|
PR COMP ASSES CARE PLAN CCM SVC
|
Professional
|
Both
|
$115.00
|
|
|
Service Code
|
CPT G0506
|
| Hospital Charge Code |
zG0506
|
| Min. Negotiated Rate |
$35.59 |
| Max. Negotiated Rate |
$66.28 |
| Rate for Payer: Aetna Commercial |
$42.76
|
| Rate for Payer: Aetna Medicare |
$42.76
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$49.17
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$47.04
|
| Rate for Payer: Cash Price |
$69.00
|
| Rate for Payer: Centivo All Commercial |
$66.28
|
| Rate for Payer: Cigna All Commercial |
$42.76
|
| Rate for Payer: CORVEL All Commercial |
$42.76
|
| Rate for Payer: Coventry All Commercial |
$51.31
|
| Rate for Payer: Encore All Commercial |
$42.76
|
| Rate for Payer: Humana ChoiceCare |
$35.59
|
| Rate for Payer: Humana Medicare |
$42.76
|
| Rate for Payer: Lucent All Commercial |
$59.86
|
| Rate for Payer: PHCS All Commercial |
$42.76
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$42.76
|
| Rate for Payer: Sagamore Health Network All Products |
$42.76
|
| Rate for Payer: United Healthcare Commercial |
$55.74
|
|
|
PR COMPLEX CHRONIC CARE MGMT SVC 1ST 60 MIN CAL MO
|
Professional
|
Both
|
$253.26
|
|
|
Service Code
|
CPT 99487
|
| Hospital Charge Code |
z99487
|
| Min. Negotiated Rate |
$75.85 |
| Max. Negotiated Rate |
$8,900.00 |
| Rate for Payer: Aetna Commercial |
$88.08
|
| Rate for Payer: Aetna Commercial |
$88.08
|
| Rate for Payer: Aetna Medicare |
$88.08
|
| Rate for Payer: Aetna Medicare |
$88.08
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$75.85
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$75.85
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$75.85
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$75.85
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$75.85
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$75.85
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$75.85
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$75.85
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$101.29
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$101.29
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$96.89
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$96.89
|
| Rate for Payer: Cash Price |
$146.35
|
| Rate for Payer: Cash Price |
$151.96
|
| Rate for Payer: Centivo All Commercial |
$136.52
|
| Rate for Payer: Centivo All Commercial |
$136.52
|
| Rate for Payer: Cigna All Commercial |
$88.08
|
| Rate for Payer: Cigna All Commercial |
$88.08
|
| Rate for Payer: CORVEL All Commercial |
$88.08
|
| Rate for Payer: CORVEL All Commercial |
$88.08
|
| Rate for Payer: Coventry All Commercial |
$105.70
|
| Rate for Payer: Coventry All Commercial |
$105.70
|
| Rate for Payer: Encore All Commercial |
$88.08
|
| Rate for Payer: Encore All Commercial |
$88.08
|
| Rate for Payer: Frontpath All Commercial |
$94.44
|
| Rate for Payer: Frontpath All Commercial |
$94.44
|
| Rate for Payer: Humana ChoiceCare |
$82.64
|
| Rate for Payer: Humana ChoiceCare |
$82.64
|
| Rate for Payer: Humana Medicare |
$88.08
|
| Rate for Payer: Humana Medicare |
$88.08
|
| Rate for Payer: Lucent All Commercial |
$123.31
|
| Rate for Payer: Lucent All Commercial |
$123.31
|
| Rate for Payer: Lutheran Preferred All Commercial |
$91.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$91.00
|
| Rate for Payer: PHCS All Commercial |
$88.08
|
| Rate for Payer: PHCS All Commercial |
$88.08
|
| Rate for Payer: PHP All Commercial |
$86.84
|
| Rate for Payer: PHP All Commercial |
$86.84
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$88.08
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$88.08
|
| Rate for Payer: Sagamore Health Network All Products |
$88.08
|
| Rate for Payer: Sagamore Health Network All Products |
$88.08
|
| Rate for Payer: Signature Care EPO |
$106.63
|
| Rate for Payer: Signature Care EPO |
$106.63
|
| Rate for Payer: Signature Care PPO |
$106.63
|
| Rate for Payer: Signature Care PPO |
$106.63
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$8,900.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$8,900.00
|
| Rate for Payer: United Healthcare Commercial |
$86.16
|
| Rate for Payer: United Healthcare Commercial |
$86.16
|
| Rate for Payer: United Healthcare Medicare |
$121.96
|
| Rate for Payer: United Healthcare Medicare |
$121.96
|
|
|
PR COMPLEX CYSTOMETROGRAM VOIDING PRESSURE STUDIES
|
Professional
|
Both
|
$25.66
|
|
|
Service Code
|
CPT 51728
|
| Hospital Charge Code |
z51728
|
| Min. Negotiated Rate |
$273.06 |
| Max. Negotiated Rate |
$541.31 |
| Rate for Payer: Aetna Commercial |
$349.23
|
| Rate for Payer: Aetna Medicare |
$349.23
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$331.76
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$401.61
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$384.15
|
| Rate for Payer: Cash Price |
$15.40
|
| Rate for Payer: Centivo All Commercial |
$541.31
|
| Rate for Payer: Cigna All Commercial |
$349.23
|
| Rate for Payer: CORVEL All Commercial |
$349.23
|
| Rate for Payer: Coventry All Commercial |
$419.08
|
| Rate for Payer: Encore All Commercial |
$349.23
|
| Rate for Payer: Frontpath All Commercial |
$465.08
|
| Rate for Payer: Humana ChoiceCare |
$273.06
|
| Rate for Payer: Humana Medicare |
$349.23
|
| Rate for Payer: Lucent All Commercial |
$488.92
|
| Rate for Payer: Managed Health Services Medicaid |
$331.76
|
| Rate for Payer: MDWise Medicaid |
$331.76
|
| Rate for Payer: PHCS All Commercial |
$349.23
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$349.23
|
| Rate for Payer: Sagamore Health Network All Products |
$349.23
|
| Rate for Payer: United Healthcare Commercial |
$337.70
|
|
|
PR COMPLEX E/M VISIT ADD ON
|
Professional
|
Both
|
$31.76
|
|
|
Service Code
|
CPT G2211
|
| Hospital Charge Code |
zG2211
|
| Min. Negotiated Rate |
$17.82 |
| Max. Negotiated Rate |
$17.82 |
| Rate for Payer: Cash Price |
$19.06
|
| Rate for Payer: United Healthcare Commercial |
$17.82
|
|
|
PR COMPLEX UROFLOWMETRY
|
Professional
|
Both
|
$311.00
|
|
|
Service Code
|
CPT 51741
|
| Hospital Charge Code |
z51741
|
| Min. Negotiated Rate |
$12.91 |
| Max. Negotiated Rate |
$102.38 |
| Rate for Payer: Aetna Commercial |
$12.91
|
| Rate for Payer: Aetna Medicare |
$12.91
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$12.99
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$14.85
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$14.20
|
| Rate for Payer: Cash Price |
$186.60
|
| Rate for Payer: Centivo All Commercial |
$20.01
|
| Rate for Payer: Cigna All Commercial |
$12.91
|
| Rate for Payer: CORVEL All Commercial |
$12.91
|
| Rate for Payer: Coventry All Commercial |
$15.49
|
| Rate for Payer: Encore All Commercial |
$12.91
|
| Rate for Payer: Frontpath All Commercial |
$17.74
|
| Rate for Payer: Humana ChoiceCare |
$72.73
|
| Rate for Payer: Humana Medicare |
$12.91
|
| Rate for Payer: Lucent All Commercial |
$18.07
|
| Rate for Payer: Managed Health Services Medicaid |
$12.99
|
| Rate for Payer: MDWise Medicaid |
$12.99
|
| Rate for Payer: PHCS All Commercial |
$12.91
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$12.91
|
| Rate for Payer: Sagamore Health Network All Products |
$12.91
|
| Rate for Payer: United Healthcare Commercial |
$102.38
|
|
|
PR COMPREHENSIVE HEARING TEST
|
Professional
|
Both
|
$69.44
|
|
|
Service Code
|
CPT 92557
|
| Hospital Charge Code |
z92557
|
| Min. Negotiated Rate |
$27.85 |
| Max. Negotiated Rate |
$3,700.00 |
| Rate for Payer: Aetna Commercial |
$31.06
|
| Rate for Payer: Aetna Commercial |
$31.06
|
| Rate for Payer: Aetna Medicare |
$31.06
|
| Rate for Payer: Aetna Medicare |
$31.06
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$47.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$47.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$47.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$47.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$47.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$47.10
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$47.10
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$47.10
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$27.85
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$27.85
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$34.15
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$34.15
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$35.72
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$35.72
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$34.17
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$34.17
|
| Rate for Payer: Cash Price |
$41.53
|
| Rate for Payer: Cash Price |
$41.66
|
| Rate for Payer: Centivo All Commercial |
$48.14
|
| Rate for Payer: Centivo All Commercial |
$48.14
|
| Rate for Payer: Cigna All Commercial |
$31.06
|
| Rate for Payer: Cigna All Commercial |
$31.06
|
| Rate for Payer: CORVEL All Commercial |
$31.06
|
| Rate for Payer: CORVEL All Commercial |
$31.06
|
| Rate for Payer: Coventry All Commercial |
$37.27
|
| Rate for Payer: Coventry All Commercial |
$37.27
|
| Rate for Payer: Encore All Commercial |
$31.06
|
| Rate for Payer: Encore All Commercial |
$31.06
|
| Rate for Payer: Frontpath All Commercial |
$35.28
|
| Rate for Payer: Frontpath All Commercial |
$35.28
|
| Rate for Payer: Humana ChoiceCare |
$50.12
|
| Rate for Payer: Humana ChoiceCare |
$50.12
|
| Rate for Payer: Humana Medicare |
$31.06
|
| Rate for Payer: Humana Medicare |
$31.06
|
| Rate for Payer: Lucent All Commercial |
$43.48
|
| Rate for Payer: Lucent All Commercial |
$43.48
|
| Rate for Payer: Lutheran Preferred All Commercial |
$40.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$40.00
|
| Rate for Payer: Managed Health Services Medicaid |
$34.15
|
| Rate for Payer: Managed Health Services Medicaid |
$34.15
|
| Rate for Payer: MDWise Medicaid |
$34.15
|
| Rate for Payer: MDWise Medicaid |
$34.15
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$27.85
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$27.85
|
| Rate for Payer: PHCS All Commercial |
$31.06
|
| Rate for Payer: PHCS All Commercial |
