|
PREGABALIN 75 MG ORAL CAP
|
Facility
|
OP
|
$4.00
|
|
|
Service Code
|
NDC 00904700061
|
| Hospital Charge Code |
42164
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.24 |
| Max. Negotiated Rate |
$3.72 |
| Rate for Payer: Aetna Commercial |
$3.38
|
| Rate for Payer: Aetna Medicare |
$1.28
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1.24
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$2.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2.50
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1.47
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1.41
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Centivo All Commercial |
$2.18
|
| Rate for Payer: Cigna All Commercial |
$3.45
|
| Rate for Payer: CORVEL All Commercial |
$3.72
|
| Rate for Payer: Coventry All Commercial |
$3.52
|
| Rate for Payer: Encore All Commercial |
$3.68
|
| Rate for Payer: Frontpath All Commercial |
$3.68
|
| Rate for Payer: Humana ChoiceCare |
$3.45
|
| Rate for Payer: Humana Medicare |
$1.28
|
| Rate for Payer: Lucent All Commercial |
$2.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3.60
|
| Rate for Payer: PHCS All Commercial |
$3.00
|
| Rate for Payer: PHP All Commercial |
$3.03
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1.56
|
| Rate for Payer: Sagamore Health Network All Products |
$3.09
|
| Rate for Payer: Signature Care EPO |
$3.32
|
| Rate for Payer: Signature Care PPO |
$3.52
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3.40
|
| Rate for Payer: United Healthcare Commercial |
$3.15
|
| Rate for Payer: United Healthcare Medicare |
$1.28
|
|
|
PREGABALIN 75 MG ORAL CAP
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
NDC 00904700061
|
| Hospital Charge Code |
42164
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$3.72 |
| Rate for Payer: Aetna Commercial |
$3.46
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cigna All Commercial |
$3.45
|
| Rate for Payer: CORVEL All Commercial |
$3.72
|
| Rate for Payer: Coventry All Commercial |
$3.52
|
| Rate for Payer: Encore All Commercial |
$3.68
|
| Rate for Payer: Frontpath All Commercial |
$3.68
|
| Rate for Payer: Humana ChoiceCare |
$3.45
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3.60
|
| Rate for Payer: PHCS All Commercial |
$3.00
|
| Rate for Payer: PHP All Commercial |
$3.03
|
| Rate for Payer: Sagamore Health Network All Products |
$3.09
|
| Rate for Payer: Signature Care EPO |
$3.32
|
| Rate for Payer: Signature Care PPO |
$3.52
|
| Rate for Payer: United Healthcare Commercial |
$3.15
|
|
|
PR EGD BALLOON DILATION ESOPHAGUS <30 MM DIAM
|
Professional
|
Both
|
$1,975.64
|
|
|
Service Code
|
CPT 43249
|
| Hospital Charge Code |
z43249
|
| Min. Negotiated Rate |
$144.27 |
| Max. Negotiated Rate |
$19,900.00 |
| Rate for Payer: Aetna Commercial |
$144.27
|
| Rate for Payer: Aetna Commercial |
$144.27
|
| Rate for Payer: Aetna Medicare |
$144.27
|
| Rate for Payer: Aetna Medicare |
$144.27
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$249.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$249.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$249.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$249.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$249.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$249.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$249.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$249.00
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$145.61
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$145.61
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$969.25
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$969.25
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$165.91
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$165.91
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$158.70
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$158.70
|
| Rate for Payer: Cash Price |
$1,182.40
|
| Rate for Payer: Cash Price |
$1,185.38
|
| Rate for Payer: Centivo All Commercial |
$223.62
|
| Rate for Payer: Centivo All Commercial |
$223.62
|
| Rate for Payer: Cigna All Commercial |
$144.27
|
| Rate for Payer: Cigna All Commercial |
$144.27
|
| Rate for Payer: CORVEL All Commercial |
$144.27
|
| Rate for Payer: CORVEL All Commercial |
$144.27
|
| Rate for Payer: Coventry All Commercial |
$173.12
|
| Rate for Payer: Coventry All Commercial |
$173.12
|
| Rate for Payer: Encore All Commercial |
$144.27
|
| Rate for Payer: Encore All Commercial |
$144.27
|
| Rate for Payer: Frontpath All Commercial |
$197.48
|
| Rate for Payer: Frontpath All Commercial |
$197.48
|
| Rate for Payer: Humana ChoiceCare |
$185.63
|
| Rate for Payer: Humana ChoiceCare |
$185.63
|
| Rate for Payer: Humana Medicare |
$144.27
|
| Rate for Payer: Humana Medicare |
$144.27
|
| Rate for Payer: Lucent All Commercial |
$201.98
|
| Rate for Payer: Lucent All Commercial |
$201.98
|
| Rate for Payer: Lutheran Preferred All Commercial |
$213.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$213.00
|
| Rate for Payer: Managed Health Services Medicaid |
$969.25
|
| Rate for Payer: Managed Health Services Medicaid |
$969.25
|
| Rate for Payer: MDWise Medicaid |
$969.25
|
| Rate for Payer: MDWise Medicaid |
$969.25
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$145.61
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$145.61
|
| Rate for Payer: PHCS All Commercial |
$144.27
|
| Rate for Payer: PHCS All Commercial |
$144.27
|
| Rate for Payer: PHP All Commercial |
$242.88
|
| Rate for Payer: PHP All Commercial |
$242.88
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$144.27
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$144.27
|
| Rate for Payer: Sagamore Health Network All Products |
$144.27
|
| Rate for Payer: Sagamore Health Network All Products |
$144.27
|
| Rate for Payer: Signature Care EPO |
$906.78
|
| Rate for Payer: Signature Care EPO |
$906.78
|
| Rate for Payer: Signature Care PPO |
$906.78
|
| Rate for Payer: Signature Care PPO |
$906.78
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$19,900.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$19,900.00
|
| Rate for Payer: United Healthcare Commercial |
$200.84
|
| Rate for Payer: United Healthcare Commercial |
$200.84
|
| Rate for Payer: United Healthcare Medicare |
$987.82
|
| Rate for Payer: United Healthcare Medicare |
$987.82
|
|
|
PR EGD DILATION GASTRIC/DUODENAL STRICTURE
|
Professional
|
Both
|
$1,030.56
|
|
|
Service Code
|
CPT 43245
|
| Hospital Charge Code |
z43245
|
| Min. Negotiated Rate |
$138.87 |
| Max. Negotiated Rate |
$543.19 |
| Rate for Payer: Aetna Commercial |
$164.57
|
| Rate for Payer: Aetna Medicare |
$164.57
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$138.87
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$536.54
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$189.26
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$181.03
|
| Rate for Payer: Cash Price |
$618.34
|
| Rate for Payer: Centivo All Commercial |
$255.08
|
| Rate for Payer: Cigna All Commercial |
$164.57
|
| Rate for Payer: CORVEL All Commercial |
$164.57
|
| Rate for Payer: Coventry All Commercial |
$197.48
|
| Rate for Payer: Encore All Commercial |
$164.57
|
| Rate for Payer: Frontpath All Commercial |
$226.51
|
| Rate for Payer: Humana ChoiceCare |
$202.83
|
| Rate for Payer: Humana Medicare |
$164.57
|
| Rate for Payer: Lucent All Commercial |
$230.40
|
| Rate for Payer: Managed Health Services Medicaid |
$536.54
|
| Rate for Payer: MDWise Medicaid |
$536.54
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$138.87
|
| Rate for Payer: PHCS All Commercial |
$164.57
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$164.57
|
| Rate for Payer: Sagamore Health Network All Products |
$164.57
|
| Rate for Payer: United Healthcare Commercial |
$215.78
|
| Rate for Payer: United Healthcare Medicare |
$543.19
|
|
|
PR EGD FLEXIBLE FOREIGN BODY REMOVAL
|
Professional
|
Both
|
$709.80
|
|
|
Service Code
|
CPT 43247
|
| Hospital Charge Code |
z43247
|
| Min. Negotiated Rate |
$166.23 |
| Max. Negotiated Rate |
$22,900.00 |
| Rate for Payer: Aetna Commercial |
$166.23
|
| Rate for Payer: Aetna Commercial |
$166.23
|
| Rate for Payer: Aetna Medicare |
$166.23
|
| Rate for Payer: Aetna Medicare |
$166.23
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$292.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$292.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$292.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$292.20
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$292.20
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$292.20
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$292.20
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$292.20
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$172.27
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$172.27
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$349.10
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$349.10
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$191.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$191.16
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$182.85
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$182.85
|
| Rate for Payer: Cash Price |
$420.78
|
| Rate for Payer: Cash Price |
$425.88
|
| Rate for Payer: Centivo All Commercial |
$257.66
|
| Rate for Payer: Centivo All Commercial |
$257.66
|
| Rate for Payer: Cigna All Commercial |
$166.23
|
| Rate for Payer: Cigna All Commercial |
$166.23
|
| Rate for Payer: CORVEL All Commercial |
$166.23
|
| Rate for Payer: CORVEL All Commercial |
$166.23
|
| Rate for Payer: Coventry All Commercial |
$199.48
|
| Rate for Payer: Coventry All Commercial |
$199.48
|
| Rate for Payer: Encore All Commercial |
