|
PR CTRL NOSEBLEED,ANTER,SIMPLE
|
Professional
|
Both
|
$288.68
|
|
|
Service Code
|
CPT 30901
|
| Hospital Charge Code |
z30901
|
| Min. Negotiated Rate |
$28.90 |
| Max. Negotiated Rate |
$7,900.00 |
| Rate for Payer: Aetna Commercial |
$52.96
|
| Rate for Payer: Aetna Commercial |
$52.96
|
| Rate for Payer: Aetna Medicare |
$52.96
|
| Rate for Payer: Aetna Medicare |
$52.96
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$120.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$120.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$120.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$120.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$120.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$120.10
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$120.10
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$120.10
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$28.90
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$28.90
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$141.98
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$141.98
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$60.90
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$60.90
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$58.26
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$58.26
|
| Rate for Payer: Cash Price |
$172.27
|
| Rate for Payer: Cash Price |
$173.21
|
| Rate for Payer: Centivo All Commercial |
$82.09
|
| Rate for Payer: Centivo All Commercial |
$82.09
|
| Rate for Payer: Cigna All Commercial |
$52.96
|
| Rate for Payer: Cigna All Commercial |
$52.96
|
| Rate for Payer: CORVEL All Commercial |
$52.96
|
| Rate for Payer: CORVEL All Commercial |
$52.96
|
| Rate for Payer: Coventry All Commercial |
$63.55
|
| Rate for Payer: Coventry All Commercial |
$63.55
|
| Rate for Payer: Encore All Commercial |
$52.96
|
| Rate for Payer: Encore All Commercial |
$52.96
|
| Rate for Payer: Frontpath All Commercial |
$74.45
|
| Rate for Payer: Frontpath All Commercial |
$74.45
|
| Rate for Payer: Humana ChoiceCare |
$71.27
|
| Rate for Payer: Humana ChoiceCare |
$71.27
|
| Rate for Payer: Humana Medicare |
$52.96
|
| Rate for Payer: Humana Medicare |
$52.96
|
| Rate for Payer: Lucent All Commercial |
$74.14
|
| Rate for Payer: Lucent All Commercial |
$74.14
|
| Rate for Payer: Lutheran Preferred All Commercial |
$84.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$84.00
|
| Rate for Payer: Managed Health Services Medicaid |
$141.98
|
| Rate for Payer: Managed Health Services Medicaid |
$141.98
|
| Rate for Payer: MDWise Medicaid |
$141.98
|
| Rate for Payer: MDWise Medicaid |
$141.98
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$28.90
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$28.90
|
| Rate for Payer: PHCS All Commercial |
$52.96
|
| Rate for Payer: PHCS All Commercial |
$52.96
|
| Rate for Payer: PHP All Commercial |
$71.96
|
| Rate for Payer: PHP All Commercial |
$71.96
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$52.96
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$52.96
|
| Rate for Payer: Sagamore Health Network All Products |
$52.96
|
| Rate for Payer: Sagamore Health Network All Products |
$52.96
|
| Rate for Payer: Signature Care EPO |
$135.15
|
| Rate for Payer: Signature Care EPO |
$135.15
|
| Rate for Payer: Signature Care PPO |
$135.15
|
| Rate for Payer: Signature Care PPO |
$135.15
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$7,900.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$7,900.00
|
| Rate for Payer: United Healthcare Commercial |
$70.76
|
| Rate for Payer: United Healthcare Commercial |
$70.76
|
| Rate for Payer: United Healthcare Medicare |
$143.56
|
| Rate for Payer: United Healthcare Medicare |
$143.56
|
|
|
PR CTRL NOSEBLEED,POST,W/PACKS &/OR CAUT
|
Professional
|
Both
|
$645.18
|
|
|
Service Code
|
CPT 30905
|
| Hospital Charge Code |
z30905
|
| Min. Negotiated Rate |
$74.79 |
| Max. Negotiated Rate |
$14,700.00 |
| Rate for Payer: Aetna Commercial |
$98.56
|
| Rate for Payer: Aetna Commercial |
$98.56
|
| Rate for Payer: Aetna Medicare |
$98.56
|
| Rate for Payer: Aetna Medicare |
$98.56
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$232.08
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$232.08
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$232.08
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$232.08
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$232.08
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$232.08
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$232.08
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$232.08
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$74.79
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$74.79
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$317.32
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$317.32
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$113.34
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$113.34
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$108.42
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$108.42
|
| Rate for Payer: Cash Price |
$385.45
|
| Rate for Payer: Cash Price |
$387.11
|
| Rate for Payer: Centivo All Commercial |
$152.77
|
| Rate for Payer: Centivo All Commercial |
$152.77
|
| Rate for Payer: Cigna All Commercial |
$98.56
|
| Rate for Payer: Cigna All Commercial |
$98.56
|
| Rate for Payer: CORVEL All Commercial |
$98.56
|
| Rate for Payer: CORVEL All Commercial |
$98.56
|
| Rate for Payer: Coventry All Commercial |
$118.27
|
| Rate for Payer: Coventry All Commercial |
$118.27
|
| Rate for Payer: Encore All Commercial |
$98.56
|
| Rate for Payer: Encore All Commercial |
$98.56
|
| Rate for Payer: Frontpath All Commercial |
$138.22
|
| Rate for Payer: Frontpath All Commercial |
$138.22
|
| Rate for Payer: Humana ChoiceCare |
$125.83
|
| Rate for Payer: Humana ChoiceCare |
$125.83
|
| Rate for Payer: Humana Medicare |
$98.56
|
| Rate for Payer: Humana Medicare |
$98.56
|
| Rate for Payer: Lucent All Commercial |
$137.98
|
| Rate for Payer: Lucent All Commercial |
$137.98
|
| Rate for Payer: Lutheran Preferred All Commercial |
$157.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$157.00
|
| Rate for Payer: Managed Health Services Medicaid |
$317.32
|
| Rate for Payer: Managed Health Services Medicaid |
$317.32
|
| Rate for Payer: MDWise Medicaid |
$317.32
|
| Rate for Payer: MDWise Medicaid |
$317.32
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$74.79
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$74.79
|
| Rate for Payer: PHCS All Commercial |
$98.56
|
| Rate for Payer: PHCS All Commercial |