$31.06
|
| Rate for Payer: PHP All Commercial |
$43.19
|
| Rate for Payer: PHP All Commercial |
$43.19
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$31.06
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$31.06
|
| Rate for Payer: Sagamore Health Network All Products |
$31.06
|
| Rate for Payer: Sagamore Health Network All Products |
$31.06
|
| Rate for Payer: Signature Care EPO |
$51.00
|
| Rate for Payer: Signature Care EPO |
$51.00
|
| Rate for Payer: Signature Care PPO |
$51.00
|
| Rate for Payer: Signature Care PPO |
$51.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,700.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,700.00
|
| Rate for Payer: United Healthcare Commercial |
$49.33
|
| Rate for Payer: United Healthcare Commercial |
$49.33
|
| Rate for Payer: United Healthcare Medicare |
$34.61
|
| Rate for Payer: United Healthcare Medicare |
$34.61
|
|
|
PR CONDITIONING PLAY AUDIOMETRY
|
Professional
|
Both
|
$159.30
|
|
|
Service Code
|
CPT 92582
|
| Hospital Charge Code |
z92582
|
| Min. Negotiated Rate |
$28.20 |
| Max. Negotiated Rate |
$9,100.00 |
| Rate for Payer: Aetna Commercial |
$70.71
|
| Rate for Payer: Aetna Commercial |
$70.71
|
| Rate for Payer: Aetna Medicare |
$70.71
|
| Rate for Payer: Aetna Medicare |
$70.71
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$28.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$28.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$28.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$28.20
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$28.20
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$28.20
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$28.20
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$28.20
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$78.35
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$78.35
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$81.32
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$81.32
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$77.78
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$77.78
|
| Rate for Payer: Cash Price |
$95.58
|
| Rate for Payer: Cash Price |
$88.38
|
| Rate for Payer: Centivo All Commercial |
$109.60
|
| Rate for Payer: Centivo All Commercial |
$109.60
|
| Rate for Payer: Cigna All Commercial |
$70.71
|
| Rate for Payer: Cigna All Commercial |
$70.71
|
| Rate for Payer: CORVEL All Commercial |
$70.71
|
| Rate for Payer: CORVEL All Commercial |
$70.71
|
| Rate for Payer: Coventry All Commercial |
$84.85
|
| Rate for Payer: Coventry All Commercial |
$84.85
|
| Rate for Payer: Encore All Commercial |
$70.71
|
| Rate for Payer: Encore All Commercial |
$70.71
|
| Rate for Payer: Frontpath All Commercial |
$79.38
|
| Rate for Payer: Frontpath All Commercial |
$79.38
|
| Rate for Payer: Humana ChoiceCare |
$30.49
|
| Rate for Payer: Humana ChoiceCare |
$30.49
|
| Rate for Payer: Humana Medicare |
$70.71
|
| Rate for Payer: Humana Medicare |
$70.71
|
| Rate for Payer: Lucent All Commercial |
$98.99
|
| Rate for Payer: Lucent All Commercial |
$98.99
|
| 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 |
$78.35
|
| Rate for Payer: Managed Health Services Medicaid |
$78.35
|
| Rate for Payer: MDWise Medicaid |
$78.35
|
| Rate for Payer: MDWise Medicaid |
$78.35
|
| Rate for Payer: PHCS All Commercial |
$70.71
|
| Rate for Payer: PHCS All Commercial |
$70.71
|
| Rate for Payer: PHP All Commercial |
$106.79
|
| Rate for Payer: PHP All Commercial |
$106.79
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$70.71
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$70.71
|
| Rate for Payer: Sagamore Health Network All Products |
$70.71
|
| Rate for Payer: Sagamore Health Network All Products |
$70.71
|
| Rate for Payer: Signature Care EPO |
$60.10
|
| Rate for Payer: Signature Care EPO |
$60.10
|
| Rate for Payer: Signature Care PPO |
$60.10
|
| Rate for Payer: Signature Care PPO |
$60.10
|
| 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 |
$45.49
|
| Rate for Payer: United Healthcare Commercial |
$45.49
|
| Rate for Payer: United Healthcare Medicare |
$73.65
|
| Rate for Payer: United Healthcare Medicare |
$73.65
|
|
|
PR CONIZATION CERVIX,KNIFE/LASER
|
Professional
|
Both
|
$659.00
|
|
|
Service Code
|
CPT 57520
|
| Hospital Charge Code |
z57520
|
| Min. Negotiated Rate |
$185.31 |
| Max. Negotiated Rate |
$36,100.00 |
| Rate for Payer: Aetna Commercial |
$278.99
|
| Rate for Payer: Aetna Commercial |
$278.99
|
| Rate for Payer: Aetna Medicare |
$278.99
|
| Rate for Payer: Aetna Medicare |
$278.99
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$414.11
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$414.11
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$414.11
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$414.11
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$414.11
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$414.11
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$414.11
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$414.11
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$185.31
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$185.31
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$324.12
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$324.12
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$320.84
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$320.84
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$306.89
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$306.89
|
| Rate for Payer: Cash Price |
$388.20
|
| Rate for Payer: Cash Price |
$395.40
|
| Rate for Payer: Centivo All Commercial |
$432.43
|
| Rate for Payer: Centivo All Commercial |
$432.43
|
| Rate for Payer: Cigna All Commercial |
$278.99
|
| Rate for Payer: Cigna All Commercial |
$278.99
|
| Rate for Payer: CORVEL All Commercial |
$278.99
|
| Rate for Payer: CORVEL All Commercial |
$278.99
|
| Rate for Payer: Coventry All Commercial |
$334.79
|
| Rate for Payer: Coventry All Commercial |
$334.79
|
| Rate for Payer: Encore All Commercial |
$278.99
|
| Rate for Payer: Encore All Commercial |
$278.99
|
| Rate for Payer: Frontpath All Commercial |
$383.73
|
| Rate for Payer: Frontpath All Commercial |
$383.73
|
| Rate for Payer: Humana ChoiceCare |
$303.86
|
| Rate for Payer: Humana ChoiceCare |
$303.86
|
| Rate for Payer: Humana Medicare |
$278.99
|
| Rate for Payer: Humana Medicare |
$278.99
|
| Rate for Payer: Lucent All Commercial |
$390.59
|
| Rate for Payer: Lucent All Commercial |
$390.59
|
| Rate for Payer: Lutheran Preferred All Commercial |
$389.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$389.00
|
| Rate for Payer: Managed Health Services Medicaid |
$324.12
|
| Rate for Payer: Managed Health Services Medicaid |
$324.12
|
| Rate for Payer: MDWise Medicaid |
$324.12
|
| Rate for Payer: MDWise Medicaid |
$324.12
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$185.31
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$185.31
|
| Rate for Payer: PHCS All Commercial |
$278.99
|
| Rate for Payer: PHCS All Commercial |
$278.99
|
| Rate for Payer: PHP All Commercial |
$357.84
|
| Rate for Payer: PHP All Commercial |
$357.84
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$278.99
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$278.99
|
| Rate for Payer: Sagamore Health Network All Products |
$278.99
|
| Rate for Payer: Sagamore Health Network All Products |
$278.99
|
| Rate for Payer: Signature Care EPO |
$433.50
|
| Rate for Payer: Signature Care EPO |
$433.50
|
| Rate for Payer: Signature Care PPO |
$433.50
|
| Rate for Payer: Signature Care PPO |
$433.50
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$36,100.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$36,100.00
|
| Rate for Payer: United Healthcare Commercial |
$305.53
|
| Rate for Payer: United Healthcare Commercial |
$305.53
|
| Rate for Payer: United Healthcare Medicare |
$323.50
|
| Rate for Payer: United Healthcare Medicare |
$323.50
|
|
|
PR CONIZATION CERVIX,LOOP ELECTRD
|
Professional
|
Both
|
$565.42
|
|
|
Service Code
|
CPT 57522
|
| Hospital Charge Code |
z57522
|
| Min. Negotiated Rate |
$181.31 |
| Max. Negotiated Rate |
$31,100.00 |
| Rate for Payer: Aetna Commercial |
$240.37
|
| Rate for Payer: Aetna Commercial |
$240.37
|
| Rate for Payer: Aetna Medicare |
$240.37
|
| Rate for Payer: Aetna Medicare |
$240.37
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$338.73
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$338.73
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$338.73
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$338.73
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$338.73
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$338.73
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$338.73
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$338.73
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$181.31
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$181.31
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$278.09
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$278.09
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$276.43
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$276.43
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$264.41
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$264.41
|
| Rate for Payer: Cash Price |
$333.46
|
| Rate for Payer: Cash Price |
$339.25
|
| Rate for Payer: Centivo All Commercial |
$372.57
|
| Rate for Payer: Centivo All Commercial |
$372.57
|
| Rate for Payer: Cigna All Commercial |
$240.37
|
| Rate for Payer: Cigna All Commercial |
$240.37
|
| Rate for Payer: CORVEL All Commercial |
$240.37
|
| Rate for Payer: CORVEL All Commercial |
$240.37
|
| Rate for Payer: Coventry All Commercial |
$288.44
|
| Rate for Payer: Coventry All Commercial |
$288.44
|
| Rate for Payer: Encore All Commercial |
$240.37
|
| Rate for Payer: Encore All Commercial |
$240.37
|
| Rate for Payer: Frontpath All Commercial |
$331.41
|