$166.23
|
| Rate for Payer: Encore All Commercial |
$166.23
|
| Rate for Payer: Frontpath All Commercial |
$228.11
|
| Rate for Payer: Frontpath All Commercial |
$228.11
|
| Rate for Payer: Humana ChoiceCare |
$214.97
|
| Rate for Payer: Humana ChoiceCare |
$214.97
|
| Rate for Payer: Humana Medicare |
$166.23
|
| Rate for Payer: Humana Medicare |
$166.23
|
| Rate for Payer: Lucent All Commercial |
$232.72
|
| Rate for Payer: Lucent All Commercial |
$232.72
|
| Rate for Payer: Lutheran Preferred All Commercial |
$246.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$246.00
|
| Rate for Payer: Managed Health Services Medicaid |
$349.10
|
| Rate for Payer: Managed Health Services Medicaid |
$349.10
|
| Rate for Payer: MDWise Medicaid |
$349.10
|
| Rate for Payer: MDWise Medicaid |
$349.10
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$172.27
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$172.27
|
| Rate for Payer: PHCS All Commercial |
$166.23
|
| Rate for Payer: PHCS All Commercial |
$166.23
|
| Rate for Payer: PHP All Commercial |
$279.47
|
| Rate for Payer: PHP All Commercial |
$279.47
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$166.23
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$166.23
|
| Rate for Payer: Sagamore Health Network All Products |
$166.23
|
| Rate for Payer: Sagamore Health Network All Products |
$166.23
|
| Rate for Payer: Signature Care EPO |
$330.95
|
| Rate for Payer: Signature Care EPO |
$330.95
|
| Rate for Payer: Signature Care PPO |
$330.95
|
| Rate for Payer: Signature Care PPO |
$330.95
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$22,900.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$22,900.00
|
| Rate for Payer: United Healthcare Commercial |
$230.86
|
| Rate for Payer: United Healthcare Commercial |
$230.86
|
| Rate for Payer: United Healthcare Medicare |
$350.65
|
| Rate for Payer: United Healthcare Medicare |
$350.65
|
|
|
PR EGD FLEX REMOVAL LESION(S) BY HOT BIOPSY FORCEPS
|
Professional
|
Both
|
$828.50
|
|
|
Service Code
|
CPT 43250
|
| Hospital Charge Code |
z43250
|
| Min. Negotiated Rate |
$159.06 |
| Max. Negotiated Rate |
$22,000.00 |
| Rate for Payer: Aetna Commercial |
$159.06
|
| Rate for Payer: Aetna Commercial |
$159.06
|
| Rate for Payer: Aetna Medicare |
$159.06
|
| Rate for Payer: Aetna Medicare |
$159.06
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$275.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$275.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$275.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$275.80
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$275.80
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$275.80
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$275.80
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$275.80
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$161.21
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$161.21
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$407.49
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$407.49
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$182.92
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$182.92
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$174.97
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$174.97
|
| Rate for Payer: Cash Price |
$494.22
|
| Rate for Payer: Cash Price |
$497.10
|
| Rate for Payer: Centivo All Commercial |
$246.54
|
| Rate for Payer: Centivo All Commercial |
$246.54
|
| Rate for Payer: Cigna All Commercial |
$159.06
|
| Rate for Payer: Cigna All Commercial |
$159.06
|
| Rate for Payer: CORVEL All Commercial |
$159.06
|
| Rate for Payer: CORVEL All Commercial |
$159.06
|
| Rate for Payer: Coventry All Commercial |
$190.87
|
| Rate for Payer: Coventry All Commercial |
$190.87
|
| Rate for Payer: Encore All Commercial |
$159.06
|
| Rate for Payer: Encore All Commercial |
$159.06
|
| Rate for Payer: Frontpath All Commercial |
$219.60
|
| Rate for Payer: Frontpath All Commercial |
$219.60
|
| Rate for Payer: Humana ChoiceCare |
$204.15
|
| Rate for Payer: Humana ChoiceCare |
$204.15
|
| Rate for Payer: Humana Medicare |
$159.06
|
| Rate for Payer: Humana Medicare |
$159.06
|
| Rate for Payer: Lucent All Commercial |
$222.68
|
| Rate for Payer: Lucent All Commercial |
$222.68
|
| Rate for Payer: Lutheran Preferred All Commercial |
$235.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$235.00
|
| Rate for Payer: Managed Health Services Medicaid |
$407.49
|
| Rate for Payer: Managed Health Services Medicaid |
$407.49
|
| Rate for Payer: MDWise Medicaid |
$407.49
|
| Rate for Payer: MDWise Medicaid |
$407.49
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$161.21
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$161.21
|
| Rate for Payer: PHCS All Commercial |
$159.06
|
| Rate for Payer: PHCS All Commercial |
$159.06
|
| Rate for Payer: PHP All Commercial |
$267.98
|
| Rate for Payer: PHP All Commercial |
$267.98
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$159.06
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$159.06
|
| Rate for Payer: Sagamore Health Network All Products |
$159.06
|
| Rate for Payer: Sagamore Health Network All Products |
$159.06
|
| Rate for Payer: Signature Care EPO |
$373.20
|
| Rate for Payer: Signature Care EPO |
$373.20
|
| Rate for Payer: Signature Care PPO |
$373.20
|
| Rate for Payer: Signature Care PPO |
$373.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$22,000.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$22,000.00
|
| Rate for Payer: United Healthcare Commercial |
$215.85
|
| Rate for Payer: United Healthcare Commercial |
$215.85
|
| Rate for Payer: United Healthcare Medicare |
$411.85
|
| Rate for Payer: United Healthcare Medicare |
$411.85
|
|
|
PR EGD PERCUTANEOUS PLACEMENT GASTROSTOMY TUBE
|
Professional
|
Both
|
$360.18
|
|
|
Service Code
|
CPT 43246
|
| Hospital Charge Code |
z43246
|
| Min. Negotiated Rate |
$179.95 |
| Max. Negotiated Rate |
$25,800.00 |
| Rate for Payer: Aetna Commercial |
$187.32
|
| Rate for Payer: Aetna Commercial |
$187.32
|
| Rate for Payer: Aetna Medicare |
$187.32
|
| Rate for Payer: Aetna Medicare |
$187.32
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$373.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$373.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$373.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$373.80
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$373.80
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$373.80
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$373.80
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$373.80
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$179.95
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$179.95
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$215.42
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$215.42
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$206.05
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$206.05
|
| Rate for Payer: Cash Price |
$216.11
|
| Rate for Payer: Cash Price |
$219.52
|
| Rate for Payer: Centivo All Commercial |
$290.35
|
| Rate for Payer: Centivo All Commercial |
$290.35
|
| Rate for Payer: Cigna All Commercial |
$187.32
|
| Rate for Payer: Cigna All Commercial |
$187.32
|
| Rate for Payer: CORVEL All Commercial |
$187.32
|
| Rate for Payer: CORVEL All Commercial |
$187.32
|
| Rate for Payer: Coventry All Commercial |
$224.78
|
| Rate for Payer: Coventry All Commercial |
$224.78
|
| Rate for Payer: Encore All Commercial |
$187.32
|
| Rate for Payer: Encore All Commercial |
$187.32
|
| Rate for Payer: Frontpath All Commercial |
$259.27
|
| Rate for Payer: Frontpath All Commercial |
$259.27
|
| Rate for Payer: Humana ChoiceCare |
$272.15
|
| Rate for Payer: Humana ChoiceCare |
$272.15
|
| Rate for Payer: Humana Medicare |
$187.32
|
| Rate for Payer: Humana Medicare |
$187.32
|
| Rate for Payer: Lucent All Commercial |
$262.25
|
| Rate for Payer: Lucent All Commercial |
$262.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$277.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$277.00
|
| Rate for Payer: Managed Health Services Medicaid |
$179.95
|
| Rate for Payer: Managed Health Services Medicaid |
$179.95
|
| Rate for Payer: MDWise Medicaid |
$179.95
|
| Rate for Payer: MDWise Medicaid |
$179.95
|
| Rate for Payer: PHCS All Commercial |
$187.32
|
| Rate for Payer: PHCS All Commercial |
$187.32
|
| Rate for Payer: PHP All Commercial |
$315.15
|
| Rate for Payer: PHP All Commercial |
$315.15
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$187.32
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$187.32
|
| Rate for Payer: Sagamore Health Network All Products |
$187.32
|
| Rate for Payer: Sagamore Health Network All Products |
$187.32
|
| Rate for Payer: Signature Care EPO |
$318.44
|
| Rate for Payer: Signature Care EPO |
$318.44
|
| Rate for Payer: Signature Care PPO |
$318.44
|
| Rate for Payer: Signature Care PPO |
$318.44
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$25,800.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$25,800.00
|
| Rate for Payer: United Healthcare Commercial |
$289.20
|
| Rate for Payer: United Healthcare Commercial |
$289.20
|
| Rate for Payer: United Healthcare Medicare |
$180.09
|
| Rate for Payer: United Healthcare Medicare |
$180.09
|
|
|
PR EGD REMOVAL TUMOR POLYP/OTHER LESION SNARE TECH
|
Professional
|
Both
|
$913.64
|
|
|
Service Code
|
CPT 43251
|
| Hospital Charge Code |
z43251
|
| Min. Negotiated Rate |
$184.45 |
| Max. Negotiated Rate |
$25,400.00 |
| Rate for Payer: Aetna Commercial |
$184.45
|
| Rate for Payer: Aetna Commercial |
$184.45
|
| Rate for Payer: Aetna Medicare |
$184.45
|
| Rate for Payer: Aetna Medicare |
$184.45