$98.56
|
| Rate for Payer: PHP All Commercial |
$134.30
|
| Rate for Payer: PHP All Commercial |
$134.30
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$98.56
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$98.56
|
| Rate for Payer: Sagamore Health Network All Products |
$98.56
|
| Rate for Payer: Sagamore Health Network All Products |
$98.56
|
| Rate for Payer: Signature Care EPO |
$286.45
|
| Rate for Payer: Signature Care EPO |
$286.45
|
| Rate for Payer: Signature Care PPO |
$286.45
|
| Rate for Payer: Signature Care PPO |
$286.45
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$14,700.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$14,700.00
|
| Rate for Payer: United Healthcare Commercial |
$118.24
|
| Rate for Payer: United Healthcare Commercial |
$118.24
|
| Rate for Payer: United Healthcare Medicare |
$321.21
|
| Rate for Payer: United Healthcare Medicare |
$321.21
|
|
|
PR CV STRS TST XERS&/OR RX CONT ECG W/O I&R
|
Professional
|
Both
|
$40.10
|
|
|
Service Code
|
CPT 93016
|
| Hospital Charge Code |
z93016
|
| Min. Negotiated Rate |
$19.72 |
| Max. Negotiated Rate |
$3,100.00 |
| Rate for Payer: Aetna Commercial |
$20.88
|
| Rate for Payer: Aetna Commercial |
$20.88
|
| Rate for Payer: Aetna Medicare |
$20.88
|
| Rate for Payer: Aetna Medicare |
$20.88
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$34.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$34.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$34.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$34.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$34.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$34.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$34.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$34.00
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$19.72
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$19.72
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$24.01
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$24.01
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$22.97
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$22.97
|
| Rate for Payer: Cash Price |
$24.06
|
| Rate for Payer: Cash Price |
$23.82
|
| Rate for Payer: Centivo All Commercial |
$32.36
|
| Rate for Payer: Centivo All Commercial |
$32.36
|
| Rate for Payer: Cigna All Commercial |
$20.88
|
| Rate for Payer: Cigna All Commercial |
$20.88
|
| Rate for Payer: CORVEL All Commercial |
$20.88
|
| Rate for Payer: CORVEL All Commercial |
$20.88
|
| Rate for Payer: Coventry All Commercial |
$25.06
|
| Rate for Payer: Coventry All Commercial |
$25.06
|
| Rate for Payer: Encore All Commercial |
$20.88
|
| Rate for Payer: Encore All Commercial |
$20.88
|
| Rate for Payer: Frontpath All Commercial |
$23.53
|
| Rate for Payer: Frontpath All Commercial |
$23.53
|
| Rate for Payer: Humana ChoiceCare |
$31.56
|
| Rate for Payer: Humana ChoiceCare |
$31.56
|
| Rate for Payer: Humana Medicare |
$20.88
|
| Rate for Payer: Humana Medicare |
$20.88
|
| Rate for Payer: Lucent All Commercial |
$29.23
|
| Rate for Payer: Lucent All Commercial |
$29.23
|
| Rate for Payer: Lutheran Preferred All Commercial |
$33.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$33.00
|
| Rate for Payer: Managed Health Services Medicaid |
$19.72
|
| Rate for Payer: Managed Health Services Medicaid |
$19.72
|
| Rate for Payer: MDWise Medicaid |
$19.72
|
| Rate for Payer: MDWise Medicaid |
$19.72
|
| Rate for Payer: PHCS All Commercial |
$20.88
|
| Rate for Payer: PHCS All Commercial |
$20.88
|
| Rate for Payer: PHP All Commercial |
$29.18
|
| Rate for Payer: PHP All Commercial |
$29.18
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$20.88
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$20.88
|
| Rate for Payer: Sagamore Health Network All Products |
$20.88
|
| Rate for Payer: Sagamore Health Network All Products |
$20.88
|
| Rate for Payer: Signature Care EPO |
$35.50
|
| Rate for Payer: Signature Care EPO |
$35.50
|
| Rate for Payer: Signature Care PPO |
$35.50
|
| Rate for Payer: Signature Care PPO |
$35.50
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,100.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,100.00
|
| Rate for Payer: United Healthcare Commercial |
$29.51
|
| Rate for Payer: United Healthcare Commercial |
$29.51
|
| Rate for Payer: United Healthcare Medicare |
$19.85
|
| Rate for Payer: United Healthcare Medicare |
$19.85
|
|
|
PR CYSTOSCOPY,DIL URETHRAL STRICTURE
|
Professional
|
Both
|
$551.82
|
|
|
Service Code
|
CPT 52281
|
| Hospital Charge Code |
z52281
|
| Min. Negotiated Rate |
$76.31 |
| Max. Negotiated Rate |
$298.05 |
| Rate for Payer: Aetna Commercial |
$141.90
|
| Rate for Payer: Aetna Medicare |
$141.90
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$76.31
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$297.72
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$163.19
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$156.09
|
| Rate for Payer: Cash Price |
$331.09
|
| Rate for Payer: Centivo All Commercial |
$219.94
|
| Rate for Payer: Cigna All Commercial |
$141.90
|
| Rate for Payer: CORVEL All Commercial |
$141.90
|
| Rate for Payer: Coventry All Commercial |
$170.28
|
| Rate for Payer: Encore All Commercial |
$141.90
|
| Rate for Payer: Frontpath All Commercial |
$194.58
|
| Rate for Payer: Humana ChoiceCare |
$147.67
|
| Rate for Payer: Humana Medicare |
$141.90
|
| Rate for Payer: Lucent All Commercial |
$198.66
|
| Rate for Payer: Managed Health Services Medicaid |
$297.72
|
| Rate for Payer: MDWise Medicaid |
$297.72
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$76.31
|
| Rate for Payer: PHCS All Commercial |
$141.90
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$141.90
|
| Rate for Payer: Sagamore Health Network All Products |
$141.90
|
| Rate for Payer: United Healthcare Commercial |
$193.30
|
| Rate for Payer: United Healthcare Medicare |
$298.05
|
|
|
PR CYSTOSCOPY,DIR VIS INT URETHROTOMY
|
Professional
|
Both
|
$238.22
|
|
|
Service Code
|
CPT 52276
|
| Hospital Charge Code |
z52276
|
| Min. Negotiated Rate |
$238.39 |
| Max. Negotiated Rate |
$382.56 |
| Rate for Payer: Aetna Commercial |
$246.81
|
| Rate for Payer: Aetna Medicare |
$246.81
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$239.34
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$283.83
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$271.49
|
| Rate for Payer: Cash Price |
$142.93
|
| Rate for Payer: Centivo All Commercial |
$382.56
|
| Rate for Payer: Cigna All Commercial |
$246.81
|
| Rate for Payer: CORVEL All Commercial |
$246.81
|
| Rate for Payer: Coventry All Commercial |
$296.17
|