| Rate for Payer: Frontpath All Commercial |
$331.41
|
| Rate for Payer: Humana ChoiceCare |
$255.29
|
| Rate for Payer: Humana ChoiceCare |
$255.29
|
| Rate for Payer: Humana Medicare |
$240.37
|
| Rate for Payer: Humana Medicare |
$240.37
|
| Rate for Payer: Lucent All Commercial |
$336.52
|
| Rate for Payer: Lucent All Commercial |
$336.52
|
| Rate for Payer: Lutheran Preferred All Commercial |
$335.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$335.00
|
| Rate for Payer: Managed Health Services Medicaid |
$278.09
|
| Rate for Payer: Managed Health Services Medicaid |
$278.09
|
| Rate for Payer: MDWise Medicaid |
$278.09
|
| Rate for Payer: MDWise Medicaid |
$278.09
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$181.31
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$181.31
|
| Rate for Payer: PHCS All Commercial |
$240.37
|
| Rate for Payer: PHCS All Commercial |
$240.37
|
| Rate for Payer: PHP All Commercial |
$307.96
|
| Rate for Payer: PHP All Commercial |
$307.96
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$240.37
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$240.37
|
| Rate for Payer: Sagamore Health Network All Products |
$240.37
|
| Rate for Payer: Sagamore Health Network All Products |
$240.37
|
| Rate for Payer: Signature Care EPO |
$374.00
|
| Rate for Payer: Signature Care EPO |
$374.00
|
| Rate for Payer: Signature Care PPO |
$374.00
|
| Rate for Payer: Signature Care PPO |
$374.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$31,100.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$31,100.00
|
| Rate for Payer: United Healthcare Commercial |
$271.11
|
| Rate for Payer: United Healthcare Commercial |
$271.11
|
| Rate for Payer: United Healthcare Medicare |
$277.88
|
| Rate for Payer: United Healthcare Medicare |
$277.88
|
|
|
PR CONT GLUC MNTR PHYSICIAN/QHP PROVIDED EQUIPTMENT
|
Professional
|
Both
|
$270.76
|
|
|
Service Code
|
CPT 95250
|
| Hospital Charge Code |
z95250
|
| Min. Negotiated Rate |
$130.14 |
| Max. Negotiated Rate |
$210.52 |
| Rate for Payer: Aetna Commercial |
$135.82
|
| Rate for Payer: Aetna Commercial |
$135.82
|
| Rate for Payer: Aetna Medicare |
$135.82
|
| Rate for Payer: Aetna Medicare |
$135.82
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$133.17
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$133.17
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$156.19
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$156.19
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$149.40
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$149.40
|
| Rate for Payer: Cash Price |
$156.17
|
| Rate for Payer: Cash Price |
$162.46
|
| Rate for Payer: Centivo All Commercial |
$210.52
|
| Rate for Payer: Centivo All Commercial |
$210.52
|
| Rate for Payer: Cigna All Commercial |
$135.82
|
| Rate for Payer: Cigna All Commercial |
$135.82
|
| Rate for Payer: CORVEL All Commercial |
$135.82
|
| Rate for Payer: CORVEL All Commercial |
$135.82
|
| Rate for Payer: Coventry All Commercial |
$162.98
|
| Rate for Payer: Coventry All Commercial |
$162.98
|
| Rate for Payer: Encore All Commercial |
$135.82
|
| Rate for Payer: Encore All Commercial |
$135.82
|
| Rate for Payer: Frontpath All Commercial |
$144.19
|
| Rate for Payer: Frontpath All Commercial |
$144.19
|
| Rate for Payer: Humana ChoiceCare |
$170.38
|
| Rate for Payer: Humana ChoiceCare |
$170.38
|
| Rate for Payer: Humana Medicare |
$135.82
|
| Rate for Payer: Humana Medicare |
$135.82
|
| Rate for Payer: Lucent All Commercial |
$190.15
|
| Rate for Payer: Lucent All Commercial |
$190.15
|
| Rate for Payer: Managed Health Services Medicaid |
$133.17
|
| Rate for Payer: Managed Health Services Medicaid |
$133.17
|
| Rate for Payer: MDWise Medicaid |
$133.17
|
| Rate for Payer: MDWise Medicaid |
$133.17
|
| Rate for Payer: PHCS All Commercial |
$135.82
|
| Rate for Payer: PHCS All Commercial |
$135.82
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$135.82
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$135.82
|
| Rate for Payer: Sagamore Health Network All Products |
$135.82
|
| Rate for Payer: Sagamore Health Network All Products |
$135.82
|
| Rate for Payer: United Healthcare Commercial |
$147.19
|
| Rate for Payer: United Healthcare Commercial |
$147.19
|
| Rate for Payer: United Healthcare Medicare |
$130.14
|
| Rate for Payer: United Healthcare Medicare |
$130.14
|
|
|
PR CONTINUOUS GLUCOSE MONITORING ANALYSIS I&R
|
Professional
|
Both
|
$65.70
|
|
|
Service Code
|
CPT 95251
|
| Hospital Charge Code |
z95251
|
| Min. Negotiated Rate |
$32.03 |
| Max. Negotiated Rate |
$52.06 |
| Rate for Payer: Aetna Commercial |
$33.59
|
| Rate for Payer: Aetna Commercial |
$33.59
|
| Rate for Payer: Aetna Medicare |
$33.59
|
| Rate for Payer: Aetna Medicare |
$33.59
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$32.31
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$32.31
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$38.63
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$38.63
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$36.95
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$36.95
|
| Rate for Payer: Cash Price |
$38.64
|
| Rate for Payer: Cash Price |
$39.42
|
| Rate for Payer: Centivo All Commercial |
$52.06
|
| Rate for Payer: Centivo All Commercial |
$52.06
|
| Rate for Payer: Cigna All Commercial |
$33.59
|
| Rate for Payer: Cigna All Commercial |
$33.59
|
| Rate for Payer: CORVEL All Commercial |
$33.59
|
| Rate for Payer: CORVEL All Commercial |
$33.59
|
| Rate for Payer: Coventry All Commercial |
$40.31
|
| Rate for Payer: Coventry All Commercial |
$40.31
|
| Rate for Payer: Encore All Commercial |
$33.59
|
| Rate for Payer: Encore All Commercial |
$33.59
|
| Rate for Payer: Frontpath All Commercial |
$35.97
|
| Rate for Payer: Frontpath All Commercial |
$35.97
|
| Rate for Payer: Humana ChoiceCare |
$32.03
|
| Rate for Payer: Humana ChoiceCare |
$32.03
|
| Rate for Payer: Humana Medicare |
$33.59
|
| Rate for Payer: Humana Medicare |
$33.59
|
| Rate for Payer: Lucent All Commercial |
$47.03
|
| Rate for Payer: Lucent All Commercial |
$47.03
|
| Rate for Payer: Managed Health Services Medicaid |
$32.31
|
| Rate for Payer: Managed Health Services Medicaid |
$32.31
|
| Rate for Payer: MDWise Medicaid |
$32.31
|
| Rate for Payer: MDWise Medicaid |
$32.31
|
| Rate for Payer: PHCS All Commercial |
$33.59
|
| Rate for Payer: PHCS All Commercial |
$33.59
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$33.59
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$33.59
|
| Rate for Payer: Sagamore Health Network All Products |
$33.59
|
| Rate for Payer: Sagamore Health Network All Products |
$33.59
|
| Rate for Payer: United Healthcare Commercial |
$48.38
|
| Rate for Payer: United Healthcare Commercial |
$48.38
|
| Rate for Payer: United Healthcare Medicare |
$32.20
|
| Rate for Payer: United Healthcare Medicare |
$32.20
|
|
|
PR CONTROL THROAT BLEED,SIMPLE
|
Professional
|
Both
|
$300.82
|
|
|
Service Code
|
CPT 42960
|
| Hospital Charge Code |
z42960
|
| Min. Negotiated Rate |
$147.85 |
| Max. Negotiated Rate |
$21,200.00 |
| Rate for Payer: Aetna Commercial |
$152.14
|
| Rate for Payer: Aetna Commercial |
$152.14
|
| Rate for Payer: Aetna Medicare |
$152.14
|
| Rate for Payer: Aetna Medicare |
$152.14
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$189.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$189.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$189.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$189.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$189.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$189.50
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$189.50
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$189.50
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$147.95
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$147.95
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$174.96
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$174.96
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$167.35
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$167.35
|
| Rate for Payer: Cash Price |
$180.49
|
| Rate for Payer: Cash Price |
$177.42
|
| Rate for Payer: Centivo All Commercial |
$235.82
|
| Rate for Payer: Centivo All Commercial |
$235.82
|
| Rate for Payer: Cigna All Commercial |
$152.14
|
| Rate for Payer: Cigna All Commercial |
$152.14
|
| Rate for Payer: CORVEL All Commercial |
$152.14
|
| Rate for Payer: CORVEL All Commercial |
$152.14
|
| Rate for Payer: Coventry All Commercial |
$182.57
|
| Rate for Payer: Coventry All Commercial |
$182.57
|
| Rate for Payer: Encore All Commercial |
$152.14
|
| Rate for Payer: Encore All Commercial |
$152.14
|
| Rate for Payer: Frontpath All Commercial |
$208.34
|
| Rate for Payer: Frontpath All Commercial |
$208.34
|
| Rate for Payer: Humana ChoiceCare |
$190.42
|
| Rate for Payer: Humana ChoiceCare |
$190.42
|
| Rate for Payer: Humana Medicare |
$152.14
|
| Rate for Payer: Humana Medicare |
$152.14
|
| Rate for Payer: Lucent All Commercial |
$213.00
|
| Rate for Payer: Lucent All Commercial |
$213.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$227.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$227.00
|
| Rate for Payer: Managed Health Services Medicaid |
$147.95
|
| Rate for Payer: Managed Health Services Medicaid |
$147.95
|
| Rate for Payer: MDWise Medicaid |
$147.95
|
| Rate for Payer: MDWise Medicaid |
$147.95
|
| Rate for Payer: PHCS All Commercial |
$152.14
|
| Rate for Payer: PHCS All Commercial |
$152.14
|
| Rate for Payer: PHP All Commercial |
$258.74
|
| Rate for Payer: PHP All Commercial |
$258.74
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$152.14
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$152.14
|
| Rate for Payer: Sagamore Health Network All Products |
$152.14
|
| Rate for Payer: Sagamore Health Network All Products |
$152.14
|
| Rate for Payer: Signature Care EPO |
$243.95
|
| Rate for Payer: Signature Care EPO |
$243.95
|
| Rate for Payer: Signature Care PPO |
$243.95
|