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$318.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$318.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$318.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$318.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$318.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$318.50
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$318.50
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$318.50
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$187.34
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$187.34
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$449.37
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$449.37
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$212.12
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$212.12
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$202.90
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$202.90
|
| Rate for Payer: Cash Price |
$544.22
|
| Rate for Payer: Cash Price |
$548.18
|
| Rate for Payer: Centivo All Commercial |
$285.90
|
| Rate for Payer: Centivo All Commercial |
$285.90
|
| Rate for Payer: Cigna All Commercial |
$184.45
|
| Rate for Payer: Cigna All Commercial |
$184.45
|
| Rate for Payer: CORVEL All Commercial |
$184.45
|
| Rate for Payer: CORVEL All Commercial |
$184.45
|
| Rate for Payer: Coventry All Commercial |
$221.34
|
| Rate for Payer: Coventry All Commercial |
$221.34
|
| Rate for Payer: Encore All Commercial |
$184.45
|
| Rate for Payer: Encore All Commercial |
$184.45
|
| Rate for Payer: Frontpath All Commercial |
$252.19
|
| Rate for Payer: Frontpath All Commercial |
$252.19
|
| Rate for Payer: Humana ChoiceCare |
$233.95
|
| Rate for Payer: Humana ChoiceCare |
$233.95
|
| Rate for Payer: Humana Medicare |
$184.45
|
| Rate for Payer: Humana Medicare |
$184.45
|
| Rate for Payer: Lucent All Commercial |
$258.23
|
| Rate for Payer: Lucent All Commercial |
$258.23
|
| Rate for Payer: Lutheran Preferred All Commercial |
$273.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$273.00
|
| Rate for Payer: Managed Health Services Medicaid |
$449.37
|
| Rate for Payer: Managed Health Services Medicaid |
$449.37
|
| Rate for Payer: MDWise Medicaid |
$449.37
|
| Rate for Payer: MDWise Medicaid |
$449.37
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$187.34
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$187.34
|
| Rate for Payer: PHCS All Commercial |
$184.45
|
| Rate for Payer: PHCS All Commercial |
$184.45
|
| Rate for Payer: PHP All Commercial |
$310.34
|
| Rate for Payer: PHP All Commercial |
$310.34
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$184.45
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$184.45
|
| Rate for Payer: Sagamore Health Network All Products |
$184.45
|
| Rate for Payer: Sagamore Health Network All Products |
$184.45
|
| Rate for Payer: Signature Care EPO |
$410.41
|
| Rate for Payer: Signature Care EPO |
$410.41
|
| Rate for Payer: Signature Care PPO |
$410.41
|
| Rate for Payer: Signature Care PPO |
$410.41
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$25,400.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$25,400.00
|
| Rate for Payer: United Healthcare Commercial |
$251.16
|
| Rate for Payer: United Healthcare Commercial |
$251.16
|
| Rate for Payer: United Healthcare Medicare |
$453.52
|
| Rate for Payer: United Healthcare Medicare |
$453.52
|
|
|
PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE
|
Professional
|
Both
|
$696.08
|
|
|
Service Code
|
CPT 43239
|
| Hospital Charge Code |
z43239
|
| Min. Negotiated Rate |
$130.03 |
| Max. Negotiated Rate |
$18,000.00 |
| Rate for Payer: Aetna Commercial |
$130.03
|
| Rate for Payer: Aetna Commercial |
$130.03
|
| Rate for Payer: Aetna Medicare |
$130.03
|
| Rate for Payer: Aetna Medicare |
$130.03
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$338.24
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$338.24
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$338.24
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$338.24
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$338.24
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$338.24
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$338.24
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$338.24
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$139.81
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$139.81
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$342.36
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$342.36
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$149.53
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$149.53
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$143.03
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$143.03
|
| Rate for Payer: Cash Price |
$413.27
|
| Rate for Payer: Cash Price |
$417.65
|
| Rate for Payer: Centivo All Commercial |
$201.55
|
| Rate for Payer: Centivo All Commercial |
$201.55
|
| Rate for Payer: Cigna All Commercial |
$130.03
|
| Rate for Payer: Cigna All Commercial |
$130.03
|
| Rate for Payer: CORVEL All Commercial |
$130.03
|
| Rate for Payer: CORVEL All Commercial |
$130.03
|
| Rate for Payer: Coventry All Commercial |
$156.04
|
| Rate for Payer: Coventry All Commercial |
$156.04
|
| Rate for Payer: Encore All Commercial |
$130.03
|
| Rate for Payer: Encore All Commercial |
$130.03
|
| Rate for Payer: Frontpath All Commercial |
$177.49
|
| Rate for Payer: Frontpath All Commercial |
$177.49
|
| Rate for Payer: Humana ChoiceCare |
$183.45
|
| Rate for Payer: Humana ChoiceCare |
$183.45
|
| Rate for Payer: Humana Medicare |
$130.03
|
| Rate for Payer: Humana Medicare |
$130.03
|
| Rate for Payer: Lucent All Commercial |
$182.04
|
| Rate for Payer: Lucent All Commercial |
$182.04
|
| Rate for Payer: Lutheran Preferred All Commercial |
$192.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$192.00
|
| Rate for Payer: Managed Health Services Medicaid |
$342.36
|
| Rate for Payer: Managed Health Services Medicaid |
$342.36
|
| Rate for Payer: MDWise Medicaid |
$342.36
|
| Rate for Payer: MDWise Medicaid |
$342.36
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$139.81
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$139.81
|
| Rate for Payer: PHCS All Commercial |
$130.03
|
| Rate for Payer: PHCS All Commercial |
$130.03
|
| Rate for Payer: PHP All Commercial |
$218.98
|
| Rate for Payer: PHP All Commercial |
$218.98
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$130.03
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$130.03
|
| Rate for Payer: Sagamore Health Network All Products |
$130.03
|
| Rate for Payer: Sagamore Health Network All Products |
$130.03
|
| Rate for Payer: Signature Care EPO |
$462.40
|
| Rate for Payer: Signature Care EPO |
$462.40
|
| Rate for Payer: Signature Care PPO |
$462.40
|
| Rate for Payer: Signature Care PPO |
$462.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$18,000.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$18,000.00
|
| Rate for Payer: United Healthcare Commercial |
$197.41
|
| Rate for Payer: United Healthcare Commercial |
$197.41
|
| Rate for Payer: United Healthcare Medicare |
$344.39
|
| Rate for Payer: United Healthcare Medicare |
$344.39
|
|
|
PR EGD TRANSORAL CONTROL BLEEDING ANY METHOD
|
Professional
|
Both
|
$1,153.18
|
|
|
Service Code
|
CPT 43255
|
| Hospital Charge Code |
z43255
|
| Min. Negotiated Rate |
$189.12 |
| Max. Negotiated Rate |
$26,000.00 |
| Rate for Payer: Aetna Commercial |
$189.12
|
| Rate for Payer: Aetna Commercial |
$189.12
|
| Rate for Payer: Aetna Medicare |
$189.12
|
| Rate for Payer: Aetna Medicare |
$189.12
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$377.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$377.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$377.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$377.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$377.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$377.50
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$377.50
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$377.50
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$196.25
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$196.25
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$567.18
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$567.18
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$217.49
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$217.49
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$208.03
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$208.03
|
| Rate for Payer: Cash Price |
$688.20
|
| Rate for Payer: Cash Price |
$691.91
|
| Rate for Payer: Centivo All Commercial |
$293.14
|
| Rate for Payer: Centivo All Commercial |
$293.14
|
| Rate for Payer: Cigna All Commercial |
$189.12
|
| Rate for Payer: Cigna All Commercial |
$189.12
|
| Rate for Payer: CORVEL All Commercial |
$189.12
|
| Rate for Payer: CORVEL All Commercial |
$189.12
|
| Rate for Payer: Coventry All Commercial |
$226.94
|
| Rate for Payer: Coventry All Commercial |
$226.94
|
| Rate for Payer: Encore All Commercial |
$189.12
|
| Rate for Payer: Encore All Commercial |
$189.12
|
| Rate for Payer: Frontpath All Commercial |
$258.30
|
| Rate for Payer: Frontpath All Commercial |
$258.30
|
| Rate for Payer: Humana ChoiceCare |
$302.79
|
| Rate for Payer: Humana ChoiceCare |
$302.79
|
| Rate for Payer: Humana Medicare |
$189.12
|
| Rate for Payer: Humana Medicare |
$189.12
|
| Rate for Payer: Lucent All Commercial |
$264.77
|
| Rate for Payer: Lucent All Commercial |
$264.77
|
| Rate for Payer: Lutheran Preferred All Commercial |
$279.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$279.00
|
| Rate for Payer: Managed Health Services Medicaid |
