rate |
$4,900.00 |
| Rate for Payer: Aetna Commercial |
$48.81
|
| Rate for Payer: Aetna Commercial |
$48.81
|
| Rate for Payer: Aetna Medicare |
$48.81
|
| Rate for Payer: Aetna Medicare |
$48.81
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$49.65
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$49.65
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$49.65
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$49.65
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$49.65
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$49.65
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$49.65
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$49.65
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$56.13
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$56.13
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$53.69
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$53.69
|
| Rate for Payer: Cash Price |
$69.18
|
| Rate for Payer: Cash Price |
$71.14
|
| Rate for Payer: Centivo All Commercial |
$75.66
|
| Rate for Payer: Centivo All Commercial |
$75.66
|
| Rate for Payer: Cigna All Commercial |
$48.81
|
| Rate for Payer: Cigna All Commercial |
$48.81
|
| Rate for Payer: CORVEL All Commercial |
$48.81
|
| Rate for Payer: CORVEL All Commercial |
$48.81
|
| Rate for Payer: Coventry All Commercial |
$58.57
|
| Rate for Payer: Coventry All Commercial |
$58.57
|
| Rate for Payer: Encore All Commercial |
$48.81
|
| Rate for Payer: Encore All Commercial |
$48.81
|
| Rate for Payer: Frontpath All Commercial |
$52.55
|
| Rate for Payer: Frontpath All Commercial |
$52.55
|
| Rate for Payer: Humana ChoiceCare |
$33.49
|
| Rate for Payer: Humana ChoiceCare |
$33.49
|
| Rate for Payer: Humana Medicare |
$48.81
|
| Rate for Payer: Humana Medicare |
$48.81
|
| Rate for Payer: Lucent All Commercial |
$68.33
|
| Rate for Payer: Lucent All Commercial |
$68.33
|
| Rate for Payer: Lutheran Preferred All Commercial |
$50.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$50.00
|
| Rate for Payer: PHCS All Commercial |
$48.81
|
| Rate for Payer: PHCS All Commercial |
$48.81
|
| Rate for Payer: PHP All Commercial |
$48.21
|
| Rate for Payer: PHP All Commercial |
$48.21
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$48.81
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$48.81
|
| Rate for Payer: Sagamore Health Network All Products |
$48.81
|
| Rate for Payer: Sagamore Health Network All Products |
$48.81
|
| Rate for Payer: Signature Care EPO |
$51.03
|
| Rate for Payer: Signature Care EPO |
$51.03
|
| Rate for Payer: Signature Care PPO |
$51.03
|
| Rate for Payer: Signature Care PPO |
$51.03
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,900.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,900.00
|
| Rate for Payer: United Healthcare Commercial |
$33.27
|
| Rate for Payer: United Healthcare Commercial |
$33.27
|
| Rate for Payer: United Healthcare Medicare |
$57.65
|
| Rate for Payer: United Healthcare Medicare |
$57.65
|
|
|
PR CHRONIC CARE MGMT SVC STAF EA ADDL 20 MIN CAL MO
|
Professional
|
Both
|
$90.58
|
|
|
Service Code
|
CPT 99439
|
| Hospital Charge Code |
z99439
|
| Min. Negotiated Rate |
$28.42 |
| Max. Negotiated Rate |
$3,400.00 |
| Rate for Payer: Aetna Commercial |
$34.37
|
| Rate for Payer: Aetna Commercial |
$34.37
|
| Rate for Payer: Aetna Medicare |
$34.37
|
| Rate for Payer: Aetna Medicare |
$34.37
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$35.19
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$35.19
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$35.19
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$35.19
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$35.19
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$35.19
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$35.19
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$35.19
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$39.53
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$39.53
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$37.81
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$37.81
|
| Rate for Payer: Cash Price |
$52.38
|
| Rate for Payer: Cash Price |
$54.35
|
| Rate for Payer: Centivo All Commercial |
$53.27
|
| Rate for Payer: Centivo All Commercial |
$53.27
|
| Rate for Payer: Cigna All Commercial |
$34.37
|
| Rate for Payer: Cigna All Commercial |
$34.37
|
| Rate for Payer: CORVEL All Commercial |
$34.37
|
| Rate for Payer: CORVEL All Commercial |
$34.37
|
| Rate for Payer: Coventry All Commercial |
$41.24
|
| Rate for Payer: Coventry All Commercial |
$41.24
|
| Rate for Payer: Encore All Commercial |
$34.37
|
| Rate for Payer: Encore All Commercial |
$34.37
|
| Rate for Payer: Frontpath All Commercial |
$37.02
|
| Rate for Payer: Frontpath All Commercial |
$37.02
|
| Rate for Payer: Humana ChoiceCare |
$28.42
|
| Rate for Payer: Humana ChoiceCare |
$28.42
|
| Rate for Payer: Humana Medicare |
$34.37
|
| Rate for Payer: Humana Medicare |
$34.37
|
| Rate for Payer: Lucent All Commercial |
$48.12
|
| Rate for Payer: Lucent All Commercial |
$48.12
|
| Rate for Payer: Lutheran Preferred All Commercial |
$35.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$35.00
|
| Rate for Payer: PHCS All Commercial |
$34.37
|
| Rate for Payer: PHCS All Commercial |
$34.37
|
| Rate for Payer: PHP All Commercial |
$33.48
|
| Rate for Payer: PHP All Commercial |
$33.48
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$34.37
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$34.37
|
| Rate for Payer: Sagamore Health Network All Products |
$34.37
|
| Rate for Payer: Sagamore Health Network All Products |
$34.37
|
| Rate for Payer: Signature Care EPO |