| Rate for Payer: Signature Care PPO |
$243.95
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$21,200.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$21,200.00
|
| Rate for Payer: United Healthcare Commercial |
$185.99
|
| Rate for Payer: United Healthcare Commercial |
$185.99
|
| Rate for Payer: United Healthcare Medicare |
$147.85
|
| Rate for Payer: United Healthcare Medicare |
$147.85
|
|
|
PR CONTROL THROAT BLEED,SURG INTERVENTN
|
Professional
|
Both
|
$967.96
|
|
|
Service Code
|
CPT 42962
|
| Hospital Charge Code |
z42962
|
| Min. Negotiated Rate |
$476.08 |
| Max. Negotiated Rate |
$68,400.00 |
| Rate for Payer: Aetna Commercial |
$485.55
|
| Rate for Payer: Aetna Commercial |
$485.55
|
| Rate for Payer: Aetna Medicare |
$485.55
|
| Rate for Payer: Aetna Medicare |
$485.55
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$641.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$641.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$641.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$641.60
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$641.60
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$641.60
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$641.60
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$641.60
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$476.08
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$476.08
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$558.38
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$558.38
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$534.11
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$534.11
|
| Rate for Payer: Cash Price |
$580.78
|
| Rate for Payer: Cash Price |
$572.33
|
| Rate for Payer: Centivo All Commercial |
$752.60
|
| Rate for Payer: Centivo All Commercial |
$752.60
|
| Rate for Payer: Cigna All Commercial |
$485.55
|
| Rate for Payer: Cigna All Commercial |
$485.55
|
| Rate for Payer: CORVEL All Commercial |
$485.55
|
| Rate for Payer: CORVEL All Commercial |
$485.55
|
| Rate for Payer: Coventry All Commercial |
$582.66
|
| Rate for Payer: Coventry All Commercial |
$582.66
|
| Rate for Payer: Encore All Commercial |
$485.55
|
| Rate for Payer: Encore All Commercial |
$485.55
|
| Rate for Payer: Frontpath All Commercial |
$664.64
|
| Rate for Payer: Frontpath All Commercial |
$664.64
|
| Rate for Payer: Humana ChoiceCare |
$578.63
|
| Rate for Payer: Humana ChoiceCare |
$578.63
|
| Rate for Payer: Humana Medicare |
$485.55
|
| Rate for Payer: Humana Medicare |
$485.55
|
| Rate for Payer: Lucent All Commercial |
$679.77
|
| Rate for Payer: Lucent All Commercial |
$679.77
|
| Rate for Payer: Lutheran Preferred All Commercial |
$733.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$733.00
|
| Rate for Payer: Managed Health Services Medicaid |
$476.08
|
| Rate for Payer: Managed Health Services Medicaid |
$476.08
|
| Rate for Payer: MDWise Medicaid |
$476.08
|
| Rate for Payer: MDWise Medicaid |
$476.08
|
| Rate for Payer: PHCS All Commercial |
$485.55
|
| Rate for Payer: PHCS All Commercial |
$485.55
|
| Rate for Payer: PHP All Commercial |
$834.65
|
| Rate for Payer: PHP All Commercial |
$834.65
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$485.55
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$485.55
|
| Rate for Payer: Sagamore Health Network All Products |
$485.55
|
| Rate for Payer: Sagamore Health Network All Products |
$485.55
|
| Rate for Payer: Signature Care EPO |
$725.05
|
| Rate for Payer: Signature Care EPO |
$725.05
|
| Rate for Payer: Signature Care PPO |
$725.05
|
| Rate for Payer: Signature Care PPO |
$725.05
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$68,400.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$68,400.00
|
| Rate for Payer: United Healthcare Commercial |
$572.03
|
| Rate for Payer: United Healthcare Commercial |
$572.03
|
| Rate for Payer: United Healthcare Medicare |
$476.94
|
| Rate for Payer: United Healthcare Medicare |
$476.94
|
|
|
PR CORACO-ACROMIAL LIG RELEASE
|
Professional
|
Both
|
$1,298.52
|
|
|
Service Code
|
CPT 23415
|
| Hospital Charge Code |
z23415
|
| Min. Negotiated Rate |
$635.54 |
| Max. Negotiated Rate |
$97,700.00 |
| Rate for Payer: Aetna Commercial |
$651.79
|
| Rate for Payer: Aetna Commercial |
$651.79
|
| Rate for Payer: Aetna Medicare |
$651.79
|
| Rate for Payer: Aetna Medicare |
$651.79
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$859.70
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$859.70
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$859.70
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$859.70
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$859.70
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$859.70
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$859.70
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$859.70
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$638.66
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$638.66
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$749.56
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$749.56
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$716.97
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$716.97
|
| Rate for Payer: Cash Price |
$779.11
|
| Rate for Payer: Cash Price |
$762.65
|
| Rate for Payer: Centivo All Commercial |
$1,010.27
|
| Rate for Payer: Centivo All Commercial |
$1,010.27
|
| Rate for Payer: Cigna All Commercial |
$651.79
|
| Rate for Payer: Cigna All Commercial |
$651.79
|
| Rate for Payer: CORVEL All Commercial |
$651.79
|
| Rate for Payer: CORVEL All Commercial |
$651.79
|
| Rate for Payer: Coventry All Commercial |
$782.15
|
| Rate for Payer: Coventry All Commercial |
$782.15
|
| Rate for Payer: Encore All Commercial |
$651.79
|
| Rate for Payer: Encore All Commercial |
$651.79
|
| Rate for Payer: Frontpath All Commercial |
$906.76
|
| Rate for Payer: Frontpath All Commercial |
$906.76
|
| Rate for Payer: Humana ChoiceCare |
$784.59
|
| Rate for Payer: Humana ChoiceCare |
$784.59
|
| Rate for Payer: Humana Medicare |
$651.79
|
| Rate for Payer: Humana Medicare |
$651.79
|
| Rate for Payer: Lucent All Commercial |
$912.51
|
| Rate for Payer: Lucent All Commercial |
$912.51
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,042.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,042.00
|
| Rate for Payer: Managed Health Services Medicaid |
$638.66
|
| Rate for Payer: Managed Health Services Medicaid |
$638.66
|
| Rate for Payer: MDWise Medicaid |
$638.66
|
| Rate for Payer: MDWise Medicaid |
$638.66
|
| Rate for Payer: PHCS All Commercial |
$651.79
|
| Rate for Payer: PHCS All Commercial |
$651.79
|
| Rate for Payer: PHP All Commercial |
$1,105.84
|
| Rate for Payer: PHP All Commercial |
$1,105.84
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$651.79
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$651.79
|
| Rate for Payer: Sagamore Health Network All Products |
$651.79
|
| Rate for Payer: Sagamore Health Network All Products |
$651.79
|
| Rate for Payer: Signature Care EPO |
$1,049.75
|
| Rate for Payer: Signature Care EPO |
$1,049.75
|
| Rate for Payer: Signature Care PPO |
$1,049.75
|
| Rate for Payer: Signature Care PPO |
$1,049.75
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$97,700.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$97,700.00
|
| Rate for Payer: United Healthcare Commercial |
$750.98
|
| Rate for Payer: United Healthcare Commercial |
$750.98
|
| Rate for Payer: United Healthcare Medicare |
$635.54
|
| Rate for Payer: United Healthcare Medicare |
$635.54
|
|
|
PR CORRECT MALROTATION OF BOWEL
|
Professional
|
Both
|
$2,685.00
|
|
|
Service Code
|
CPT 44055
|
| Hospital Charge Code |
z44055
|
| Min. Negotiated Rate |
$1,320.55 |
| Max. Negotiated Rate |
$2,131.90 |
| Rate for Payer: Aetna Commercial |
$1,375.42
|
| Rate for Payer: Aetna Medicare |
$1,375.42
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$1,320.62
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,581.73
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,512.96
|
| Rate for Payer: Cash Price |
$1,611.00
|
| Rate for Payer: Centivo All Commercial |
$2,131.90
|
| Rate for Payer: Cigna All Commercial |
$1,375.42
|
| Rate for Payer: CORVEL All Commercial |
$1,375.42
|
| Rate for Payer: Coventry All Commercial |
$1,650.50
|
| Rate for Payer: Encore All Commercial |
$1,375.42
|
| Rate for Payer: Frontpath All Commercial |
$1,970.80
|
| Rate for Payer: Humana ChoiceCare |
$1,413.61
|
| Rate for Payer: Humana Medicare |
$1,375.42
|
| Rate for Payer: Lucent All Commercial |
$1,925.59
|
| Rate for Payer: Managed Health Services Medicaid |
$1,320.62
|
| Rate for Payer: MDWise Medicaid |
$1,320.62
|
| Rate for Payer: PHCS All Commercial |
$1,375.42
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,375.42
|
| Rate for Payer: Sagamore Health Network All Products |
$1,375.42
|
| Rate for Payer: United Healthcare Commercial |
$1,597.90
|
| Rate for Payer: United Healthcare Medicare |
$1,320.55
|
|
|
PR CORRJ HLX VLGS BNCTY SESMDC DSTL METAR OSTEOT
|
Professional
|
Both
|
$1,648.30
|
|
|
Service Code
|
CPT 28296
|
| Hospital Charge Code |
z28296
|
| Min. Negotiated Rate |
$314.31 |
| Max. Negotiated Rate |
$72,700.00 |
| Rate for Payer: Aetna Commercial |
$485.39
|
| Rate for Payer: Aetna Commercial |
$485.39
|
| Rate for Payer: Aetna Medicare |
$485.39
|
| Rate for Payer: Aetna Medicare |
$485.39
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$788.02
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$788.02
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$788.02
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$788.02
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$788.02
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$788.02
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$788.02
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$788.02
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$314.31
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$314.31
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$810.70