$567.18
|
| Rate for Payer: Managed Health Services Medicaid |
$567.18
|
| Rate for Payer: MDWise Medicaid |
$567.18
|
| Rate for Payer: MDWise Medicaid |
$567.18
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$196.25
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$196.25
|
| Rate for Payer: PHCS All Commercial |
$189.12
|
| Rate for Payer: PHCS All Commercial |
$189.12
|
| Rate for Payer: PHP All Commercial |
$317.38
|
| Rate for Payer: PHP All Commercial |
$317.38
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$189.12
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$189.12
|
| Rate for Payer: Sagamore Health Network All Products |
$189.12
|
| Rate for Payer: Sagamore Health Network All Products |
$189.12
|
| Rate for Payer: Signature Care EPO |
$521.06
|
| Rate for Payer: Signature Care EPO |
$521.06
|
| Rate for Payer: Signature Care PPO |
$521.06
|
| Rate for Payer: Signature Care PPO |
$521.06
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$26,000.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$26,000.00
|
| Rate for Payer: United Healthcare Commercial |
$326.88
|
| Rate for Payer: United Healthcare Commercial |
$326.88
|
| Rate for Payer: United Healthcare Medicare |
$573.50
|
| Rate for Payer: United Healthcare Medicare |
$573.50
|
|
|
PR ELBOW ARTHROSCOP,FULL SYNOVECT
|
Professional
|
Both
|
$1,087.60
|
|
|
Service Code
|
CPT 29836
|
| Hospital Charge Code |
z29836
|
| Min. Negotiated Rate |
$533.57 |
| Max. Negotiated Rate |
$82,000.00 |
| Rate for Payer: Aetna Commercial |
$546.85
|
| Rate for Payer: Aetna Commercial |
$546.85
|
| Rate for Payer: Aetna Medicare |
$546.85
|
| Rate for Payer: Aetna Medicare |
$546.85
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$724.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$724.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$724.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$724.60
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$724.60
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$724.60
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$724.60
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$724.60
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$534.92
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$534.92
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$628.88
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$628.88
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$601.53
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$601.53
|
| Rate for Payer: Cash Price |
$652.56
|
| Rate for Payer: Cash Price |
$640.28
|
| Rate for Payer: Centivo All Commercial |
$847.62
|
| Rate for Payer: Centivo All Commercial |
$847.62
|
| Rate for Payer: Cigna All Commercial |
$546.85
|
| Rate for Payer: Cigna All Commercial |
$546.85
|
| Rate for Payer: CORVEL All Commercial |
$546.85
|
| Rate for Payer: CORVEL All Commercial |
$546.85
|
| Rate for Payer: Coventry All Commercial |
$656.22
|
| Rate for Payer: Coventry All Commercial |
$656.22
|
| Rate for Payer: Encore All Commercial |
$546.85
|
| Rate for Payer: Encore All Commercial |
$546.85
|
| Rate for Payer: Frontpath All Commercial |
$758.43
|
| Rate for Payer: Frontpath All Commercial |
$758.43
|
| Rate for Payer: Humana ChoiceCare |
$621.77
|
| Rate for Payer: Humana ChoiceCare |
$621.77
|
| Rate for Payer: Humana Medicare |
$546.85
|
| Rate for Payer: Humana Medicare |
$546.85
|
| Rate for Payer: Lucent All Commercial |
$765.59
|
| Rate for Payer: Lucent All Commercial |
$765.59
|
| Rate for Payer: Lutheran Preferred All Commercial |
$875.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$875.00
|
| Rate for Payer: Managed Health Services Medicaid |
$534.92
|
| Rate for Payer: Managed Health Services Medicaid |
$534.92
|
| Rate for Payer: MDWise Medicaid |
$534.92
|
| Rate for Payer: MDWise Medicaid |
$534.92
|
| Rate for Payer: PHCS All Commercial |
$546.85
|
| Rate for Payer: PHCS All Commercial |
$546.85
|
| Rate for Payer: PHP All Commercial |
$928.42
|
| Rate for Payer: PHP All Commercial |
$928.42
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$546.85
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$546.85
|
| Rate for Payer: Sagamore Health Network All Products |
$546.85
|
| Rate for Payer: Sagamore Health Network All Products |
$546.85
|
| Rate for Payer: Signature Care EPO |
$828.75
|
| Rate for Payer: Signature Care EPO |
$828.75
|
| Rate for Payer: Signature Care PPO |
$828.75
|
| Rate for Payer: Signature Care PPO |
$828.75
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$82,000.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$82,000.00
|
| Rate for Payer: United Healthcare Commercial |
$626.00
|
| Rate for Payer: United Healthcare Commercial |
$626.00
|
| Rate for Payer: United Healthcare Medicare |
$533.57
|
| Rate for Payer: United Healthcare Medicare |
$533.57
|
|
|
PR ELECTROCARDIOGRAM, COMPLETE
|
Professional
|
Both
|
$26.70
|
|
|
Service Code
|
CPT 93000
|
| Hospital Charge Code |
z93000
|
| Min. Negotiated Rate |
$13.13 |
| Max. Negotiated Rate |
$2,000.00 |
| Rate for Payer: Aetna Commercial |
$13.37
|
| Rate for Payer: Aetna Commercial |
$13.37
|
| Rate for Payer: Aetna Medicare |
$13.37
|
| Rate for Payer: Aetna Medicare |
$13.37
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$24.45
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$24.45
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$24.45
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$24.45
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$24.45
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$24.45
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$24.45
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$24.45
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$13.13
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$13.13
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$15.38
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$15.38
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$14.71
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$14.71
|
| Rate for Payer: Cash Price |
$16.02
|
| Rate for Payer: Cash Price |
$15.79
|
| Rate for Payer: Centivo All Commercial |
$20.72
|
| Rate for Payer: Centivo All Commercial |
$20.72
|
| Rate for Payer: Cigna All Commercial |
$13.37
|
| Rate for Payer: Cigna All Commercial |
$13.37
|
| Rate for Payer: CORVEL All Commercial |
$13.37
|
| Rate for Payer: CORVEL All Commercial |
$13.37
|
| Rate for Payer: Coventry All Commercial |
$16.04
|
| Rate for Payer: Coventry All Commercial |
$16.04
|
| Rate for Payer: Encore All Commercial |
$13.37
|
| Rate for Payer: Encore All Commercial |
$13.37
|
| Rate for Payer: Frontpath All Commercial |
$15.30
|
| Rate for Payer: Frontpath All Commercial |
$15.30
|
| Rate for Payer: Humana ChoiceCare |
$33.23
|
| Rate for Payer: Humana ChoiceCare |
$33.23
|
| Rate for Payer: Humana Medicare |
$13.37
|
| Rate for Payer: Humana Medicare |
$13.37
|
| Rate for Payer: Lucent All Commercial |
$18.72
|
| Rate for Payer: Lucent All Commercial |
$18.72
|
| Rate for Payer: Lutheran Preferred All Commercial |
$22.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$22.00
|
| Rate for Payer: Managed Health Services Medicaid |
$13.13
|
| Rate for Payer: Managed Health Services Medicaid |
$13.13
|
| Rate for Payer: MDWise Medicaid |
$13.13
|
| Rate for Payer: MDWise Medicaid |
$13.13
|
| Rate for Payer: PHCS All Commercial |
$13.37
|
| Rate for Payer: PHCS All Commercial |
$13.37
|
| Rate for Payer: PHP All Commercial |
$19.35
|
| Rate for Payer: PHP All Commercial |
$19.35
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$13.37
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$13.37
|
| Rate for Payer: Sagamore Health Network All Products |
$13.37
|
| Rate for Payer: Sagamore Health Network All Products |
$13.37
|
| Rate for Payer: Signature Care EPO |
$22.73
|
| Rate for Payer: Signature Care EPO |
$22.73
|
| Rate for Payer: Signature Care PPO |
$22.73
|
| Rate for Payer: Signature Care PPO |
$22.73
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,000.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,000.00
|
| Rate for Payer: United Healthcare Commercial |
$24.20
|
| Rate for Payer: United Healthcare Commercial |
$24.20
|
| Rate for Payer: United Healthcare Medicare |
$13.16
|
| Rate for Payer: United Healthcare Medicare |
$13.16
|
|
|
PR ELECTROCARDIOGRAM REPORT
|
Professional
|
Both
|
$15.32
|
|
|
Service Code
|
CPT 93010
|
| Hospital Charge Code |
z93010
|
| Min. Negotiated Rate |
$7.54 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$7.91
|
| Rate for Payer: Aetna Commercial |
$7.91
|
| Rate for Payer: Aetna Medicare |
$7.91
|
| Rate for Payer: Aetna Medicare |
$7.91
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$8.67
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$8.67
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$8.67
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$8.67
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$8.67
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$8.67
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$8.67
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$8.67
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$7.54
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$7.54
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$9.10
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$9.10
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$8.70
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$8.70
|
| Rate for Payer: Cash Price |
$9.19
|
| Rate for Payer: Cash Price |
$9.10
|
| Rate for Payer: Centivo All Commercial |
$12.26
|
| Rate for Payer: Centivo All Commercial |
$12.26
|