$38.48
|
| Rate for Payer: Signature Care EPO |
$38.48
|
| Rate for Payer: Signature Care PPO |
$38.48
|
| Rate for Payer: Signature Care PPO |
$38.48
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,400.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,400.00
|
| Rate for Payer: United Healthcare Commercial |
$29.36
|
| Rate for Payer: United Healthcare Commercial |
$29.36
|
| Rate for Payer: United Healthcare Medicare |
$43.65
|
| Rate for Payer: United Healthcare Medicare |
$43.65
|
|
|
PR CIRCUMCISION AGE >28 DAYS
|
Professional
|
Both
|
$361.54
|
|
|
Service Code
|
CPT 54161
|
| Hospital Charge Code |
z54161
|
| Min. Negotiated Rate |
$179.89 |
| Max. Negotiated Rate |
$287.51 |
| Rate for Payer: Aetna Commercial |
$185.49
|
| Rate for Payer: Aetna Medicare |
$185.49
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$181.48
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$213.31
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$204.04
|
| Rate for Payer: Cash Price |
$216.92
|
| Rate for Payer: Centivo All Commercial |
$287.51
|
| Rate for Payer: Cigna All Commercial |
$185.49
|
| Rate for Payer: CORVEL All Commercial |
$185.49
|
| Rate for Payer: Coventry All Commercial |
$222.59
|
| Rate for Payer: Encore All Commercial |
$185.49
|
| Rate for Payer: Frontpath All Commercial |
$253.66
|
| Rate for Payer: Humana ChoiceCare |
$230.06
|
| Rate for Payer: Humana Medicare |
$185.49
|
| Rate for Payer: Lucent All Commercial |
$259.69
|
| Rate for Payer: Managed Health Services Medicaid |
$181.48
|
| Rate for Payer: MDWise Medicaid |
$181.48
|
| Rate for Payer: PHCS All Commercial |
$185.49
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$185.49
|
| Rate for Payer: Sagamore Health Network All Products |
$185.49
|
| Rate for Payer: United Healthcare Commercial |
$242.28
|
| Rate for Payer: United Healthcare Medicare |
$179.89
|
|
|
PR CIRCUMCISION NEONATE
|
Professional
|
Both
|
$412.92
|
|
|
Service Code
|
CPT 54160
|
| Hospital Charge Code |
z54160
|
| Min. Negotiated Rate |
$73.54 |
| Max. Negotiated Rate |
$17,700.00 |
| Rate for Payer: Aetna Commercial |
$136.76
|
| Rate for Payer: Aetna Commercial |
$136.76
|
| Rate for Payer: Aetna Medicare |
$136.76
|
| Rate for Payer: Aetna Medicare |
$136.76
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$333.83
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$333.83
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$333.83
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$333.83
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$333.83
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$333.83
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$333.83
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$333.83
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$73.54
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$73.54
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$203.09
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$203.09
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$157.27
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$157.27
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$150.44
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$150.44
|
| Rate for Payer: Cash Price |
$241.20
|
| Rate for Payer: Cash Price |
$247.75
|
| Rate for Payer: Centivo All Commercial |
$211.98
|
| Rate for Payer: Centivo All Commercial |
$211.98
|
| Rate for Payer: Cigna All Commercial |
$136.76
|
| Rate for Payer: Cigna All Commercial |
$136.76
|
| Rate for Payer: CORVEL All Commercial |
$136.76
|
| Rate for Payer: CORVEL All Commercial |
$136.76
|
| Rate for Payer: Coventry All Commercial |
$164.11
|
| Rate for Payer: Coventry All Commercial |
$164.11
|
| Rate for Payer: Encore All Commercial |
$136.76
|
| Rate for Payer: Encore All Commercial |
$136.76
|
| Rate for Payer: Frontpath All Commercial |
$186.82
|
| Rate for Payer: Frontpath All Commercial |
$186.82
|
| Rate for Payer: Humana ChoiceCare |
$170.74
|
| Rate for Payer: Humana ChoiceCare |
$170.74
|
| Rate for Payer: Humana Medicare |
$136.76
|
| Rate for Payer: Humana Medicare |
$136.76
|
| Rate for Payer: Lucent All Commercial |
$191.46
|
| Rate for Payer: Lucent All Commercial |
$191.46
|
| Rate for Payer: Lutheran Preferred All Commercial |
$190.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$190.00
|
| Rate for Payer: Managed Health Services Medicaid |
$203.09
|
| Rate for Payer: Managed Health Services Medicaid |
$203.09
|
| Rate for Payer: MDWise Medicaid |
$203.09
|
| Rate for Payer: MDWise Medicaid |
$203.09
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$73.54
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$73.54
|
| Rate for Payer: PHCS All Commercial |
$136.76
|
| Rate for Payer: PHCS All Commercial |
$136.76
|
| Rate for Payer: PHP All Commercial |
$175.07
|
| Rate for Payer: PHP All Commercial |
$175.07
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$136.76
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$136.76
|
| Rate for Payer: Sagamore Health Network All Products |
$136.76
|
| Rate for Payer: Sagamore Health Network All Products |
$136.76
|
| Rate for Payer: Signature Care EPO |
$178.06
|
| Rate for Payer: Signature Care EPO |
$178.06
|
| Rate for Payer: Signature Care PPO |
$178.06
|
| Rate for Payer: Signature Care PPO |
$178.06
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$17,700.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$17,700.00
|
| Rate for Payer: United Healthcare Commercial |
$178.68
|
| Rate for Payer: United Healthcare Commercial |
$178.68
|
| Rate for Payer: United Healthcare Medicare |
$201.00
|
| Rate for Payer: United Healthcare Medicare |
$201.00
|
|