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$810.70
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$558.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$558.20
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$533.93
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$533.93
|
| Rate for Payer: Cash Price |
$968.86
|
| Rate for Payer: Cash Price |
$988.98
|
| Rate for Payer: Centivo All Commercial |
$752.35
|
| Rate for Payer: Centivo All Commercial |
$752.35
|
| Rate for Payer: Cigna All Commercial |
$485.39
|
| Rate for Payer: Cigna All Commercial |
$485.39
|
| Rate for Payer: CORVEL All Commercial |
$485.39
|
| Rate for Payer: CORVEL All Commercial |
$485.39
|
| Rate for Payer: Coventry All Commercial |
$582.47
|
| Rate for Payer: Coventry All Commercial |
$582.47
|
| Rate for Payer: Encore All Commercial |
$485.39
|
| Rate for Payer: Encore All Commercial |
$485.39
|
| Rate for Payer: Frontpath All Commercial |
$656.32
|
| Rate for Payer: Frontpath All Commercial |
$656.32
|
| Rate for Payer: Humana ChoiceCare |
$637.77
|
| Rate for Payer: Humana ChoiceCare |
$637.77
|
| Rate for Payer: Humana Medicare |
$485.39
|
| Rate for Payer: Humana Medicare |
$485.39
|
| Rate for Payer: Lucent All Commercial |
$679.55
|
| Rate for Payer: Lucent All Commercial |
$679.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$775.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$775.00
|
| Rate for Payer: Managed Health Services Medicaid |
$810.70
|
| Rate for Payer: Managed Health Services Medicaid |
$810.70
|
| Rate for Payer: MDWise Medicaid |
$810.70
|
| Rate for Payer: MDWise Medicaid |
$810.70
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$314.31
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$314.31
|
| Rate for Payer: PHCS All Commercial |
$485.39
|
| Rate for Payer: PHCS All Commercial |
$485.39
|
| Rate for Payer: PHP All Commercial |
$822.62
|
| Rate for Payer: PHP All Commercial |
$822.62
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$485.39
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$485.39
|
| Rate for Payer: Sagamore Health Network All Products |
$485.39
|
| Rate for Payer: Sagamore Health Network All Products |
$485.39
|
| Rate for Payer: Signature Care EPO |
$1,009.80
|
| Rate for Payer: Signature Care EPO |
$1,009.80
|
| Rate for Payer: Signature Care PPO |
$1,009.80
|
| Rate for Payer: Signature Care PPO |
$1,009.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$72,700.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$72,700.00
|
| Rate for Payer: United Healthcare Commercial |
$610.26
|
| Rate for Payer: United Healthcare Commercial |
$610.26
|
| Rate for Payer: United Healthcare Medicare |
$807.38
|
| Rate for Payer: United Healthcare Medicare |
$807.38
|
|
|
PR CPLX CHRONIC CARE MGMT SVC EA ADDL 30 MIN CAL MO
|
Professional
|
Both
|
$136.36
|
|
|
Service Code
|
CPT 99489
|
| Hospital Charge Code |
z99489
|
| Min. Negotiated Rate |
$38.07 |
| Max. Negotiated Rate |
$4,900.00 |
| Rate for Payer: Aetna Commercial |
$48.50
|
| Rate for Payer: Aetna Commercial |
$48.50
|
| Rate for Payer: Aetna Medicare |
$48.50
|
| Rate for Payer: Aetna Medicare |
$48.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$38.07
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$38.07
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$38.07
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$38.07
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$38.07
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$38.07
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$38.07
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$38.07
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$55.77
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$55.77
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$53.35
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$53.35
|
| Rate for Payer: Cash Price |
$77.50
|
| Rate for Payer: Cash Price |
$81.82
|
| Rate for Payer: Centivo All Commercial |
$75.17
|
| Rate for Payer: Centivo All Commercial |
$75.17
|
| Rate for Payer: Cigna All Commercial |
$48.50
|
| Rate for Payer: Cigna All Commercial |
$48.50
|
| Rate for Payer: CORVEL All Commercial |
$48.50
|
| Rate for Payer: CORVEL All Commercial |
$48.50
|
| Rate for Payer: Coventry All Commercial |
$58.20
|
| Rate for Payer: Coventry All Commercial |
$58.20
|
| Rate for Payer: Encore All Commercial |
$48.50
|
| Rate for Payer: Encore All Commercial |
$48.50
|
| Rate for Payer: Frontpath All Commercial |
$52.22
|
| Rate for Payer: Frontpath All Commercial |
$52.22
|
| Rate for Payer: Humana ChoiceCare |
$41.49
|
| Rate for Payer: Humana ChoiceCare |
$41.49
|
| Rate for Payer: Humana Medicare |
$48.50
|
| Rate for Payer: Humana Medicare |
$48.50
|
| Rate for Payer: Lucent All Commercial |
$67.90
|
| Rate for Payer: Lucent All Commercial |
$67.90
|
| Rate for Payer: Lutheran Preferred All Commercial |
$50.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$50.00
|
| Rate for Payer: PHCS All Commercial |
$48.50
|
| Rate for Payer: PHCS All Commercial |
$48.50
|
| Rate for Payer: PHP All Commercial |
$47.90
|
| Rate for Payer: PHP All Commercial |
$47.90
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$48.50
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$48.50
|
| Rate for Payer: Sagamore Health Network All Products |
$48.50
|
| Rate for Payer: Sagamore Health Network All Products |
$48.50
|
| Rate for Payer: Signature Care EPO |
$56.05
|
| Rate for Payer: Signature Care EPO |
$56.05
|
| Rate for Payer: Signature Care PPO |
$56.05
|
| Rate for Payer: Signature Care PPO |
$56.05
|
| 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 |
$43.26
|
| Rate for Payer: United Healthcare Commercial |
$43.26
|
| Rate for Payer: United Healthcare Medicare |
$64.58
|
| Rate for Payer: United Healthcare Medicare |
$64.58
|
|
|
PR CREATE EARDRUM OPENING,GEN ANESTH
|
Professional
|
Both
|
$293.18
|
|
|
Service Code
|
CPT 69436
|
| Hospital Charge Code |
z69436
|
| Min. Negotiated Rate |
$146.59 |
| Max. Negotiated Rate |
$22,500.00 |
| Rate for Payer: Aetna Commercial |
$149.75
|
| Rate for Payer: Aetna Commercial |
$149.75
|
| Rate for Payer: Aetna Commercial |
$149.75
|
| Rate for Payer: Aetna Commercial |
$149.75
|
| Rate for Payer: Aetna Medicare |
$149.75
|
| Rate for Payer: Aetna Medicare |
$149.75
|
| Rate for Payer: Aetna Medicare |
$149.75
|
| Rate for Payer: Aetna Medicare |
$149.75
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$193.70
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$193.70
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$193.70
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$193.70
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$193.70
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$193.70
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$193.70
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$193.70
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$193.70
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$193.70
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$193.70
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$193.70
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$193.70
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$193.70
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$193.70
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$193.70
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$147.10
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$147.10
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$147.10
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$147.10
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$172.21
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$172.21
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$172.21
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$172.21
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$164.72
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$164.72
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$164.72
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$164.72
|
| Rate for Payer: Cash Price |
$175.91
|
| Rate for Payer: Cash Price |
$358.92
|
| Rate for Payer: Cash Price |
$351.82
|
| Rate for Payer: Cash Price |
$179.46
|
| Rate for Payer: Centivo All Commercial |
$232.11
|
| Rate for Payer: Centivo All Commercial |
$232.11
|
| Rate for Payer: Centivo All Commercial |
$232.11
|
| Rate for Payer: Centivo All Commercial |
$232.11
|
| Rate for Payer: Cigna All Commercial |
$149.75
|
| Rate for Payer: Cigna All Commercial |
$149.75
|
| Rate for Payer: Cigna All Commercial |
$149.75
|
| Rate for Payer: Cigna All Commercial |
$149.75
|
| Rate for Payer: CORVEL All Commercial |
$149.75
|
| Rate for Payer: CORVEL All Commercial |
$149.75
|
| Rate for Payer: CORVEL All Commercial |
$149.75
|
| Rate for Payer: CORVEL All Commercial |
$149.75
|
| Rate for Payer: Coventry All Commercial |
$179.70
|
| Rate for Payer: Coventry All Commercial |
$179.70
|
| Rate for Payer: Coventry All Commercial |
$179.70
|
| Rate for Payer: Coventry All Commercial |
$179.70
|
| Rate for Payer: Encore All Commercial |
$149.75
|
| Rate for Payer: Encore All Commercial |
$149.75
|
| Rate for Payer: Encore All Commercial |
$149.75
|
| Rate for Payer: Encore All Commercial |
$149.75
|
| Rate for Payer: Frontpath All Commercial |
$204.02
|
| Rate for Payer: Frontpath All Commercial |
$204.02
|
| Rate for Payer: Frontpath All Commercial |
$204.02
|
| Rate for Payer: Frontpath All Commercial |
$204.02
|
| Rate for Payer: Humana ChoiceCare |
$173.12
|
| Rate for Payer: Humana ChoiceCare |
$173.12
|
| Rate for Payer: Humana ChoiceCare |
$173.12
|
| Rate for Payer: Humana ChoiceCare |
$173.12
|
| Rate for Payer: Humana Medicare |
$149.75
|
| Rate for Payer: Humana Medicare |
$149.75
|
| Rate for Payer: Humana Medicare |
$149.75
|
| Rate for Payer: Humana Medicare |
$149.75
|
| Rate for Payer: Lucent All Commercial |
$209.65
|
| Rate for Payer: Lucent All Commercial |
$209.65
|