| Rate for Payer: Cigna All Commercial |
$7.91
|
| Rate for Payer: Cigna All Commercial |
$7.91
|
| Rate for Payer: CORVEL All Commercial |
$7.91
|
| Rate for Payer: CORVEL All Commercial |
$7.91
|
| Rate for Payer: Coventry All Commercial |
$9.49
|
| Rate for Payer: Coventry All Commercial |
$9.49
|
| Rate for Payer: Encore All Commercial |
$7.91
|
| Rate for Payer: Encore All Commercial |
$7.91
|
| Rate for Payer: Frontpath All Commercial |
$8.98
|
| Rate for Payer: Frontpath All Commercial |
$8.98
|
| Rate for Payer: Humana ChoiceCare |
$11.78
|
| Rate for Payer: Humana ChoiceCare |
$11.78
|
| Rate for Payer: Humana Medicare |
$7.91
|
| Rate for Payer: Humana Medicare |
$7.91
|
| Rate for Payer: Lucent All Commercial |
$11.07
|
| Rate for Payer: Lucent All Commercial |
$11.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$12.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$12.00
|
| Rate for Payer: Managed Health Services Medicaid |
$7.54
|
| Rate for Payer: Managed Health Services Medicaid |
$7.54
|
| Rate for Payer: MDWise Medicaid |
$7.54
|
| Rate for Payer: MDWise Medicaid |
$7.54
|
| Rate for Payer: PHCS All Commercial |
$7.91
|
| Rate for Payer: PHCS All Commercial |
$7.91
|
| Rate for Payer: PHP All Commercial |
$11.15
|
| Rate for Payer: PHP All Commercial |
$11.15
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$7.91
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$7.91
|
| Rate for Payer: Sagamore Health Network All Products |
$7.91
|
| Rate for Payer: Sagamore Health Network All Products |
$7.91
|
| Rate for Payer: Signature Care EPO |
$13.45
|
| Rate for Payer: Signature Care EPO |
$13.45
|
| Rate for Payer: Signature Care PPO |
$13.45
|
| Rate for Payer: Signature Care PPO |
$13.45
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,200.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,200.00
|
| Rate for Payer: United Healthcare Commercial |
$10.84
|
| Rate for Payer: United Healthcare Commercial |
$10.84
|
| Rate for Payer: United Healthcare Medicare |
$7.58
|
| Rate for Payer: United Healthcare Medicare |
$7.58
|
|
|
PR ELECTROCARDIOGRAM, TRACING
|
Professional
|
Both
|
$11.38
|
|
|
Service Code
|
CPT 93005
|
| Hospital Charge Code |
z93005
|
| Min. Negotiated Rate |
$5.46 |
| Max. Negotiated Rate |
$21.45 |
| Rate for Payer: Aetna Commercial |
$5.46
|
| Rate for Payer: Aetna Commercial |
$5.46
|
| Rate for Payer: Aetna Medicare |
$5.46
|
| Rate for Payer: Aetna Medicare |
$5.46
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$5.59
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$5.59
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$6.28
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$6.28
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$6.01
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$6.01
|
| Rate for Payer: Cash Price |
$6.83
|
| Rate for Payer: Cash Price |
$6.70
|
| Rate for Payer: Centivo All Commercial |
$8.46
|
| Rate for Payer: Centivo All Commercial |
$8.46
|
| Rate for Payer: Cigna All Commercial |
$5.46
|
| Rate for Payer: Cigna All Commercial |
$5.46
|
| Rate for Payer: CORVEL All Commercial |
$5.46
|
| Rate for Payer: CORVEL All Commercial |
$5.46
|
| Rate for Payer: Coventry All Commercial |
$6.55
|
| Rate for Payer: Coventry All Commercial |
$6.55
|
| Rate for Payer: Encore All Commercial |
$5.46
|
| Rate for Payer: Encore All Commercial |
$5.46
|
| Rate for Payer: Frontpath All Commercial |
$6.32
|
| Rate for Payer: Frontpath All Commercial |
$6.32
|
| Rate for Payer: Humana ChoiceCare |
$21.45
|
| Rate for Payer: Humana ChoiceCare |
$21.45
|
| Rate for Payer: Humana Medicare |
$5.46
|
| Rate for Payer: Humana Medicare |
$5.46
|
| Rate for Payer: Lucent All Commercial |
$7.64
|
| Rate for Payer: Lucent All Commercial |
$7.64
|
| Rate for Payer: Managed Health Services Medicaid |
$5.59
|
| Rate for Payer: Managed Health Services Medicaid |
$5.59
|
| Rate for Payer: MDWise Medicaid |
$5.59
|
| Rate for Payer: MDWise Medicaid |
$5.59
|
| Rate for Payer: PHCS All Commercial |
$5.46
|
| Rate for Payer: PHCS All Commercial |
$5.46
|
| Rate for Payer: PHP All Commercial |
$8.20
|
| Rate for Payer: PHP All Commercial |
$8.20
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$5.46
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$5.46
|
| Rate for Payer: Sagamore Health Network All Products |
$5.46
|
| Rate for Payer: Sagamore Health Network All Products |
$5.46
|
| Rate for Payer: Signature Care EPO |
$9.28
|
| Rate for Payer: Signature Care EPO |
$9.28
|
| Rate for Payer: Signature Care PPO |
$9.28
|
| Rate for Payer: Signature Care PPO |
$9.28
|
| Rate for Payer: United Healthcare Commercial |
$13.38
|
| Rate for Payer: United Healthcare Commercial |
$13.38
|
| Rate for Payer: United Healthcare Medicare |
$5.58
|
| Rate for Payer: United Healthcare Medicare |
$5.58
|
|
|
PR ELECTROCONVULSIVE THERAPY,1 SEIZ
|
Professional
|
Both
|
$328.04
|
|
|
Service Code
|
CPT 90870
|
| Hospital Charge Code |
z90870
|
| Min. Negotiated Rate |
$53.64 |
| Max. Negotiated Rate |
$12,200.00 |
| Rate for Payer: Aetna Commercial |
$103.85
|
| Rate for Payer: Aetna Commercial |
$103.85
|
| Rate for Payer: Aetna Medicare |
$103.85
|
| Rate for Payer: Aetna Medicare |
$103.85
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$168.95
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$168.95
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$168.95
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$168.95
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$168.95
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$168.95
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$168.95
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$168.95
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$53.64
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$53.64
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$161.34
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$161.34
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$119.43
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$119.43
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$114.23
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$114.23
|
| Rate for Payer: Cash Price |
$191.78
|
| Rate for Payer: Cash Price |
$196.82
|
| Rate for Payer: Centivo All Commercial |
$160.97
|
| Rate for Payer: Centivo All Commercial |
$160.97
|
| Rate for Payer: Cigna All Commercial |
$103.85
|
| Rate for Payer: Cigna All Commercial |
$103.85
|
| Rate for Payer: CORVEL All Commercial |
$103.85
|
| Rate for Payer: CORVEL All Commercial |
$103.85
|
| Rate for Payer: Coventry All Commercial |
$124.62
|
| Rate for Payer: Coventry All Commercial |
$124.62
|
| Rate for Payer: Encore All Commercial |
$103.85
|
| Rate for Payer: Encore All Commercial |
$103.85
|
| Rate for Payer: Frontpath All Commercial |
$116.64
|
| Rate for Payer: Frontpath All Commercial |
$116.64
|
| Rate for Payer: Humana ChoiceCare |
$74.66
|
| Rate for Payer: Humana ChoiceCare |
$74.66
|
| Rate for Payer: Humana Medicare |
$103.85
|
| Rate for Payer: Humana Medicare |
$103.85
|
| Rate for Payer: Lucent All Commercial |
$145.39
|
| Rate for Payer: Lucent All Commercial |
$145.39
|
| Rate for Payer: Lutheran Preferred All Commercial |
$133.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$133.00
|
| Rate for Payer: Managed Health Services Medicaid |
$161.34
|
| Rate for Payer: Managed Health Services Medicaid |
$161.34
|
| Rate for Payer: MDWise Medicaid |
$161.34
|
| Rate for Payer: MDWise Medicaid |
$161.34
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$53.64
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$53.64
|
| Rate for Payer: PHCS All Commercial |
$103.85
|
| Rate for Payer: PHCS All Commercial |
$103.85
|
| Rate for Payer: PHP All Commercial |
$108.54
|
| Rate for Payer: PHP All Commercial |
$108.54
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$103.85
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$103.85
|
| Rate for Payer: Sagamore Health Network All Products |
$103.85
|
| Rate for Payer: Sagamore Health Network All Products |
$103.85
|
| Rate for Payer: Signature Care EPO |
$144.84
|
| Rate for Payer: Signature Care EPO |
$144.84
|
| Rate for Payer: Signature Care PPO |
$144.84
|
| Rate for Payer: Signature Care PPO |
$144.84
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$12,200.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$12,200.00
|
| Rate for Payer: United Healthcare Commercial |
$104.05
|
| Rate for Payer: United Healthcare Commercial |
$104.05
|
| Rate for Payer: United Healthcare Medicare |
$159.82
|
| Rate for Payer: United Healthcare Medicare |
$159.82
|
|
|
PR ELECTRODESSICATN,ANAL LESN(S)
|
Professional
|
Both
|
$489.82
|
|
|
Service Code
|
CPT 46910
|
| Hospital Charge Code |
z46910
|
| Min. Negotiated Rate |
$104.73 |
| Max. Negotiated Rate |
$17,600.00 |
| Rate for Payer: Aetna Commercial |
$126.53
|
| Rate for Payer: Aetna Commercial |
$126.53
|
| Rate for Payer: Aetna Medicare |
$126.53
|
| Rate for Payer: Aetna Medicare |
$126.53
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$192.76
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$192.76
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$192.76
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$192.76
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$192.76
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$192.76
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$192.76
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$192.76
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$104.73
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$104.73
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$240.91
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$240.91