| Rate for Payer: Encore All Commercial |
$246.81
|
| Rate for Payer: Frontpath All Commercial |
$339.04
|
| Rate for Payer: Humana ChoiceCare |
$258.40
|
| Rate for Payer: Humana Medicare |
$246.81
|
| Rate for Payer: Lucent All Commercial |
$345.53
|
| Rate for Payer: Managed Health Services Medicaid |
$239.34
|
| Rate for Payer: MDWise Medicaid |
$239.34
|
| Rate for Payer: PHCS All Commercial |
$246.81
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$246.81
|
| Rate for Payer: Sagamore Health Network All Products |
$246.81
|
| Rate for Payer: United Healthcare Commercial |
$334.16
|
| Rate for Payer: United Healthcare Medicare |
$238.39
|
|
|
PR CYSTOSCOPY,INSERT URETERAL STENT
|
Professional
|
Both
|
$672.98
|
|
|
Service Code
|
CPT 52332
|
| Hospital Charge Code |
z52332
|
| Min. Negotiated Rate |
$121.22 |
| Max. Negotiated Rate |
$366.18 |
| Rate for Payer: Aetna Commercial |
$145.11
|
| Rate for Payer: Aetna Medicare |
$145.11
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$121.22
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$364.17
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$166.88
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$159.62
|
| Rate for Payer: Cash Price |
$403.79
|
| Rate for Payer: Centivo All Commercial |
$224.92
|
| Rate for Payer: Cigna All Commercial |
$145.11
|
| Rate for Payer: CORVEL All Commercial |
$145.11
|
| Rate for Payer: Coventry All Commercial |
$174.13
|
| Rate for Payer: Encore All Commercial |
$145.11
|
| Rate for Payer: Frontpath All Commercial |
$199.06
|
| Rate for Payer: Humana ChoiceCare |
$147.94
|
| Rate for Payer: Humana Medicare |
$145.11
|
| Rate for Payer: Lucent All Commercial |
$203.15
|
| Rate for Payer: Managed Health Services Medicaid |
$364.17
|
| Rate for Payer: MDWise Medicaid |
$364.17
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$121.22
|
| Rate for Payer: PHCS All Commercial |
$145.11
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$145.11
|
| Rate for Payer: Sagamore Health Network All Products |
$145.11
|
| Rate for Payer: United Healthcare Commercial |
$195.34
|
| Rate for Payer: United Healthcare Medicare |
$366.18
|
|
|
PR CYSTOSCOPY,REMV CALCULUS,SIMPLE
|
Professional
|
Both
|
$543.50
|
|
|
Service Code
|
CPT 52310
|
| Hospital Charge Code |
z52310
|
| Min. Negotiated Rate |
$104.50 |
| Max. Negotiated Rate |
$291.39 |
| Rate for Payer: Aetna Commercial |
$141.34
|
| Rate for Payer: Aetna Medicare |
$141.34
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$104.50
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$291.39
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$162.54
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$155.47
|
| Rate for Payer: Cash Price |
$326.10
|
| Rate for Payer: Centivo All Commercial |
$219.08
|
| Rate for Payer: Cigna All Commercial |
$141.34
|
| Rate for Payer: CORVEL All Commercial |
$141.34
|
| Rate for Payer: Coventry All Commercial |
$169.61
|
| Rate for Payer: Encore All Commercial |
$141.34
|
| Rate for Payer: Frontpath All Commercial |
$194.08
|
| Rate for Payer: Humana ChoiceCare |
$146.32
|
| Rate for Payer: Humana Medicare |
$141.34
|
| Rate for Payer: Lucent All Commercial |
$197.88
|
| Rate for Payer: Managed Health Services Medicaid |
$291.39
|
| Rate for Payer: MDWise Medicaid |
$291.39
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$104.50
|
| Rate for Payer: PHCS All Commercial |
$141.34
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$141.34
|
| Rate for Payer: Sagamore Health Network All Products |
$141.34
|
| Rate for Payer: United Healthcare Commercial |
$190.03
|
| Rate for Payer: United Healthcare Medicare |
$290.85
|
|
|
PR CYSTO/URETERO/PYELOSCOPY, CALCULUS TX
|
Professional
|
Both
|
$637.76
|
|
|
Service Code
|
CPT 52352
|
| Hospital Charge Code |
z52352
|
| Min. Negotiated Rate |
$319.45 |
| Max. Negotiated Rate |
$512.60 |
| Rate for Payer: Aetna Commercial |
$330.71
|
| Rate for Payer: Aetna Medicare |
$330.71
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$320.39
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$380.32
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$363.78
|
| Rate for Payer: Cash Price |
$382.66
|
| Rate for Payer: Centivo All Commercial |
$512.60
|
| Rate for Payer: Cigna All Commercial |
$330.71
|
| Rate for Payer: CORVEL All Commercial |
$330.71
|
| Rate for Payer: Coventry All Commercial |
$396.85
|
| Rate for Payer: Encore All Commercial |
$330.71
|
| Rate for Payer: Frontpath All Commercial |
$453.86
|
| Rate for Payer: Humana ChoiceCare |
$357.47
|
| Rate for Payer: Humana Medicare |
$330.71
|
| Rate for Payer: Lucent All Commercial |
$462.99
|
| Rate for Payer: Managed Health Services Medicaid |
$320.39
|
| Rate for Payer: MDWise Medicaid |
$320.39
|
| Rate for Payer: PHCS All Commercial |
$330.71
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$330.71
|
| Rate for Payer: Sagamore Health Network All Products |
$330.71
|
| Rate for Payer: United Healthcare Commercial |
$463.66
|
| Rate for Payer: United Healthcare Medicare |
$319.45
|
|
|
PR CYSTO/URETERO/PYELOSCOPY, DX
|
Professional
|
Both
|
$545.16
|
|
|
Service Code
|
CPT 52351
|
| Hospital Charge Code |
z52351
|
| Min. Negotiated Rate |
$272.90 |
| Max. Negotiated Rate |
$437.88 |
| Rate for Payer: Aetna Commercial |
$282.50
|
| Rate for Payer: Aetna Medicare |
$282.50
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$274.12
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$324.88
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$310.75
|
| Rate for Payer: Cash Price |
$327.10
|
| Rate for Payer: Centivo All Commercial |
$437.88
|
| Rate for Payer: Cigna All Commercial |
$282.50
|
| Rate for Payer: CORVEL All Commercial |
$282.50
|
| Rate for Payer: Coventry All Commercial |
$339.00
|
| Rate for Payer: Encore All Commercial |
$282.50
|
| Rate for Payer: Frontpath All Commercial |
$387.86
|
| Rate for Payer: Humana ChoiceCare |
$304.72
|
| Rate for Payer: Humana Medicare |
$282.50
|
| Rate for Payer: Lucent All Commercial |
$395.50
|
| Rate for Payer: Managed Health Services Medicaid |
$274.12
|
| Rate for Payer: MDWise Medicaid |
$274.12
|
| Rate for Payer: PHCS All Commercial |
$282.50
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$282.50
|
| Rate for Payer: Sagamore Health Network All Products |
$282.50
|
| Rate for Payer: United Healthcare Commercial |
$394.83
|
| Rate for Payer: United Healthcare Medicare |
$272.90
|
|
|
PR CYSTO/URETERO/PYELOSCOPY W/LITHOTRIPSY
|
Professional
|
Both
|
$704.58
|
|
|
Service Code
|
CPT 52353
|
| Hospital Charge Code |
z52353
|
| Min. Negotiated Rate |
$353.35 |
| Max. Negotiated Rate |
$567.64 |
| Rate for Payer: Aetna Commercial |