| Rate for Payer: Lucent All Commercial |
$209.65
|
| Rate for Payer: Lucent All Commercial |
$209.65
|
| Rate for Payer: Lutheran Preferred All Commercial |
$240.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$240.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$240.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$240.00
|
| Rate for Payer: Managed Health Services Medicaid |
$147.10
|
| Rate for Payer: Managed Health Services Medicaid |
$147.10
|
| Rate for Payer: Managed Health Services Medicaid |
$147.10
|
| Rate for Payer: Managed Health Services Medicaid |
$147.10
|
| Rate for Payer: MDWise Medicaid |
$147.10
|
| Rate for Payer: MDWise Medicaid |
$147.10
|
| Rate for Payer: MDWise Medicaid |
$147.10
|
| Rate for Payer: MDWise Medicaid |
$147.10
|
| Rate for Payer: PHCS All Commercial |
$149.75
|
| Rate for Payer: PHCS All Commercial |
$149.75
|
| Rate for Payer: PHCS All Commercial |
$149.75
|
| Rate for Payer: PHCS All Commercial |
$149.75
|
| Rate for Payer: PHP All Commercial |
$190.57
|
| Rate for Payer: PHP All Commercial |
$190.57
|
| Rate for Payer: PHP All Commercial |
$190.57
|
| Rate for Payer: PHP All Commercial |
$190.57
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$149.75
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$149.75
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$149.75
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$149.75
|
| Rate for Payer: Sagamore Health Network All Products |
$149.75
|
| Rate for Payer: Sagamore Health Network All Products |
$149.75
|
| Rate for Payer: Sagamore Health Network All Products |
$149.75
|
| Rate for Payer: Sagamore Health Network All Products |
$149.75
|
| Rate for Payer: Signature Care EPO |
$200.60
|
| Rate for Payer: Signature Care EPO |
$200.60
|
| Rate for Payer: Signature Care EPO |
$200.60
|
| Rate for Payer: Signature Care EPO |
$200.60
|
| Rate for Payer: Signature Care PPO |
$200.60
|
| Rate for Payer: Signature Care PPO |
$200.60
|
| Rate for Payer: Signature Care PPO |
$200.60
|
| Rate for Payer: Signature Care PPO |
$200.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$22,500.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$22,500.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$22,500.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$22,500.00
|
| Rate for Payer: United Healthcare Commercial |
$177.59
|
| Rate for Payer: United Healthcare Commercial |
$177.59
|
| Rate for Payer: United Healthcare Commercial |
$177.59
|
| Rate for Payer: United Healthcare Commercial |
$177.59
|
| Rate for Payer: United Healthcare Medicare |
$146.59
|
| Rate for Payer: United Healthcare Medicare |
$146.59
|
| Rate for Payer: United Healthcare Medicare |
$146.59
|
| Rate for Payer: United Healthcare Medicare |
$146.59
|
|
|
PR CREATE EARDRUM OPENING,LOCAL ANESTH
|
Professional
|
Both
|
$376.50
|
|
|
Service Code
|
CPT 69433
|
| Hospital Charge Code |
z69433
|
| Min. Negotiated Rate |
$67.31 |
| Max. Negotiated Rate |
$18,700.00 |
| Rate for Payer: Aetna Commercial |
$123.28
|
| Rate for Payer: Aetna Commercial |
$123.28
|
| Rate for Payer: Aetna Commercial |
$123.28
|
| Rate for Payer: Aetna Commercial |
$123.28
|
| Rate for Payer: Aetna Medicare |
$123.28
|
| Rate for Payer: Aetna Medicare |
$123.28
|
| Rate for Payer: Aetna Medicare |
$123.28
|
| Rate for Payer: Aetna Medicare |
$123.28
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$213.89
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$213.89
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$213.89
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$213.89
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$213.89
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$213.89
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$213.89
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$213.89
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$213.89
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$213.89
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$213.89
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$213.89
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$213.89
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$213.89
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$213.89
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$213.89
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$67.31
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$67.31
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$67.31
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$67.31
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$185.18
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$185.18
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$185.18
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$185.18
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$141.77
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$141.77
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$141.77
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$141.77
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$135.61
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$135.61
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$135.61
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$135.61
|
| Rate for Payer: Cash Price |
$445.13
|
| Rate for Payer: Cash Price |
$225.90
|
| Rate for Payer: Cash Price |
$451.80
|
| Rate for Payer: Cash Price |
$222.56
|
| Rate for Payer: Centivo All Commercial |
$191.08
|
| Rate for Payer: Centivo All Commercial |
$191.08
|
| Rate for Payer: Centivo All Commercial |
$191.08
|
| Rate for Payer: Centivo All Commercial |
$191.08
|
| Rate for Payer: Cigna All Commercial |
$123.28
|
| Rate for Payer: Cigna All Commercial |
$123.28
|
| Rate for Payer: Cigna All Commercial |
$123.28
|
| Rate for Payer: Cigna All Commercial |
$123.28
|
| Rate for Payer: CORVEL All Commercial |
$123.28
|
| Rate for Payer: CORVEL All Commercial |
$123.28
|
| Rate for Payer: CORVEL All Commercial |
$123.28
|
| Rate for Payer: CORVEL All Commercial |
$123.28
|
| Rate for Payer: Coventry All Commercial |
$147.94
|
| Rate for Payer: Coventry All Commercial |
$147.94
|
| Rate for Payer: Coventry All Commercial |
$147.94
|
| Rate for Payer: Coventry All Commercial |
$147.94
|
| Rate for Payer: Encore All Commercial |
$123.28
|
| Rate for Payer: Encore All Commercial |
$123.28
|
| Rate for Payer: Encore All Commercial |
$123.28
|
| Rate for Payer: Encore All Commercial |
$123.28
|
| Rate for Payer: Frontpath All Commercial |
$167.71
|
| Rate for Payer: Frontpath All Commercial |
$167.71
|
| Rate for Payer: Frontpath All Commercial |
$167.71
|
| Rate for Payer: Frontpath All Commercial |
$167.71
|
| Rate for Payer: Humana ChoiceCare |
$128.48
|
| Rate for Payer: Humana ChoiceCare |
$128.48
|
| Rate for Payer: Humana ChoiceCare |
$128.48
|
| Rate for Payer: Humana ChoiceCare |
$128.48
|
| Rate for Payer: Humana Medicare |
$123.28
|
| Rate for Payer: Humana Medicare |
$123.28
|
| Rate for Payer: Humana Medicare |
$123.28
|
| Rate for Payer: Humana Medicare |
$123.28
|
| Rate for Payer: Lucent All Commercial |
$172.59
|
| Rate for Payer: Lucent All Commercial |
$172.59
|
| Rate for Payer: Lucent All Commercial |
$172.59
|
| Rate for Payer: Lucent All Commercial |
$172.59
|
| Rate for Payer: Lutheran Preferred All Commercial |
$199.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$199.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$199.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$199.00
|
| Rate for Payer: Managed Health Services Medicaid |
$185.18
|
| Rate for Payer: Managed Health Services Medicaid |
$185.18
|
| Rate for Payer: Managed Health Services Medicaid |
$185.18
|
| Rate for Payer: Managed Health Services Medicaid |
$185.18
|
| Rate for Payer: MDWise Medicaid |
$185.18
|
| Rate for Payer: MDWise Medicaid |
$185.18
|
| Rate for Payer: MDWise Medicaid |
$185.18
|
| Rate for Payer: MDWise Medicaid |
$185.18
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$67.31
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$67.31
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$67.31
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$67.31
|
| Rate for Payer: PHCS All Commercial |
$123.28
|
| Rate for Payer: PHCS All Commercial |
$123.28
|
| Rate for Payer: PHCS All Commercial |
$123.28
|
| Rate for Payer: PHCS All Commercial |
$123.28
|
| Rate for Payer: PHP All Commercial |
$157.71
|
| Rate for Payer: PHP All Commercial |
$157.71
|
| Rate for Payer: PHP All Commercial |
$157.71
|
| Rate for Payer: PHP All Commercial |
$157.71
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$123.28
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$123.28
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$123.28
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$123.28
|
| Rate for Payer: Sagamore Health Network All Products |
$123.28
|
| Rate for Payer: Sagamore Health Network All Products |
$123.28
|
| Rate for Payer: Sagamore Health Network All Products |
$123.28
|
| Rate for Payer: Sagamore Health Network All Products |
$123.28
|
| Rate for Payer: Signature Care EPO |
$217.60
|
| Rate for Payer: Signature Care EPO |
$217.60
|
| Rate for Payer: Signature Care EPO |
$217.60
|
| Rate for Payer: Signature Care EPO |
$217.60
|
| Rate for Payer: Signature Care PPO |
$217.60
|
| Rate for Payer: Signature Care PPO |
$217.60
|
| Rate for Payer: Signature Care PPO |
$217.60
|
| Rate for Payer: Signature Care PPO |
$217.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$18,700.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$18,700.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$18,700.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$18,700.00
|
| Rate for Payer: United Healthcare Commercial |
$139.58
|
| Rate for Payer: United Healthcare Commercial |
$139.58
|
| Rate for Payer: United Healthcare Commercial |
$139.58
|
| Rate for Payer: United Healthcare Commercial |
$139.58
|
| Rate for Payer: United Healthcare Medicare |
$185.47
|
| Rate for Payer: United Healthcare Medicare |