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$145.51
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$145.51
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$139.18
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$139.18
|
| Rate for Payer: Cash Price |
$287.80
|
| Rate for Payer: Cash Price |
$293.89
|
| Rate for Payer: Centivo All Commercial |
$196.12
|
| Rate for Payer: Centivo All Commercial |
$196.12
|
| Rate for Payer: Cigna All Commercial |
$126.53
|
| Rate for Payer: Cigna All Commercial |
$126.53
|
| Rate for Payer: CORVEL All Commercial |
$126.53
|
| Rate for Payer: CORVEL All Commercial |
$126.53
|
| Rate for Payer: Coventry All Commercial |
$151.84
|
| Rate for Payer: Coventry All Commercial |
$151.84
|
| Rate for Payer: Encore All Commercial |
$126.53
|
| Rate for Payer: Encore All Commercial |
$126.53
|
| Rate for Payer: Frontpath All Commercial |
$174.29
|
| Rate for Payer: Frontpath All Commercial |
$174.29
|
| Rate for Payer: Humana ChoiceCare |
$131.69
|
| Rate for Payer: Humana ChoiceCare |
$131.69
|
| Rate for Payer: Humana Medicare |
$126.53
|
| Rate for Payer: Humana Medicare |
$126.53
|
| Rate for Payer: Lucent All Commercial |
$177.14
|
| Rate for Payer: Lucent All Commercial |
$177.14
|
| Rate for Payer: Lutheran Preferred All Commercial |
$188.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$188.00
|
| Rate for Payer: Managed Health Services Medicaid |
$240.91
|
| Rate for Payer: Managed Health Services Medicaid |
$240.91
|
| Rate for Payer: MDWise Medicaid |
$240.91
|
| Rate for Payer: MDWise Medicaid |
$240.91
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$104.73
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$104.73
|
| Rate for Payer: PHCS All Commercial |
$126.53
|
| Rate for Payer: PHCS All Commercial |
$126.53
|
| Rate for Payer: PHP All Commercial |
$214.15
|
| Rate for Payer: PHP All Commercial |
$214.15
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$126.53
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$126.53
|
| Rate for Payer: Sagamore Health Network All Products |
$126.53
|
| Rate for Payer: Sagamore Health Network All Products |
$126.53
|
| Rate for Payer: Signature Care EPO |
$251.60
|
| Rate for Payer: Signature Care EPO |
$251.60
|
| Rate for Payer: Signature Care PPO |
$251.60
|
| Rate for Payer: Signature Care PPO |
$251.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$17,600.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$17,600.00
|
| Rate for Payer: United Healthcare Commercial |
$139.55
|
| Rate for Payer: United Healthcare Commercial |
$139.55
|
| Rate for Payer: United Healthcare Medicare |
$239.83
|
| Rate for Payer: United Healthcare Medicare |
$239.83
|
|
|
PR ELECTRO HEARINGAID TEST, BOTH
|
Professional
|
Both
|
$100.00
|
|
|
Service Code
|
CPT 92595
|
| Hospital Charge Code |
z92595
|
| Min. Negotiated Rate |
$32.82 |
| Max. Negotiated Rate |
$85.00 |
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$40.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$40.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$40.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$40.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Frontpath All Commercial |
$47.23
|
| Rate for Payer: Humana ChoiceCare |
$32.82
|
| Rate for Payer: Lutheran Preferred All Commercial |
$85.00
|
| Rate for Payer: Signature Care EPO |
$51.00
|
| Rate for Payer: Signature Care PPO |
$51.00
|
| Rate for Payer: United Healthcare Commercial |
$44.66
|
|
|
PR ELECTRO HEARING AID TEST, ONE
|
Professional
|
Both
|
$50.00
|
|
|
Service Code
|
CPT 92594
|
| Hospital Charge Code |
z92594
|
| Min. Negotiated Rate |
$20.63 |
| Max. Negotiated Rate |
$42.50 |
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$30.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$30.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$30.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$30.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Frontpath All Commercial |
$21.66
|
| Rate for Payer: Humana ChoiceCare |
$22.03
|
| Rate for Payer: Lutheran Preferred All Commercial |
$42.50
|
| Rate for Payer: Signature Care EPO |
$34.00
|
| Rate for Payer: Signature Care PPO |
$34.00
|
| Rate for Payer: United Healthcare Commercial |
$20.63
|
|
|
PR EMERGENCY DEPARTMENT VISIT HIGH MDM
|
Professional
|
Both
|
$327.74
|
|
|
Service Code
|
CPT 99285
|
| Hospital Charge Code |
z99285
|
| Min. Negotiated Rate |
$161.20 |
| Max. Negotiated Rate |
$288.75 |
| Rate for Payer: Aetna Commercial |
$168.54
|
| Rate for Payer: Aetna Commercial |
$168.54
|
| Rate for Payer: Aetna Medicare |
$168.54
|
| Rate for Payer: Aetna Medicare |
$168.54
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$237.74
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$237.74
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$237.74
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$237.74
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$237.74
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$237.74
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$237.74
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$237.74
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$161.20
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$161.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$193.82
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$193.82
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$185.39
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$185.39
|
| Rate for Payer: Cash Price |
$195.16
|
| Rate for Payer: Cash Price |
$196.64
|
| Rate for Payer: Cash Price |
$196.64
|
| Rate for Payer: Cash Price |
$195.16
|
| Rate for Payer: Centivo All Commercial |
$261.24
|
| Rate for Payer: Centivo All Commercial |
$261.24
|
| Rate for Payer: Cigna All Commercial |
$168.54
|
| Rate for Payer: Cigna All Commercial |
$168.54
|
| Rate for Payer: CORVEL All Commercial |
$168.54
|
| Rate for Payer: CORVEL All Commercial |
$168.54
|
| Rate for Payer: Coventry All Commercial |
$202.25
|
| Rate for Payer: Coventry All Commercial |
$202.25
|
| Rate for Payer: Encore All Commercial |
$168.54
|
| Rate for Payer: Encore All Commercial |
$168.54
|
| Rate for Payer: Frontpath All Commercial |
$288.75
|
| Rate for Payer: Frontpath All Commercial |
$288.75
|
| Rate for Payer: Humana ChoiceCare |
$192.17
|
| Rate for Payer: Humana ChoiceCare |
$192.17
|
| Rate for Payer: Humana Medicare |
$168.54
|
| Rate for Payer: Humana Medicare |
$168.54
|
| Rate for Payer: Lucent All Commercial |
$235.96
|
| Rate for Payer: Lucent All Commercial |
$235.96
|
| Rate for Payer: Lutheran Preferred All Commercial |
$278.58
|
| Rate for Payer: Lutheran Preferred All Commercial |
$276.47
|
| Rate for Payer: Managed Health Services Medicaid |
$161.20
|
| Rate for Payer: Managed Health Services Medicaid |
$161.20
|
| Rate for Payer: MDWise Medicaid |
$161.20
|
| Rate for Payer: MDWise Medicaid |
$161.20
|
| Rate for Payer: PHCS All Commercial |
$168.54
|
| Rate for Payer: PHCS All Commercial |
$168.54
|
| Rate for Payer: PHP All Commercial |
$167.51
|
| Rate for Payer: PHP All Commercial |
$167.51
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$168.54
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$168.54
|
| Rate for Payer: Sagamore Health Network All Products |
$168.54
|
| Rate for Payer: Sagamore Health Network All Products |
$168.54
|
| Rate for Payer: Signature Care EPO |
$267.75
|
| Rate for Payer: Signature Care EPO |
$267.75
|
| Rate for Payer: Signature Care PPO |
$267.75
|
| Rate for Payer: Signature Care PPO |
$267.75
|
| Rate for Payer: United Healthcare Commercial |
$255.55
|
| Rate for Payer: United Healthcare Commercial |
$255.55
|
| Rate for Payer: United Healthcare Medicare |
$162.63
|
| Rate for Payer: United Healthcare Medicare |
$162.63
|
|
|
PR EMERGENCY DEPARTMENT VISIT LOW MDM
|
Professional
|
Both
|
$132.88
|
|
|
Service Code
|
CPT 99283
|
| Hospital Charge Code |
z99283
|
| Min. Negotiated Rate |
$65.36 |
| Max. Negotiated Rate |
$138.75 |
| Rate for Payer: Aetna Commercial |
$68.54
|
| Rate for Payer: Aetna Commercial |
$68.54
|
| Rate for Payer: Aetna Medicare |
$68.54
|
| Rate for Payer: Aetna Medicare |
$68.54
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$94.45
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$94.45
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$94.45
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$94.45
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$94.45
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$94.45
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$94.45
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$94.45
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$65.36
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$65.36
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$78.82
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$78.82
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$75.39
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$75.39
|
| Rate for Payer: Cash Price |
$79.52
|
| Rate for Payer: Cash Price |
$79.73
|
| Rate for Payer: Cash Price |
$79.73
|
| Rate for Payer: Cash Price |
$79.52
|
| Rate for Payer: Centivo All Commercial |
$106.24
|
| Rate for Payer: Centivo All Commercial |
$106.24
|
| Rate for Payer: Cigna All Commercial |
$68.54
|
| Rate for Payer: Cigna All Commercial |
$68.54
|
| Rate for Payer: CORVEL All Commercial |
$68.54
|
| Rate for Payer: CORVEL All Commercial |
$68.54
|
| Rate for Payer: Coventry All Commercial |
$82.25
|
| Rate for Payer: Coventry All Commercial |
$82.25
|
| Rate for Payer: Encore All Commercial |
$68.54
|
| Rate for Payer: Encore All Commercial |
$68.54
|
| Rate for Payer: Frontpath All Commercial |
$138.75
|