$366.22
|
| Rate for Payer: Aetna Medicare |
$366.22
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$354.39
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$421.15
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$402.84
|
| Rate for Payer: Cash Price |
$422.75
|
| Rate for Payer: Centivo All Commercial |
$567.64
|
| Rate for Payer: Cigna All Commercial |
$366.22
|
| Rate for Payer: CORVEL All Commercial |
$366.22
|
| Rate for Payer: Coventry All Commercial |
$439.46
|
| Rate for Payer: Encore All Commercial |
$366.22
|
| Rate for Payer: Frontpath All Commercial |
$503.28
|
| Rate for Payer: Humana ChoiceCare |
$412.55
|
| Rate for Payer: Humana Medicare |
$366.22
|
| Rate for Payer: Lucent All Commercial |
$512.71
|
| Rate for Payer: Managed Health Services Medicaid |
$354.39
|
| Rate for Payer: MDWise Medicaid |
$354.39
|
| Rate for Payer: PHCS All Commercial |
$366.22
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$366.22
|
| Rate for Payer: Sagamore Health Network All Products |
$366.22
|
| Rate for Payer: United Healthcare Commercial |
$533.59
|
| Rate for Payer: United Healthcare Medicare |
$353.35
|
|
|
PR CYSTO/URETERO W/LITHOTRIPSY &INDWELL STENT INSRT
|
Professional
|
Both
|
$747.80
|
|
|
Service Code
|
CPT 52356
|
| Hospital Charge Code |
z52356
|
| Min. Negotiated Rate |
$374.58 |
| Max. Negotiated Rate |
$601.99 |
| Rate for Payer: Aetna Commercial |
$388.38
|
| Rate for Payer: Aetna Medicare |
$388.38
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$375.94
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$446.64
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$427.22
|
| Rate for Payer: Cash Price |
$448.68
|
| Rate for Payer: Centivo All Commercial |
$601.99
|
| Rate for Payer: Cigna All Commercial |
$388.38
|
| Rate for Payer: CORVEL All Commercial |
$388.38
|
| Rate for Payer: Coventry All Commercial |
$466.06
|
| Rate for Payer: Encore All Commercial |
$388.38
|
| Rate for Payer: Frontpath All Commercial |
$533.58
|
| Rate for Payer: Humana ChoiceCare |
$408.18
|
| Rate for Payer: Humana Medicare |
$388.38
|
| Rate for Payer: Lucent All Commercial |
$543.73
|
| Rate for Payer: Managed Health Services Medicaid |
$375.94
|
| Rate for Payer: MDWise Medicaid |
$375.94
|
| Rate for Payer: PHCS All Commercial |
$388.38
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$388.38
|
| Rate for Payer: Sagamore Health Network All Products |
$388.38
|
| Rate for Payer: United Healthcare Commercial |
$508.54
|
| Rate for Payer: United Healthcare Medicare |
$374.58
|
|
|
PR CYSTOURETHROSCOPY
|
Professional
|
Both
|
$395.70
|
|
|
Service Code
|
CPT 52000
|
| Hospital Charge Code |
z52000
|
| Min. Negotiated Rate |
$51.84 |
| Max. Negotiated Rate |
$218.92 |
| Rate for Payer: Aetna Commercial |
$75.63
|
| Rate for Payer: Aetna Medicare |
$75.63
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$51.84
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$218.26
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$86.97
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$83.19
|
| Rate for Payer: Cash Price |
$237.42
|
| Rate for Payer: Centivo All Commercial |
$117.23
|
| Rate for Payer: Cigna All Commercial |
$75.63
|
| Rate for Payer: CORVEL All Commercial |
$75.63
|
| Rate for Payer: Coventry All Commercial |
$90.76
|
| Rate for Payer: Encore All Commercial |
$75.63
|
| Rate for Payer: Frontpath All Commercial |
$104.06
|
| Rate for Payer: Humana ChoiceCare |
$105.42
|
| Rate for Payer: Humana Medicare |
$75.63
|
| Rate for Payer: Lucent All Commercial |
$105.88
|
| Rate for Payer: Managed Health Services Medicaid |
$218.26
|
| Rate for Payer: MDWise Medicaid |
$218.26
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$51.84
|
| Rate for Payer: PHCS All Commercial |
$75.63
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$75.63
|
| Rate for Payer: Sagamore Health Network All Products |
$75.63
|
| Rate for Payer: United Healthcare Commercial |
$155.23
|
| Rate for Payer: United Healthcare Medicare |
$218.92
|
|
|
PR CYSTOURETHROSCOPY,BIOPSY
|
Professional
|
Both
|
$637.44
|
|
|
Service Code
|
CPT 52204
|
| Hospital Charge Code |
z52204
|
| Min. Negotiated Rate |
$107.63 |
| Max. Negotiated Rate |
$345.14 |
| Rate for Payer: Aetna Commercial |
$131.99
|
| Rate for Payer: Aetna Medicare |
$131.99
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$107.63
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$343.49
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$151.79
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$145.19
|
| Rate for Payer: Cash Price |
$382.46
|
| Rate for Payer: Centivo All Commercial |
$204.58
|
| Rate for Payer: Cigna All Commercial |
$131.99
|
| Rate for Payer: CORVEL All Commercial |
$131.99
|
| Rate for Payer: Coventry All Commercial |
$158.39
|
| Rate for Payer: Encore All Commercial |
$131.99
|
| Rate for Payer: Frontpath All Commercial |
$181.06
|
| Rate for Payer: Humana ChoiceCare |
$124.52
|
| Rate for Payer: Humana Medicare |
$131.99
|
| Rate for Payer: Lucent All Commercial |
$184.79
|
| Rate for Payer: Managed Health Services Medicaid |
$343.49
|
| Rate for Payer: MDWise Medicaid |
$343.49
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$107.63
|
| Rate for Payer: PHCS All Commercial |
$131.99
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$131.99
|
| Rate for Payer: Sagamore Health Network All Products |
$131.99
|
| Rate for Payer: United Healthcare Commercial |
$175.99
|
| Rate for Payer: United Healthcare Medicare |
$345.14
|
|
|
PR CYSTOURETHROSCOPY,FULGUR 0.5-2 CM LESN
|
Professional
|
Both
|
$442.90
|
|
|
Service Code
|
CPT 52234
|
| Hospital Charge Code |
z52234
|
| Min. Negotiated Rate |
$221.92 |
| Max. Negotiated Rate |
$355.93 |
| Rate for Payer: Aetna Commercial |
$229.63
|
| Rate for Payer: Aetna Medicare |
$229.63
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$222.67
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$264.07
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$252.59
|
| Rate for Payer: Cash Price |
$265.74
|
| Rate for Payer: Centivo All Commercial |
$355.93
|
| Rate for Payer: Cigna All Commercial |
$229.63
|
| Rate for Payer: CORVEL All Commercial |
$229.63
|
| Rate for Payer: Coventry All Commercial |
$275.56
|
| Rate for Payer: Encore All Commercial |
$229.63
|
| Rate for Payer: Frontpath All Commercial |
$315.50
|
| Rate for Payer: Humana ChoiceCare |
$239.44
|
| Rate for Payer: Humana Medicare |
$229.63
|
| Rate for Payer: Lucent All Commercial |
$321.48
|
| Rate for Payer: Managed Health Services Medicaid |
$222.67
|
| Rate for Payer: MDWise Medicaid |
$222.67
|
| Rate for Payer: PHCS All Commercial |
$229.63