$185.47
|
| Rate for Payer: United Healthcare Medicare |
$185.47
|
| Rate for Payer: United Healthcare Medicare |
$185.47
|
|
|
PR CRITICAL CARE, ADDL 30 MIN
|
Professional
|
Both
|
$220.74
|
|
|
Service Code
|
CPT 99292
|
| Hospital Charge Code |
z99292
|
| Min. Negotiated Rate |
$55.03 |
| Max. Negotiated Rate |
$187.63 |
| Rate for Payer: Aetna Commercial |
$103.67
|
| Rate for Payer: Aetna Commercial |
$103.67
|
| Rate for Payer: Aetna Medicare |
$103.67
|
| Rate for Payer: Aetna Medicare |
$103.67
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$161.67
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$161.67
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$161.67
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$161.67
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$161.67
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$161.67
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$161.67
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$161.67
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$55.03
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$55.03
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$110.54
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$110.54
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$119.22
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$119.22
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$114.04
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$114.04
|
| Rate for Payer: Cash Price |
$132.44
|
| Rate for Payer: Cash Price |
$132.44
|
| Rate for Payer: Cash Price |
$134.84
|
| Rate for Payer: Cash Price |
$134.84
|
| Rate for Payer: Centivo All Commercial |
$160.69
|
| Rate for Payer: Centivo All Commercial |
$160.69
|
| Rate for Payer: Cigna All Commercial |
$103.67
|
| Rate for Payer: Cigna All Commercial |
$103.67
|
| Rate for Payer: CORVEL All Commercial |
$103.67
|
| Rate for Payer: CORVEL All Commercial |
$103.67
|
| Rate for Payer: Coventry All Commercial |
$124.40
|
| Rate for Payer: Coventry All Commercial |
$124.40
|
| Rate for Payer: Encore All Commercial |
$103.67
|
| Rate for Payer: Encore All Commercial |
$103.67
|
| Rate for Payer: Frontpath All Commercial |
$141.13
|
| Rate for Payer: Frontpath All Commercial |
$141.13
|
| Rate for Payer: Humana ChoiceCare |
$99.59
|
| Rate for Payer: Humana ChoiceCare |
$99.59
|
| Rate for Payer: Humana Medicare |
$103.67
|
| Rate for Payer: Humana Medicare |
$103.67
|
| Rate for Payer: Lucent All Commercial |
$145.14
|
| Rate for Payer: Lucent All Commercial |
$145.14
|
| Rate for Payer: Lutheran Preferred All Commercial |
$191.03
|
| Rate for Payer: Lutheran Preferred All Commercial |
$187.63
|
| Rate for Payer: Managed Health Services Medicaid |
$110.54
|
| Rate for Payer: Managed Health Services Medicaid |
$110.54
|
| Rate for Payer: MDWise Medicaid |
$110.54
|
| Rate for Payer: MDWise Medicaid |
$110.54
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$55.03
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$55.03
|
| Rate for Payer: PHCS All Commercial |
$103.67
|
| Rate for Payer: PHCS All Commercial |
$103.67
|
| Rate for Payer: PHP All Commercial |
$101.89
|
| Rate for Payer: PHP All Commercial |
$101.89
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$103.67
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$103.67
|
| Rate for Payer: Sagamore Health Network All Products |
$103.67
|
| Rate for Payer: Sagamore Health Network All Products |
$103.67
|
| Rate for Payer: Signature Care EPO |
$148.75
|
| Rate for Payer: Signature Care EPO |
$148.75
|
| Rate for Payer: Signature Care PPO |
$148.75
|
| Rate for Payer: Signature Care PPO |
$148.75
|
| Rate for Payer: United Healthcare Commercial |
$171.55
|
| Rate for Payer: United Healthcare Commercial |
$171.55
|
| Rate for Payer: United Healthcare Medicare |
$110.37
|
| Rate for Payer: United Healthcare Medicare |
$110.37
|
|
|
PR CRITICAL CARE, E/M 30-74 MINUTES
|
Professional
|
Both
|
$504.10
|
|
|
Service Code
|
CPT 99291
|
| Hospital Charge Code |
z99291
|
| Min. Negotiated Rate |
$109.53 |
| Max. Negotiated Rate |
$428.49 |
| Rate for Payer: Aetna Commercial |
$206.55
|
| Rate for Payer: Aetna Commercial |
$206.55
|
| Rate for Payer: Aetna Medicare |
$206.55
|
| Rate for Payer: Aetna Medicare |
$206.55
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$298.08
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$298.08
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$298.08
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$298.08
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$298.08
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$298.08
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$298.08
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$298.08
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$109.53
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$109.53
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$252.44
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$252.44
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$237.53
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$237.53
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$227.21
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$227.21
|
| Rate for Payer: Cash Price |
$302.46
|
| Rate for Payer: Cash Price |
$302.46
|
| Rate for Payer: Cash Price |
$307.96
|
| Rate for Payer: Cash Price |
$307.96
|
| Rate for Payer: Centivo All Commercial |
$320.15
|
| Rate for Payer: Centivo All Commercial |
$320.15
|
| Rate for Payer: Cigna All Commercial |
$206.55
|
| Rate for Payer: Cigna All Commercial |
$206.55
|
| Rate for Payer: CORVEL All Commercial |
$206.55
|
| Rate for Payer: CORVEL All Commercial |
$206.55
|
| Rate for Payer: Coventry All Commercial |
$247.86
|
| Rate for Payer: Coventry All Commercial |
$247.86
|
| Rate for Payer: Encore All Commercial |
$206.55
|
| Rate for Payer: Encore All Commercial |
$206.55
|
| Rate for Payer: Frontpath All Commercial |
$280.96
|
| Rate for Payer: Frontpath All Commercial |
$280.96
|
| Rate for Payer: Humana ChoiceCare |
$198.63
|
| Rate for Payer: Humana ChoiceCare |
$198.63
|
| Rate for Payer: Humana Medicare |
$206.55
|
| Rate for Payer: Humana Medicare |
$206.55
|
| Rate for Payer: Lucent All Commercial |
$289.17
|
| Rate for Payer: Lucent All Commercial |
$289.17
|
| Rate for Payer: Lutheran Preferred All Commercial |
$436.27
|
| Rate for Payer: Lutheran Preferred All Commercial |
$428.49
|
| Rate for Payer: Managed Health Services Medicaid |
$252.44
|
| Rate for Payer: Managed Health Services Medicaid |
$252.44
|
| Rate for Payer: MDWise Medicaid |
$252.44
|
| Rate for Payer: MDWise Medicaid |
$252.44
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$109.53
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$109.53
|
| Rate for Payer: PHCS All Commercial |
$206.55
|
| Rate for Payer: PHCS All Commercial |
$206.55
|
| Rate for Payer: PHP All Commercial |
$203.15
|
| Rate for Payer: PHP All Commercial |
$203.15
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$206.55
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$206.55
|
| Rate for Payer: Sagamore Health Network All Products |
$206.55
|
| Rate for Payer: Sagamore Health Network All Products |
$206.55
|
| Rate for Payer: Signature Care EPO |
$318.75
|
| Rate for Payer: Signature Care EPO |
$318.75
|
| Rate for Payer: Signature Care PPO |
$318.75
|
| Rate for Payer: Signature Care PPO |
$318.75
|
| Rate for Payer: United Healthcare Commercial |
$378.17
|
| Rate for Payer: United Healthcare Commercial |
$378.17
|
| Rate for Payer: United Healthcare Medicare |
$252.05
|
| Rate for Payer: United Healthcare Medicare |
$252.05
|
|
|
PR C-SEC ONLY,PREV C-SEC
|
Professional
|
Both
|
$1,668.20
|
|
|
Service Code
|
CPT 59620
|
| Hospital Charge Code |
z59620
|
| Min. Negotiated Rate |
$820.49 |
| Max. Negotiated Rate |
$109,600.00 |
| Rate for Payer: Aetna Commercial |
$849.68
|
| Rate for Payer: Aetna Commercial |
$849.68
|
| Rate for Payer: Aetna Medicare |
$849.68
|
| Rate for Payer: Aetna Medicare |
$849.68
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$1,072.59
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$1,072.59
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,072.59
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,072.59
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,072.59
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,072.59
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,072.59
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,072.59
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$820.49
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$820.49
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$977.13
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$977.13
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$934.65
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$934.65
|
| Rate for Payer: Cash Price |
$1,000.92
|
| Rate for Payer: Cash Price |
$987.17
|
| Rate for Payer: Centivo All Commercial |
$1,317.00
|
| Rate for Payer: Centivo All Commercial |
$1,317.00
|
| Rate for Payer: Cigna All Commercial |
$849.68
|
| Rate for Payer: Cigna All Commercial |
$849.68
|
| Rate for Payer: CORVEL All Commercial |
$849.68
|
| Rate for Payer: CORVEL All Commercial |
$849.68
|
| Rate for Payer: Coventry All Commercial |
$1,019.62
|
| Rate for Payer: Coventry All Commercial |
$1,019.62
|
| Rate for Payer: Encore All Commercial |
$849.68
|
| Rate for Payer: Encore All Commercial |
$849.68
|
| Rate for Payer: Frontpath All Commercial |
$1,224.40
|
| Rate for Payer: Frontpath All Commercial |
$1,224.40
|
| Rate for Payer: Humana ChoiceCare |
$964.74
|
| Rate for Payer: Humana ChoiceCare |
$964.74
|
| Rate for Payer: Humana Medicare |
$849.68
|
| Rate for Payer: Humana Medicare |
$849.68
|
| Rate for Payer: Lucent All Commercial |
$1,189.55
|
| Rate for Payer: Lucent All Commercial |
$1,189.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,181.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,181.00