| Rate for Payer: Frontpath All Commercial |
$138.75
|
| Rate for Payer: Humana ChoiceCare |
$78.63
|
| Rate for Payer: Humana ChoiceCare |
$78.63
|
| Rate for Payer: Humana Medicare |
$68.54
|
| Rate for Payer: Humana Medicare |
$68.54
|
| Rate for Payer: Lucent All Commercial |
$95.96
|
| Rate for Payer: Lucent All Commercial |
$95.96
|
| Rate for Payer: Lutheran Preferred All Commercial |
$112.95
|
| Rate for Payer: Lutheran Preferred All Commercial |
$112.66
|
| Rate for Payer: Managed Health Services Medicaid |
$65.36
|
| Rate for Payer: Managed Health Services Medicaid |
$65.36
|
| Rate for Payer: MDWise Medicaid |
$65.36
|
| Rate for Payer: MDWise Medicaid |
$65.36
|
| Rate for Payer: PHCS All Commercial |
$68.54
|
| Rate for Payer: PHCS All Commercial |
$68.54
|
| Rate for Payer: PHP All Commercial |
$68.25
|
| Rate for Payer: PHP All Commercial |
$68.25
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$68.54
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$68.54
|
| Rate for Payer: Sagamore Health Network All Products |
$68.54
|
| Rate for Payer: Sagamore Health Network All Products |
$68.54
|
| Rate for Payer: Signature Care EPO |
$102.00
|
| Rate for Payer: Signature Care EPO |
$102.00
|
| Rate for Payer: Signature Care PPO |
$102.00
|
| Rate for Payer: Signature Care PPO |
$102.00
|
| Rate for Payer: United Healthcare Commercial |
$91.78
|
| Rate for Payer: United Healthcare Commercial |
$91.78
|
| Rate for Payer: United Healthcare Medicare |
$66.27
|
| Rate for Payer: United Healthcare Medicare |
$66.27
|
|
|
PR EMERGENCY DEPARTMENT VISIT MAY NOT REQ PHYS/QHP
|
Professional
|
Both
|
$21.40
|
|
|
Service Code
|
CPT 99281
|
| Hospital Charge Code |
z99281
|
| Min. Negotiated Rate |
$10.47 |
| Max. Negotiated Rate |
$60.00 |
| Rate for Payer: Aetna Commercial |
$20.84
|
| Rate for Payer: Aetna Commercial |
$20.84
|
| Rate for Payer: Aetna Medicare |
$20.84
|
| Rate for Payer: Aetna Medicare |
$20.84
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$33.30
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$33.30
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$33.30
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$33.30
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$33.30
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$33.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$33.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$33.30
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$10.47
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$10.47
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$23.97
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$23.97
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$22.92
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$22.92
|
| Rate for Payer: Cash Price |
$12.78
|
| Rate for Payer: Cash Price |
$12.84
|
| Rate for Payer: Cash Price |
$12.84
|
| Rate for Payer: Cash Price |
$12.78
|
| Rate for Payer: Centivo All Commercial |
$32.30
|
| Rate for Payer: Centivo All Commercial |
$32.30
|
| Rate for Payer: Cigna All Commercial |
$20.84
|
| Rate for Payer: Cigna All Commercial |
$20.84
|
| Rate for Payer: CORVEL All Commercial |
$20.84
|
| Rate for Payer: CORVEL All Commercial |
$20.84
|
| Rate for Payer: Coventry All Commercial |
$25.01
|
| Rate for Payer: Coventry All Commercial |
$25.01
|
| Rate for Payer: Encore All Commercial |
$20.84
|
| Rate for Payer: Encore All Commercial |
$20.84
|
| Rate for Payer: Frontpath All Commercial |
$60.00
|
| Rate for Payer: Frontpath All Commercial |
$60.00
|
| Rate for Payer: Humana ChoiceCare |
$21.19
|
| Rate for Payer: Humana ChoiceCare |
$21.19
|
| Rate for Payer: Humana Medicare |
$20.84
|
| Rate for Payer: Humana Medicare |
$20.84
|
| Rate for Payer: Lucent All Commercial |
$29.18
|
| Rate for Payer: Lucent All Commercial |
$29.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$18.19
|
| Rate for Payer: Lutheran Preferred All Commercial |
$18.11
|
| Rate for Payer: Managed Health Services Medicaid |
$10.47
|
| Rate for Payer: Managed Health Services Medicaid |
$10.47
|
| Rate for Payer: MDWise Medicaid |
$10.47
|
| Rate for Payer: MDWise Medicaid |
$10.47
|
| Rate for Payer: PHCS All Commercial |
$20.84
|
| Rate for Payer: PHCS All Commercial |
$20.84
|
| Rate for Payer: PHP All Commercial |
$11.02
|
| Rate for Payer: PHP All Commercial |
$11.02
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$20.84
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$20.84
|
| Rate for Payer: Sagamore Health Network All Products |
$20.84
|
| Rate for Payer: Sagamore Health Network All Products |
$20.84
|
| Rate for Payer: Signature Care EPO |
$26.35
|
| Rate for Payer: Signature Care EPO |
$26.35
|
| Rate for Payer: Signature Care PPO |
$26.35
|
| Rate for Payer: Signature Care PPO |
$26.35
|
| Rate for Payer: United Healthcare Commercial |
$30.44
|
| Rate for Payer: United Healthcare Commercial |
$30.44
|
| Rate for Payer: United Healthcare Medicare |
$10.70
|
| Rate for Payer: United Healthcare Medicare |
$10.70
|
|
|
PR EMERGENCY DEPARTMENT VISIT MODERATE MDM
|
Professional
|
Both
|
$226.16
|
|
|
Service Code
|
CPT 99284
|
| Hospital Charge Code |
z99284
|
| Min. Negotiated Rate |
$111.23 |
| Max. Negotiated Rate |
$221.25 |
| Rate for Payer: Aetna Commercial |
$116.15
|
| Rate for Payer: Aetna Commercial |
$116.15
|
| Rate for Payer: Aetna Medicare |
$116.15
|
| Rate for Payer: Aetna Medicare |
$116.15
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$159.95
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$159.95
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$159.95
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$159.95
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$159.95
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$159.95
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$159.95
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$159.95
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$111.23
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$111.23
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$133.57
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$133.57
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$127.77
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$127.77
|
| Rate for Payer: Cash Price |
$134.39
|
| Rate for Payer: Cash Price |
$135.70
|
| Rate for Payer: Cash Price |
$135.70
|
| Rate for Payer: Cash Price |
$134.39
|
| Rate for Payer: Centivo All Commercial |
$180.03
|
| Rate for Payer: Centivo All Commercial |
$180.03
|
| Rate for Payer: Cigna All Commercial |
$116.15
|
| Rate for Payer: Cigna All Commercial |
$116.15
|
| Rate for Payer: CORVEL All Commercial |
$116.15
|
| Rate for Payer: CORVEL All Commercial |
$116.15
|
| Rate for Payer: Coventry All Commercial |
$139.38
|
| Rate for Payer: Coventry All Commercial |
$139.38
|
| Rate for Payer: Encore All Commercial |
$116.15
|
| Rate for Payer: Encore All Commercial |
$116.15
|
| Rate for Payer: Frontpath All Commercial |
$221.25
|
| Rate for Payer: Frontpath All Commercial |
$221.25
|
| Rate for Payer: Humana ChoiceCare |
$122.83
|
| Rate for Payer: Humana ChoiceCare |
$122.83
|
| Rate for Payer: Humana Medicare |
$116.15
|
| Rate for Payer: Humana Medicare |
$116.15
|
| Rate for Payer: Lucent All Commercial |
$162.61
|
| Rate for Payer: Lucent All Commercial |
$162.61
|
| Rate for Payer: Lutheran Preferred All Commercial |
$192.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$190.38
|
| Rate for Payer: Managed Health Services Medicaid |
$111.23
|
| Rate for Payer: Managed Health Services Medicaid |
$111.23
|
| Rate for Payer: MDWise Medicaid |
$111.23
|
| Rate for Payer: MDWise Medicaid |
$111.23
|
| Rate for Payer: PHCS All Commercial |
$116.15
|
| Rate for Payer: PHCS All Commercial |
$116.15
|
| Rate for Payer: PHP All Commercial |
$115.35
|
| Rate for Payer: PHP All Commercial |
$115.35
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$116.15
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$116.15
|
| Rate for Payer: Sagamore Health Network All Products |
$116.15
|
| Rate for Payer: Sagamore Health Network All Products |
$116.15
|
| Rate for Payer: Signature Care EPO |
$180.20
|
| Rate for Payer: Signature Care EPO |
$180.20
|
| Rate for Payer: Signature Care PPO |
$180.20
|
| Rate for Payer: Signature Care PPO |
$180.20
|
| Rate for Payer: United Healthcare Commercial |
$171.93
|
| Rate for Payer: United Healthcare Commercial |
$171.93
|
| Rate for Payer: United Healthcare Medicare |
$111.99
|
| Rate for Payer: United Healthcare Medicare |
$111.99
|
|
|
PR EMERGENCY DEPARTMENT VISIT STRAIGHTFORWARD MDM
|
Professional
|
Both
|
$78.04
|
|
|
Service Code
|
CPT 99282
|
| Hospital Charge Code |
z99282
|
| Min. Negotiated Rate |
$34.99 |
| Max. Negotiated Rate |
$82.50 |
| Rate for Payer: Aetna Commercial |
$40.33
|
| Rate for Payer: Aetna Commercial |
$40.33
|
| Rate for Payer: Aetna Medicare |
$40.33
|
| Rate for Payer: Aetna Medicare |
$40.33
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$56.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$56.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$56.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$56.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$56.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$56.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$56.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$56.00
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$38.38
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$38.38
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$46.38
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$46.38
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$44.36
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$44.36