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$229.63
|
| Rate for Payer: Sagamore Health Network All Products |
$229.63
|
| Rate for Payer: United Healthcare Commercial |
$309.90
|
| Rate for Payer: United Healthcare Medicare |
$221.92
|
|
|
PR CYSTOURETHROSCOPY,FULGUR <0.5 CM LESN
|
Professional
|
Both
|
$1,330.46
|
|
|
Service Code
|
CPT 52224
|
| Hospital Charge Code |
z52224
|
| Min. Negotiated Rate |
$134.03 |
| Max. Negotiated Rate |
$713.24 |
| Rate for Payer: Aetna Commercial |
$190.56
|
| Rate for Payer: Aetna Medicare |
$190.56
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$134.03
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$707.06
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$219.14
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$209.62
|
| Rate for Payer: Cash Price |
$798.28
|
| Rate for Payer: Centivo All Commercial |
$295.37
|
| Rate for Payer: Cigna All Commercial |
$190.56
|
| Rate for Payer: CORVEL All Commercial |
$190.56
|
| Rate for Payer: Coventry All Commercial |
$228.67
|
| Rate for Payer: Encore All Commercial |
$190.56
|
| Rate for Payer: Frontpath All Commercial |
$262.67
|
| Rate for Payer: Humana ChoiceCare |
$163.42
|
| Rate for Payer: Humana Medicare |
$190.56
|
| Rate for Payer: Lucent All Commercial |
$266.78
|
| Rate for Payer: Managed Health Services Medicaid |
$707.06
|
| Rate for Payer: MDWise Medicaid |
$707.06
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$134.03
|
| Rate for Payer: PHCS All Commercial |
$190.56
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$190.56
|
| Rate for Payer: Sagamore Health Network All Products |
$190.56
|
| Rate for Payer: United Healthcare Commercial |
$212.48
|
| Rate for Payer: United Healthcare Medicare |
$713.24
|
|
|
PR CYSTOURETHROSCOPY,FULGUR 2-5 CM LESN
|
Professional
|
Both
|
$519.06
|
|
|
Service Code
|
CPT 52235
|
| Hospital Charge Code |
z52235
|
| Min. Negotiated Rate |
$260.23 |
| Max. Negotiated Rate |
$417.12 |
| Rate for Payer: Aetna Commercial |
$269.11
|
| Rate for Payer: Aetna Medicare |
$269.11
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$261.23
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$309.48
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$296.02
|
| Rate for Payer: Cash Price |
$311.44
|
| Rate for Payer: Centivo All Commercial |
$417.12
|
| Rate for Payer: Cigna All Commercial |
$269.11
|
| Rate for Payer: CORVEL All Commercial |
$269.11
|
| Rate for Payer: Coventry All Commercial |
$322.93
|
| Rate for Payer: Encore All Commercial |
$269.11
|
| Rate for Payer: Frontpath All Commercial |
$369.55
|
| Rate for Payer: Humana ChoiceCare |
$281.45
|
| Rate for Payer: Humana Medicare |
$269.11
|
| Rate for Payer: Lucent All Commercial |
$376.75
|
| Rate for Payer: Managed Health Services Medicaid |
$261.23
|
| Rate for Payer: MDWise Medicaid |
$261.23
|
| Rate for Payer: PHCS All Commercial |
$269.11
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$269.11
|
| Rate for Payer: Sagamore Health Network All Products |
$269.11
|
| Rate for Payer: United Healthcare Commercial |
$363.39
|
| Rate for Payer: United Healthcare Medicare |
$260.23
|
|
|
PR CYSTOURETHROSCOPY,FULGUR >5 CM LESN
|
Professional
|
Both
|
$704.58
|
|
|
Service Code
|
CPT 52240
|
| Hospital Charge Code |
z52240
|
| Min. Negotiated Rate |
$353.35 |
| Max. Negotiated Rate |
$636.01 |
| Rate for Payer: Aetna Commercial |
$366.22
|
| Rate for Payer: Aetna Medicare |
$366.22
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$354.69
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$421.15
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$402.84
|
| Rate for Payer: Cash Price |
$422.75
|
| Rate for Payer: Centivo All Commercial |
$567.64
|
| Rate for Payer: Cigna All Commercial |
$366.22
|
| Rate for Payer: CORVEL All Commercial |
$366.22
|
| Rate for Payer: Coventry All Commercial |
$439.46
|
| Rate for Payer: Encore All Commercial |
$366.22
|
| Rate for Payer: Frontpath All Commercial |
$503.28
|
| Rate for Payer: Humana ChoiceCare |
$496.98
|
| Rate for Payer: Humana Medicare |
$366.22
|
| Rate for Payer: Lucent All Commercial |
$512.71
|
| Rate for Payer: Managed Health Services Medicaid |
$354.69
|
| Rate for Payer: MDWise Medicaid |
$354.69
|
| Rate for Payer: PHCS All Commercial |
$366.22
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$366.22
|
| Rate for Payer: Sagamore Health Network All Products |
$366.22
|
| Rate for Payer: United Healthcare Commercial |
$636.01
|
| Rate for Payer: United Healthcare Medicare |
$353.35
|
|
|
PR CYSTOURETHROSCOPY,FULGURATN
|
Professional
|
Both
|
$1,270.62
|
|
|
Service Code
|
CPT 52214
|
| Hospital Charge Code |
z52214
|
| Min. Negotiated Rate |
$137.44 |
| Max. Negotiated Rate |
$682.51 |
| Rate for Payer: Aetna Commercial |
$164.78
|
| Rate for Payer: Aetna Medicare |
$164.78
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$137.44
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$676.47
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$189.50
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$181.26
|
| Rate for Payer: Cash Price |
$762.37
|
| Rate for Payer: Centivo All Commercial |
$255.41
|
| Rate for Payer: Cigna All Commercial |
$164.78
|
| Rate for Payer: CORVEL All Commercial |
$164.78
|
| Rate for Payer: Coventry All Commercial |
$197.74
|
| Rate for Payer: Encore All Commercial |
$164.78
|
| Rate for Payer: Frontpath All Commercial |
$226.51
|
| Rate for Payer: Humana ChoiceCare |
$191.70
|
| Rate for Payer: Humana Medicare |
$164.78
|
| Rate for Payer: Lucent All Commercial |
$230.69
|
| Rate for Payer: Managed Health Services Medicaid |
$676.47
|
| Rate for Payer: MDWise Medicaid |
$676.47
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$137.44
|
| Rate for Payer: PHCS All Commercial |
$164.78
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$164.78
|
| Rate for Payer: Sagamore Health Network All Products |
$164.78
|
| Rate for Payer: United Healthcare Commercial |
$271.50
|
| Rate for Payer: United Healthcare Medicare |
$682.51
|
|
|
PR CYSTOURETHROSCOPY INJ CHEMODENERVATION BLADDER
|
Professional
|
Both
|
$658.60
|
|
|
Service Code
|
CPT 52287
|
| Hospital Charge Code |
z52287
|
| Min. Negotiated Rate |
$104.18 |
| Max. Negotiated Rate |
$354.99 |
| Rate for Payer: Aetna Commercial |
$158.29
|
| Rate for Payer: Aetna Medicare |
$158.29
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$104.18
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$353.12
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$182.03
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$174.12
|
| Rate for Payer: Cash Price |
$395.16
|
| Rate for Payer: Centivo All Commercial |