|
| Rate for Payer: Managed Health Services Medicaid |
$820.49
|
| Rate for Payer: Managed Health Services Medicaid |
$820.49
|
| Rate for Payer: MDWise Medicaid |
$820.49
|
| Rate for Payer: MDWise Medicaid |
$820.49
|
| Rate for Payer: PHCS All Commercial |
$849.68
|
| Rate for Payer: PHCS All Commercial |
$849.68
|
| Rate for Payer: PHP All Commercial |
$1,085.89
|
| Rate for Payer: PHP All Commercial |
$1,085.89
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$849.68
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$849.68
|
| Rate for Payer: Sagamore Health Network All Products |
$849.68
|
| Rate for Payer: Sagamore Health Network All Products |
$849.68
|
| Rate for Payer: Signature Care EPO |
$1,237.60
|
| Rate for Payer: Signature Care EPO |
$1,237.60
|
| Rate for Payer: Signature Care PPO |
$1,237.60
|
| Rate for Payer: Signature Care PPO |
$1,237.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$109,600.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$109,600.00
|
| Rate for Payer: United Healthcare Commercial |
$1,133.75
|
| Rate for Payer: United Healthcare Commercial |
$1,133.75
|
| Rate for Payer: United Healthcare Medicare |
$822.64
|
| Rate for Payer: United Healthcare Medicare |
$822.64
|
|
|
PR C-SEC+POSTPARTUM CARE,PREV C-SEC
|
Professional
|
Both
|
$2,481.34
|
|
|
Service Code
|
CPT 59622
|
| Hospital Charge Code |
z59622
|
| Min. Negotiated Rate |
$1,087.79 |
| Max. Negotiated Rate |
$158,700.00 |
| Rate for Payer: Aetna Commercial |
$1,229.51
|
| Rate for Payer: Aetna Commercial |
$1,229.51
|
| Rate for Payer: Aetna Medicare |
$1,229.51
|
| Rate for Payer: Aetna Medicare |
$1,229.51
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$1,164.12
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$1,164.12
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,164.12
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,164.12
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,164.12
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,164.12
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,164.12
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,164.12
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$1,220.42
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$1,220.42
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,413.94
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,413.94
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,352.46
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,352.46
|
| Rate for Payer: Cash Price |
$1,488.80
|
| Rate for Payer: Cash Price |
$1,429.20
|
| Rate for Payer: Centivo All Commercial |
$1,905.74
|
| Rate for Payer: Centivo All Commercial |
$1,905.74
|
| Rate for Payer: Cigna All Commercial |
$1,229.51
|
| Rate for Payer: Cigna All Commercial |
$1,229.51
|
| Rate for Payer: CORVEL All Commercial |
$1,229.51
|
| Rate for Payer: CORVEL All Commercial |
$1,229.51
|
| Rate for Payer: Coventry All Commercial |
$1,475.41
|
| Rate for Payer: Coventry All Commercial |
$1,475.41
|
| Rate for Payer: Encore All Commercial |
$1,229.51
|
| Rate for Payer: Encore All Commercial |
$1,229.51
|
| Rate for Payer: Frontpath All Commercial |
$1,761.18
|
| Rate for Payer: Frontpath All Commercial |
$1,761.18
|
| Rate for Payer: Humana ChoiceCare |
$1,087.79
|
| Rate for Payer: Humana ChoiceCare |
$1,087.79
|
| Rate for Payer: Humana Medicare |
$1,229.51
|
| Rate for Payer: Humana Medicare |
$1,229.51
|
| Rate for Payer: Lucent All Commercial |
$1,721.31
|
| Rate for Payer: Lucent All Commercial |
$1,721.31
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,709.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,709.00
|
| Rate for Payer: Managed Health Services Medicaid |
$1,220.42
|
| Rate for Payer: Managed Health Services Medicaid |
$1,220.42
|
| Rate for Payer: MDWise Medicaid |
$1,220.42
|
| Rate for Payer: MDWise Medicaid |
$1,220.42
|
| Rate for Payer: PHCS All Commercial |
$1,229.51
|
| Rate for Payer: PHCS All Commercial |
$1,229.51
|
| Rate for Payer: PHP All Commercial |
$1,572.12
|
| Rate for Payer: PHP All Commercial |
$1,572.12
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,229.51
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,229.51
|
| Rate for Payer: Sagamore Health Network All Products |
$1,229.51
|
| Rate for Payer: Sagamore Health Network All Products |
$1,229.51
|
| Rate for Payer: Signature Care EPO |
$1,397.40
|
| Rate for Payer: Signature Care EPO |
$1,397.40
|
| Rate for Payer: Signature Care PPO |
$1,397.40
|
| Rate for Payer: Signature Care PPO |
$1,397.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$158,700.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$158,700.00
|
| Rate for Payer: United Healthcare Commercial |
$1,320.06
|
| Rate for Payer: United Healthcare Commercial |
$1,320.06
|
| Rate for Payer: United Healthcare Medicare |
$1,191.00
|
| Rate for Payer: United Healthcare Medicare |
$1,191.00
|
|
|
PR CT ANGIO ABD&PLVIS CNTRST MTRL W/WO CNTRST IMGES
|
Professional
|
Both
|
$192.34
|
|
|
Service Code
|
CPT 74174
|
| Hospital Charge Code |
z74174
|
| Min. Negotiated Rate |
$356.86 |
| Max. Negotiated Rate |
$659.22 |
| Rate for Payer: Aetna Commercial |
$376.92
|
| Rate for Payer: Aetna Medicare |
$376.92
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$356.86
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$433.46
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$414.61
|
| Rate for Payer: Cash Price |
$115.40
|
| Rate for Payer: Centivo All Commercial |
$584.23
|
| Rate for Payer: Cigna All Commercial |
$376.92
|
| Rate for Payer: CORVEL All Commercial |
$376.92
|
| Rate for Payer: Coventry All Commercial |
$452.30
|
| Rate for Payer: Encore All Commercial |
$376.92
|
| Rate for Payer: Frontpath All Commercial |
$653.65
|
| Rate for Payer: Humana ChoiceCare |
$659.22
|
| Rate for Payer: Humana Medicare |
$376.92
|
| Rate for Payer: Lucent All Commercial |
$527.69
|
| Rate for Payer: Managed Health Services Medicaid |
$356.86
|
| Rate for Payer: MDWise Medicaid |
$356.86
|
| Rate for Payer: PHCS All Commercial |
$376.92
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$376.92
|
| Rate for Payer: Sagamore Health Network All Products |
$376.92
|
| Rate for Payer: United Healthcare Commercial |
$524.15
|
|
|
PR CTRL NOSEBLEED,ANTER,COMPLEX
|
Professional
|
Both
|
$449.76
|
|
|
Service Code
|
CPT 30903
|
| Hospital Charge Code |
z30903
|
| Min. Negotiated Rate |
$59.08 |
| Max. Negotiated Rate |
$10,800.00 |
| Rate for Payer: Aetna Commercial |
$72.27
|
| Rate for Payer: Aetna Commercial |
$72.27
|
| Rate for Payer: Aetna Medicare |
$72.27
|
| Rate for Payer: Aetna Medicare |
$72.27
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$187.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$187.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$187.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$187.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$187.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$187.10
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$187.10
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$187.10
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$59.08
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$59.08
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$221.20
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$221.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$83.11
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$83.11
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$79.50
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$79.50
|
| Rate for Payer: Cash Price |
$269.83
|
| Rate for Payer: Cash Price |
$269.86
|
| Rate for Payer: Centivo All Commercial |
$112.02
|
| Rate for Payer: Centivo All Commercial |
$112.02
|
| Rate for Payer: Cigna All Commercial |
$72.27
|
| Rate for Payer: Cigna All Commercial |
$72.27
|
| Rate for Payer: CORVEL All Commercial |
$72.27
|
| Rate for Payer: CORVEL All Commercial |
$72.27
|
| Rate for Payer: Coventry All Commercial |
$86.72
|
| Rate for Payer: Coventry All Commercial |
$86.72
|
| Rate for Payer: Encore All Commercial |
$72.27
|
| Rate for Payer: Encore All Commercial |
$72.27
|
| Rate for Payer: Frontpath All Commercial |
$101.30
|
| Rate for Payer: Frontpath All Commercial |
$101.30
|
| Rate for Payer: Humana ChoiceCare |
$94.38
|
| Rate for Payer: Humana ChoiceCare |
$94.38
|
| Rate for Payer: Humana Medicare |
$72.27
|
| Rate for Payer: Humana Medicare |
$72.27
|
| Rate for Payer: Lucent All Commercial |
$101.18
|
| Rate for Payer: Lucent All Commercial |
$101.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$115.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$115.00
|
| Rate for Payer: Managed Health Services Medicaid |
$221.20
|
| Rate for Payer: Managed Health Services Medicaid |
$221.20
|
| Rate for Payer: MDWise Medicaid |
$221.20
|
| Rate for Payer: MDWise Medicaid |
$221.20
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$59.08
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$59.08
|
| Rate for Payer: PHCS All Commercial |
$72.27
|
| Rate for Payer: PHCS All Commercial |
$72.27
|
| Rate for Payer: PHP All Commercial |
$98.50
|
| Rate for Payer: PHP All Commercial |
$98.50
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$72.27
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$72.27
|
| Rate for Payer: Sagamore Health Network All Products |
$72.27
|
| Rate for Payer: Sagamore Health Network All Products |
$72.27
|
| Rate for Payer: Signature Care EPO |
$224.40
|
| Rate for Payer: Signature Care EPO |
$224.40
|
| Rate for Payer: Signature Care PPO |
$224.40
|
| Rate for Payer: Signature Care PPO |
$224.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$10,800.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$10,800.00
|
| Rate for Payer: United Healthcare Commercial |
$91.98
|
| Rate for Payer: United Healthcare Commercial |
$91.98
|
| Rate for Payer: United Healthcare Medicare |
$224.86
|
| Rate for Payer: United Healthcare Medicare |
$224.86
|
|