|
| Rate for Payer: Cash Price |
$46.37
|
| Rate for Payer: Cash Price |
$46.82
|
| Rate for Payer: Cash Price |
$46.82
|
| Rate for Payer: Cash Price |
$46.37
|
| Rate for Payer: Centivo All Commercial |
$62.51
|
| Rate for Payer: Centivo All Commercial |
$62.51
|
| Rate for Payer: Cigna All Commercial |
$40.33
|
| Rate for Payer: Cigna All Commercial |
$40.33
|
| Rate for Payer: CORVEL All Commercial |
$40.33
|
| Rate for Payer: CORVEL All Commercial |
$40.33
|
| Rate for Payer: Coventry All Commercial |
$48.40
|
| Rate for Payer: Coventry All Commercial |
$48.40
|
| Rate for Payer: Encore All Commercial |
$40.33
|
| Rate for Payer: Encore All Commercial |
$40.33
|
| Rate for Payer: Frontpath All Commercial |
$82.50
|
| Rate for Payer: Frontpath All Commercial |
$82.50
|
| Rate for Payer: Humana ChoiceCare |
$34.99
|
| Rate for Payer: Humana ChoiceCare |
$34.99
|
| Rate for Payer: Humana Medicare |
$40.33
|
| Rate for Payer: Humana Medicare |
$40.33
|
| Rate for Payer: Lucent All Commercial |
$56.46
|
| Rate for Payer: Lucent All Commercial |
$56.46
|
| Rate for Payer: Lutheran Preferred All Commercial |
$66.33
|
| Rate for Payer: Lutheran Preferred All Commercial |
$65.69
|
| Rate for Payer: Managed Health Services Medicaid |
$38.38
|
| Rate for Payer: Managed Health Services Medicaid |
$38.38
|
| Rate for Payer: MDWise Medicaid |
$38.38
|
| Rate for Payer: MDWise Medicaid |
$38.38
|
| Rate for Payer: PHCS All Commercial |
$40.33
|
| Rate for Payer: PHCS All Commercial |
$40.33
|
| Rate for Payer: PHP All Commercial |
$39.80
|
| Rate for Payer: PHP All Commercial |
$39.80
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$40.33
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$40.33
|
| Rate for Payer: Sagamore Health Network All Products |
$40.33
|
| Rate for Payer: Sagamore Health Network All Products |
$40.33
|
| Rate for Payer: Signature Care EPO |
$45.05
|
| Rate for Payer: Signature Care EPO |
$45.05
|
| Rate for Payer: Signature Care PPO |
$45.05
|
| Rate for Payer: Signature Care PPO |
$45.05
|
| Rate for Payer: United Healthcare Commercial |
$59.26
|
| Rate for Payer: United Healthcare Commercial |
$59.26
|
| Rate for Payer: United Healthcare Medicare |
$38.64
|
| Rate for Payer: United Healthcare Medicare |
$38.64
|
|
|
PR ENDOCERVICAL CURETTAGE
|
Professional
|
Both
|
$288.24
|
|
|
Service Code
|
CPT 57505
|
| Hospital Charge Code |
z57505
|
| Min. Negotiated Rate |
$56.58 |
| Max. Negotiated Rate |
$13,300.00 |
| Rate for Payer: Aetna Commercial |
$102.95
|
| Rate for Payer: Aetna Commercial |
$102.95
|
| Rate for Payer: Aetna Medicare |
$102.95
|
| Rate for Payer: Aetna Medicare |
$102.95
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.12
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.12
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$134.12
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$134.12
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$134.12
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$134.12
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$134.12
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$134.12
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$56.58
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$56.58
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$141.77
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$141.77
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$118.39
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$118.39
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$113.25
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$113.25
|
| Rate for Payer: Cash Price |
$170.42
|
| Rate for Payer: Cash Price |
$172.94
|
| Rate for Payer: Centivo All Commercial |
$159.57
|
| Rate for Payer: Centivo All Commercial |
$159.57
|
| Rate for Payer: Cigna All Commercial |
$102.95
|
| Rate for Payer: Cigna All Commercial |
$102.95
|
| Rate for Payer: CORVEL All Commercial |
$102.95
|
| Rate for Payer: CORVEL All Commercial |
$102.95
|
| Rate for Payer: Coventry All Commercial |
$123.54
|
| Rate for Payer: Coventry All Commercial |
$123.54
|
| Rate for Payer: Encore All Commercial |
$102.95
|
| Rate for Payer: Encore All Commercial |
$102.95
|
| Rate for Payer: Frontpath All Commercial |
$140.60
|
| Rate for Payer: Frontpath All Commercial |
$140.60
|
| Rate for Payer: Humana ChoiceCare |
$97.45
|
| Rate for Payer: Humana ChoiceCare |
$97.45
|
| Rate for Payer: Humana Medicare |
$102.95
|
| Rate for Payer: Humana Medicare |
$102.95
|
| Rate for Payer: Lucent All Commercial |
$144.13
|
| Rate for Payer: Lucent All Commercial |
$144.13
|
| Rate for Payer: Lutheran Preferred All Commercial |
$143.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$143.00
|
| Rate for Payer: Managed Health Services Medicaid |
$141.77
|
| Rate for Payer: Managed Health Services Medicaid |
$141.77
|
| Rate for Payer: MDWise Medicaid |
$141.77
|
| Rate for Payer: MDWise Medicaid |
$141.77
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$56.58
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$56.58
|
| Rate for Payer: PHCS All Commercial |
$102.95
|
| Rate for Payer: PHCS All Commercial |
$102.95
|
| Rate for Payer: PHP All Commercial |
$131.80
|
| Rate for Payer: PHP All Commercial |
$131.80
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$102.95
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$102.95
|
| Rate for Payer: Sagamore Health Network All Products |
$102.95
|
| Rate for Payer: Sagamore Health Network All Products |
$102.95
|
| Rate for Payer: Signature Care EPO |
$126.65
|
| Rate for Payer: Signature Care EPO |
$126.65
|
| Rate for Payer: Signature Care PPO |
$126.65
|
| Rate for Payer: Signature Care PPO |
$126.65
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$13,300.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$13,300.00
|
| Rate for Payer: United Healthcare Commercial |
$100.78
|
| Rate for Payer: United Healthcare Commercial |
$100.78
|
| Rate for Payer: United Healthcare Medicare |
$142.02
|
| Rate for Payer: United Healthcare Medicare |
$142.02
|
|
|
PR ENDOMET BIOPSY DONE W/COLPOSCOPY
|
Professional
|
Both
|
$92.90
|
|
|
Service Code
|
CPT 58110
|
| Hospital Charge Code |
z58110
|
| Min. Negotiated Rate |
$30.63 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$37.92
|
| Rate for Payer: Aetna Commercial |
$37.92
|
| Rate for Payer: Aetna Medicare |
$37.92
|
| Rate for Payer: Aetna Medicare |
$37.92
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$59.13
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$59.13
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$59.13
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$59.13
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$59.13
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$59.13
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$59.13
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$59.13
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$30.63
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$30.63
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$45.69
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$45.69
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$43.61
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$43.61
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$41.71
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$41.71
|
| Rate for Payer: Cash Price |
$54.49
|
| Rate for Payer: Cash Price |
$55.74
|
| Rate for Payer: Centivo All Commercial |
$58.78
|
| Rate for Payer: Centivo All Commercial |
$58.78
|
| Rate for Payer: Cigna All Commercial |
$37.92
|
| Rate for Payer: Cigna All Commercial |
$37.92
|
| Rate for Payer: CORVEL All Commercial |
$37.92
|
| Rate for Payer: CORVEL All Commercial |
$37.92
|
| Rate for Payer: Coventry All Commercial |
$45.50
|
| Rate for Payer: Coventry All Commercial |
$45.50
|
| Rate for Payer: Encore All Commercial |
$37.92
|
| Rate for Payer: Encore All Commercial |
$37.92
|
| Rate for Payer: Frontpath All Commercial |
$52.87
|
| Rate for Payer: Frontpath All Commercial |
$52.87
|
| Rate for Payer: Humana ChoiceCare |
$48.33
|
| Rate for Payer: Humana ChoiceCare |
$48.33
|
| Rate for Payer: Humana Medicare |
$37.92
|
| Rate for Payer: Humana Medicare |
$37.92
|
| Rate for Payer: Lucent All Commercial |
$53.09
|
| Rate for Payer: Lucent All Commercial |
$53.09
|
| Rate for Payer: Lutheran Preferred All Commercial |
$52.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$52.00
|
| Rate for Payer: Managed Health Services Medicaid |
$45.69
|
| Rate for Payer: Managed Health Services Medicaid |
$45.69
|
| Rate for Payer: MDWise Medicaid |
$45.69
|
| Rate for Payer: MDWise Medicaid |
$45.69
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$30.63
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$30.63
|
| Rate for Payer: PHCS All Commercial |
$37.92
|
| Rate for Payer: PHCS All Commercial |
$37.92
|
| Rate for Payer: PHP All Commercial |
$48.02
|
| Rate for Payer: PHP All Commercial |
$48.02
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$37.92
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$37.92
|
| Rate for Payer: Sagamore Health Network All Products |
$37.92
|
| Rate for Payer: Sagamore Health Network All Products |
$37.92
|
| Rate for Payer: Signature Care EPO |
$57.80
|
| Rate for Payer: Signature Care EPO |
$57.80
|
| Rate for Payer: Signature Care PPO |
$57.80
|
| Rate for Payer: Signature Care PPO |
$57.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,800.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare Commercial |
$47.49
|
| Rate for Payer: United Healthcare Commercial |
$47.49
|
| Rate for Payer: United Healthcare Medicare |
$45.41
|
| Rate for Payer: United Healthcare Medicare |
$45.41
|
|