$245.35
|
| Rate for Payer: Cigna All Commercial |
$158.29
|
| Rate for Payer: CORVEL All Commercial |
$158.29
|
| Rate for Payer: Coventry All Commercial |
$189.95
|
| Rate for Payer: Encore All Commercial |
$158.29
|
| Rate for Payer: Frontpath All Commercial |
$217.87
|
| Rate for Payer: Humana ChoiceCare |
$159.42
|
| Rate for Payer: Humana Medicare |
$158.29
|
| Rate for Payer: Lucent All Commercial |
$221.61
|
| Rate for Payer: Managed Health Services Medicaid |
$353.12
|
| Rate for Payer: MDWise Medicaid |
$353.12
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$104.18
|
| Rate for Payer: PHCS All Commercial |
$158.29
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$158.29
|
| Rate for Payer: Sagamore Health Network All Products |
$158.29
|
| Rate for Payer: United Healthcare Commercial |
$209.05
|
| Rate for Payer: United Healthcare Medicare |
$354.99
|
|
|
PR CYSTOURETHROSCOPY,URETER CATHETER
|
Professional
|
Both
|
$511.36
|
|
|
Service Code
|
CPT 52005
|
| Hospital Charge Code |
z52005
|
| Min. Negotiated Rate |
$66.62 |
| Max. Negotiated Rate |
$277.16 |
| Rate for Payer: Aetna Commercial |
$123.90
|
| Rate for Payer: Aetna Medicare |
$123.90
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$66.62
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$276.63
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$142.49
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$136.29
|
| Rate for Payer: Cash Price |
$306.82
|
| Rate for Payer: Centivo All Commercial |
$192.04
|
| Rate for Payer: Cigna All Commercial |
$123.90
|
| Rate for Payer: CORVEL All Commercial |
$123.90
|
| Rate for Payer: Coventry All Commercial |
$148.68
|
| Rate for Payer: Encore All Commercial |
$123.90
|
| Rate for Payer: Frontpath All Commercial |
$169.69
|
| Rate for Payer: Humana ChoiceCare |
$124.17
|
| Rate for Payer: Humana Medicare |
$123.90
|
| Rate for Payer: Lucent All Commercial |
$173.46
|
| Rate for Payer: Managed Health Services Medicaid |
$276.63
|
| Rate for Payer: MDWise Medicaid |
$276.63
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$66.62
|
| Rate for Payer: PHCS All Commercial |
$123.90
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$123.90
|
| Rate for Payer: Sagamore Health Network All Products |
$123.90
|
| Rate for Payer: United Healthcare Commercial |
$165.65
|
| Rate for Payer: United Healthcare Medicare |
$277.16
|
|
|
PR DBRDMT EXTENSV ECZMT/INFCT SKIN UP 10% BDY SURF
|
Professional
|
Both
|
$110.92
|
|
|
Service Code
|
CPT 11000
|
| Hospital Charge Code |
z11000
|
| Min. Negotiated Rate |
$20.73 |
| Max. Negotiated Rate |
$3,100.00 |
| Rate for Payer: Aetna Commercial |
$26.55
|
| Rate for Payer: Aetna Commercial |
$26.55
|
| Rate for Payer: Aetna Medicare |
$26.55
|
| Rate for Payer: Aetna Medicare |
$26.55
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$56.09
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$56.09
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$56.09
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$56.09
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$56.09
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$56.09
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$56.09
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$56.09
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$20.73
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$20.73
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$54.56
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$54.56
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$30.53
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$30.53
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$29.20
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$29.20
|
| Rate for Payer: Cash Price |
$63.95
|
| Rate for Payer: Cash Price |
$66.55
|
| Rate for Payer: Centivo All Commercial |
$41.15
|
| Rate for Payer: Centivo All Commercial |
$41.15
|
| Rate for Payer: Cigna All Commercial |
$26.55
|
| Rate for Payer: Cigna All Commercial |
$26.55
|
| Rate for Payer: CORVEL All Commercial |
$26.55
|
| Rate for Payer: CORVEL All Commercial |
$26.55
|
| Rate for Payer: Coventry All Commercial |
$31.86
|
| Rate for Payer: Coventry All Commercial |
$31.86
|
| Rate for Payer: Encore All Commercial |
$26.55
|
| Rate for Payer: Encore All Commercial |
$26.55
|
| Rate for Payer: Frontpath All Commercial |
$36.02
|
| Rate for Payer: Frontpath All Commercial |
$36.02
|
| Rate for Payer: Humana ChoiceCare |
$31.45
|
| Rate for Payer: Humana ChoiceCare |
$31.45
|
| Rate for Payer: Humana Medicare |
$26.55
|
| Rate for Payer: Humana Medicare |
$26.55
|
| Rate for Payer: Lucent All Commercial |
$37.17
|
| Rate for Payer: Lucent All Commercial |
$37.17
|
| Rate for Payer: Lutheran Preferred All Commercial |
$34.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$34.00
|
| Rate for Payer: Managed Health Services Medicaid |
$54.56
|
| Rate for Payer: Managed Health Services Medicaid |
$54.56
|
| Rate for Payer: MDWise Medicaid |
$54.56
|
| Rate for Payer: MDWise Medicaid |
$54.56
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$20.73
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$20.73
|
| Rate for Payer: PHCS All Commercial |
$26.55
|
| Rate for Payer: PHCS All Commercial |
$26.55
|
| Rate for Payer: PHP All Commercial |
$35.40
|
| Rate for Payer: PHP All Commercial |
$35.40
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$26.55
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$26.55
|
| Rate for Payer: Sagamore Health Network All Products |
$26.55
|
| Rate for Payer: Sagamore Health Network All Products |
$26.55
|
| Rate for Payer: Signature Care EPO |
$48.45
|
| Rate for Payer: Signature Care EPO |
$48.45
|
| Rate for Payer: Signature Care PPO |
$48.45
|
| Rate for Payer: Signature Care PPO |
$48.45
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,100.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,100.00
|
| Rate for Payer: United Healthcare Commercial |
$36.39
|
| Rate for Payer: United Healthcare Commercial |
$36.39
|
| Rate for Payer: United Healthcare Medicare |
$53.29
|
| Rate for Payer: United Healthcare Medicare |
$53.29
|
|
|
PR DBRDMT SKN SBQ T/M/F NECRO INFCTJ XTRNL GENT&PER
|
Professional
|
Both
|
$1,029.24
|
|
|
Service Code
|
CPT 11004
|
| Hospital Charge Code |
z11004
|
| Min. Negotiated Rate |
$506.22 |
| Max. Negotiated Rate |
$62,500.00 |
| Rate for Payer: Aetna Commercial |
$529.60
|
| Rate for Payer: Aetna Commercial |
$529.60
|
| Rate for Payer: Aetna Medicare |
$529.60
|
| Rate for Payer: Aetna Medicare |
$529.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$697.87
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$697.87
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$697.87
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$697.87
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$697.87
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$697.87
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$697.87
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$697.87
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$506.22
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$506.22
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$609.04
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$609.04
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$582.56
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$582.56
|
| Rate for Payer: Cash Price |
$617.54
|
| Rate for Payer: Cash Price |
$610.03
|
| Rate for Payer: Centivo All Commercial |
$820.88
|
| Rate for Payer: Centivo All Commercial |
$820.88
|
| Rate for Payer: Cigna All Commercial |
$529.60
|
| Rate for Payer: Cigna All Commercial |
$529.60
|
| Rate for Payer: CORVEL All Commercial |
$529.60
|
| Rate for Payer: CORVEL All Commercial |
$529.60
|
| Rate for Payer: Coventry All Commercial |
$635.52
|
| Rate for Payer: Coventry All Commercial |
$635.52
|
| Rate for Payer: Encore All Commercial |
$529.60
|
| Rate for Payer: Encore All Commercial |
$529.60
|
| Rate for Payer: Frontpath All Commercial |
$748.51
|
| Rate for Payer: Frontpath All Commercial |
$748.51
|
| Rate for Payer: Humana ChoiceCare |
$536.04
|
| Rate for Payer: Humana ChoiceCare |
$536.04
|
| Rate for Payer: Humana Medicare |
$529.60
|
| Rate for Payer: Humana Medicare |
$529.60
|
| Rate for Payer: Lucent All Commercial |
$741.44
|
| Rate for Payer: Lucent All Commercial |
$741.44
|
| Rate for Payer: Lutheran Preferred All Commercial |
$677.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$677.00
|
| Rate for Payer: Managed Health Services Medicaid |
$506.22
|
| Rate for Payer: Managed Health Services Medicaid |
$506.22
|
| Rate for Payer: MDWise Medicaid |
$506.22
|
| Rate for Payer: MDWise Medicaid |
$506.22
|
| Rate for Payer: PHCS All Commercial |
$529.60
|
| Rate for Payer: PHCS All Commercial |
$529.60
|
| Rate for Payer: PHP All Commercial |
$711.70
|
| Rate for Payer: PHP All Commercial |
$711.70
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$529.60
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$529.60
|
| Rate for Payer: Sagamore Health Network All Products |
$529.60
|
| Rate for Payer: Sagamore Health Network All Products |
$529.60
|
| Rate for Payer: Signature Care EPO |
$602.65
|
| Rate for Payer: Signature Care EPO |
$602.65
|
| Rate for Payer: Signature Care PPO |
$602.65
|
| Rate for Payer: Signature Care PPO |
$602.65
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$62,500.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$62,500.00
|
| Rate for Payer: United Healthcare Commercial |
$652.33
|
| Rate for Payer: United Healthcare Commercial |
$652.33
|
| Rate for Payer: United Healthcare Medicare |
$508.36
|
| Rate for Payer: United Healthcare Medicare |
$508.36
|
|
|
PR DBRDMT SKN SUBQ T/M/F NECRO INFCTJ ABDL WALL
|
Professional
|
Both
|
$1,383.16
|
|
|
Service Code
|
CPT 11005
|
| Hospital Charge Code |
z11005
|
| Min. Negotiated Rate |
$680.30 |
| Max. Negotiated Rate |
$84,100.00 |
| Rate for Payer: Aetna Commercial |
$713.63
|
| Rate for Payer: Aetna Commercial |
$713.63
|
| Rate for Payer: Aetna Medicare |
$713.63
|
| Rate for Payer: Aetna Medicare |
$713.63
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$950.66
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$950.66
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$950.66
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$950.66
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$950.66
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$950.66
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$950.66
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$950.66
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$680.30
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$680.30
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$820.67
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$820.67
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$784.99
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$784.99
|
| Rate for Payer: Cash Price |
$829.90
|
| Rate for Payer: Cash Price |
$820.50
|
| Rate for Payer: Centivo All Commercial |
$1,106.13
|
| Rate for Payer: Centivo All Commercial |
$1,106.13
|
| Rate for Payer: Cigna All Commercial |
$713.63
|
| Rate for Payer: Cigna All Commercial |
$713.63
|
| Rate for Payer: CORVEL All Commercial |
$713.63
|
| Rate for Payer: CORVEL All Commercial |
$713.63
|
| Rate for Payer: Coventry All Commercial |
$856.36
|
| Rate for Payer: Coventry All Commercial |
$856.36
|
| Rate for Payer: Encore All Commercial |
$713.63
|
| Rate for Payer: Encore All Commercial |
$713.63
|
| Rate for Payer: Frontpath All Commercial |
$1,025.09
|
| Rate for Payer: Frontpath All Commercial |
$1,025.09
|
| Rate for Payer: Humana ChoiceCare |
$728.54
|
| Rate for Payer: Humana ChoiceCare |
$728.54
|
| Rate for Payer: Humana Medicare |
$713.63
|
| Rate for Payer: Humana Medicare |
$713.63
|
| Rate for Payer: Lucent All Commercial |
$999.08
|
| Rate for Payer: Lucent All Commercial |
$999.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$911.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$911.00
|
| Rate for Payer: Managed Health Services Medicaid |
$680.30
|
| Rate for Payer: Managed Health Services Medicaid |
$680.30
|
| Rate for Payer: MDWise Medicaid |
$680.30
|
| Rate for Payer: MDWise Medicaid |
$680.30
|
| Rate for Payer: PHCS All Commercial |
$713.63
|
| Rate for Payer: PHCS All Commercial |
$713.63
|
| Rate for Payer: PHP All Commercial |
$957.25
|
| Rate for Payer: PHP All Commercial |
$957.25
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$713.63
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$713.63
|
| Rate for Payer: Sagamore Health Network All Products |
$713.63
|
| Rate for Payer: Sagamore Health Network All Products |
$713.63
|
| Rate for Payer: Signature Care EPO |
$818.55
|
| Rate for Payer: Signature Care EPO |
$818.55
|
| Rate for Payer: Signature Care PPO |
$818.55
|
| Rate for Payer: Signature Care PPO |
$818.55
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$84,100.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$84,100.00
|
| Rate for Payer: United Healthcare Commercial |
$851.25
|
| Rate for Payer: United Healthcare Commercial |
$851.25
|
| Rate for Payer: United Healthcare Medicare |
$683.75
|
| Rate for Payer: United Healthcare Medicare |
$683.75
|
|
|
PR D&C AFTER DELIVERY
|
Professional
|
Both
|
$497.84
|
|
|
Service Code
|
CPT 59160
|
| Hospital Charge Code |
z59160
|
| Min. Negotiated Rate |
$124.38 |
| Max. Negotiated Rate |
$22,400.00 |
| Rate for Payer: Aetna Commercial |
$173.16
|
| Rate for Payer: Aetna Commercial |
$173.16
|
| Rate for Payer: Aetna Medicare |
$173.16
|
| Rate for Payer: Aetna Medicare |
$173.16
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$325.51
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$325.51
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$325.51
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$325.51
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$325.51
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$325.51
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$325.51
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$325.51
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$124.38
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$124.38
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$244.86
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$244.86
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$199.13
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$199.13
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$190.48
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$190.48
|
| Rate for Payer: Cash Price |
$295.54
|
| Rate for Payer: Cash Price |
$298.70
|
| Rate for Payer: Centivo All Commercial |
$268.40
|
| Rate for Payer: Centivo All Commercial |
$268.40
|
| Rate for Payer: Cigna All Commercial |
$173.16
|
| Rate for Payer: Cigna All Commercial |
$173.16
|
| Rate for Payer: CORVEL All Commercial |
$173.16
|
| Rate for Payer: CORVEL All Commercial |
$173.16
|
| Rate for Payer: Coventry All Commercial |
$207.79
|
| Rate for Payer: Coventry All Commercial |
$207.79
|
| Rate for Payer: Encore All Commercial |
$173.16
|
| Rate for Payer: Encore All Commercial |
$173.16
|
| Rate for Payer: Frontpath All Commercial |
$244.58
|
| Rate for Payer: Frontpath All Commercial |
$244.58
|
| Rate for Payer: Humana ChoiceCare |
$186.75
|
| Rate for Payer: Humana ChoiceCare |
$186.75
|
| Rate for Payer: Humana Medicare |
$173.16
|
| Rate for Payer: Humana Medicare |
$173.16
|
| Rate for Payer: Lucent All Commercial |
$242.42
|
| Rate for Payer: Lucent All Commercial |
$242.42
|
| Rate for Payer: Lutheran Preferred All Commercial |
$241.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$241.00
|
| Rate for Payer: Managed Health Services Medicaid |
$244.86
|
| Rate for Payer: Managed Health Services Medicaid |
$244.86
|
| Rate for Payer: MDWise Medicaid |
$244.86
|
| Rate for Payer: MDWise Medicaid |
$244.86
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$124.38
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$124.38
|
| Rate for Payer: PHCS All Commercial |
$173.16
|
| Rate for Payer: PHCS All Commercial |
$173.16
|
| Rate for Payer: PHP All Commercial |
$221.73
|
| Rate for Payer: PHP All Commercial |
$221.73
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$173.16
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$173.16
|
| Rate for Payer: Sagamore Health Network All Products |
$173.16
|
| Rate for Payer: Sagamore Health Network All Products |
$173.16
|
| Rate for Payer: Signature Care EPO |
$291.55
|
| Rate for Payer: Signature Care EPO |
$291.55
|
| Rate for Payer: Signature Care PPO |
$291.55
|
| Rate for Payer: Signature Care PPO |
$291.55
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$22,400.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$22,400.00
|
| Rate for Payer: United Healthcare Commercial |
$200.79
|
| Rate for Payer: United Healthcare Commercial |
$200.79
|
| Rate for Payer: United Healthcare Medicare |
$246.28
|
| Rate for Payer: United Healthcare Medicare |
$246.28
|
|
|
PR DEBRIDE ASSOC OPEN FX/DISLOC SKIN/MUSCLE
|
Professional
|
Both
|
$918.78
|
|
|
Service Code
|
CPT 11011
|
| Hospital Charge Code |
z11011
|
| Min. Negotiated Rate |
$151.06 |
| Max. Negotiated Rate |
$451.89 |
| Rate for Payer: Aetna Commercial |
$274.70
|
| Rate for Payer: Aetna Commercial |
$274.70
|
| Rate for Payer: Aetna Medicare |
$274.70
|
| Rate for Payer: Aetna Medicare |
$274.70
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$151.06
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$151.06
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$451.89
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$451.89
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$315.90
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$315.90
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$302.17
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$302.17
|
| Rate for Payer: Cash Price |
$540.61
|
| Rate for Payer: Cash Price |
$551.27
|
| Rate for Payer: Centivo All Commercial |
$425.79
|
| Rate for Payer: Centivo All Commercial |
$425.79
|
| Rate for Payer: Cigna All Commercial |
$274.70
|
| Rate for Payer: Cigna All Commercial |
$274.70
|
| Rate for Payer: CORVEL All Commercial |
$274.70
|
| Rate for Payer: CORVEL All Commercial |
$274.70
|
| Rate for Payer: Coventry All Commercial |
$329.64
|
| Rate for Payer: Coventry All Commercial |
$329.64
|
| Rate for Payer: Encore All Commercial |
$274.70
|
| Rate for Payer: Encore All Commercial |
$274.70
|
| Rate for Payer: Frontpath All Commercial |
$385.64
|
| Rate for Payer: Frontpath All Commercial |
$385.64
|
| Rate for Payer: Humana ChoiceCare |
$280.13
|
| Rate for Payer: Humana ChoiceCare |
$280.13
|
| Rate for Payer: Humana Medicare |
$274.70
|
| Rate for Payer: Humana Medicare |
$274.70
|
| Rate for Payer: Lucent All Commercial |
$384.58
|
| Rate for Payer: Lucent All Commercial |
$384.58
|
| Rate for Payer: Managed Health Services Medicaid |
$451.89
|
| Rate for Payer: Managed Health Services Medicaid |
$451.89
|
| Rate for Payer: MDWise Medicaid |
$451.89
|
| Rate for Payer: MDWise Medicaid |
$451.89
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$151.06
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$151.06
|
| Rate for Payer: PHCS All Commercial |
$274.70
|
| Rate for Payer: PHCS All Commercial |
$274.70
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$274.70
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$274.70
|
| Rate for Payer: Sagamore Health Network All Products |
$274.70
|
| Rate for Payer: Sagamore Health Network All Products |
$274.70
|
| Rate for Payer: United Healthcare Commercial |
$334.16
|
| Rate for Payer: United Healthcare Commercial |
$334.16
|
| Rate for Payer: United Healthcare Medicare |
$450.51
|
| Rate for Payer: United Healthcare Medicare |
$450.51
|
|
